Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 798564

Filing Accepted: 12/30/2024

Print Filing

Complainant

Last/Business Name *

EBERT

First Name

DARRELL AND LINDA

Street Address *

33 TROPICANA DRIVE

City, State Zip *

PUNTA GORDA, FL 33950

Email Address *

CFREY@GADCLAW.COM

Complainant Type: *

Insured

Last/Business Name*		EBERT		First Name		DARRELL AND LINDA
Policy # *		AGH0082263		Claim #*		CHO-00142860

Attorney

Attorney is Applicable

Last Name*	FREY First Name * CALLIE Initial
Street Address*		6609 WILLOW PARK DRIVE, SECOND FLOOR
City, State Zip*		NAPLES , FL 34109
Email Address *		CFREY@GADCLAW.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 12841

Name of individual responsible for violation (if any):* COURTNEY BOOKER (CROSS COUNTRY ADJUSTING); SHASHUNDRA ROBERSON (CROSS COUNTRY ADJUSTING); LAQUATER ROBERSON (CROSS COUNTRY ADJUSTING); SHARYN HALL (CROSS COUNTRY ADJUSTING); STACY CHAPMAN (CROSS COUNTRY ADJUSTING); JENNIFER DOW (AMERICAN INTEGRITY AD
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Unsatisfactory Settlement Offer
	Unfair Trade Practice
	Other : Bad Faith
	Claim Delay
	Other : Improper Claim Handling

* 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)(2)		A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
	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)(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.
	626.9541(1)(i)(3)(g)		Failing to promptly notify the insured of any additional information necessary for the processing of a claim.

* Specific policy language that is relevant to the violation.
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FLORIDA STATUTES, ETC. VIOLATED (continued): Florida Statutes § 626.877 – Every adjuster shall adjust or investigate every claim, damage, or loss made or occurring under an insurance contract, in accordance with the terms and conditions of the contract and of the applicable laws of this state.; Florida Administrative Code 69B-220.201 – The work of adjusting insurance claims engages the public trust.; Florida Administrative Code 69B-220.201(3) – An adjuster shall put the duty for fair and honest treatment of the claimant above the adjuster’s own interests in every instance.; Florida Administrative Code 69B-220.201(3)(b)(2) – An adjuster shall adjust all claims strictly in accordance with the insurance contract.; Florida Administrative Code 69B-220.201(3)(c) – An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured.; Florida Administrative Code 69B-220.201(3)(d) – An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.; Florida Administrative Code 69B-220.201(3)(f) – An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim. Specific policy language that is relevant to the violations includes, but is not limited to, the following: The specific policy language at issue includes, but may not be limited to: HOMEOWNERS 3 SPECIAL FORM (AIIC HO3 12 19) Section I – Property Coverages COVERAGE A – Dwelling 1. We cover: a. The dwelling on the "residence premises" shown in the Declarations, including structures attached wall-to-wall carpeting if damage to the dwelling is caused by covered loss. b. Materials and supplies located on or next to the "residence premises" used to construct, alter or repair the dwelling or other structures on the "residence premises." c. In-ground swimming pools including related permanently installed equipment such as pumps and filters. *** 3. We do not cover land, including land on which the dwelling is located. COVERAGE B – Other Structures 1. We cover: a. Other structures on the “residence premises” set apart from the dwelling by a clear space. b. Other structures connected to the dwelling by only a fence, utility line, or similar connection. c. Fences, whether attached or not attached to the dwelling. *** COVERAGE C – Personal Property 1. Covered Property We cover personal property owned or used by an “insured” while it is anywhere in the world. At your request, we will cover personal property owned by: a. Others while the property is on the part of the “resident premises” occupied by an “insured”; b. A guest or “residence employee,” while the property is in any residence occupied by an “insured.” *** *** ADDITIONAL COVERAGES 1. Debris Removal. We will pay your reasonable expense for the removal of: a. Debris of covered property if a Peril Insured Against that applies to the damaged property causes the loss; or b. Ash, dust or particles from a volcanic eruption that has caused direct loss to a building or property contained in a building. This expense is included in the limit of liability that applies to the damaged property. If the amount to be paid for the actual damage to the property plus the debris removal expense is more than the limit of liability for the damaged property, an additional 5% of that limit of liability is available for debris removal expense. We will also pay your reasonable expense, up to $500, for the removal from the “residence premises” of: a. Your tree(s) felled by the peril of windstorm or Hail or weight of Ice, Snow or Sleet; b. A neighbor's tree(s) felled by a Peril Insured Against under COVERAGE C – Personal Property; provided the tree(s) damages a covered structure. The $500 limit is the most we will pay in any one loss regardless of the number of fallen trees. *** 11. Ordinance or law. You may use up to 25% of the limit of liability unless otherwise noted in this policy that applies to Coverage A - Dwelling for the increased costs you incur due to the enforcement of any ordinance or law which requires or regulates: a. The construction, demolition, remodeling, renovation or repair of that part of a covered building or other structure damaged by a Peril Insured Against; b. The demolition and reconstruction of the undamaged part of a covered building or other structure, when that building or other structure must be totally demolished because of damage by a Peril Insured Against to another part of that covered building or other structure; or c. The remodeling, removal or replacement of the portion of the undamaged part of a covered building or other structure necessary to complete the remodeling, repair or replacement of that part of the covered building or other structure damaged by a Peril Insured Against. You may use all or part of this ordinance or law coverage to pay for the increased costs you incur to remove debris resulting from: a. The construction, demolition, remodeling, renovation, repair or b. Replacement Of property as stated in a. through c. above. *** SECTION I – CONDITIONS 3. Loss Settlement. Covered property losses are settled as follows: a. Property of the following types: (1) Personal property; (2) Awnings, carpeting, household appliances, outdoor antennas and outdoor equipment, whether or not attached to buildings; (3) Structures that are not buildings; and (4) Driveways, walkways or fences; At “actual cash value” at the time of loss but not more than the amount required to repair or replace with property of similar kind and quality. b. Buildings under COVERAGE A - Dwelling or COVERAGE B – Other Structures 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 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. *** 10. Loss Payment. We will adjust all losses with you. We will pay you unless some other person is named in the policy or is legally entitled to receive payment. Loss will be paid upon the earliest of the following: *** c. Within 90 days after we receive notice of an initial claim, “reopened claim” or “supplemental claim” from you, we will pay or deny such claim or a portion of the claim unless the failure to pay such claim or portion of claim is caused by factors beyond our control, which reasonably prevent such payment. *** PERSONAL PROPERTY REPLACEMENT COST COVERAGE (AIC RCC 11 14) SECTION I – PROPERTY COVERAGES C. COVERAGE C – Personal Property The following is added: 3. Personal Property Replacement Cost a. We will pay for covered losses on the basis of replacement cost at the time of loss for the following property: (1) COVERAGE C – Personal Property (2) If covered in this policy: (a) Awnings; (b) Carpeting; (c) Household appliances; (d) Outdoor antennas; and (e) Outdoor equipment: Whether or not attached to buildings. b. Personal Property Replacement Cost coverage will apply to the following articles or classes of property if they are separately described and specifically insured in this policy: (1) Jewelry; (2) Furs and garments trimmed with fur or consisting principally of fur; (3) Cameras, projection machines, films and related articles of equipment; (4) Musical equipment and related articles of equipment; (5) Silverware, silver-plated ware, goldware, gold-plated ware and pewterware, but excluding pens, pencils, flasks, smoking implements or jewelry; and (6) Golfer’s equipment meaning golf clubs, golf clothing and golf equipment. Personal Property Replacement Cost coverage will not apply to other classes of property separately Described and specifically insured. *** SECTION I – CONDITIONS 3. Loss Settlement. Item c. is added: c. REPLACEMENT COST Loss Settlement applies to all property insured under this endorsement: (1) We will pay no more than the least of the following amounts: (a) Replacement cost at the time of loss without deduction for depreciation; (b) The full cost of repair at the time of loss; (c)The limit of liability that applies to COVERAGE C – Personal Property, if applicable; (d) Any applicable special limits of liability stated in this policy; or (e) For loss to any item separately described and specifically insured in this policy, the Limit of liability that applies to the item. (2) When insured for replacement cost, the company will make payment whether or not actual repair or replacement is complete. All other provisions of this policy apply.

* Facts and circumstances giving rise to the violation.
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This civil remedy notice is being filed with the Department of Financial Services. As such, its contents are a matter of public record and thus American Integrity Insurance Company of Florida (the “Insurance Company” or “American Integrity”) is on notice of the alleged bad faith behavior and therefore should not later enjoy the “advice of counsel” defense. The Florida Statutes and Florida Administrative Code set forth comprehensive requirements for insurance companies and insurance adjusters, and regulate the adjustment of property insurance claims. Generally, there is a common theme that sounds throughout these various laws and rules – one that requires ethical behavior on the part of insurers and their adjusters so as to provide fair treatment to insureds, and for quick adjustment, payment, and resolution of claims. These principles are generally refined, condensed, and reflected in Rule 69B-220.201 of the Florida Administrative Code (entitled “Ethical Requirements”), which states, in part: “the work of adjusting insurance claims [in Florida] engages the public trust.” The relevant laws and rules mandate fair and honest treatment of insureds, and require that insurance adjusters behave with integrity. More specifically, Florida Administrative Code 69B-220.201(3) states: “[a]n adjuster shall put the duty for fair and honest treatment of the claimant above the adjuster’s own interests in every instance.” This is consistent with Florida Statutes § 624.155(1)(b)(1), which states that an adjuster has a duty to attempt in good faith to resolve claims and act “fairly and honestly” toward an insured with “due regard” for the “interests” of the insured; and Florida Administrative Code 69B-220.201(3)(e), which states that adjusters are required to handle every claim “with honesty” and “integrity.” See also Florida Administrative Code 69B-220.201(3)(d)(stating that insurance adjusters are required to make truthful and unbiased reports regarding their investigation of insurance claims). Perhaps most importantly, and particularly relevant to the instant claim, insurance adjusters shall not “approach investigations, adjustments, and settlements in a manner prejudicial to the insured.” Florida Administrative Code 69B-220.201(3)(c). The laws and rules also require insurers and adjusters to act in a manner that effectuates the quick resolution of claims. These laws and rules run hand in hand with the aforementioned ones; if an insurance adjuster acts fairly, honestly, and with integrity, there should be few delays in resolving claims. In any event and more specifically, insurance adjusters in Florida are required to act “with dispatch and due diligence” in handling and resolving claims. Florida Administrative Code 69B-220.201(3)(f). See also Florida Statute § 624.155(1)(b)(1). Additionally, insurance adjusters are required to adjust and investigate every claim in accordance with the terms and conditions of the insurance policy/policies and the laws of Florida. Florida Statutes § 626.877; Florida Administrative Code 69B-220.201(3)(b)(2); Board of Public Instruction of Dade County v. Town of Bay Harbor Islands, 81 So. 2d 637 (Fla. 1955)(holding that the laws of Florida are a part of every Florida contract.). Adjusters that stray from the aforementioned requirements are in breach of the policy, the Florida Statutes, and Florida Administrative Code. Lastly, property insurers operating in Florida have the duty to adopt and implement standards for the proper investigation of claims. Florida Statutes § 626.9541(1)(i)(3)(a). Part of that requirement is to assign competent and knowledgeable adjusters to investigate and pay claims. See Florida Administrative Code 69B-220.201(3)(k)(stating: “[a]n adjuster shall not undertake the adjustment of any claim concerning which the adjuster is not currently competent and knowledgeable as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster’s current expertise.”). And, insurers have the duty to act in good faith as to the business of insurance, the policies they issue, the risks they cover, and the insureds they protect. See QBE Ins. Corp. v. Chalfonte Condo. Apartment Ass’n, Inc., 94 So. 3d 541 (Fla. 2012). In doing so, they should incorporate the laws and rules referenced above into their training so that their adjusters and representatives are in compliance with such laws and rules, and the insurance policies they issue. See Florida Statute § 627.4108. It is believed American Integrity and its adjusters and other representatives have breached the Florida Statutes, Florida Administrative Code, the insurance policy at issue, and the associated duties therein, by their handling of the insured’s claim. In doing so, it is believed American Integrity and its adjusters and representatives have committed ethical violations. Amongst other things, American Integrity and its adjusters and representatives have wrongfully attempted to frustrate the insured and otherwise dissuade her from pursuing a valid loss and claim. They have done this by ignoring the facts of the claim, and the obligations under the policy and pursuant to Florida law. It is believed this behavior was done for financial reasons in favor of American Integrity, which has no place in the business of insurance and adjusting insurance claims, where the ultimate level of faith and trust is generally placed in the hands of insurers and their representatives by the insureds after substantial sums (in the form of premiums) are paid for the assurance that covered losses will be promptly and timely paid through adjusters who act in good faith, fairly and with honesty and integrity, and with due regard for the interests of the insureds (and not in a manner that is prejudicial to the same). Darrell Ebert and Linda Ebert (the “Insureds”) paid for a policy of insurance with American Integrity bearing policy number AGH0082263 (the “Policy”), which provided coverage for damage to the Insureds’ property, including significant damage sustained as a result of hurricane wind from Hurricane Ian. American Integrity has failed and refused to fully compensate the Insureds for the damages suffered from this covered loss. The actions by American Integrity and its adjusters and representatives are reckless and unfair and have created a financial hardship on the Insureds. Specific examples of bad faith on the part of American Integrity and its adjusters and representatives include, but are not limited to, the following: On September 28, 2022, the Insureds’ property suffered substantial damage as a result of a windstorm from Hurricane Ian. Specifically, the property suffered damage, including but not limited to, damage to the roof, exterior elevations, boat lift, and sustained interior water damage. On December 6, 2022, American Integrity acknowledged that the loss was covered by the covered policy but under the Insureds’ deductible. American Integrity based its coverage decision on an October 10, 2022 estimate and determined that the covered loss was $7,288.74 but did not issue payment. On January 18, 2023, after the Insureds submitted additional documentation for their damages, American Integrity issued supplemental payment. American Integrity determined that the covered loss was $21,019.46 ($1,189.05 for Coverage A Dwelling; $55.41 for Coverage B Other Structures; $19,755.00 for Limited Carport(s), Pool Cage(s), and Screen Enclosure(s)), and issued payment of $11,134.54 after applying depreciation and the deductible. On May 9, 2023, American Integrity extended coverage for chemical power wash, stucco repair, and painting to all elevations. American Integrity determined the covered loss was $25,148.36 ($5,317.95 for Coverage A Dwelling; $55.41 for Coverage B Other Structures; $19,755.00 for Limited Carport(s), Pool Cage(s), and Screen Enclosure(s)), and issued payment of $3,883.95 for Coverage A after applying prior payments. On July 12, 2023, American Integrity again issued supplemental payment. American Integrity determined the covered loss was $25,702.74 ($5,866.80 for Coverage A Dwelling; $60.94 for Coverage B Other Structures; $19,755.00 for Limited Carport(s), Pool Cage(s), and Screen Enclosure(s)), and issued payment of $900.11 after applying prior payments. On July 24, 2023, the Insureds demanded appraisal under the policy. After multiple follow-ups on the status of a response, nearly six months after the request, on January 9, 2024, American Integrity declined the Insureds request for appraisal. Between August 2023 and March 2024, the Insureds were in constant communication with American Integrity. Notably, American Integrity failed to respond to several of the Insureds’ emails. When new adjusters were assigned to the claim, American Integrity failed to keep records of the Insureds file, including emails, correspondence, estimates, photos, reports, and documents previously sent between the Insureds and American Integrity. American Integrity’s acts and/or omissions unquestionably delayed the Insureds’ claim. Furthermore, while the Insureds are claiming damages to their boat lift, American Integrity is claiming that damages to the boat “dock” (not lift) are excluded under a policy provision that does not apply. Specifically, American Integrity contends that the boat “dock” was damaged by the Insureds’ boat, but uses a policy provision stating, “We do not insure, however, for loss: (2) freezing, thawing, pressure or weight of water or ice . . . (c) pier, wharf or dock.” When the Insureds asked for a different provision that aligns with American Integrity’s denial, American Integrity fails to provide the same. On March 1, 2024, the undersigned law firm sent a Letter of Representation to American Integrity. In response, LaQuater Roberson, the desk adjuster for Cross Country Adjusting, provided the Insureds with American Integrity’s July 12, 2023 correspondence and supporting estimate. Mr. Roberson also advised the Insureds claim was currently pending the Insurer’s engineer report, which was being reviewed and was said to be available by March 29, 2024 as another inspection took place on March 12, 2024 at the Insureds’ property. On April 1, 2024, the undersigned counsel followed up with American Integrity for its engineers report but did not receive a response. The undersigned counsel also followed up on April 16, 2024, and April 19, 2024, and did not receive a response. On May 7, 2024, Sharyn Hall from Cross Country Adjusting advised that she was the new adjuster for the claim and that she was in receipt of engineer report. She advised that once review of the report was complete, she would let the Insureds know. The undersigned counsel’s office followed up with Ms. Hall for American Integrity’s engineer report on May 7, 2024, June 11, 2024, September 19, 2024, October 17, 2024, November 4, 2024, November 21, 2024, and December 17, 2024. Even after eight months of trying to obtain said report, American Integrity failed to respond regarding the same. It was not until December 17, 2024 when American Integrity responded. In an attempt to cover up American Integrity’s bad faith in not responding for several months, American Integrity advised that the report would not be provided because American Integrity considered it work product. On June 13, 2024, Sharyn Hall from Cross Country Adjusting provided the Insureds with a partial denial letter. On September 27, 2024, the Insureds sent American Integrity their final demand for payment and again requested the above-referenced engineer report. It is evident that American Integrity has delayed and refused to resolve the disputed amount of the claim in any reasonable manner. To date, American Integrity has refused to fully indemnify the Insureds for the loss despite the obligation to do so under the Policy. As explained in greater detail below, it is believed that American Integrity has breached the insurance policy, the Florida Statutes, and the Florida Administrative Code, and Florida law in bad faith by the following acts/or omissions: (A) American Integrity approached the Insureds’ claim in a manner that was prejudicial to the Insureds and placed its own interests above those of its insured by delaying the investigation Insureds’ claim rather than looking for ways to provide additional coverage. American Integrity has made payment on the loss which is greatly below the Insureds’ damages and has failed to make any further payment and failed to further investigate the loss. American Integrity used incorrect policy provisions for its denial and failed to keep record of the Insureds claim file. In doing so, it is believed American Integrity violated: the policy (See Florida Statutes § 626.877 (stating insurance adjusters are required to adjust and investigate every claim in accordance with the terms and conditions of the insurance policy/policies and the laws of Florida); Florida Administrative Code 69B-220.201(3)(b)(2)(stating that [a]n adjuster shall adjust all claims strictly in accordance with the insurance contract); and, Board of Public Instruction of Dade County v. Town of Bay Harbor Islands, 81 So. 2d 637 (Fla. 1955)(holding that the laws of Florida are a part of every Florida contract.)); Florida Statutes § 624.155(1)(b)(1) (stating that an adjuster has a duty to attempt in good faith to resolve claims and act “fairly and honestly” toward an insured with “due regard” for the “interests” of the insured), and 626.9541; and the following Rules of the Florida Administrative Code: 69B-220.201 (which states, in part: “the work of adjusting insurance claims [in Florida] engages the public trust.”); 69B-220.201(3) (which states: “[a]n adjuster shall put the duty for fair and honest treatment of the claimant above the adjuster’s own interests in every instance.”); 69B-220.201(3)(c)(stating that insurance adjusters shall not “approach investigations, adjustments, and settlements in a manner prejudicial to the insured.”); and, 69B-220.201(3)(e) (which states that adjusters are required to handle every claim “with honesty” and “integrity.”). (B) American Integrity failed to timely pay the Insureds’ full claim. To date, American Integrity has failed to issue any payment to the Insureds for the covered loss beyond its payments of $15,918.61, despite the fact that the Insureds have incurred out of pocket expenses and provided complete documentation regarding the extent of their claim, the Insureds are still not fully indemnified. While American Integrity expects the Insureds to pay its premium payments in a timely manner, American Integrity completely disregards the interests of the Insureds and fails to timely evaluate and pay the Insureds’ full claim when it has a loss. This is fundamentally unfair and believed to be inconsistent with the following and/or constitutes violations of the same: the policy (See Florida Statutes § 626.877; Florida Administrative Code 69B-220.201(3)(b)(2); and, Board of Public Instruction of Dade County v. Town of Bay Harbor Islands, 81 So. 2d 637 (Fla. 1955)); Florida Statutes §§ 624.155(1)(b)(1) and 626.9541(1)(i)(4)(payment of undisputed amounts of partial or full benefits owed under first-party property insurance policies should be made within 90 days after an insurer receives notice of the claim).; and, Florida Administrative Code 69B-220.201(3)(f). (C) American Integrity failed to settle the Insureds’ claim when it was readily apparent that the Insureds suffered a covered loss. American Integrity has had every opportunity to evaluate the Insureds’ claim and properly indemnify the Insureds. More specifically, American Integrity has had the benefit of access to the Insureds’ property to conduct inspections and/or testing and has been provided complete estimates and documentation from the Insureds regarding the loss. Despite having more than enough information, it has now been more than two years since the loss and American Integrity still has not fully indemnified the Insureds. These acts and/or omissions on the part of American Integrity are believed to be a breach of the following: the policy (See Florida Statutes § 624.155(1)(b)(3); Florida Administrative Code 69B-220.201(3)(b)(2); and, Board of Public Instruction of Dade County v. Town of Bay Harbor Islands, 81 So. 2d 637 (Fla. 1955)); Florida Statutes § 624.155(1)(b)(1); and, Rules 69B-220.201, 69B-220.201(3), 69B-220.201(3)(c), 69B-220.201(3)(d), 69B-220.201(3)(e), and 69B-220.201(3)(f) of the Florida Administrative Code. (D) American Integrity has clearly failed to adopt and implement standards for proper investigation of claims as it has not fully indemnified the Insureds. Florida Statutes § 626.9541(1)(i)(3)(a). American Integrity inspected the Insureds’ property and refused and/or failed to provide its engineers report after the Insureds requested it multiple times and before American Integrity claimed work product privilege. American Integrity also failed to keep record of the Insureds claim file as new adjusters were assigned to the claim. Clearly, American Integrity does not have proper standards in place for investigation of this type of loss. Furthermore, this is evidence of a failure to properly communicate with the Insureds as to the loss and necessary investigation of the loss. (E) American Integrity failed to acknowledge and act promptly with regard to communications with the Insureds. The Insureds consistently had to follow up with the adjusters on the file to receive a response. The undersigned counsel’s office also requested American Integrity’s engineer report nine times with no response. These acts and/or omissions on the part of American Integrity are believed to be a breach of the following: the policy (See Florida Statutes § 626.877; Florida Administrative Code 69B-220.201(3)(b)(2); and, Board of Public Instruction of Dade County v. Town of Bay Harbor Islands, 81 So. 2d 637 (Fla. 1955)); Florida Statutes §§ 624.155, 626.9541 and 626.9541(1)(i)(3)(c); and, Florida Administrative Code 69B-220.201(3)(c) and 69B-220.201(3)(f). (F) American Integrity failed to pay undisputed amounts of benefits owed, despite more than two years passing since the loss, and further delayed the resolution of the Insureds’ claim. Despite having the obligation to investigate the Insureds’ claim from the time it was placed on notice of the claim, American Integrity has refused to issue further payment beyond the initial payments for the loss, despite receiving invoices, estimates, and other supporting documentation and invoices for months. Again, American Integrity demands prompt payment from the Insureds for its premiums, yet when it comes time to promptly pay a claim, American Integrity delays the payments for as long as possible. This business practice is fundamentally unfair to American Integrity’s Insureds. These acts and/or omissions on the part of American Integrity are believed to be a breach of the following: the policy (See Florida Statutes § 626.9541(1)(i)(3)(a); Florida Administrative Code 69B-220.201(3)(b)(2); and, Board of Public Instruction of Dade County v. Town of Bay Harbor Islands, 81 So. 2d 637 (Fla. 1955)); and, Florida Administrative Code 69B-220.201(3)(f). (G) American Integrity failed to act in good faith in handling and otherwise adjusting the Insureds’ claim (based on all of the acts and/or omissions noted above). More specifically, American Integrity acknowledged the insured catastrophic loss such that it provided payments of $15,918.61. Yet American Integrity has since failed and refused to fully indemnify the Insureds for this loss. The minimal payment is a gross under-evaluation of the amount of the total claim and thus is significantly inaccurate. After more than two years of investigation, American Integrity has refused issuance of additional funds. These acts and/or omissions on the part of American Integrity are believed to be a breach of the following: the policy (See Florida Statutes § 626.877; Florida Administrative Code 69B-220.201(3)(b)(2); and, Board of Public Instruction of Dade County v. Town of Bay Harbor Islands, 81 So. 2d 637 (Fla. 1955)); Florida Statutes §§ 624.155(1)(b)(1), 626.9541(1)(i)(3)(b), and 626.9541(1)(i)(4); and Rules 69B-220.201, 69B-220.201(3), 69B-220.201(3)(c), 69B-220.201(3)(d), 69B-220.201(3)(e), and 69B-220.201(3)(f) of the Florida Administrative Code. The foregoing actions and/or inactions and others on behalf of American Integrity and its adjusters and representatives were done at a time when they had full knowledge that Insureds suffered a loss covered by the insurance policy at issue. As a result of this unreasonable and wrongful behavior, it is clear that American Integrity and its adjusters and representatives have exhibited a pattern and practice of wrongfully delaying the Insureds’ claim – and seem intent on continuing this behavior. Consequently, American Integrity has breached the insurance policy and is liable for the resulting damages. American Integrity can cure the violations noted above as to the Insureds by agreeing to immediately tendering payment to the Insureds for the full amount of its loss as has been previously provided to American Integrity with fully supporting documentation.

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, Florida 32399-0322 Callie Frey, Esq. 6609 Willow Park Drive Second Floor Naples, Florida 34109 CFrey@GADCLaw.com Re: DFS File No: 798564 Complainants: Darrell and Linda Ebert Insureds: Darrell and Linda Ebert Policy No: AGH0082263 Insurer: American Integrity Insurance Company of Florida Claim No: CHO-00142860 To Whom It May Concern: We are in receipt of the Civil Remedy Notice (“CRN”) filed by Callie Frey, Esq. on behalf of the above referenced Complainant and matter. The Florida Department of Financial Services (“DFS”) accepted the CRN on December 30, 2024 and assigned it DFS File No. of 798564. 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 Insureds, Darrell and Linda Ebert. 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: Callie Frey, Esq. via email at: CFrey@GADCLaw.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. 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