Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 798291

Filing Accepted: 12/26/2024

Print Filing

Complainant

Last/Business Name *

A-WD MULTI SERVICES LLC

First Name

Street Address *

95 MERRICK WAY STE 316

City, State Zip *

CORAL GABLES, FL 33146

Email Address *

AWDMULTISERVICES@GMAIL.COM

Complainant Type: *

Third Party

Insured

Last/Business Name*		RONALD CEZARD AND ALINE FORTULIEN		First Name
Policy # *		ATH1074671		Claim #*		AH141646

Attorney

Attorney is Applicable

Last Name*	GONZALEZ ESQ. First Name * ROBERT F. Initial
Street Address*		8950 SW 74TH CT., STE 2267
City, State Zip*		MIAMI , FLORIDA 33152
Email Address *		INTAKE@FLINSLAW.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		AMERICAN TRADITIONS INSURANCE COMPANY
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 12359

Name of individual responsible for violation (if any):* UNKNOWN
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)(b)		Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
	626.9541(1)(i)(3)(d)		Denying claims without conducting reasonable investigations based upon available information.

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

Section 1 - Perlis Insured Against Section 1 - Property Coverages Loss Settlement Provision

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

Page 1 of 1On August 30, 2023, Ronald Cezard and Aline Fortulien suffered a loss due to covered perilscontemplated under the Policy; and timely reported the damage to Defendant. Ronald Cezardand Aline Fortulien contracted A-WD Multi Services LLC in order to perform MOLDASSESSMENT services to the Insureddirectly relating to the loss. In exchange for A-WD MultiServices LLC's services Ronald Cezard and Aline Fortulien executed an assignment of benefits.On or about August 5, 2024, A-WD Multi Services LLC provided American TraditionsInsurance Company with notice of the Assignment of Benefits. Within the statutory period, A-WD Multi Services LLC provide American Traditions Insurance Company with a copy of itsinvoice, assignment agreement, demand for payment of insurance benefits and supportingdocumentation. During the investigation of the claim, American Traditions Insurance Companysent an unqualified person to make determinations of causation of damage in violations of626.9541(1)(i)(3)(d). After completing its deficient investigation American Traditions InsuranceCompany should have provided coverage for the loss. American Traditions Insurance Companyhas unduly delayed full payment and coverage over the claim in violation of the insurancecontract and has done so in a manner which violates multiple Florida Statutes. Furthermore,American Traditions Insurance Company failed to promptly provide a reasonable explanation inwriting to the insured of the basis in the insurance policy, in relation to the facts or applicablelaw, for denial of a claim or for the offer of a compromise settlement.The failure to issue payment when there was no applicable exclusion for the type of service orclaim in relation to the covered claim is a violation of 624.155(1)(b)(1) and 624.155(1)(b)(3).American Traditions Insurance Company has been provided sufficient evidence to supportcoverage for the subject claim and services. Despite making numerous payments in the past forthese types of services which were performed in relation to valid insurance claims, AmericanTraditions Insurance Company has subsequently made it a business practice to deny theseservices irrespective of the facts for each claim in direct violation of 626.9541(1)(i)(3)(a) and626.9541(1)(i)(3)(b).American Traditions Insurance Company has repeatedly and continuously acted in bad faith inthis matter and others like it. Despite the fact that these services are directly related to coveredlosses and not excluded under the policy of insurance, American Traditions Insurance Companyrefuses to pay insurance benefits for same. In order to cure American Traditions InsuranceCompany’s continuous acts of bad faith, American Traditions Insurance Company must issuepayment for the invoiced amount of $ 2,850.00 and which has a current balance of $ 2,850.00; aswell as, statutory interest. In addition, American Traditions Insurance Company must cease itsunfair trade practice of citing to irrelevant policy provisions in order to misrepresent thecoverages afforded under its policies of insurance.PDC24-001225

Comments

User Id		Date Added		Comment
LVick@bressler.com		02-24-2025		Via U.S. Mail, Certified Mail and E-mail: INTAKE@FLINSLAW.com Robert F. Gonzalez, Esq. Insurance Trial Lawyers 8950 SW 74th Court, Suite 2267 Miami, FL 33152 Complainant: A-WD Multi Services, LLC a/a/o Ronald Cezard and/or Aline Fortulien Policy #: ATH1074671 Claim #: AH141646 DFS Filing #: 798291 To Whom It May Concern: We write on behalf of American Traditions Insurance Company (hereafter “American Traditions”) to respond to the Civil Remedy Notice (hereafter “CRN”) submitted to the Florida Department of Financial Services (hereafter “DFS”) on behalf of A-WD Multi Services, LLC, a/a/o Ronald Cezard and Aline Fortulien (hereafter “A-WD” or “the Complainant”). A-WD is the purported recipient of an assignment of benefits from American Traditions’ Insureds Ronald Cezard and Aline Fortulien (hereafter “the Insureds”). DFS accepted the CRN on December 26, 2024, and American Traditions is hereby responding to and rejecting all of the allegations made against American Traditions in connection with the above referenced claim and otherwise. As described in detail below, the CRN fails to allege factual support for statutory allegations raised, or that the loss and services rendered in connection with the loss are covered under the policy. As a result, the CRN must be rejected and is legally invalid. The CRN alleges violations of the following statutory provisions: • 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. • 626.155(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)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. • 626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information. To summarize the below, American Traditions hereby denies any allegation of not attempting to settle claims in good faith when it could and should have done so; failing to promptly settle claims when it could and should have done so; failing to adopt and implement standards for the proper investigation of claims; misrepresenting pertinent facts; denying claims without conducting reasonable investigations, and states that it has at all times handled and adjusted the Insureds’ and/or Complainant’s claim with utmost good faith. Simply put, American Traditions denies any acts or omission that could be construed or found to be deemed bad faith and/or a violation of Florida Statutes § 624.155 and/or § 626.9541, whether expressly stated in the Civil Remedy Notice or implied. Any and all allegations of bad faith are hereby denied and rejected in their entirety by American Traditions. First and foremost, American Traditions denies and rejects the instant CRN as it fails to comply with the requirements of Florida Statute § 624.155. The CRN is therefore deficient and fails to preserve any and all claims for statutory bad faith under Florida Law. Florida Statute § 624.155 requires a complainant to file with the Department of Financial Services a Civil Remedy Notice which shall be “on a form provided by the [Department] and shall state with specificity…such other information as the Department may require.” The Department created a CRN form, Form DFS-10-363, which lays out 15 requirements, including in part, the Complainant’s e-mail address, Complainant type, attorney’s name, attorney’s address, attorney’s e-mail address, type of insurer, the person with knowledge of the facts giving rise to the allegations, and the reason for notice. According to § 624.155, these mandates are required by the Department, and they must be stated with specificity. The instant CRN fails to identify the name of the person(s) most knowledgeable of the facts giving rise to the allegations, instead indicating “UNKNOWN” in the space allocated to this form requirement. Due to the Insureds failure to provide this mandated information, the CRN is facially deficient and fails to comply with the form requirements set forth in Florida Statute § 624.155, and specifically § 624.155(3)(b)(3). See Bay v. United Servs. Auto. Ass’n, No. 4D19-3332, 2020 WL 6154256 (Fla. 4th DCA Oct. 21, 2020). Additionally, Florida Statute § 624.155 requires the Complainant to reference specific policy language that is relevant to the violation. Here, the CRN does not refer to any policy language that is pertinent to the allegations of bad faith. The CRN does not even attempt to reference policy language and makes the most basic reference to a general subheading within the policy, “Section 1 – Perils Insured Against Section 1 – Property Coverages Loss Settlement Provision,” without including any specific policy language as required by the Department’s form. It is unclear from the face of the CRN which policy provisions are being referenced especially in light of the fact that the subheading “Loss Settlement” does not appear under the Section of the Policy entitled “Property Coverages” but rather under the “Conditions” Section of the Policy which is not referenced. Therefore, the CRN is vague and ambiguous as to whether the CRN is intending to reference the entirety of the “Coverages” Section and the “Loss Settlement” Section or is misquoting the subject policy. Moreover, the Complainant’s generic references to the policy provisions are overly broad and provide absolutely no guidance as to the policy provisions relevant to the alleged violations and upon which the Complainant intends to rely. The failure to provide specific reference to policy language is direct and clear noncompliance with the requirements of Fla. Stat. § 624.155. “Courts have found that listing whole sections of the insurance policy constitutes insufficient specificity.” See Fox v. Starr Indem. & Liab. Co., No. 8:16-CV-3254-T-23MAP, 2017 WL 1541294 at 2 and Julien v. United Property & Casualty Insurance Company No. 4D19-2763 (Fla. 4th DCA 2020).” The Complainant makes no attempt to set forth a basis for their noncompliance with the statute. Therefore, failure to include policy language renders the CRN deficient on its face, as to form and substance and the reference to the policy section(s) as a whole are insufficient to place American Traditions on notice of the allegations set forth against it in connection with this CRN. Additionally, Florida Statute § 624.155(1)(b)(1) requires that a CRN “state with specificity,” inter alia, the facts and circumstances giving rise to the violation(s) alleged. Here, A-WD Multi Services LLC wholly failed to provide specific facts or circumstances giving rise to each and every statutory violation alleged in the CRN, and instead alleges generally that, “[American Traditions] has unduly delayed fullpayment and coverage over the claim in violation of the insurance contract and has done so in amanner which violates multiple Florida Statutes.” The extent of the factual allegations pertaining to the loss include that “[the Insureds] suffered a loss due to covered perilscontemplated under the Policy; and timely reported the damage to [American Traditions],” and “[the Insureds] contracted A-WD Multi Services LLC in order to perform MOLDASSESSMENT services to the Insureddirectly relating to the loss,” and “[i]n exchange for A-WD Multi Services LLC’s services [the Insureds] executed an assignment of benefits.” In addition to these allegations being vague and unclear, they are also incorrect. The instant CRN alleges that the insureds sustained a loss and timely reported the damage, which could not be further from the truth. Rather, the loss was first reported to American Traditions on July 16, 2024, nearly a year after the date of loss on August 30, 2023. Also, noticeably absent from the CRN is any mention of the type of loss that occurred, or the specifics of any services rendered at the Insureds’ property, making it impossible to evaluate if such type of loss and/or services would be compensable under the policy. Additionally, the CRN fails to contain the method by which the purported assignment was provided to American Traditions, the type of supporting documents provided and the date and method by which they were submitted to American Traditions, and the basis for believing that the services completed were covered under the policy. The CRN provides no support of its generic statement that American Traditions “has repeatedly and continuously acted in bad faith inthis matter and others like it,” or that American Traditions had “made it a business practice to deny theseservices irrespective of the facts for each claim” and no facts to support bad faith of any kind. The Complainant’s failure to provide any description of facts relating to circumstances which give rise to the alleged statutory violations prevents American Tradition from providing any meaningful or complete response. Accordingly, the CRN does not provide the contemplated and mandated notice of alleged bad faith that is required as a condition precedent to any civil claim for bad faith pursuant to Fla. Stat. § 624.155. For these reasons alone, the CRN fails at its inception. Due to the lack of any facts in support of the claim of bad faith, the CRN must be rejected. Moreover, American Traditions maintains that it adjusted the loss in good faith at all times. In contrast to the allegations of the civil remedy notice, American Traditions did not use an “unqualified person to make determinations of causation and damage…” Rather, American Traditions performed an inspection with a licensed independent engineer, Phillip S. Vanciel, PE, (Florida Registration Number 87446), of U.S. Forensic, LLC, on September 3, 2024. Additionally, American Traditions has not “unduly delayed fullpayment and coverage over the claim” or failed to “provide a reasonable explanation in writing … for denial of the claim” because the investigation is ongoing for reasons outside the control of American Traditions. On or about September 25, 2024, American Traditions requested the Examination Under Oath of the Insured to assist in its claim determination. On December 12, 2024, this examination was scheduled for February 17th, however on February 4th, American Traditions was advised by counsel for the Insureds, Florida Trial Lawyers, that they were unable to proceed with the Examination and requested re-scheduling until March. It should be noted that Florida Trial Lawyers represents both the Insureds, as well as the Complainant A-WD, in connection with this matter. Due to American Traditions’ inability to complete the Examination Under Oath, the claim investigation in this matter is ongoing. To that end, the allegations set forth regarding improper denial of the claim are pre-mature and unfounded. The CRN does not state with specificity the information required by the Department and the Complainant lacks standing. The CRN does not state with specificity the facts and circumstances giving rise to the violation, the names of the individuals involved in the violation and the specific policy language at issue. The CRN fails to establish statutory compliance by the AOB, thus negating the AOB’s ability to prove that it was valid and enforceable. The CRN lacks factual support as it relates to the timely delivery of the AOB to American Traditions and proof of delivery to American Traditions. Florida Court’s have held that CRN’s that are similarly broad and list general policy provisions do not satisfy the statutory requirements. The inclusion of only conclusory statements without the requisite specificity renders the CRN facially deficient. Notwithstanding these deficiencies, American Traditions expressly denies the allegations contained within the CRN. Lastly, the cure demanded in the CRN is deficient as it is entirely broad, ambiguous, vague, and improper. First and foremost, the cure demands that American Traditions “must issuepayment for the invoiced amount of $2,850.00… as well as, statutory interest,” but gives no specific date nor basis for American Traditions to even attempt to calculate the amount of interest being requested by the cure. The cure also requires that “American Traditions Insurance Company must cease itsunfair trade practice of citing to irrelevant policy provisions in order to misrepresent thecoverages afforded”. Yet the CRN provides no notice of what irrelevant policy provision American Traditions has allegedly used to misrepresent the coverages afforded or any facts in support of the allegation that American Traditions has engaged in this as a trade practice. Due to the lack of specificity included in this cure demand American Traditions is unable to identify the actions taken that constitute the alleged violation, and therefore certainly cannot identify the actions needed in order to cure the violation. The non-monetary cure conditions are entirely illusory and unascertainable due to the lack of specificity contained in the CRN. As for the monetary cure requested, this request is the functional equivalent of “pay me everything I’ve asked for.” Rousso v. Liberty Surplis Ins. Co., 2010 WL 736059, 5 (S.D. Fla. 2010). “Insurers are not required to pay any amount demanded by their insureds to avoid a bad-faith claim.” Id. (citing 316, Inc. v. Maryland Cas. Co., 625 F. Supp. 2d 1187, 1194 (N.D. Fla. 2008)). Yet the CRN fails to assert facts sufficient to entitle them to payment. Given the cure and its deficiencies, American Traditions affirmatively asserts that the CRN is deficient. The purpose of the statute’s requirement is to allow an insurer against which such a notice is filed to both understand and effectively be allowed to cure any purported violations. See Longpoint Condo. Assoc. v. Allstate Ins. Co., 2005 U.S. Dis. LEXIS 43917, *7 n. 3 (N.D. Fla. June 1, 2005) (citing Talat Enters., Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278, 1281-82 (Fla. 2000)). The cure demanded in the Complaint is to vague to provide sufficient notice and allow American Traditions an opportunity to cure and therefore the CRN fails at inception. To conclude, the Complainant posits the aforementioned conduct and alleged statutory violations without stating specific supporting facts to each and every statutory violation alleged. Instead, the facts stated in support of the alleged statutory violations are wholly conclusory in nature or blatantly incorrect, premature and misleading. A CRN must state the facts and circumstances that give rise to an alleged violation with specificity sufficient to allow an insurer to cure the alleged violation within the sixty-day statutory period. Lane v. Westfield Insurance Company, 862 So. 2d 774 (Fla. 5th DCA 2003). Merely stating a litany of alleged wrongful conduct and statutory violations in a conclusory manner is insufficient without stating supporting facts specific to the insurance claim. In consideration of the foregoing, it instead appears the Complainant has taken an overly broad and vague “kitchen sink” approach to the drafting of the instant CRN as it concerns policy provisions, statutory violations asserted, and vague, conclusory facts without specificity or regard for application, which is improper under Florida law. On these grounds, the instant CRN is deficient on its face, invalid per Florida Statute § 624.155, and lacks any merit against American Traditions. See Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021). In sum, American Traditions denies any failure to handle, investigate and adjust the claim, and all of the allegations contained in the CRN are hereby denied. To the extent that this response does not address each and every allegation of bad faith conduct made by the Complainant, American Traditions hereby expressly denies any and all allegations of bad faith conduct or omission set forth in the CRN, and/or any alleged violation of Florida Statutes or any other statutory section set forth therein. Again, American Traditions insists it has acted, at all times, in utmost good faith. American Traditions expressly denies all allegations against it. Should you need any additional information from American Traditions regarding the foregoing, please feel free to contact the undersigned. Very truly yours, s/ Lisa G. Vick, Esq. _ Lisa G. Vick, Esq.

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