Filing Number: 804348
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| Filing Accepted: 1/30/2025 |
| Last/Business Name
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DRUMMER
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First Name |
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MAGGIE |
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| Street Address
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8323 BAHIA AVENUE |
| City, State Zip
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TAMPA,
FL
33619-74
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| Email Address
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MAGGIEDRUMMER56@GMAIL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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DRUMMER |
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First Name |
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MAGGIE |
| Policy # * |
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AGD289277 |
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Claim #* |
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CDP-00175729 |
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Attorney is Applicable
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| Last Name* |
TORRE
First Name *
GABRIEL
Initial
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| Street Address* |
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908 WEST HORATIO STREET |
| City, State Zip* |
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TAMPA
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FLORIDA
33606
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| Email Address * |
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GABE@MAKRISMULLINAX.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):*
TONY JANSSEN
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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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Claim Delay
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Unfair Trade Practice
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Unsatisfactory Settlement Offer
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Other
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Unreasonable Investigation
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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)(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.
THE POLICY PROVISIONS INCLUDE BUT ARE NOT LIMITED TO THE PERILS INSURED AGAINST SECTION OF THE POLICY AND THE LOSS PAYMENT PROVISION OF THE POLICY AS WELL AS THE PROVISIONS OF THE POLICY OUTLINED IN AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA’S (“AMERICAN INTEGRITY”) LETTER TO THE INSURED DATED AUGUST 20, 2024, INCLUDING:
“COVERAGE A - DWELLING AND COVERAGE B - OTHER STRUCTURES.
1. 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.
WE DO NOT INSURE, HOWEVER, FOR LOSS:
H. (1) WEAR AND TEAR, MARRING, DETERIORATION; (2) INHERENT VICE, LATENT DEFECT, MECHANICAL BREAKDOWN; (3) SMOG, RUST OR OTHER CORROSION, MOLD, WET OR DRY ROT;
(6) SETTLING, SHRINKING, BULGING OR EXPANSION, INCLUDING RESULTANT CRACKING, OF PAVEMENTS, PATIOS, FOUNDATIONS, WALLS, FLOORS, ROOFS OR CEILINGS;
AT THIS TIME, THESE ARE THE ONLY PROVISIONS OF THE POLICY KNOWN TO BE IN DISPUTE, BECAUSE THESE WERE THE BASIS FOR AMERICAN INTEGRITY’S DENIAL OF THE INSURED’S CLAIM. IF THERE ARE OTHER PORTIONS OF THE POLICY THAT WERE NOT INCLUDED IN AMERICAN INTEGRITY’S COVERAGE LETTER, WHICH AMERICAN INTEGRITY BELIEVES LIMIT OR EXCLUDE COVERAGE FOR THE INSURED’S LOSS, THEN THE INSURED’S REQUEST TO BE NOTIFIED OF THAT, AND THE INSURED ASSERTS THOSE PROVISIONS OF THE POLICY TO ALSO BE APPLICABLE TO THIS NOTICE.
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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.
• 626.9541(1)(i)(3)(i) -- Unfair claim settlement practices.
WHILE THE POLICY WAS IN FULL FORCE AND EFFECT, THE SUBJECT PROPERTY SUSTAINED A COVERED LOSS AS A RESULT OF A HURRICANE AND RELATED DAMAGES WERE FOUND TO THE ROOF, EXTERIOR, AND INTERIOR OF THE SUBJECT PROPERTY. AMERICAN INTEGRITY RECEIVED TIMELY NOTICE OF THE LOSS AND ASSIGNED CLAIM NUMBER CDP-00175729 TO THE CLAIM.
THEREAFTER, AMERICAN INTEGRITY ISSUED A COVERAGE LETTER TO THE INSURED DATED AUGUST 20, 2024, WRONGFULLY DENYING THE INSURED’S CLAIM. THE LETTER STATES THAT AMERICAN INTEGRITY DID NOT FIND ANY WIND DAMAGE TO THE ROOF CAUSED BY THE HURRICANE, AND THEREFORE ANY DAMAGE TO THE ROOF AND INTERIOR WOULD BE DENIED. AMERICAN INTEGRITY’S INVESTIGATION WAS INSUFFICIENT AND FAILED TO INCLUDE DAMAGES AND REPAIRS COVERED BY THE POLICY AND FLORIDA LAW.
AMERICAN INTEGRITY FAILED TO PERFORM A PROMPT INVESTIGATION OF THE CLAIM AND PERFORMED A CURSORY INSPECTION OF THE PROPERTY FAILING TO RETAIN THE EXPERTS NECESSARY TO IDENTIFY THE REPAIRS NECESSARY TO RESTORE THE PROPERTY TO ITS PRE-LOSS CONDITION. ADDITIONALLY, THIS FLAWED INVESTIGATION WAS CONDUCTED BY CERTAIN INDIVIDUALS RETAINED BY AMERICAN INTEGRITY FOR THE SOLE PURPOSE OF SEEKING A “RESULTS-ORIENTED” OPINION TO DENY OR UNDERPAY THE INSURANCE CLAIM.
THIS FORCED THE INSURED AND HER REPRESENTATIVES TO RETAIN THEIR OWN PROFESSIONALS TO PERFORM AN INSPECTION OF THE PROPERTY, WHICH IDENTIFIED DAMAGES THAT AMERICAN INTEGRITY KNEW EXISTED, BUT FAILED TO ADDRESS. DURING THE INSPECTION, WIND DAMAGE TO THE ROOF. IT WAS DETERMINED THAT A FULL ROOF REPLACEMENT WAS NECESSARY TO RESTORE THE SUBJECT PROPERTY TO ITS PRE-LOSS CONDITION. ADDITIONALLY, DAMAGE TO THE EXTERIOR ELEVATIONS WERE OBSERVED IN THE FORM OF IMPACT DAMAGE TO THE STUCCO. LASTLY, DAMAGE TO THE INTERIOR WAS OBSERVED FROM WIND DRIVEN RAIN THROUGH OPENINGS IN THE BUILDING’S MEMBRANE CAUSED BY THE HURRICANE.
AMERICAN INTEGRITY’S FAILURE TO CONDUCT A REASONABLE INVESTIGATION AND FAILURE TO PAY THE INSURED FOR THE COVERED LOSS UNDER THE POLICY ISSUED BY AMERICAN INTEGRITY EXHIBITS BAD FAITH. FURTHER, AMERICAN INTEGRITY FAILED TO COMPLY WITH ITS LOSS SETTLEMENT PROVISION. RATHER THAN ISSUING THE PROPER PAYMENT OR ATTEMPTING TO REACH AN AGREEMENT WITH ITS INSURED, AMERICAN INTEGRITY IS DELAYING AND DENYING THE CLAIM. UPON INFORMATION AND BELIEF, AMERICAN INTEGRITY PERFORMS THE SUBJECT ACTIONS AS A BUSINESS PRACTICE, INCLUDING DELAYING THE CLAIM AND DENYING THE CLAIM IN AN ATTEMPT TO DISSUADE ITS INSURED FROM PURSUING THE CLAIM TO THE DETRIMENT OF ITS INSURED TO INCREASE FINANCIAL PROFITS.
IN THE EVENT AMERICAN INTEGRITY BELIEVES THIS CIVIL REMEDY NOTICE LACKS INFORMATION NECESSARY FOR AMERICAN INTEGRITY TO CURE THE DEFECTS OUTLINED IN THIS NOTICE, OR THAT IT LACKS REQUIRED SPECIFICS IN ANY WAY, AMERICAN INTEGRITY SHOULD CONTACT THE FILER OF THIS NOTICE DIRECTLY AND ALERT THEM TO THAT AS SOON AS POSSIBLE, PRIOR TO ANY FORMAL RESPONSE.
THIS NOTICE IS FILED AND GIVEN TO AMERICAN INTEGRITY TO PERFECT THE RIGHT TO PURSUE THE CIVIL REMEDY THAT SECTION 624.155 AUTHORIZES.
TO CURE THE DEFECTS OUTLINED IN THIS CIVIL REMEDY NOTICE, AMERICAN INTEGRITY MUST:
(1). ADMIT FULL COVERAGE FOR THE INSURED’S LOSS;
(2). PAY IN ACCORDANCE WITH THE ESTIMATE PREPARED BY THE INSURED’S PUBLIC ADJUSTER IN THE AMOUNT OF $ 87,184.22;
A COPY OF THIS FORM SUBMITTED TO THE FDFS HAS BEEN PROVIDED TO THE FOLLOWING PARTIES PROVIDING THEM NOTICE OF THE FILING OF THE CIVIL REMEDY NOTICE:
CLAIMSMAIL@AIICFL.COM
TONY JANSSEN
AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA
5426 BAY CENTER DRIVE, SUITE 600,
TAMPA, FLORIDA 33609
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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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