Civil Remedy Notice of Insurer Violations
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Filing Number:     798296
Filing Accepted:  12/26/2024
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Complainant
Last/Business Name *  
HIS AND HERS ROOFING LLC   First Name  
Street Address * 515 18TH STREET
City, State Zip * ORLANDO, FL 32805
Email Address * JBAER@HHROOFS.COM
Complainant Type: * Third Party
Insured
Last/Business Name*   TYRE   First Name   ALVIN
Policy # * AGD10407185 Claim #* CDP00177801
Attorney
Attorney is Applicable
Last Name* TORRES First Name * ALEXIS Initial
Street Address* 515 18TH STREET
City, State Zip* ORLANDO , FLORIDA 32805
Email Address * ALEXIS@HHROOFS.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA
NAIC Company Code 12841
 
Name of individual responsible for violation (if any):* UNKNOWN
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unfair Trade Practice
* Statutory provision(s) which the insurer allegedly violated.
 
626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
626.9541(1)(i)(4) Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

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

December 26, 2024 Sent Via Email: claimsmail@aiiflorida.com American Integrity Insurance Company of Florida P.O. Box 748042, Atlanta, GA 30374 RE: Complainant : His and Hers Roofing, LLC Insured : Alvin Tyre Policy Number : AGD10407185 Claim Number : CDP00177801 Property Address : 5611 Lejeune Drive, Orlando 32808 Dear American Integrity Insurance Company of Florida: As discussed in greater detail in the notice, Carrier has not attempted in to settle the claim 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 their interests. Carrier is required to properly investigate and adjust claims and cannot place that burden upon the insured or complainant. 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 insureds…”). Carrier’s actions are in violation of Florida Statute §§ 626.9541(1)(i)(3)(c) 626.9541(1)(i)(3)(g), 626.9541(1)(i)(4) and 627.70131(7)(1)(a). Insureds home was damaged by a hurricane on or about 11/09/2022. Carrier received insured’s claim upon receipt of a valid assignment of benefits in complainant’s favor following an inspection of the home wherein Complainant confirmed the damage was a result of this date of loss. Carrier then assigned a claim number to the loss and should have retained someone licensed to perform an inspection of the property to determine the extent of the damage. Complainant is unsure of the results of this inspection as carrier has yet to confirm what caused the damage to the home and if carrier believes the policy affords any coverage for the loss. The policy and Florida law, at the time of this claim, both require a carrier issue a coverage letter within 60 days from when the claim is first reported. Failing to do so is a breach of the policy and a violation of Florida law. Complainant requested a status on this required letter on November 4, 2024, and November 19, 2024, but continues to be ignored. To date, carrier has failed to issue the statutorily required coverage determination following the completed inspection and adjustment of the loss. As a direct result, Complainant is unsure what carrier is pending on the claim, or if carrier is still investigating the loss. In fact, Carrier not failed to even provide a statutory status letter informing anyone involved in the claim of the reason behind Carrier’s delay. Carrier is not acting in good faith by failing to promptly acknowledge communications in relation to this claim in an effort to avoid communications with a roofing contractor and their counsel when a valid assignment of benefits is in effect. Carrier also shows a lack of a standard of good faith adjustment when it fails to even provide an answer as to the outcome of a claim within the required 60-day period, despite insured nor complainant creating any reason that carrier could not do so. All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless regard for claimant’s rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) issue the statutorily required coverage determination letter to complainant dated prior to 60 days from when the claim was first reported. A copy of this letter and filed form submitted to the FDFS has been emailed as indicated above. Should you have any questions upon receipt of this filing, please do not hesitate to contact me at (407) 214-9305. We appreciate your attention to this matter. Sincerely, Alexis Torres, Esq. General Counsel for His and Hers Roofing, LLC Enclosed: Civil Remedy Notice Filing
Comments
User Id Date Added Comment
swozniak@aii.com 01-08-2025 January 8, 2025 Via Electronic Submission Florida Department of Financial Services Consumer Assistance Civil Remedy Section Larson Building 200 E. Gaines Street Tallahassee, FL 32399-0322 Alexis Torres, Esq. 515 18th Street Orlando, Florida 32805 Alexis@HHRoofs.com Re: DFS File No: 798296 Complainant: His and Hers Roofing LLC Insured: Alvin Tyre Policy No: AGD10407185 Insurer: American Integrity Insurance Company of Florida Claim No: CDP-00177801 To Whom It May Concern: We are in receipt of the Civil Remedy Notice (“CRN”) filed by Alexis Torres, Esq. on behalf of the above referenced Complainant and matter. The Florida Department of Financial Services (“DFS”) accepted the CRN on December 26, 2024 and assigned it DFS File No. of 798296. While American Integrity asserts that the subject CRN is legally insufficient and non-compliant with Florida law, American Integrity, without waiving any arguments regarding same, contends that it has at all times performed its obligations under the insurance policy in a prompt and diligent manner with due regard for the interest of its Insured, Alvin Tyre. The CRN contains a list of purported violations which are alleged to have been committed by American Integrity. In fact, none of the listed violations/allegations have occurred and/or are irrelevant to the alleged violations and American Integrity categorically denies any violations of §624.155 and §626.9541, Fla. Stat., as well as any and all other statutes/regulations/codes/rules contained in the CRN. In addition, American Integrity denies any and all allegations of any kind and/or any inferences therefrom referenced and/or contained in the CRN. American Integrity believes this response adequately addresses the allegations and violations contained within the CRN. Sincerely, Michael S. Sperounes Michael S. Sperounes, Esq. Senior Vice President of Litigation American Integrity Insurance Group cc: Alexis Torres, Esq. via email at: Alexis@HHRoofs.com CRN Response If this document contains an excerpt from an American Integrity Insurance Policy (“the Policy”) it is provided here for informational purposes only. This excerpt is not the official version of the Policy. The official version of the Policy is the policy issued to the Insureds on the policy effective date. In the event there is inconsistency between this document and the Policy, the Policy shall serve as the official version. Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree. F.S. 817.234
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.

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