Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 797341

Filing Accepted: 12/18/2024

Print Filing

Complainant

Last/Business Name *

NARDINI

First Name

ANTHONY

Street Address *

28024 EAGLE RAY CT,

City, State Zip *

BONITA SPRINGS, FL 34135

Email Address *

WITHHELD

Complainant Type: *

Insured

Last/Business Name*		NARDINI		First Name		ANTHONY
Policy # *		FLP423272		Claim #*		141644-241013

Attorney

Attorney is Applicable

Last Name*	WALLACE First Name * BLAKE Initial
Street Address*		8635 W. HILLSBOROUGH AVE., STE. 401
City, State Zip*		TAMPA , FL 33615
Email Address *		BLAKE@KLINGLAW.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		ASI PREFERRED INSURANCE CORP.
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 13142

Name of individual responsible for violation (if any):* AUSTIN R. NEGUS & KEVIN WISNIEWSKI
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Denial
	Claim Delay
	Unsatisfactory Settlement Offer
	Unfair Trade Practice

* Statutory provision(s) which the insurer allegedly violated.

	624.155(1)(b)(1)		Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
	624.155(1)(b)(3)		Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
	626.9541(1)(i)(3)(a)		Failing to adopt and implement standards for the proper investigation of claims.
	626.9541(1)(i)(3)(c)		Failing to acknowledge and act promptly upon communications with respect to claims.
	626.9541(1)(i)(3)(d)		Denying claims without conducting reasonable investigations based upon available information.
	626.9541(1)(i)(3)(f)		Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement.

* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

COVERAGE A – DWELLING and COVERAGE B – OTHER STRUCTURES We insure against risk of direct loss to property described in Coverages A and B only if that loss is a physical loss to property; however, we do not insure loss: 1. involving collapse, other than as provided in Other Coverages 10; 2. caused by: a. freezing of a plumbing, heating, air conditioning or automatic fire protective sprinkler system or of a household appliance, or by discharge, leakage or overflow from within the system or appliance caused by freezing. This exclusion applies only while the dwelling is vacant, unoccupied or being constructed unless you have used reasonable care to: (1) maintain heat in the building; or (2) shut off the water supply and drain the system and appliances of water; b. freezing, thawing, pressure or weight of water or ice, whether driven by wind or not, to a: (1) fence, pavement, patio or swimming pool; (2) foundation, retaining wall or bulkhead; or (3) pier, wharf or dock; c. theft of property not part of a covered building or structure; d. theft in or to a dwelling or structure under construction; e. wind, hail, ice, snow or sleet to: (1) outdoor radio and television antennas and aerials including their lead-in wiring, masts or towers; or (2) trees, shrubs, plants or lawns; f. vandalism and malicious mischief, theft or attempted theft if the dwelling has been vacant for more than 30 consecutive days immediately before the loss. A dwelling being constructed is not considered vacant; Kling Law, P.A. 8635 W. Hillsborough Avenue, Suite 401 Tampa, FL 33615 (813) 468 - 1500 g. constant or repeated seepage or leakage of water or steam over a period of weeks, months or years from within a plumbing, heating, air conditioning or automatic fire protective sprinkler system or from within a household appliance; h. (1) wear and tear, marring, deterioration; (2) inherent vice, latent defect, mechanical breakdown; (3) smog, rust or other corrosion, mold, wet or dry rot; (4) smoke from agricultural smudging or industrial operations; (5) discharge, dispersal, seepage, migration release or escape of pollutants. Pollutants means any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste includes materials to be recycled, reconditioned or reclaimed; (6) settling, shrinking, bulging or expansion, including resultant cracking, of pavements, patios, foundations, walls, floors, roofs or ceilings; or (7) birds, vermin, rodents, insects or domestic animals. If any of these cause water damage not otherwise excluded, from a plumbing, heating, air conditioning or automatic fire protective sprinkler system or household appliance, we cover loss caused by the water including the cost of tearing out and replacing any part of a building necessary to repair the system or appliance. We do not cover loss to the system or appliance from which this water escaped. 3. excluded under General Exclusions. 5. Loss Settlement. Covered property losses are settled as follows: b. Buildings under Coverage A or B at replacement cost without deduction for depreciation, subject to the following: (1) If, at the time of loss, the amount of insurance in this policy on the damaged building is 80% or more of the full replacement cost of the building immediately before the loss, we will pay the cost to repair or replace, after Kling Law, P.A. 8635 W. Hillsborough Avenue, Suite 401 Tampa, FL 33615 (813) 468 - 1500 application of deductible and without deduction for depreciation, but not more than the least of the following amounts: (a) the limit of liability under this policy that applies to the building; (b) the replacement cost of that part of the building damaged for like construction and use on the same premises; or (c) the necessary amount actually spent to repair or replace the damaged building. (2) If, at the time of loss, the amount of insurance in this policy on the damaged building is less than 80% of the full replacement cost of the building immediately before the loss, we will pay the greater of the following amounts, but not more than the limit of liability under this policy that applies to the building: (a) the actual cash value of that part of the building damaged; or (b) that proportion of the cost to repair or replace, after application of deductible and without deduction for depreciation, that part of the building damaged, which the total amount of insurance in this policy on the damaged building bears to 80% of the replacement cost of the building. (3) To determine the amount of insurance required to equal 80% of the full replacement cost of the building immediately before the loss, do not include the value of: (a) excavations, foundations, piers or any supports which are below the undersurface of the lowest basement floor; (b) those supports in (a) above which are below the surface of the ground inside the foundation walls, if there is no basement; and (c) underground flues, pipes, wiring and drains. (4) We will pay no more than the actual cash value of the damage unless: (a) actual repair or replacement is complete; or Kling Law, P.A. 8635 W. Hillsborough Avenue, Suite 401 Tampa, FL 33615 (813) 468 - 1500 (b) the cost to repair or replace the damage is both: (i) less than 5% of the amount of insurance in this policy on the building; and (ii) less than $2500. (5) You may disregard the replacement cost loss settlement provisions and make claim under this policy for loss or damage to buildings on an actual cash value basis. You may then make claim within 180 days after loss for any additional liability on a replacement cost basis.

* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Dear ASI PREFERRED INSURANCE CORP.: Please find enclosed the civil remedy notice filed for the above referenced claim. This notice is given in order to perfect the right to pursue the civil remedy authorized by Florida Statute §624.155 As discussed in greater detail in the notice, the carrier has not attempted in good faith to settle the claimant’s claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its claimant and with due regard for its interests. The carrier has done everything possible to delay the claim and refuses to provide any sort of status of the claim. Furthermore, the carrier is required to properly investigate and adjust claims and cannot place that burden upon the insured. This was made clear by the appellate court and the Florida Supreme Court in Allstate Indemnity Co. v. Ruiz, 899 So. 2d 1121 (Fla. 2005) (“The Legislature has clearly chosen to impose on the insurance companies a duty to use good faith and fair dealing in processing and litigating the claims of their insured…”). The carrier was put on notice of the insured’s Hurricane Ian claim on September 20, 2024. Since the commencement of the claim the carrier has failed to timely communicate with the insured. It is obvious that the carrier is not attempting to pay for the clearly covered damages owed under the policy. The carrier assigned its own field adjuster, who is not an engineer, to inspect the loss. On October 4, 2024, only fourteen (14) days after being notified of the loss, the carrier made the unilateral determinations that the damages to the property would be excluded under the policy and therefore denied. Moreover, in reaching those conclusions, ASI Preferred failed to adopt and implement standards for the proper investigation of claims. There was no explanation whatsoever as to how the field adjuster, Mr. Wisniewski, determined which items of damage were caused by covered or excluded perils. Instead, the carrier generally averred to what it had determined to be the cause of loss without any showing of pertinent fact or evidence of how such conclusions were reached to support said facts. This is in violation of F.S. §626.9541(1)(i)(3)(f) as the carrier failed to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of the claim. Furthermore, the carrier’s Kling Law, P.A. 8635 W. Hillsborough Avenue, Suite 401 Tampa, FL 33615 (813) 468 - 1500 failure to assign a qualified and experienced engineer further violates F.S. §626.9541(1)(i)(3)(a). Additionally, as the carrier denied coverage without conducting a reasonable investigation based upon available information, the carrier violated F.S. §626.9541(1)(i)(3)(d). Florida Statute 627.70131(3)(e) requires the carrier to provide an estimate within 7 days after the estimate is generated by the insurer’s adjuster. However, ASI Preferred only provided provide a copy of the estimate or report from its initial field adjuster on December 12, 2024, once a Letter of Representation was sent by the insured’s counsel, over seventy-four (74) days after the completion of said estimate. The insurer must send the policyholder a copy of any detailed estimate of the amount of the loss within 7 days after the estimate is generated by an insurer’s adjuster. The carrier’s failure to produce the estimate generated by Mr. Wisniewski in a timely manner is in further violation of F.S. §626.9541(1)(i)(3)(c) as the carrier failed to acknowledge and act promptly upon communications with respect to the claim. The insured has been compelled to obtain an independently adjusted estimate totaling in the amount of $133,033.41 that would be needed to repair the property back to its pre-loss condition. The insured has complied with all the carrier’s requests to date. The carrier has still refused to pay the fully covered amount owed under the policy, instead electing to stand by its unilaterally determined deficient valuation of the loss while denying the rest of the loss. It is clear that the carrier is not treating the claimant with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the claimant; failing to implement proper standards for the adjustment and investigation of claims and placing the company’s interests before the claimant’s interests; not training, supervising or managing adjusters properly so that prompt and full payments are made; refusing to pay the full amount owed to the insured despite the fact that the damages are covered under the policy; looking for ways to delay full recovery or any recovery to the insured; and refusing to provide coverage for the claimant’s loss in a timely manner. The Carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(d), 627.4137(1), and Fla. Stat. §627.70131. The actions taken by ASI Preferred in the handling/adjustment of the insured’s claim were willful, wanton, malicious, and in reckless disregard for the rights of any insureds and occur with such frequency as to indicate a general business practice, and further are in violation of Florida Statutes §624.155 and F.S. §626.954. Indeed, when performing a search on the Florida Department of Financial Services website’s Civil Remedy Notice of Insurer Violation page the results of searches of violations of the statutes referenced herein by the carrier returned the following results thereby indicating that the number of times they occur rise to the level of a general business practice, and warrant punitive damages: §624.155(1)(b)(1) = 4,317 Kling Law, P.A. 8635 W. Hillsborough Avenue, Suite 401 Tampa, FL 33615 (813) 468 - 1500 §624.155(1)(b)(3) = 3,010 §626.9541(1)(i)(3)(a) = 4,164 §626.9541(1)(i)(3)(c) = 2,739 §626.9541(1)(i)(3)(d) = 2,328 §626.9541(1)(i)(3)(f) = 4,484 Based upon the above-referenced acts and omissions, the carrier has breached the insurance contract by failing to pay the amount due to the insured, by denying coverage which existed under the insurance contract with the insured in the instant dispute, by failing to adjust the loss with the insureds, and by failing to perform an adequate investigation. These are violations and breaches of the policy language cited above. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1) Pay the complete covered loss in the amount of $133,033.41 less any applicable policy deductible; and 2) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been emailed to the carrier. The specific policy provisions the carrier violated are the loss payment provision, the loss settlement provision, and the coverage provisions. Specifically, the loss payment provision states “we will adjust all losses with you.” Yet, the carrier did not consult the homeowner in deciding who would investigate the cause or amount of damages, and what the ultimate payment should be. The other provisions are pasted on the pages following the signature block. If you have any questions or concerns, please send all correspondence via email to Blake@klinglaw.com and Jorlyn@KlingLaw.com to ensure a prompt response. We ask that all correspondence be done via email rather than regular mail. Should you need to send something regular mail, please advise us prior to sending same via the emails above. Sincerely, Blake M. Wallace, Esq. Blake M. Wallace Attorney at Law

Comments

User Id		Date Added		Comment
darryl_j_roles@progressive.com		12-20-2024		While ASI Preferred Insurance Corp believes that the Civil Remedy Notice fails to comply with the requirements of Florida Statute §624.155 and Florida Case law, it has responded to the notice in writing to Kling Law, PA, on December 20, 2024.

Acknowledgement
*	The submitter hereby states that this notice is given in order to perfect the rights of the person(s) damaged to pursue civil remedies authorized by Section 624.155, Florida Statutes. Before submitting a Notice using this system, please verify that all text has been entered correctly and completely. Once the Notice has been submitted, the text cannot be changed or deleted.

DFS-10-363
Rev. 10/14/2008