Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 807362

Filing Accepted: 2/18/2025

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Complainant

Last/Business Name *

NYALANI

First Name

TARISAI

Street Address *

1705 TURTLE HILL RD

City, State Zip *

DELTONA, FL 32725

Email Address *

WITHHELD

Complainant Type: *

Insured

Last/Business Name*		NYALANI		First Name		TARISAI
Policy # *		AGD10620600		Claim #*		CDP-00185516

Attorney

Attorney is Applicable

Last Name*	GUTIERREZ First Name * DANIEL Initial
Street Address*		924 DELANEY AVENUE
City, State Zip*		ORLANDO , FLORIDA 32806
Email Address *		SERVICE@DGPALAW.COM

Violation

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):* TONY JANSSEN
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Delay
	Claim Denial
	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.
	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)(b)		Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
	626.9541(1)(i)(3)(c)		Failing to acknowledge and act promptly upon communications with respect to claims.
	626.9541(1)(i)(3)(d)		Denying claims without conducting reasonable investigations based upon available information.
	626.9541(1)(i)(3)(e)		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.
	626.9541(1)(i)(3)(f)		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.
	626.9541(1)(i)(3)(g)		Failing to promptly notify the insured of any additional information necessary for the processing of a claim.

* 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 Insurer has failed to provide any coverage decision correspondence, therefore, it is unknown whether the Insurer relies on any policy language for their underpayment of the claim. However, they have failed to properly adjust and pay the claim pursuant to the Section I – Conditions, Loss Settlement provision and the Section I – Conditions, Loss Payment provision.

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

On October 9, 2024, the home of Tarisai Nyalani (“Insured”) was damaged by Hurricane Milton. The Insureds reported the damages to American Integrity Insurance Company of Florida (“Insurer”). The Insurer inspected and subsequently sent a small payment to the Insured; however, they failed to send the payment with any correspondence explaining their coverage determination and no estimate was provided to explain the payment. A contractor prepared an estimate of the necessary repairs required from the loss totaling $104,513.87 RCV and $91,117.89 ACV, which is significantly more than the payment received. The Insured’s contractor submitted the estimate via email on November 12, 2024 and advised that no paperwork was received by the Insured with the claim payment. Additionally, the Insured’s contractor provided a copy of their agreement with the Insured, a copy of the permit from the last re-roof, and a link to a virtual tour showing the damages. The Insured’s contractor followed up with the Insurer via email on December 17, 2024 asking whether the information submitted had been reviewed. Nothing further was heard from the Insurer or anyone on their behalf until Tony Janssen of Ryze Claims responded to the Insured’s contractor’s emails and sent a letter rejecting the possibility of an appraisal to resolve the amount of loss dispute. As of the date of this filing, the Insured has still not received an explanation of the lowball claims payment and estimate to explain what coverage has been provided. It is the Insurer’s duty to acknowledge communications within 7 calendar days and acknowledge receipt of such communication pursuant to Florida Statute 627.70131; however, the Insurer has failed to do so. Additionally, Florida Statute 627.70131 states that the Insurer must send the policyholder a copy of any detailed estimate of the amount of the loss within 7 days after the estimate is generated by an insurer’s adjuster. It is clear that the carrier is not treating the Insured with good faith claims conduct by failing to pay a claim clearly owed, not adjusting the claim and evaluating the loss properly, failing to promptly and fairly provide full and prompt indemnity to the Insured, failing to advise of any information necessary for further processing of the claim, failing to provide a reasonable explanation in writing of the basis in the insurance policy in relation to the facts for the denial of the claim, failing to provide an estimate covered repairs, and failing to implement proper standards for the adjustment and investigation of claims by its adjusters. This Insurer is placing the company’s interests before the Insured’s interests when a reasonable carrier in a similar position would have provided full coverage. In particular, it is a business practice of the Insurer to severely lowball storm damage claims with their initial claim adjustment with the intent of effecting settlement of such claims on less favorable terms than those provided by the policy. All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless disregard for the Insured’s rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $91,117.89 ACV (after application of the deductible and reduction for prior payment), and 2.) Pay the statutory interest on the amount of unpaid damages from the date the loss was reported to the date payment is finally made. A copy of this form has been submitted to the FDFS and has been printed out and mailed to the following parties providing them notice of the filing of the Civil Remedy Notice: American Integrity Insurance Company of Florida 5426 Bay Center Drive, Suite 600 Tampa, Florida 33609 Certified Return Receipt #9589 0710 5270 1579 4213 23

Comments

User Id		Date Added		Comment
swozniak@aii.com		03-07-2025		March 7, 2025 Via Electronic Submission Florida Department of Financial Services Consumer Assistance Civil Remedy Section Larson Building 200 E. Gaines Street Tallahassee, FL 32399-0322 Daniel Gutierrez, Esq. 924 Delaney Avenue Orlando, Florida 32806 Service@DGPALaw.com Re: DFS File No: 807362 Complainant: Tarisai Nyalani Insured: Tarisai Nyalani Policy No: AGD10620600 Insurer: American Integrity Insurance Company of Florida Claim No: CDP-00185516 To Whom It May Concern: We are in receipt of the Civil Remedy Notice (“CRN”) filed by Daniel Gutierrez, Esq. on behalf of the above referenced Complainant and matter. The Florida Department of Financial Services (“DFS”) accepted the CRN on February 18, 2025 and assigned it DFS File No. of 807362. While American Integrity asserts that the subject CRN is legally insufficient and non-compliant with Florida law, American Integrity, without waiving any arguments regarding same, contends that it has at all times performed its obligations under the insurance policy in a prompt and diligent manner with due regard for the interest of its Insured, Tarisai Nyalani. The CRN contains a list of purported violations which are alleged to have been committed by American Integrity. In fact, none of the listed violations/allegations have occurred and/or are irrelevant to the alleged violations and American Integrity categorically denies any violations of §624.155 and §626.9541, Fla. Stat., as well as any and all other statutes/regulations/codes/rules contained in the CRN. In addition, American Integrity denies any and all allegations of any kind and/or any inferences therefrom referenced and/or contained in the CRN. American Integrity believes this response adequately addresses the allegations and violations contained within the CRN. Sincerely, Michael S. Sperounes Michael S. Sperounes, Esq. Senior Vice President of Litigation American Integrity Insurance Group cc: Daniel Gutierrez, Esq. via email at: Service@DGPALaw.com CRN Response If this document contains an excerpt from an American Integrity Insurance Policy (“the Policy”) it is provided here for informational purposes only. This excerpt is not the official version of the Policy. The official version of the Policy is the policy issued to the Insureds on the policy effective date. In the event there is inconsistency between this document and the Policy, the Policy shall serve as the official version. Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree. F.S. 817.234

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