Filing Number: 805421
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| Filing Accepted: 2/6/2025 |
| Last/Business Name
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YOWELL
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First Name |
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ANDREW AND KAYE |
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| Street Address
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19681 SUMMERLIN RD. #613 |
| City, State Zip
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FT. MYERS,
FL
33903
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| Email Address
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INSURED@MCDONALDBARNHILL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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YOWELL |
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First Name |
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ANDREW AND KAYE |
| Policy # * |
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ATM212118 |
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Claim #* |
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AM134961 |
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Attorney is Applicable
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| Last Name* |
GONTRUM
First Name *
RYAN
Initial
L
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| Street Address* |
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505 S. MAGNOLIA AVENUE |
| City, State Zip* |
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TAMPA
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FL
33606
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| Email Address * |
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TAL@MCDONALDBARNHILL.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 TRADITIONS INSURANCE COMPANY
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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 12359 |
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| Name of individual responsible for violation (if any):*
ANTHONY HUSBAND AND ROBERT DAWSON
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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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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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Statutory provision(s) which the insurer allegedly violated.
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| 626.9541(1)(i)(1) |
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Attempting to settle claims on the basis of an application, when serving as a binder or intended to become a part of the policy, or any other material document which was altered without notice to, or knowledge or consent of, the insured.
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| 626.9541(1)(i)(2) |
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A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
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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)(e) |
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Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
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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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| 626.9541(1)(i)(3)(g) |
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Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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| 626.9541(1)(i)(3)(h) |
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Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
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| 626.9541(1)(i)(4) |
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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).
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| 626.9541(1)(i)(3)(j) |
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Altering or amending an insurance adjuster’s report without:
(I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and
(II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or
(III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change;
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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.
***ADDITIONAL STATUTORY PROVISIONS ALLEGED TO HAVE BEEN VIOLATED AS FOLLOWS:***
§624.155(1)(a) Any person may bring a civil action against an insurer when such person is damaged:
By the commission of any of the following acts by the insurer:
1. Section 626.9541(1)(i), (o), or (x);
§624.155(1)(a) Any person may bring a civil action against an insurer when such person is damaged:
By the commission of any of the following acts by the insurer:
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 towards its insured and with due regard for his interests;
2. Making claims payments to insures or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made; or
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.
§624.155 (5) No punitive damages shall be awarded under this section unless the acts giving rise to the violation occur with such frequency as to indicate a general business practice and these acts are:
a. Willful, wanton, and malicious;
b. In reckless disregard for the rights of any insured; or
c. In reckless disregard for the rights of a beneficiary under a life insurance contract;
(8) The damages recoverable pursuant to this section shall include those damages which are a reasonably foreseeable result of a specified violation of this section by the authorized insurer and may include an award or judgment in an amount that exceeds the policy limits.
§627.70131 Insurer’s duty to acknowledge communications regarding claims; investigation
(1)(a) Upon an insurer’s receiving a communication with respect to a claim, the insurer shall, within 14 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 which reasonably prevent such acknowledgement. If the acknowledgement is not in writing, a notification indicating acknowledgement shall be made in the insurer’s claim file and dated. A communication made to or by an agent of an insurer with respect to a claim shall constitute communication to or by the insurer.
(b) As used in this subsection, the term “agent” means any person to whom an insurer has granted authority or responsibility to receive or make such communications with respect to claims on behalf of the insurer.
(c) This subsection shall not apply to claimants represented by counsel beyond those communications necessary to provide forms and instructions.
(2) Such acknowledgement shall be responsive to the communication. If the communication constitutes a notification of a claim, unless the acknowledgement reasonably advises the claimant that the claim appears not to be covered by the insurer, the acknowledgement shall provide necessary claim forms, and instructions, including an appropriate telephone number.
(3) Unless otherwise provided by the policy of insurance or by law, within 10 working days after an insurer receives proof of loss statements, the insurer shall begin such investigation as is reasonably necessary unless the failure to begin such investigation is caused by factors beyond the control of the insurer which reasonably prevent the commencement of such investigation.
(4) For purposes of this section, the term “insurer” means any residential property insurer.
(5) Within 90 days after an insurer receives notice of a property insurance claim from a policyholder, the insurer shall pay or deny such claim unless the failure to pay such claim is caused by factors beyond the control of the insurer which reasonably prevent such payment. Failure to comply with this subsection constitutes a violation of this code.
***Specific policy language that is relevant to the violation***
American Traditions Insurance Company (“ATIC”) failed to adequately adjust and pay the claim covered under the subject insurance policy. Specifically, but not limited to, ATIC failed to properly apply the Loss Settlement and Loss Payment provisions of the policy. In addition to the policy sections specifically cited herein, any endorsements or changes to said sections are relevant to the Insured’s claim for civil remedy. There may be additional policy language relevant to this violation that may be discovered.
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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.
Andrew and Kaye Yowell’s claim results from wind and water damage from Hurricane Ian which occurred on September 28, 2022, to their property located at 19681 Summerlin Rd. #613, Ft. Myers, FL 33903. The severe wind affected the roof, gutters, windows, and exterior siding, which in turn allowed water to intrude into the dwelling, causing damage to the ceilings, walls, and floors, rendering the property unsafe, and ultimately resulting in the property being demolished. The property was insured under policy number ATM212118, and was underinsured, with $45,000 in Coverage A limits. The claim was reported to American Traditions Insurance Company (“ATIC”) and was assigned the claim number AM134961. The carrier assigned Anthony Husband as the desk adjuster and Robert Dawson as the field adjuster to the claim. Mr. Dawson inspected the property and prepared a perfunctory estimate totaling just $3,504.02. This estimate failed to include any interior damage whatsoever and omitted all but the most minor of exterior repairs. Pursuant to this estimate, ATIC issued payment of just $505.43 for the loss. This payment included nothing for additional living expenses, and at least partially due to ATIC’s negligence, Mr. and Mrs. Yowell were left homeless for a time.
Mr. and Mrs. Yowell hired Stellar Public Adjusting Services Inc. (“Stellar”) to represent their interests in the claim. After the property was demolished, Stellar submitted a claim for the policy limits in accordance with the Valued Policy Law. Photos, a proof of loss, and other relevant documentation were submitted to ATIC in support of the claim. Unfortunately, there is no evidence ATIC ever considered this information or did anything further to adjust the loss. Instead, ATIC decided to demand appraisal of the loss, forcing the insured to incur related expenses and suffer additional delay. Even after the appraisal was complete, and the appraisal panel returned an award for policy limits, ATIC refused to pay, citing without any factual basis that the loss resulted from flood, and filed suit against Mr. and Mrs. Yowell to avoid payment. ATIC’s course of action has continuously delayed indemnification while the Insureds’ costs continue to rise.
In Florida, the work of adjusting insurance claims engages the public trust. ATIC has breached this duty in the adjustment of this loss by filing a frivolous lawsuit, refusing to provide proper indemnity, delaying resolution of the claim, and failing to take into consideration documentation provided to them which would support further compensation. ATIC has failed to create and implement adequate guidelines for proper investigation of claims handling and for training and supervision of employees and representatives which have resulted in some of the statutory violations set forth above.
ATIC charged Mr. and Mrs. Yowell a substantial premium for these coverages but has refused to tender proper payment when under all circumstances it could have and should have done so had it acted fairly and honestly. Additionally, it appears this is done companywide. The Insureds have been forced to retain legal counsel to protect their interests, defend ATIC’s frivolous lawsuit, and compel payment of the appraisal award.
Therefore, to cure the defects outlined in this Civil Remedy Notice, ATIC must:
1. Immediately tender all insurance monies due to the Insureds for the loss;
2. Act fairly and honestly towards the Insureds and with due regard for their interests in attempting to settle the claim;
3. Pay statutory interest on the amount of unpaid contractual damages from the date the claim was reported;
4. Cease and desist all present and future bad faith actions with regard to the Insureds’ claim;
Failure to cure all defects during the 60-day safe harbor period may result in additional extra-contractual damages.
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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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