Filing Number: 800504
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| Filing Accepted: 1/10/2025 |
| Last/Business Name
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BURKE
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First Name |
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MICHAEL BURKE AND CHRISTINA |
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| Street Address
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2511 89TH STREET NORTHWEST |
| City, State Zip
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BRADENTON,
FL
34209
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| Email Address
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DRMWBURKE@GMAIL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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BURKE |
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First Name |
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MICHAEL BURKE AND CHRISTINA |
| Policy # * |
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AGH0210104 |
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Claim #* |
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CHO-00185287 |
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Attorney is Applicable
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| Last Name* |
ROSS
First Name *
VANESSA
Initial
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| Street Address* |
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2501 S. TAMIAMI TRAIL |
| City, State Zip* |
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SARASOTA
,
FLORIDA
34239
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| Email Address * |
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ESERVICE@ROSSLEGALFL.COM |
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| Insurer Type
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 Authorized Insurer
 Unauthorized Insurer
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| Insurer Name |
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| Insurer Name* |
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AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA
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| Insurer Name* |
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| Street Address* |
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| City, State Zip* |
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,
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NAIC Company Code 12841 |
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| Name of individual responsible for violation (if any):*
DIEGO GUATEMALA, AND ALL OTHER ADJUSTERS, SUPERVISORS, MANAGEMENT AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA INVOLVED IN THE CLAIM.
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| Type of Insurance
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Residential Property & Casualty
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| Reason for Notice
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Unsatisfactory Settlement Offer
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Claim Delay
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Claim Denial
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Unfair Trade Practice
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Statutory provision(s) which the insurer allegedly violated.
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| 624.155(1)(b)(1) |
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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.
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| 624.155(1)(b)(3) |
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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.
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| 626.9541(1)(i)(3)(a) |
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Failing to adopt and implement standards for the proper investigation of claims.
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| 626.9541(1)(i)(3)(c) |
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Failing to acknowledge and act promptly upon communications with respect to claims.
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| 626.9541(1)(i)(3)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Dwelling Coverage provisions
We cover: a. The dwelling on the “residence premises,” shown in the Declarations, including attached structures and attached wall-towall
carpeting if damage to the dwelling is caused by a 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.
Perils Insured Against
We insure for sudden and accidental direct loss to property described in COVERAGE A - Dwelling and COVERAGE B -
Other Structures only if that loss is a physical loss to covered property
Loss Payment
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:
a. 20 days after:
(1) We receive your written proof of loss and reach a written, executed agreement of settlement with you according to
the terms of the written agreement; or
b. 60 days after we receive your written proof of loss and:
(1) There is an entry of a final judgment or, in the case of an appeal from such judgment, within 60 days from and
after the affirmance of the same by the appellate court; or
(2) Written executed mediation settlement with you according to the terms of the written mediation settlement or an appraisal award;
c. Within 60 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.
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.
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Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
In Florida, the work of adjusting insurance claims engages the public trust. American Integrity Insurance Company of Florida (“INSURER”) has breached the public’s trust by its adjustment of Michael Burke and Christina Burke (“INSURED”) claim of loss. American Integrity Insurance Company of Florida’s mailing address is 5426 Bay Center Drive, Suite 600, Tampa, FL 33609.
INSURER has failed to create and implement adequate guidelines for the proper investigation and evaluation of claims, claims handling, and for training and supervision of employees resulting in statutory violations as set forth above. INSURER has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the INSURED’S insurance claim for damages.
INSURER has failed to promptly settle the INSURED’S insurance claim when the obligation to settle the insurance claim had become reasonably clear. To date, notwithstanding the INSURED’S pleas otherwise, INSURER has continued to refuse to acknowledge its obligation to conduct a proper investigation, and to tender the full amount of insurance monies due and owing its INSURED under the policy.
This claim involves the INSUREDS’ property located at 2511 89th Street Northwest, Bradenton, FL 34209 which sustained significant damage from wind on or about October 9, 2024. The INSUREDS immediately reported the loss to INSURER and allowed for inspection.
The INSUREDS suffered damage to the roof, exterior, and interior of the property. The INSUREDS also incurred emergency repair costs of $1,100.00 for having a tarp put on their roof. INSURER inspected the property and accepted coverage for the claim, however they estimated the loss to total just $18,288.25, which was under the INSUREDS’ hurricane deductible of $23,940.00 so no payment was tendered.
The INSUREDS retained Storm One Claims, LLC to assist with determining the amount of damage sustained to the property. Storm One prepared an estimate in the amount of $167,241.34. The INSUREDS are owed additional insurance benefits in order to return the property to pre-loss condition.
Therefore, demand is hereby made as follows:
Estimate $167,241.34
Emergency Tarp $1,100.00
Less Deductible $23,940.00
TOTAL $144,401.34
The concept of insurance is that the insurer will investigate and grant timely and prompt indemnity or security against a contingent loss. Florida Statute §624.02 defines “insurance” as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit upon determinable contingencies. Inherent in that definition is the fact that payment must be made timely and promptly so that the INSURED may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. INSURER has breached this duty.
The INSURED was, and still is, forced to expend out of pocket monies to submit her insurance claim, e.g., retaining an attorney and other experts to force INSURER to honor its obligations under the insurance policy and to pay all the insurance proceeds due and owing to them.
INSURER has refused and/or failed to tender all the insurance proceeds due and owing to the INSURED. INSURER’s refusal and/or failure to settle the insurance claim when under all circumstances it could have and should have done so had it acted fairly and honestly towards the INSURED is wrongful conduct. Furthermore, the INSURED contends that INSURER’s adjusters and/or representatives financially benefit from such wrongful conduct.
This notice is given in order to perfect the right to pursue the civil remedy authorized by Fla. Stat. §624.155.
Therefore, to cure the defects outlined in this Civil Remedy Notice, INSURER must:
(1) Create and implement adequate guidelines for the proper investigation and evaluation of claims and for the training and supervision of employees, which will avoid future statutory violations as set forth above, and prevent this from occurring in the future;
(2) INSURER must create and implement adequate guidelines for the proper investigation and evaluation of these types of claims and for the training and supervision of employees with regard to these claims to ensure that the claims handling procedure with regard to these types of losses are adequate to prevent other Insureds from being treated unfairly and wrongfully;
(3) INSURER must tender to the INSURED $144,401.34 as set forth above; and,
(4) INSURER must act fairly and honestly towards its INSURED and with due regard for her interests in attempting to settle its INSURED’S claim.
Attachments: PA Estimate, tarp invoice and proposed complaint
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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.
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DFS-10-363
Rev. 10/14/2008
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