Filing Number: 800861
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| Filing Accepted: 1/14/2025 |
| Last/Business Name
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ROBINSON
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First Name |
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JOHN AND LILLIE |
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| Street Address
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2727 FLINTLOCK AVENUE |
| City, State Zip
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CLERMONT,
FL
34711
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| Email Address
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CFAUNTLEROY@FSATLAW.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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ROBINSON |
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First Name |
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JOHN AND LILLIE |
| Policy # * |
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FLA370948 |
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Claim #* |
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1328410-241001 |
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Attorney is Applicable
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| Last Name* |
FAUNTLEROY
First Name *
CHRISTOPHER
Initial
B
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| Street Address* |
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100 S ASHLEY DRIVE, SUITE |
| City, State Zip* |
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TAMPA
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FLORIDA
33602
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| Email Address * |
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CFAUNTLEROY@FSATLAW.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 STRATEGIC INSURANCE CORP.
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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 10872 |
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| Name of individual responsible for violation (if any):*
PAUL TRAN AND AMERICAN STRATEGIC AND ITS ADJUSTERS
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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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Claim Denial
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Unfair Trade Practice
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Unsatisfactory Settlement Offer
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Claim Delay
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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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| 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)(b) |
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Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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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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| 626.9541(1)(i)(3)(f) |
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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.
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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.
Specific policy language that is relevant to violation:
COVERAGE A
COVERAGE A – Dwelling
We cover:
1. The dwelling on the "residence premises" shown
in the Declarations, including structures attached
to the dwelling; and
2. 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."
This coverage does not apply to land, including land
on which the dwelling is located.
LOSS SETTLEMENT
3. Loss Settlement. Covered property losses are
settled as follows:
Under Form HO 00 03, item b.(4) is replaced by the
following:
b.(4) We will pay at least the actual cash value of
the damage, less any applicable deductible,
until actual repair is performed. We will pay
any remaining amounts necessary to
perform such repairs as the work is
performed and the expenses are incurred
and according to the provisions of b.(1) and
b.(2) above.
However, if the cost to repair or replace the
damage is both:
(a) Less than 5% of the amount of
insurance in this policy on the building;
and
(b) Less than $2500;
we will settle the loss according to the
provisions of b.(1) and b.(2) above whether
or not actual repair or replacement is
complete. If a total loss, we will pay the
replacement cost amount without deduction
for depreciation.
Under Form HO 00 03, item b.(5) is deleted.
Under Form HO 00 06, Coverage A – Dwelling
paragraph b.(1) is replaced by the following:
b.(1) We will pay at least the actual cash value
of the damage, less any deductible, until
actual repair is performed. We will pay any
remaining amounts necessary to perform
such repairs as the work is performed and
the expenses are incurred, but not more
than the least of the following amounts:
(a) The necessary amount actually spent
to repair or replace the damaged
building; or
(b) The limit of liability under this policy
that applies to the building.
LOSS PAYMENT
10. Loss Payment is replaced by the following:
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 payable upon the earlier of
the following:
a. 20 days after:
(1) We receive your proof of loss and reach
written agreement with you; or
(2) Written executed mediation settlement
with you according to the terms of the
written mediation settlement; or
b. 60 days after we receive your 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) There is a filing of an appraisal award or,
in the case of an appeal from such award,
within 60 days from and after the
affirmance of the same by the appellate
court; or
c. Within 90 days after we receive notice from
you of an initial, reopened, or supplemental
property insurance claim, we shall pay or deny
such claim or a portion of the claim unless the
failure to do so is caused by factors beyond
our control which reasonably prevent such
payment. However, failure to pay or deny
within 90 days does not form the sole basis for
a private cause of action.
Any payment made by us shall not constitute a waiver
of our rights within the policy.
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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 Strategic Insurance Corporation (American Strategic) has breached this duty in the adjustment of John Robinson’s and Lillie Robinson’s (the Robinsons’) claim.
American Strategic has failed to adopt and implement proper standards for investigation, evaluation and adjustment of claims; has failed to properly train, manage, supervise and promote claims adjusters so that policy holder receives good faith, fair, prompt adjustment of claim, service and indemnity; has failed to conduct a full and fair investigation of the claim and has failed to provide full reasons and facts to the claimant for delay of the claim resulting in statutory violations as set forth in this notice.
Furthermore, American Strategic has engaged in unfair claim delay; has used business or outcome-oriented investigations and experts to determine the outcome of the claim; has wrongfully denied the claim without fully stating reasons and reserving unwritten reasons; has looked for ways to, delay payment and otherwise “stonewall” the claim; and has used improper claims practices to rush the claims process and profit from wrongful claims practices.
The Robinsons’ claim results from hail damage to the dwelling roof and elevations of their home that occurred on February 4, 2024. To mitigate the damages to their home, the Robinsons contacted their insurance company, American Strategic, to report the damages. As part of the investigation of the Robinsons’ claim, American Strategic assigned a claim number 1328410-241001 and property claims adjuster Paul Tran. American Strategic investigated of Robinsons’ claim of damages and determined that there were no covered damages to the damages caused to the roof and elevations of the property. Therefore, American Strategic has denied the Robinsons of any monetary compensation to repair the damages caused to their property.
In view of the foregoing, it is clear and unequivocal that American Strategic has failed to provide proper and sufficient compensation to repair the damages caused to the Robinsons’ property. Due to American Strategic’s handling of the Robinsons’ claim, the Robinsons chose to retain a public adjuster to further assess the damages to their home. As such, upon inspection and view of the damages, it was clear that the dwelling roof and elevations of the property required extensive repair. After the inspection, the public adjuster provided an estimate for repairs in the amount of $46,744.64, which is the full amount to return Robinsons’ home back to pre-loss condition. American Strategic continues to hold their stance for their claim determination concerning the Robinsons’ loss.
The Robinsons have complied with all conditions under the policy. Nonetheless, American Strategic failed to properly compensate the Robinsons for their loss. The facts of this claim show that for whatever reason, American Strategic not only substantially misinterpreted the scope of damages to the Robinsons’ property, but also failed to conduct a thorough investigation as to the scope of damages to the roof and elevations. Upon view of American Strategic claims handling procedures, it is clear American Strategic conducted a limited and quick outcome orientated investigation in the hopes that the Robinsons would make the required repairs with their own money. The Robinsons now must incur costs for assistance to obtain what should have been paid had they been treated fairly and honestly by American Strategic.
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In view of the facts surrounding the Robinsons’ claim, it is evident that American Strategic has failed to create and implement adequate guidelines for proper investigations to evaluate claims handling for training and supervision of employees in violation of Fla. Stat. §624.155 and §626.9541 statutory regulations, as well as the applicable provisions in the Florida Administrative Code resulting in the statute violations set forth herein. As stated, American Strategic has failed and/or refused to investigate the insureds’ claim thoroughly, accurately, and completely for damages
Florida Statute §626.9744(2) provides that “When a loss requires replacement of items and the replaced items do not match in quality color or size, the insurer shall make reasonable repairs or replacement of items in adjoining areas”. In the instance of American Strategic, their adjusters and the estimate provided, it is clear that American Strategic did not adhere to Florida law, as their estimate provides paltry repair items that would result in mismatching areas which fails to acknowledge the true extent of damage of the Robinsons’ home as well as the surrounding areas that would need to be replaced. Florida Statute §624.02, defines “insurance” as a contract where one undertakes to indemnify another or pay or allow specified amounts, or a determinable benefit, upon determinable contingencies – inherent is the fact that payment must be made timely and promptly. The fact that payment must be made timely and promptly so that the insureds may mitigate their damages, and to put the insureds back into the position they enjoyed prior to the loss as quickly as possible. American Strategic has breached this duty by improperly investigating the Robinsons’ claim and failing to properly pay the Robinsons for their loss. American Strategic has refused and/or failed to tender insurance proceeds as required by the policy and/or Florida law. It has refused and/or failed to settle the claim when under all the circumstances it could have and should have done so if it had acted fairly and honestly towards the Robinsons
Furthermore, American Strategic has failed to adopt and implement proper standards for investigation, evaluation, and adjustment of claims; has failed to properly train, manage, supervise, and promote claims adjusters so that policy holder receives good faith, fair, prompt adjustment of claim, service, and indemnity, has failed to conduct a full and fair investigation of the claim.
Florida Statutes Violated by American Strategic are as applied to the facts in this matter is as follows: § 626.951 engaging in acts defined as “unfair trade practices” relating to the business of insurance in accordance with the intent of congress as expressed in the act of congress of March 9, 1945 (pub. L. No. 15, 79th congress), by defining, or providing for the determination of, all such practices in this state which constitute unfair methods of competition or unfair or deceptive acts or practices and by prohibiting the trade practices so defined or determined.
§ 624.155(1)(b)(1) to tender all insurance proceeds monies due and owing the insured or assist the insured in the mitigation of their damages. The insurer breached these statutory duties. Not attempting in good faith to settle claims when, under all circumstance, insurer could have and should have done so, had the insurer acted fairly and honestly toward its insured and with due regard. § 624.155(1)(b)(3) failing to promptly settle claims, when the obligation to settle the 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 investigations of claims. § 626.9541(1)(i)(3)c Failing to acknowledge and to act promptly upon communications with respect to claims.
Their actions are willful, wanton and in disregard of the rights of its insured and occur with such a frequency as to indicate a general business practice. American Strategic can cure this default by the following:
A. Create, adopt, and implement adequate standards and/or guidelines for the proper investigation and adjustment of claims.
B. Provide sufficient training and supervision of employees and agents to avoid further violations as set forth in the paragraphs above from occurring in the future.
C. Tender payment to the Robinsons in the amount of $46,744.64, which is the amount to return the Robinsons’ home back to pre-loss condition.
D. Tender prejudgment interest from the date the claim was reported through today.
E. Agree to pay the Robinsons’ reasonable attorney’s fees pursuant to Florida Statute §627.428 and all taxable costs.
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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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