Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 803573

Filing Accepted: 1/27/2025

Print Filing

Complainant

Last/Business Name *

KRAGT

First Name

NICOLE

Street Address *

3442 NORTHWEST 37TH AVENUE

City, State Zip *

GAINESVILLE, FL 32605

Email Address *

NIKKI.KRAGT@GMAIL.COM

Complainant Type: *

Insured

Last/Business Name*		KRAGT		First Name		NICOLE
Policy # *		FLP570603		Claim #*		1343287-241013

Attorney

Attorney is Applicable

Last Name*	KRAPF First Name * GRANT Initial W
Street Address*		2790 SUNSET POINT RD
City, State Zip*		CLEARWATER , FL 33759
Email Address *		GRANT@KRAPFLEGAL.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		ASI PREFERRED INSURANCE CORP.
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 13142

Name of individual responsible for violation (if any):* RICKY GIBBS, ANDREW DAVIS, VICTORIA SNOVEL, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, ASI PREFERRED INSURANCE CORPORATION, WHO WAS INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Delay
	Unfair Trade Practice
	Other : Not treating the Insured with good faith claims conduct
	Other : Looking for ways to deny full recovery to the Insured
	Other : Looking for ways to delay full recovery to the Insured
	Other : Failing to properly investigate the Insured's loss
	Other : Failing to provide the Insured with the full benefits awarded under the contract of insurance in a t
	Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made
	Other : Not adjusting claims and evaluating loss properly
	Other : Shifting the burden of insuring the loss to the Insured
	Other : Failing to implement proper standards for the adjustment and investigation of claims

* 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)(2)		Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
	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)(4)		Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).

* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

627.70131 (1)(a) - 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 the acknowledgment is not in writing, a notification indicating acknowledgment shall be made in the insurer's claim file and dated. A communication made to or by a representative of an insurer with respect to a claim shall constitute communication to or by the insurer. 627.70131(7)(a)Within 60 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer. The insurer shall provide a reasonable explanation in writing to the policyholder of the basis in the insurance policy, in relation to the facts or applicable law, for the payment, denial, or partial denial of a claim. If the insurer's claim payment is less than specified in any insurer's detailed estimate of the amount of the loss, the insurer must provide a reasonable explanation in writing of the difference to the policyholder. Any payment of an initial or supplemental claim or portion of such claim made 60 days after the insurer receives notice of the claim, or made after the expiration of any additional timeframe provided to pay or deny a claim or a portion of a claim made pursuant to an order of the office finding factors beyond the control of the insurer, whichever is later, bears interest at the rate set forth in s. 55.03. Interest begins to accrue from the date the insurer receives notice of the claim. The provisions of this subsection may not be waived, voided, or nullified by the terms of the insurance policy. If there is a right to prejudgment interest, the insured must select whether to receive prejudgment interest or interest under this subsection. Interest is payable when the claim or portion of the claim is paid. Failure to comply with this subsection constitutes a violation of this code. However, failure to comply with this subsection does not form the sole basis for a private cause of action. Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language. "It is an accepted principle of law that when parties contract upon a matter which is the subject of statutory regulation, the parties are presumed to have entered into their agreement with reference to such statute, which becomes a part of the contract, unless the contract discloses a contrary intention." Westside EKG Assocs. v. Found. Health, 932 So. 2d 214, 216 (Fla. 4th DCA 2005), aff'd, 944 So. 2d 188 (Fla. 2006).

* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

ASI Preferred Insurance Corporation (the "Insurer") has committed the following in handling the Insured's claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the policyholder and the Insured; 3) looking for ways to deny benefit payments and otherwise "low ball" or "stone wall" claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; 8) shifting the burden of investigating the loss onto the Insured; 9) failing to render a claims determination within sixty (60) days; 10) failing to pay interest on a claim that is older than sixty (60) days; and 11) failing to acknowledge and act promptly upon communications with respect to claims. On April 30, 2024, at 11:30 AM while the subject policy was in full force and effect, the Insured's suffered a loss caused by a water leak due to vehicular damage to the insured property. The at-fault driver crashed into the Insured's laundry room. The Insured called the Insurer at 11:52 AM who instructed the Insured to contact the at-fault driver's insurer and assigned claim number 1343287-241013 to the loss and elected to engage in the managed repair program, assigning Paul Davis Restoration to perform emergency water damage mitigation. Due to the unlivable condition of the dwelling due to the subject incident, the Insurer contracted Housing HQ to provide the Insured temporary hotel accommodations. The Insurer then sent a field adjuster to inspect the property on May 2, 2024. The Insured then attempted to communicate with the Insurer's adjuster, Ricky Gibbs, to arrange the restoration of the insured property to begin as soon as possible. The Insurer's agents and chosen contractor failed to timely respond to communications, creating unnecessary delay in the resolution of the Insured's claim. Subsequently, in a letter dated June 20, 2024, the Insurer requested a detailed content list from the Insured and, on June 22, 2024, issued payment unaccompanied by a statement detailing under what coverage or for what reason the payment was issued. The Insured's communications to the Insurer's agents were again frustrated by unnecessary delay, creating worsening damages in the still unrepaired property. Given the extended vacancy, delay in repairing the property to its pre-loss condition, poorly remediated water damage by the Insurer's chosen restoration expert, Paul Davis, and the scope and nature of the damage, the Insured retained restoration and mold inspection services. The Insurer's delay in properly restoring the property to its pre-loss condition caused worsened damage and increased additional living expenses. After assessing the damage and the true scope of repairs, the restoration services and mold inspectors prepared estimates and created identifying and confirming drastic and prolonged damage to the dwelling. The foregoing estimates, invoices, photographs, and reports were sent to the Insurer. The Insurer has, to date, failed to fully indemnify the Insured for their loss as the insured property remains uninhabitable. Repairs made to the property by the Insurer's chosen contractor have been inadequate and the Insurer continues to delay the resolution of the claim by failing to provide the Insured and their retained services with the full amounts necessary to restore the property to its pre-loss condition. The Insurer is not conferring the benefits on their policy holders as required by Florida law and is unfairly leveraging use of its managed repair program as a means of delaying policy benefits. Moreover, payments issued to the Insured have failed to arrive in a statutory timeframe and have not contained interest owed for the same. Upon receiving notice of the loss, the Insurer had the duty to provide the full benefits under the policy. This includes providing the Insured with a proper investigation and the funds necessary to return the home to its pre-loss condition. There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer's claim file and standards and procedures for the adjustment and investigation of claims. The Insurer has placed obstacles to the Insured's ability to have the claim adjusted promptly to begin restoring the home by waiting more than sixty (60) days after receiving notice of the loss to make a claims determination. Under Fla. Stat. 627.70131(7)(a), "[w]ithin 60 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer which reasonably prevent such payment." There were and are currently no factors outside of the Insurer's control. As the Insurer has failed to make a timely determination, it has violated this code. As such, in addition to the below requirements to cure this CRN, any payment made to the Insured must contain interest for the damage as a result of the loss from the date the Insurer received first notice of the loss. Despite the obvious water damage, the Insurer did not feel it was necessary to inspect the Insured's home for mold. A mold inspection test can be purchased online from Amazon for around $46 before tax. This mold test only takes five minutes to assess whether or not the property has mold-particulates. However, the Insurer would much rather risk the health of the Insured in order to save some time and a money. In short, when it comes to mold, the Insurer accepts premiums but does not accept the responsibility of inspecting for mold. This is further evidence that the Insurer is placing its financial interest over the health and safety of the Insured. Additionally, Insurer shifted the burden and cost of investigating and insuring the loss onto the Insured. During their investigation, the insurer's adjuster did not use a moisture meter, despite the presence of interior water damage. A moisture meter can be purchased online from Amazon for around $40 before tax. The Insurer could purchase a moisture meter and assess thousands of properties with one meter. Instead, the Insurer would rather place its financial interests over those of the Insured by failing to provide the adjuster with the necessary tools to correctly inspect the loss. As a result of the inadequate investigation and surrounding circumstances it is apparent that the Insurer significantly underestimated the scope of the loss to the Insured's property. The Insurer and its adjuster have colluded to misrepresent the true scope of damages to the insured property and the true replacement costs of the damages. In short, the Insurer is not acting with due regard for the Insured's interests or safety. In Florida the work of adjusting insurance claims engages the public trust. The Insurer has breached this trust and its duty to the Insured. The Insurer and its agents conducted cursory and inadequate investigations and wrongfully undervalued the amount required to restore the insured property to its pre-loss condition and has manufactured unnecessary delay in the full indemnification of its Insured. Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer's actions and inactions have continued to frustrate and delay the resolution of the Insured claim. The Insurer's actions amount to but are not limited to the following: 1. Claim delay 2. Not treating the Insured with good faith claims conduct 3. Looking for way to reduce recovery to the Insured 4. Looking for ways to deny recovery to the Insured 5. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured 6. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company's interests before the Insured's interests 7. Placing the financial interest of the Insurer over that of the health and safety of the Insured 8. Shifting the burden of investigating onto the Insured 9. Conducting inadequate investigations 10. Failing to render a written claims determination to the Insured within 60 days pursuant to Florida Statute 627.70131 11. Failing to pay interest on a claim that is older than sixty (60) days 12. Requesting a re-inspection despite no changes to the above-referenced insured property 13. Treat represented and unrepresented Insured differently Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must: (1). Admit full coverage for the Insured's loss. (2). Tender full benefits owed to the Insured under the insurance contract. A copy of this form submitted to the FDFS has been sent via e-mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to badfaith@krapflegal.com. Via E-mail: ASI Preferred Insurance Corporation 1 ASI Way St. Petersburg, FL 33731 claims@asicorp.org

Comments

User Id		Date Added		Comment
Gissella_Reyes@progressive.com		02-24-2025		While ASI Preferred Insurance Corp believes that the Civil Remedy Notice fails to comply with the requirements of Florida Statute §624.155 and Florida Case law, it has responded to the notice in writing to Krapf Legal, PA, on February 24, 2025.

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