Filing Number: 805221
|
| Filing Accepted: 2/5/2025 |
| Last/Business Name
*
|
|
|
NICOLE GOODWIN AND DANIEL GOODWIN
|
|
First Name |
|
|
|
| Street Address
*
|
|
1257 TUPELO TRAIL |
| City, State Zip
*
|
|
HANES CITY,
FL
33844
|
| Email Address
*
|
|
CLAY@THEKRFIRM.COM |
| Complainant Type:
*
|
|
Insured |
|
| Last/Business Name* |
|
NICOLE GOODWIN AND DANIEL GOODWIN |
|
First Name |
|
|
| Policy # * |
|
AGH0466078 |
|
Claim #* |
|
CHO-00179109 |
|
Attorney is Applicable
|
| Last Name* |
KUHN
First Name *
CLAYTON
Initial
|
| Street Address* |
|
2110 WEST PLATT STREET |
| City, State Zip* |
|
TAMPA
,
FLORIDA
33606
|
| Email Address * |
|
CLAY@THEKRFIRM.COM |
|
|
| Insurer Type
*
|
|
 Authorized Insurer
 Unauthorized Insurer
|
|
|
| Insurer Name |
|
|
| Insurer Name* |
|
AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA
|
| Insurer Name* |
|
|
| Street Address* |
|
|
| City, State Zip* |
|
,
|
|
NAIC Company Code 12841 |
|
|
| Name of individual responsible for violation (if any):*
ANY AND ALL PERSONS ASSOCIATED WITH THE CLAIMS HANDLING FROM AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA
|
| Type of Insurance
*
Residential Property & Casualty
|
|
|
| Reason for Notice
*
|
|
|
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.
|
|
| 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)(d) |
|
Denying claims without conducting reasonable investigations based upon available information.
|
|
*
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 LANGUAGE RELEVANT TO THE VIOLATIONS INCLUDES ALL APPLICABLE LOSS PAYMENT AND COVERAGE PROVISIONS OF POLICY NUMBER AGH0466078 INCLUDING THE DECLARATIONS PAGE AND ALL ENDORSEMENTS TO THE POLICY, WITH RESPECT TO COVERAGES A, B, C, AND D. ADDITIONALLY, ANY SECTIONS RELIED UPON BY THE INSURER IN ITS DENIAL TO FULLY PAY THE CLAIM, INCLUDING THE DUTIES IN THE EVENT OF LOSS PROVISIONS AND THE POLICY'S EXCLUSION OF COVERAGE PROVISIONS.
|
| |
*
Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Nicole Goodwin and Daniel Goodwin (hereinafter “Insureds”) are homeowners insured with an all-risks policy issued by American Integrity Insurance Company of Florida (hereinafter “Carrier”).
On or about October 10, 2024, Insureds’ home located at 1257 Tupelo Trail, Haines City, Florida 33844 sustained significant damage as a result of a windstorm event. Specifically, Hurricane Milton created multiple openings to the roof of Insureds’ property. This resulted in interior water damage to various areas of the interior of Insureds’ property including but not limited to, the kitchen, living room, front entrance hallway, laundry room, and garage. The Loss is covered under Insureds’ policy issued by Carrier. The Insureds mitigated damages by contacting Family First Restoration who performed mitigation services and placed a tarp on the roof of the subject property. All of the relevant documents were provided to Carrier.
Insureds promptly reported the claim and fully cooperated with all requests for inspections. Carrier assigned Claim No. CHO-00179109 to the loss. The Insureds have fully cooperated with Carrier’s investigation of the claim, including providing all requested documentation and complying with all post-loss policy conditions. Specifically, the Insureds, with assistance from their public adjuster, submitted an estimate for $108,888.99, which was a fair and reasonable assessment for the repair/replacement of damages. Family First Restoration has an outstanding balance in the amount of $36,986.52 for their mitigation services and tarp placement.
After reporting the claim, Carrier retained an unqualified and biased field adjuster, Jason Kern, to adjust the loss . This adjuster had a financial incentive to adjust the loss in a manner that would minimize Carrier’s losses. This adjuster performed a mere cursory inspection of the property on October 13, 2024. Instead of adjusting the claim fairly, honestly, in good faith, and with due regard for the Insureds’ interests, this adjuster made a conscious effort to ignore evidence of covered losses to the property.
Worse still, Carrier failed to retain qualified experts necessary to identify the repairs necessary to restore the property to its pre-loss condition. Despite Insureds providing Carrier with a detailed estimate, Carrier failed to pay Insureds the amount necessary to repair/replace the damaged property, less the applicable deductible. Instead, Carrier gave Insureds a lowball estimate that failed to encompass all covered damages. The carrier only offered to pay $11,131.86, after applicable deductible of $3,630.00, a gross underpayment for all the damage associated with this claim. This has become a common business practice for Carrier.
Under the circumstances surrounding this claim, had Carrier acted fairly and honestly toward the Insureds and with due regard for the Insureds’ interests, Carrier could and should have attempted in good faith to settle this claim. Carrier did not and, instead, dishonestly, and unfairly placed its own interests well ahead of those of the Insureds. In doing so, Carrier violated Section 624.155(1)(b)(1), Florida Statutes.
Carrier’s use of unqualified and biased adjusters, and failure to retain experts necessary to identify the repairs necessary to restore the property to its pre-loss condition, evidence Carrier’s failure to adopt and implement standards for the proper investigation of claims in violation of Section 626.9541(1)(i)(3)(a), Florida Statutes.
Carrier’s use of unqualified and biased adjusters, and failure to retain experts necessary to identify the repairs necessary to restore the property to its pre-loss condition, evidence Carrier’s failure to conduct a reasonable investigation based upon available information. In denying full coverage for this claim without conducting reasonable investigations based upon available information, Carrier has violated Section 626.9541(1)(i)(3)(d), Florida Statutes. By representing to Insureds that the Policy does not afford full coverage for this loss, Carrier is misrepresenting pertinent facts and/or insurance policy provisions relating to coverages at issue, in violation of Section 626.9541(1)(i)(3)(b), Florida Statutes.
When applying the facts present here to Florida law, it is clear that Carrier is acting in bad faith. 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 based on determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. Carrier has breached this duty by refusing to properly and timely adjust the loss.
Moreover, Section 69B-220.201 of the Florida Administrative Code defines Carrier’s adjusters conduct here as an unfair claims settlement practice. Specifically, Section 69B-220.201(3) provides that “[a]n adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured” and that “[a]n adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.” As detailed above, Carrier’s investigation and adjustment of this claim was done in a manner prejudicial to Insureds, was incomplete, and lacked truthful and unbiased reports of the facts.
Carrier has more than enough information and is still refusing to accept coverage for the Insureds’ claim. This continued and repeated reckless claim delay and denial of coverage will result in a significant punitive damage award if a bad faith lawsuit is filed.
Carrier can cure the defects outlined in this Civil Remedy Notice and avoid a lawsuit for bad faith by immediately accepting full coverage under the subject insurance policy for this claim and by paying Insured’s estimate of $108,888.99, and Family First Restoration in the amount of $36,986.52, less applicable deductible and prior payments, which is the reasonable amount of the covered loss pursuant to the policy.
A copy of this form has been submitted to the Florida Department of Financial Services who has transmitted the same to the following parties providing them notice of the filing of this Civil Remedy Notice: American Integrity Insurance Company of Florida.
|
|
|
*
|
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
|