Civil Remedy Notice of Insurer Violations
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Filing Number:     800205
Filing Accepted:  1/9/2025
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Complainant
Last/Business Name *  
AKERS   First Name   TRAVIS & APRIL
Street Address * 12430 GREEN STONE CT
City, State Zip * FORT MYERS, FL 33913-67
Email Address * WITHHELD
Complainant Type: * Insured
Insured
Last/Business Name*   AKERS   First Name   TRAVIS & APRIL
Policy # * AGH0355407 Claim #* CHO-00175036
Attorney
Attorney is Applicable
Last Name* WALLACE First Name * BLAKE Initial
Street Address* 8635 W. HILLSBOROUGH AVE., STE. 401
City, State Zip* FORT MYERS , FLORIDA 33913-6737
Email Address * BLAKE@KLINGLAW.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):* NONE
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.
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)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

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. On December 2, 2024, a certified copy of the policy as well as other claim documentation was requested by counsel of the insured. To date of the filing of this civil remedy notice the policy has
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

January 9, 2025 Sent Via Email AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA claimsmail@aiiflorida.com RE: Insured : TRAVIS AKERS & APRIL AKERS (hereinafter, “Insured/Claimant”) Policy # : AGH0355407 Claim # : CHO-00175036 Property Address : 12430 Green Stone Ct., Fort Myers, FL 33913-6737 Persons most knowledgeable of facts giving rise to the Violations: Dear AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA: 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 prior to August 6, 2024, when the carrier’s counsel requested an examination under oath of the insureds. The Examinations under Oath took place shortly after with insureds and counsel for the defendant as well as the insureds attending. 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 has assigned an unnamed field adjuster, who is not an engineer, to inspect the loss. On December 14, 2024, the carrier had an engineer go out to the property investigate the loss further. To the date of the filing of this Civil Remedy Notice, the carrier has failed to issue a coverage decision, even with the insureds complying with each request made by the carrier including, but not limited to the Examinations under Oath, and a subsequent engineer inspection In failing to reach a coverage decision, American Integrity failed to adopt and implement standards for the proper investigation of claims. There has been no explanation whatsoever as to why American Integrity has not determined which items of damage were caused by covered or excluded perils, this violates F.S. §626.9541(1)(i)(3)(a). Moreover, as the carrier has failed to come to a coverage decision by conducting a reasonable and timely investigation based upon available information, the carrier violated F.S. §626.9541(1)(i)(3)(d) as its failure to come to a coverage determination is effectively a denial of the benefits of the insurance policy by the carrier related to the loss. 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. Here, however, American Integrity failed to provide any copy of a report created and/or generated by its field adjuster. 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. Furthermore, as the carrier has failed to come to coverage decision, nor communicate in a timely manner with the insureds and their counsel, the carrier has violated F.S. §626.9541(1)(i)(3)(g) and §626.9541(1)(i)(3)(h) as the carrier has failed to promptly notify of any additional information necessary for the processing of a claim and failed to clearly explain the nature of the requested information and the reasons why such information is necessary. The insured has been compelled to obtain an independently adjusted estimate totaling in the amount of $171,143.78 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 failing to come to a coverage determination in the statutorily allotted time and continuing to leave the insureds with no notification as to what else what would be needed to come to said determination. This is in violation of F.S. 624.155(1)(b)(1) and 624.155(1)(b)(3) as the carrier is clearly placing the company’s interests before the claimant’s interests and not attempting in good faith to settle claims. Furthermore, it is further in violation of F.S. §626.9541(1)(i)(3)(a) as the carrier failed to adopt and implement standards for a proper investigation of the claim. 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 American Integrity 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) = 9,200 §624.155(1)(b)(3) = 6,174 §626.9541(1)(i)(3)(a) = 8,751 §626.9541(1)(i)(3)(c) = 6,028 §626.9541(1)(i)(3)(d) = 5,414 §626.9541(1)(i)(3)(f) = 5,044 §626.9541(1)(i)(3)(g) = 3,354 §626.9541(1)(i)(3)(h) = 2,086 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 and 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 $171,143.78 less any applicable policy deductible; 2) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made; and 3) provide the insureds and insureds’ counsel with a certified copy of the policy and other requested claim documents . 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. On December 2, 2024, a certified copy of the policy as well as other claim documentation was requested by counsel of the insured. To date of the filing of this civil remedy notice the policy has not been provided by the carrier. This is in violation of F.S. §626.9541(1)(i)(3)(c) as the carrier has failed to acknowledge and act promptly upon communications with respect to claims. F.S. §627.70131(1)(a) provides that upon an insurer’s receiving a communication with respect to a claim, the insurer shall, within 7 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer. 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 Enclosed: Civil Remedy Filing
Comments
User Id Date Added Comment
swozniak@aii.com 02-03-2025 February 3, 2025 Via Electronic Submission Florida Department of Financial Services Consumer Assistance Civil Remedy Section Larson Building 200 E. Gaines Street Tallahassee, Florida 32399-0322 Blake Wallace, Esq. 501 East Las Olas Blvd. Suite 200/300 Fort Lauderdale, Florida 33301 Blake@KWGLegal.com Re: DFS File No: 800205 Complainants: Travis and April Akers Insureds: Travis and April Akers Policy No: AGH0355407 Insurer: American Integrity Insurance Company of Florida Claim No: CHO-00175036 To Whom It May Concern: We are in receipt of the Civil Remedy Notice (“CRN”) filed by Blake Wallace, Esq. on behalf of the above referenced Complainant and matter. The Florida Department of Financial Services (“DFS”) accepted the CRN on January 9, 2025 and assigned it DFS File No. of 800205. 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, Travis and April Akers. 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: Blake Wallace, Esq. via email at: Blake@KWGLegal.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