Civil Remedy Notice of Insurer Violations
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Filing Number:     800290
Filing Accepted:  1/9/2025
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Complainant
Last/Business Name *  
JUAREZ   First Name   ARMANDO
Street Address * 101 WILDLIFE TRAIL
City, State Zip * LAKELAND, FL 33809
Email Address * ARMANDOJUAREZ910@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   JUAREZ   First Name   ARMANDO
Policy # * ATM252491 Claim #* AM152153
Attorney
Attorney is Applicable
Last Name* VELMOSKY First Name * AARON Initial M
Street Address* 800 EAST BROWARD BLVD, SUITE 501
City, State Zip* FT. LAUDERDALE , FL 33301
Email Address * AV@WEKLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   AMERICAN TRADITIONS INSURANCE COMPANY
NAIC Company Code 12359
 
Name of individual responsible for violation (if any):* TIFFANY WRIGHT, JAMES BARLEY
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
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)(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.
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SECTION I – PROPERTY COVERAGES ADDITIONAL COVERAGES 11. “Fungi”, Mold Wet or Dry Rot or Bacteria a. We will pay up to $10,000 per occurrence for: (1) The total of all loss payable under Section I – Property Coverage caused by or resulting directly or indirectly from fungi”, mold, wet or dry rot, or bacteria; (2) The cost to remove “fungi”, mold, wet or dry rot, or bacteria from property coverage under Section I – Property Coverages; (3) The cost to tear out and replace any part of the building or other covered property as neeed to gain access to the “fungi”, mold wet or dry rot, or bacteria. Section I - Conditions, Loss Settlement; Section I - Conditions, Loss Payment;
 
* Facts and circumstances giving rise to the violation.
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Armando Juarez (the "Insured") purchased an insurance policy ("Policy") from American Traditions Insurance Company ("ATIC"), with effective coverage on the date of the loss, on or about May 13, 2024, and policy number ATM252491 to insure his home located at 101 Wildlife Trail, Lakeland, FL 33809 (the "Property"). On or about May 13, 2024, the Property’s exterior was damaged as a result of a severe weather event, which included high winds and hail (the “Loss”). As a result of this event, the Property sustained immediate direct damage to various portions of its exterior, including its roofing system and siding, and ensuing water damage to the master bedroom, guest bedroom and guest bathroom. After discovering the sustained damage, the Insured retained a mitigation company, Tarp and Restoration Geeks to perform mold assessment and mold remediation services. Tarp and Restoration Geeks submitted invoices for the performed mold assessment and mold remediation services to ATIC. The Insured promptly reported his claim to ATIC after discovering the interior damage. ATIC acknowledged receipt of the claim by generating claim number AM152153. Thereafter, ATIC conceded coverage for a portion of the sustained damage and sent correspondence, dated July 11, 2024, to the Insured advising that the cost of the covered repairs (the replacement of twenty four linear feet (24 LF) of skirting was less than his $1,000 deductible. The estimate upon which this determination was rendered was drafted by James Barley of Menard Adjusting. Despite this concession of coverage, ATIC further represented that it denying coverage for the reported damage to the roofing system and interior. ATIC’s claim determination inexplicably did not include payment for any of the invoices produced by Tarp and Restoration Geeks for post-loss mold assessment or mold remediation services or for any damage caused by rain that entered the dwelling through the admitted coverage opening in the skirting. Tarp and Restoration Geek’s submitted invoices totaling $10,645.61. The Insured cannot understand what additional information was needed from ATIC to render a coverage determination for those services. ATIC conceded that the cause of the damage to the skirting was covered. It follows that the subject insurance contract clearly affords coverage for same: SECTION I – PROPERTY COVERAGES ADDITIONAL COVERAGES 11. “Fungi”, Mold Wet or Dry Rot or Bacteria a. We will pay up to $10,000 per occurrence for: (1) The total of all loss payable under Section I – Property Coverage caused by or resulting directly or indirectly from fungi”, mold, wet or dry rot, or bacteria; (2) The cost to remove “fungi”, mold, wet or dry rot, or bacteria from property coverage under Section I – Property Coverages; (3) The cost to tear out and replace any part of the building or other covered property as neeed to gain access to the “fungi”, mold wet or dry rot, or bacteria. The Insured suspects, but is not certain, that ATIC implements similar tactics for all of its insureds so as to constitute a business practice concerning otherwise covered mold remediation and assessment efforts performed by third parties retained directly by or on behalf of a named insureds; instead of, at the direction of ATIC. Such practice is in contravention of its duty to investigate and settle claims in good faith and honesty toward its Insured. On October 10, 2024, the Insured served a notice of intent to initiate litigation upon ATIC. To explain the alleged acts or omissions of the insurer, the Insured identified the following: Pursuant to Insurer’s policy with Claimant, Insurer was to provide insurance coverage to Claimant’s property against loss. While Policy was in effect, Property suffered a direct physical loss (Loss) and reported same. Insurer assigned the above identified claim number to Loss and investigated Loss. Pursuant to Policy, Insurer was obligated to determine cause of Loss and to determine whether Policy excluded or excepted coverage. In the absence of exclusion or exception, Insurer was obligated to indemnify Claimant for Loss. Insurer failed to correctly (a) determine cause of Loss, (b) determine whether Policy excluded or accepted coverage, and/or (c) to indemnify Claimant for Loss. Insurer’s failure is a material breach of Policy. Insurer’s failure discharged Claimant of any further Policy obligations. Insurer’s failure waived its right to assert post-loss compliance as an avoidance of Policy obligations. Insurer’s failure resulted in damages, in form of unpaid contracted for insurance benefits, suffered by Claimant. All conditions precedent to this Notice were performed, occurred, discharged, and/or waived. If Policy limits apply to demanded amounts, reduce demand by any excess over such Policy limits, subject to Claimants agreement as to applicability. A copy of this Notice is provided to Claimant through the portal. The disputed amount is unknown. By stating the above detailed facts, it is clear that ATIC has violated the following Florida statutes: • 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 their interest; • 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) 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; or • 626.9541(1)(i)(3)(b) 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, by failing to respond to the Insured’ public adjuster, and Insured’ counsel with respect to supplemental requests for payments; • 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 and/or their public adjuster of the basis in the insurance policy, in relation to the facts or applicable law, for the offer of a compromise settlement; To date, ATIC has failed to accept and fully perform its obligations under the operable insurance contract. The Property remains in an unsafe condition because they have not been paid the necessary, covered insurance proceeds sufficient to return the Property to its pre-loss condition. As a direct result of ATIC’s initial insufficient investigation and handling of the claim, deficient extension of coverage and subsequent breaches of not only the policy of insurance, but also Florida Statutes, the Insured had no choice other than to seek the help of licensed professionals to assist him. Considering the aforementioned conduct, it is irrefutable that ATIC knowingly and intentionally, and in bad faith delays the claims process in order to further disadvantage the Insured. The financial detriment caused to the Insured is a direct result of ATIC’s dismissive, reckless treatment of the claims process. The Insured made the Property available for inspection and submitted documentation in support of the insurance proceeds sought under his insurance contract, including invoices identifying the amounts incurred to protect his property from further damage, as he was obligated to do under the subject insurance contract. Nevertheless, ATIC failed to properly assess this information and reach the logical conclusion that the submitted mold remediation and mold assessment invoices were afforded coverage and needed to be paid. To deny the Insured the remaining benefits clearly due and owing under the Policy, for which he has time and time again been making premium payments for and after he has satisfied all his obligations is morally and ethically reprehensible, and reeks of Unfair Claims Practice and Bad Faith. Upon information and belief, the above identified actions taken by ATIC, among others, were made so often as to constitute a general business practice, evidencing a motive to enhance ATIC’s profits, and designed to cause a detrimental effect to its policyholders. Such motive seems readily apparent to the participants of ATIC’s claim investigation concerning the initial field adjuster’s comment to the Insured concerning his belief that ATIC would not pay for the roofing system damage. This notice is given to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should ATIC fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, ATIC must: (1) Immediately tender all proceeds due and owing to the Insured that are fairly owed to the Insured under the insurance policy that would reasonably compensate the Insured in order to put the loss property back to its pre-loss condition in the sum of at least $16,168.36; (2) Immediately tender all proceeds due and owing for the post-loss mold remediation and mold assessment invoices in the sum of $10,645.61; (3) Agree to reimburse the Insured for interest on the amount of benefits that was found to be due and owing to the Insured, relating back to the date of lossJ.
Comments
User Id Date Added Comment
jessicajgross.91@gmail.com 03-10-2025 March 10, 2025 VIA UPLOAD TO DFS Florida Department of Financial Services Division of Insurance Regulation Consumer Assistance 200 East Gaines Street Tallahassee, Florida 32399-0322 Re: Civil Remedy Notice of Insurer Violations DFS File No.: 800290 Complainant: Armando Juarez Filed By: Aaron M. Velmosky, Esq. Reported DOL: May 13, 2024 Dear Sir or Madam: American Traditions Insurance Company (“ATIC”) received the Civil Remedy Notice of Insurer Violation (“CRN”) submitted by Aaron M. Velmosky, Esq. on behalf of Armando Juarez (“Complainant”), which was accepted by the Department of Financial Services (the “Department”) on January 9, 2025. The CRN relates to a windstorm claim reported by Complainant on June 14, 2024. Upon receipt of notice of the loss, ATIC promptly assigned claim number AM152153 (the “Claim”) to the loss, sent written acknowledgment to Complainant, and retained an independent field adjuster for purposes of scoping, diagramming, and photographing the alleged damage and surrounding areas. The Claim was reported under policy number ATM252491 (the “Policy”) issued by ATIC to Armando Juarez for the dwelling located at 101 Wildlife Trl., Lakeland, Florida 33809 (the “Property”) and effective for a period of April 12, 2024 through April 12, 2025. The Policy defines an “Insured” as resident(s) of the Property who are either relatives of Complainant or person(s) under the age of 21 and in the care of any person(s) who are relatives of Complainant. As such, Complainant’s spouse, Melissa Juarez, who is named as a Co-Plaintiff in the lawsuit filed for the Claim, but not as a complainant, is an insured under the Policy. ATIC objects to the validity of the CRN as it is deficient on its face. The CRN lacks the specificity required by s. 624.155(3)(a), Florida Statutes and provides nothing more than vague, ambiguous, and conclusory allegations regarding what Complainant believes to be ATIC’s motivations, positions, and business practices—none of which are true or supported by fact. Florida law is clear that a claimant is required to set forth with specificity the “facts and circumstances giving rise to the violation,” to allow the insurer to understand and cure any purported violation. Longpoint Condo. Assn v. Allstate Ins. Co., 2005 WL 1315810 (N.D. Fla. 2005). A written CRN that is vague and “shotgun” in nature or written in general terms fails the specificity requirement of the Statute. See Heritage Corp. of South Fla. v. National Union Fire Ins. Co. of Pittsburgh, P.A., 580 F. Supp. 2d 1294, 1300 (S.D. Fla. 2008); Rousso v. Liberty Surplus Ins. Corp., 2010 WL 7367059 (S.D. Fla. 2010); Valenti v. Unum Life Ins. Co. of America, 2006 WL 1627276 (M.D. Fla. 2006). The very purpose of the civil remedy notice, pursuant to Chapter 624, is to inform the insurer of alleged violations with specific information to encourage settlement of the subject claim. “The sixty-day window [as provided for in F.S. § 624.155] is designed to be a cure period that will encourage payment of the underlying claim, and avoid unnecessary bad faith litigation.” Talat Enters., Inc. v. Aetna Cas. & Sur. Co., 753 So.2d 1278 (Fla. 2000). Notice sent to the Department of Insurance concerning settlement violation(s) is intended to serve as a basis for the Department to assist in the settling of claims and to monitor the insurance industry. Id. However, whenever a complainant provides little in the way of adequate notice, the statutory intent of the CRN is frustrated. Pursuant to Florida law, an insurer waives any defects in a CRN if it fails to raise these deficiencies in its response. This includes such deficiencies as a misnomer in the name of the correct insurer, or the untimeliness of the CRN. Neal v. Geico Ins. Co., 48 Fla. L. Weekly D423, D424 (Fla. 4th DCA Feb. 22, 2023). ATIC does not waive compliance with any contractual, statutory, or constitutional right by responding to this CRN. Rather, in an abundance of caution, ATIC provides this timely response in an effort to overcome any rebuttable presumption of bad faith. ATIC denies all of the allegations contained therein and specifically denies that it has violated the Florida Statutes cited in the CRN in its handling of the Claim. As further evidence that ATIC has not violated any policy or statutory provisions, it summarizes below the following facts with such specificity to circumvent the blatant mischaracterizations set forth by Complainant in the CRN. On June 14, 2024, nearly one (1) month after the purported date of loss of May 13, 2024, Complainant reported alleged windstorm damage to ATIC. That same day, ATIC sent an Acknowledgment of Claim and Notification of Mediation Rights letter setting forth when the Claim was reported, what the assigned claim number was, and the name and contact information for the claim examiner assigned. A message sent via SMS was also sent to Complainant with the foregoing information. ATIC further sent a Homeowner Claims Bill of Rights, and correspondence stating that an independent adjuster (“IA”) was enlisted to inspect the alleged damage and separate correspondence that gave early notice of the option to repair provision of the Policy, if applicable. On the time of first notice of loss, ATIC provided Complainant’s public adjuster, Giancarlo Andujar with America Property Claims (“PA”) a letter to acknowledge his notice of representation and policy request. ATIC advised that a true copy of the Policy would be sent via email and requested that the Proof of Loss enclosed therein be submitted to ATIC within sixty (60) days from the date of the letter. This letter provided mailing instructions for submitting the completed original notarized Proof of Loss and the Policy conditions. To date, ATIC has not received an executed Proof of Loss from Complainant. On June 20, 2024, the IA retained by ATIC timely inspected the Property in the presence of Complainant and an employee of the PA, Teodoro Seminario. Complainant advised the IA that the home was purchased three (3) months prior and made some repairs but did not have photographs to show the alleged pre-loss condition. The inspection of the roofing system did not reveal any openings or damage associate with the reported weather event. The IA did not find damage to the exterior A/C unit, windows, window screens, or exterior doors. With respect to the interior, the IA saw mitigation had already been performed in “bedroom 1” with removal of the wall paneling, insulation, and carpet. The sub-floor had discoloration by the exterior wall with visible rot. Complainant and his representative were asked by the IA who performed the mitigation and both failed to provide any information. The hallway bathroom ceiling displayed drywall repairs that were performed by Complainant. Other areas of the interior appeared to be undergoing renovations which were not attributed to the reported loss. The IA then prepared an estimate totaling $499.18 RCV to repair approximately 24 LF of exterior siding. On or around June 25, 2024, ATIC received mitigation documents from Restoration Geeks Corp. This included and invoice entered on June 21, 2024, totaling $8,595.61. Notably, the invoice indicated a date of loss of June 13, 2024, notwithstanding the reported date alleged being May 13, 2024. On June 28, 2024, ATIC received a mold report prepared by Mold Details, Corp. and became aware, for the first time, on October 2, 2024, that an invoice totaling $2,025.00 existed as it was attached to Complainant’s Notice of Intent to Initiate Litigation No. 212389 (“NOI”). On July 11, 2024, the claims examiner for ATIC left Complainant a detailed voicemail to advise of its below deductible coverage decision for the Claim. ATIC then immediately sent the Coverage Determination letter to Complainant and the PA. The letter explained that part of ATIC’s investigation included an IA inspection and enclosed a copy his estimate therein. ATIC explicitly stated that the estimate was based on the covered damages visible at the time of inspection. ATIC also provided a payment breakdown to demonstrate why the Claim fell below the $1,000.00 deductible. The Coverage Determination letter further stated that based upon all information received and collected to date, along with the relevant Policy language cited therein, ATIC was unable to provide coverage for the roof and interior. ATIC instructed Complainant to provide additional information that was believed to alter the determination as soon as possible. However, notwithstanding this directive, Complainant nor his representatives notified ATIC of a dispute with the coverage decision. Complainant contends that to cure the CRN, ATIC must tender the sum of at least $16,168.36, which appears based in large part, on the estimate prepared by the PA for $17,168.36. This estimate exaggerates pricing and seeks costs to repair areas that were not physically damaged as a result of the reported loss. Moreover, there is no coverage for matching undamaged property to damaged property for the purpose of matching or conformity as the only covered damage was located to the exterior right elevation of the Property. Complainant further seeks payment for the mold and mitigation invoices totaling $10,645.61, which were enclosed for the first time within the NOI and indisputably excessive. With respect to the amount invoiced for water mitigation, the Policy states that ATIC will pay up to the greater of $3,000.00 or 1% of the Coverage A limit (i.e., $740.00) for the reasonable costs incurred for necessary emergency measures taken solely to protect covered property, when the damage or loss is caused by a Peril Insured Against. This limit cannot be exceeded unless a request to exceed the cap is made. As for the mold invoice, the Policy does not cover “fungi”, mold, wet or dry rot. This exclusion does not apply to the extent coverage is provided for in the “Fungi”, We or Dry Rot, or Bacterial Additional Coverage under Section I – Property Coverages with respect to loss caused by a Peril Insured Against. Based on the foregoing facts of the Claim, this provision is inapplicable and no amounts are due and owing under the Policy. Accordingly, as a matter of law, ATIC is not in breach of any obligation under the Policy or Florida law. The CRN alleges, without any factual predicate, that the CRN was submitted due to ATIC’s purported failure to act in good faith towards Complainant. This is untrue. Complainant further asserts the reason for submitting the CRN is based on ATIC’s alleged “bad faith” practices. However, there is no support for this. Complainant lists some statutory provisions, but fails to identify any ultimate facts that support the empty and false accusations. As such, ATIC rejects the same as vague and statutorily non-compliant, and further responds by stating the following: The CRN goes on to assert that ATIC violated numerous statutory provisions which is false and for which Complainant provides no facts. ATIC denies all allegations and inferences of bad faith along with denying the allegations specifically as follows: 624.155(1)(b)(1): Denied. ATIC attempted in good faith to reach a resolution of this matter and in doing so has always acted fairly and honestly towards Complainant with due regard for his interests. Complainant has provided absolutely no facts or circumstances supporting this allegation in the CRN. 624.155(1)(b)(3): Denied: ATIC promptly resolved the Claim under the appropriate provisions of the Policy. ATIC has never settled a claim under one portion of the Certificate in order to influence settlements under other provisions of the Certificate. Complainant has provided absolutely no facts or circumstances supporting this allegation in the CRN. 626.9541(1)(i)(3)(a): Denied. ATIC has never failed to adopt and implement standards in such a way that would constitute a business practice. Complainant has provided absolutely no facts or circumstances supporting this allegation in the CRN. 626.9541(1)(i)(3)(b): Denied. ATIC has never misrepresented facts or insurance policy provisions relating to the coverage at issue to Complainant. Indeed, ATIC provided Complainant details from its investigation along with the applicable terms and conditions of the Policy within the Coverage Determination Letter. Complainant has provided absolutely no facts or circumstances supporting this allegation in the CRN. 626.9541(1)(i)(3)(c): Denied. ATIC acknowledged the Claim acts promptly with Claim. Complainant alleges without any factual support that ATIC failed to respond to the PA and supplemental requests for payments which is patently false. Complainant has provided absolutely no facts or circumstances supporting this allegation in the CRN. 626.9541(1)(i)(3)(d): Denied. ATIC conducted a reasonable investigation and has not denied claims without conducting a reasonable investigation based upon available information in a way which would constitute a business practice. Complainant has provided absolutely no facts or circumstances supporting this allegation in the CRN. 626.9541(1)(i)(3)(f): Denied. This allegation is based upon a false predicate and without merit as ATIC extended coverage pursuant to the terms, conditions, and exclusions of the Policy and provided a reasonably explanation in writing to Complainant which explained the benefits afforded and/or excluded under same. Complainant has provided absolutely no facts or circumstances supporting this allegation in the CRN. At all times material to this Claim, ATIC has: (a) acted in good faith to investigate the Claim, acted fairly and honestly in its dealings with the Complainant and her representatives; (b) promptly investigated the Complainant’s Claim; (c) acknowledged and acted promptly in response to all communications with the Complainant; and (d) complied with its obligations in accordance with the terms of the subject insurance contract and Florida law. If you are in need of or seek any further information, please feel free to contact the undersigned. If you are in need of or seek any further information, please feel free to contact the undersigned. Sincerely, /s/ Jessica J. Gross Jessica J. Gross H. Jacey Kaps
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