Civil Remedy Notice of Insurer Violations
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Filing Number:     807312
Filing Accepted:  2/18/2025
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Complainant
Last/Business Name *  
FAIRFIELD OF NAPLES INC.   First Name  
Street Address * 750 MOORING LINE DR
City, State Zip * NAPLES, FL 34102
Email Address * JAMESF@CAMBRIDGESWFL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   FAIRFIELD OF NAPLES INC.   First Name  
Policy # * AMC-36228-03 Claim #* 45806
Attorney
Attorney is Applicable
Last Name* DUROCHER First Name * JOSHUA Initial
Street Address* 3310 WEST CYPRESS STREET SUITE 202
City, State Zip* TAMPA , FL 33607
Email Address * JD@THEKDLEGALGROUP.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   AMERICAN COASTAL INSURANCE COMPANY
NAIC Company Code 12968
 
Name of individual responsible for violation (if any):* ANY AND ALL ADJUSTERS, SUPERVISORS, MANAGEMENT, ATTORNEYS AND/OR INDIVIDUALS ASSOCIATED WITH THE CLAIM. SPECIFICALLY, BUT NOT LIMITED TO SHARON BLOW, SCOTT SHUMAKER, RANDY CIARLONE.
Type of Insurance * Commercial Property & Casualty   
Reason for Notice *
Unsatisfactory Settlement Offer
* 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)(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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Section I Property Coverages of the appliable policy provides coverage for the reported claim. The Insured has complied with all policy conditions, and there are no exclusions that apply. The Insured believes the Policy language relevant to the violations include all applicable policy coverages, loss payment provisions, loss settlement provisions, valuation provisions and other terms and conditions of the subject policy. In particular, the Insured refers to the following policy language: Coverage A – Dwelling, Coverage B - Other Structures, Coverage C - Personal Property, Coverage D - Loss of Use, Additional Coverages, Law and Ordinance Coverage, and/or Additional Endorsements and Forms. The carrier has failed to issue insurance benefits to its Insured pursuant to the Loss Settlement, Loss Payment, and other Provisions in the applicable policy.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

This complaint is made on behalf of Fairfield of Naples Inc. (“Insured”). Fairfield of Naples Inc. purchased their policy from American Coastal Insurance Company (“Carrier”), Policy No. AMC-36228-03 (the “Policy”), which provided coverage for the properties located at 750 Mooring Line Dr Naples, FL 34102 (the “Properties”). Fairfield of Naples Inc. paid all premiums associated with the Policy which was in full force and effect at the relevant times herein. On or about September 28, 2022, the Properties were damaged because of Hurricane Ian. The loss caused substantial damages, including, but not limited to, damage to the roofs, HVAC unit fins, gutters, downspouts, soffits, fascia, windows, doors, handrails, carport, etc.. The Insured notified American Coastal Insurance Company of the damages. Thereafter, the Carrier acknowledged the claim and assigned it Claim No. 45806. From there the Carrier exhibited a blatant, unacceptable failure to properly investigate the claim, in violation of Florida law, and committed clear bad faith in refusing to properly pay Fairfield of Naples Inc. for the Hurricane Ian claim and neglecting and delaying the claim as long as possible in order to increase its profits to the detriment of its Insured. Following receipt of the claim, American Coastal Insurance Company retained an insurance industry-oriented adjuster, Scott Shumaker, to evaluate the property on June 27, 2024. American Coastal also had their retained engineer, Randy Ciarlone, inspect the same day. Mr. Shumaker determined the value of the loss - but seemingly without considering their engineer’s findings. In other words, it seems the field adjuster and engineer both inspected in tandem with each other, but their findings did not correspond accordingly. Mr. Cairlone’s report confirms that the buildings sustained wind speeds of at least 102 miles per hour on the date of loss. In regard to building one, Mr. Ciarlone found the shingles in a brittle condition and that there were at least 4 creased and 1 missing shingle. He also identified dents in the air conditioning unit, as well as dents in the drip edge. Both of these observed conditions were later deemed to be mechanical damage without any support. Building two also was found by the carrier’s engineer to have at least 3 shingles with missing portions of upper laminates “to indicate damage as the result of wind.” Again, the shingles were noted to be brittle. The engineer also determined linear markings on the roof were related to foot traffic without any support. As far as the carports, the engineer confirmed that one of the carports was damaged by wind as evidenced by a missing metal panel. The engineer report then goes on to say, “based upon the observed conditions and age of the shingles of these roofs, spot replacement of the storm damaged shingles could be problematic.” The engineer’s conclusion states the roofs are “allowed” to be repaired per the applicable building code, but this is clearly contradicted by the prior statements that the repairs could be problematic. The engineer also states in the conclusion that he did not observe damage to the exterior consistent with wind- or wind-borne debris. However, the pictures that are contained within the report suggest otherwise. Photograph 6 is labeled “impact damage to rear facing railing.” Photographs 7 and 8 are labeled “impact damage to window frame.” Photograph 9 is labeled “impact damage to gutter.” These noted damages were found to be unrelated to wind without any explanation or justification. The report even states “not all damage or distress that may be present was not necessarily observed or photographed.” This is very evident when comparing the pictures taken from the carrier’s engineer with insured’s public adjuster’s. Put simply, the engineer missed a great amount of wind damaged conditions. Following the inspection, a coverage determination letter was issued on October 15, 2024. At that time, a meager payment of $452.25 was issued. The letter confirms wind damaged shingles, fascia, gutter downspouts, and carport of location #2. The estimate shows that both buildings (per the carrier) needed 2 SQ of shingles on both roofs to be repaired. Once again, this estimate fails to consider the brittle nature of these shingles, and their inability to be repaired. The insured had already provided their own estimate of the true scope and pricing of the damages, and submitted a sworn statement in proof of loss. The Carrier has not increased their offers at all. It has also not addressed the elephant in the room – which is their agreement that the roofs need 2 SQ replaced but that this repair is not possible. Because of Carrier’s refusal to properly adjust the claim, failure to make payment, continued delay of benefits, denying and underpaying of claims, Fairfield of Naples Inc. was forced to hire private counsel to enforce the rights under the Policy and under Florida law. In Florida, the work of adjusting insurance claims engages the Public Trust. American Coastal Insurance Company  has breached this duty by its improper adjustment of this claim. The actions by the Carrier and its adjuster(s) are contrary to the Loss Payment and Valuation provisions of the Policy. Carrier, through its adjuster and persons entrusted to investigate this loss, has failed to investigate this loss adequately and fairly. The Carrier has, based on the above facts to date, committed the following violations: 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 their interests; by 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; by failing to adopt and implement standards for the proper investigation of claims; by misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue; and by participating in unfair claim settlement practices. This is unconscionable and a gross violation of ethical standards by the Carrier and clear evidence of bad faith by the Carrier who should have evaluated and fairly provided coverage for the true cost of the damages associated with the loss. This failure to investigate and consider adverse information is evidence that Adjusters Sharon Blow, and Scott Shumaker, approach investigations in a manner that is prejudicial to its Insureds in violation of Florida Administrative code 69B-220.201(3)(c). American Coastal Insurance Company  has a contractual obligation not to look the other way when confronted with facts revealing the possibility of coverage. The concept of insurance is that insurance is the insurer’s granting of timely and prompt indemnity or security against a contingent loss. Florida Statute §624.02 defines “insurance” as a contract whereby one undertakes to indemnify another or pay or allow specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that the insured may mitigate damages and to put the Property back into the position it was in prior to the loss as quickly as possible. Here, American Coastal Insurance Company  has breached this duty. As detailed above, American Coastal Insurance Company  has refused or failed to cooperate or “Adjust the Loss” with the Insured during the claims adjustment process in compliance with the Policy’s “Loss Payment” provision. This is a breach of the Policy. American Coastal Insurance Company ’s handling and adjustment of this claim and the conduct of the adjusters, supervisors, management, and individuals associated with or retained by the carrier in this claim to date, evidence that it has failed to create and implement adequate guidelines for proper investigation to evaluate claims handling and for training and supervision of employees resulting in statutory violations set forth above. American Coastal Insurance Company  has also failed and/or refused to thoroughly, accurately, and completely investigate and evaluate Fairfield of Naples Inc.’s claim for damages, and has failed to provide sufficient explanation under the terms of the policy for the coverage position adopted, and has failed to provide their insured with documents which purportedly support the position taken. This notice is given in order to perfect the right to pursue the civil remedy authorized by Florida Statute, including any and all bad faith/extra contractual, should the Carrier fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. The Insured also intends to seek punitive damages against the Carrier as it appears that their violations occur with such frequency as to evidence a general business practice and the violations were willful, wanton, and malicious and were in reckless disregard for the rights of the Insured. While no specific “cure amount” is required for this Civil Remedy Notice to be valid, the Insured will consider the allegations contained herein “cured” if Carrier: (1) Immediately tenders an actual cash value payment listed within their public adjuster’s estimate, with no requirement for the Insured to sign a release. While the Insured is requesting that this be done to “cure” this Civil Remedy Notice, the Insured is willing to consider, and may accept, any reasonable counteroffer. Therefore, if Carrier disagrees with the requests, the Insured requests that Carrier make a counteroffer before the end of the “cure period” and provide supporting documentation for any such offer so that they may understand any discrepancies that could exist regarding the estimates.
Comments
User Id Date Added Comment
azesch@amcoastal.com 04-18-2025 This correspondence constitutes AmCoastal’s response to the Notice. As a preliminary matter, AmCoastal objects to the libelous and defamatory nature of the allegations in the Notice. AmCoastal rejects these false allegations and hereby reserves all rights, including legal action. The Notice amounts to nothing more than the Insured disagreeing with the outcome of AmCoastal’s investigation and valuation of this Hurricane Ian Claim. AmCoastal has thoroughly investigated the Claim, communicated consistently with the Insured and its representatives throughout, and paid all undisputed amounts owed. AmCoastal has not paid the Insured the amount it is claiming because that amount is not remotely supported by AmCoastal’s investigation or the documentation the Insured has provided. The Notice is invalid on its face because it fails to strictly comply with the requirements of Section 624.155, Florida Statutes. First, the Notice does not comply with the requirement of Section 624.155(3)(b)(3) to state with specificity the name of any individual involved in the alleged violation. Although the Notice names a desk adjuster, it also casts a net over “[a]ny and all adjusters, supervisors, management, attorneys and/or individuals associated with the claim” – an absurdly nonspecific allegation that every single individual working for or on behalf of AmCoastal acted in bad faith. As a result, the Notice does not comply with Section 624.155 and is not valid. Second, the Notice does not comply with the requirement of Section 614.155(3)(b)(4) to refer to specific policy language relevant to the alleged violation. Instead, the Notice simply parrots language from other notices filed by the Insured’s counsel in claims involving residential homeowner policies, rather than condominium policies. The Notice refers to “all applicable policy coverages,” including coverages that the Policy does not provide. As a result, the Notice does not comply with Section 624.155 and is not valid. Third, the Notice does not comply with the requirement imposed by Section 614.155(3)(b)(1) and (2) that it “state with specificity … [t]he statutory provision, including the specific language of the statute, which the authorized insurer allegedly violated” and “[t]he facts and circumstances giving rise to the violation.” The Notice lists four statutory provisions allegedly violated but contains no specific details whatsoever that would amount to a violation of these provisions. The Notice lists Section 624.155(1)(b)(1.), Florida Statutes, but does not explain how AmCoastal failed to attempt to settle the Claim in good faith. In fact, the Insured’s allegations demonstrate that AmCoastal continued to investigate the Claim thoroughly and fairly. The fact that AmCoastal did not pay the Insured what it and its contractor wanted, by itself, does not amount to an unfair trade practice. AmCoastal denies that it violated this statutory provision. The Notice lists Section 624.155(1)(b)(3.), Florida Statutes, but does not discuss which separate portions of the Policy would have been implicated in this Claim, let alone how AmCoastal failed to settle under one coverage portion in order to influence settlements under another. It is entirely unclear what relevance this statutory provision may have to this Claim or the Notice. AmCoastal denies that it violated this statutory provision. The Notice lists Section 626.9541(1)(i)(3)(a), Florida Statutes, but does not explain what led the Insured to allege that AmCoastal failed “to adopt and implement standards for the proper investigation of claims” or what these standards should be. AmCoastal investigated this claim thoroughly and fairly. AmCoastal denies that it violated this statutory provision. The Notice lists Section 626.9541(1)(i)(3)(c), Florida Statutes, but does not list a single communication AmCoastal did not acknowledge promptly. AmCoastal denies that it violated this statutory provision. In addition to being facially invalid by failing to support any statutory or Policy violations, the allegations in the Notice are not supported by the actual facts and circumstances of this Claim. The Insured reported this Hurricane Ian claim on June 10, 2024, nearly two years after Hurricane Ian. AmCoastal inspected the Property on June 27, 2024, with a field adjuster and an independent engineer. Based on the inspections, AmCoastal issued a payment of $452.25, which was the amount exceeding the insured’s substantial deductible. AmCoastal rejects the characterization of the field adjuster as “insurance industry-oriented.” On its face, describing the field adjuster as “insurance industry-oriented” is like calling a doctor “healthcare industry-oriented.” However, the description and its obviously intentional connotation of bias are merely part of the Notice’s overwrought and comically dramatic tone. AmCoastal denies all allegations of bias. AmCoastal also rejects the Notice’s gross misrepresentation of the engineer’s findings and the allegation that the field adjuster and engineer’s findings “did not correspond.” The Notice claims that Mr. Ciarlone identified damage he deemed mechanical or due to foot traffic “without any support.” This characterization disregards the entirety of the report and Mr. Ciarlone’s training and expertise, which is the reason AmCoastal retained him in the first place to supports its claim investigation. The Notice also states that Mr. Ciarlone’s observation that roof repairs “could be problematic” (underline added) due to shingle brittleness contradicts the conclusion that the roofs were repairable. This is false. Mr. Ciarlone’s use of the word “could” indicates a potential problem, not an actual one. The Insured has submitted no evidence whatsoever that the roofs are not repairable. In fact, the brittleness of the roofs demonstrates that the Insured is abusing this Claim to get roof replacements that were long overdue to the roofs’ age-related deterioration, wear and tear, and other non-covered causes. Next, the Notice claims that AmCoastal’s investigation failed to note “a great amount of wind damaged conditions.” This is false, as seen on the face of the Notice. Mr. Ciarlone’s report includes impact damage to the buildings’ exteriors and notes that not all such damage was documented because, according to Mr. Ciarlone’s expertise and training, it was not deemed wind damage. The Notice fails to mention that the insured buildings are over half of a century old and exhibit the normal signs of age one would expect from a structure of this age. The Notice then describes AmCoastal’s payment as “meager” but fails to mention that the Claim is subject to a 5 percent hurricane deductible amounting to $143,187.75. Finally, the Notice attempts to find bad faith in AmCoastal paying only for roof repairs and not replacements. At this point, the Notice has escalated Mr. Ciarlone’s observation that roof repairs “could be problematic” to “this repair is not possible.” This is a gross mischaracterization of Mr. Ciarlone’s report. Finally, the Notice’s claim that “the Insured is willing to consider, and may accept, any reasonable counteroffer” rings hollow given the complete lack of any response from the Insured’s attorney to AmCoastal’s multiple attempts to communicate and negotiate a mutually acceptable resolution of the Claim. In short, the Notice’s allegations amount to nothing more than the Insured’s disagreement with AmCoastal’s coverage determination and valuation of the Claim. None of the allegations in the Notice, let alone the actual facts, amount to bad faith or to violations of any Policy provisions or the statutory provisions the Notice cites. To summarize, the Notice is invalid because it does not meet the specificity requirements of Section 624.155, Florida Statutes. To the extent the Notice contains allegations capable of being responded to, AmCoastal categorically denies the allegations. While this response is meant to be comprehensive, it is based upon the limited information provided in the Notice and the information known to date. This response or any act or failure to act on the part of AmCoastal or any agent or representative of AmCoastal should not be construed as a waiver of any rights or defenses, including but not limited to proper notice and service by the complainants, available to it by contract or at law as all such rights and defenses are hereby specifically reserved. We trust the foregoing addresses all questions and concerns raised by the Notice. Please contact us if we can be of any further assistance. ALEXANDER ZESCH Senior Corporate Attorney American Coastal Insurance Corporation E- MAIL: azesch@amcoastal.com TEL: (727) 633-0934
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.

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DFS-10-363
Rev. 10/14/2008