Civil Remedy Notice of Insurer Violations
Login

Filing Number:     808043
Filing Accepted:  2/24/2025
         Print Filing
Complainant
Last/Business Name *  
JONES   First Name   ANTONIO & LATRESIA
Street Address * 5742 STERLING LAKE DR
City, State Zip * FORT PIERCE, FL 34951
Email Address * JONESFAMILYSMART@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   JONES   First Name   ANTONIO & LATRESIA
Policy # * FLP348510 Claim #* 1378041-241013
Attorney
Attorney is Applicable
Last Name* ALTMAN First Name * ALEXIS Initial
Street Address* 925 SOUTH FEDERAL HIGHWAY, 7TH FLOOR
City, State Zip* BOCA RATON , FL 33432
Email Address * AALTMAN@KPATTORNEY.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   ASI PREFERRED INSURANCE CORP.
NAIC Company Code 13142
 
Name of individual responsible for violation (if any):* WILL MARULANDO
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unsatisfactory Settlement Offer
Unfair Trade Practice
Claim Delay
* 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)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

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

ASI Preferred Insurance Corp (“carrier”) has not attempted, in good faith, to settle the insured’s claim when under all the circumstances it could have and should have done so had it acted fairly and honestly toward its insured and with due regard for their interests. In fact, the carrier has refused to pay the entire appraisal award citing to Florida Statute, thereby preventing the insured from being able to restore his home to its pre-loss conditions. Foremost has engaged in these actions, despite the clear and unequivocal burden discussed in Allstate Indemnity Co. v. Ruiz, 899 So. 2d 1121 (Fla. 2005), wherein the Florida Supreme Court held, “The Legislature has clearly chosen to impose on the insurance companies a duty to use good faith and fair dealing in processing and litigating the claims of their insureds.” The insured put the carrier on notice of the damages to their home after the wind and hailstorm that caused leaking into their home. Thereafter an adjuster was sent out to the home and a letter was sent stating as follows: “In response to the reported claim, we completed our investigation and reviewed the policy. Based on our review, we have found water damage to the interior of your home as a result of wind driven rain through the deteriorated roofing tiles and side wall flashing. Wear, tear and deterioration is specifically excluded from coverage. The resulting water damage is covered. As noted prior, these types of damages are not afforded coverage in your policy.” A payment in the amount of $3,409.28 was made. The claim ended up going to appraisal and an award in the amount of $72,332.86 was entered, significantly larger amount then the first payment that was made. It was clear that the first adjuster either was unqualified or was instructed to misrepresent the amount of damages. However, this deceit continued after the appraisal award was entered. In the award, $7,898.24 was entered by the umpire for mold. Will Marulando the adjuster on the claim refused to pay this amount citing Florida Statute 468.8411 and stating that the area of mold was not more than 10 square feet. It should be noted that Mr. Marulando has never stepped foot in the insureds home. The Carrier and its representative have failed at every step of the process. ASI has failed to adjust and settle the claim in good faith, in accordance with the insurance contract and Florida Statutes. ASI sent out an unqualified adjuster who wrote up an estimate of damages in the amount of $4,904.07. After that the claim went to appraisal where an umpire determined there was $72,332.86 of damages to the home. Rather than paying the full binding award, ASI refused to pay the amount of $7,898.24 allowed for mold. ASI is continuing to conduct its investigation in a manner prejudicial to the insured, failing to complete a thorough and truthful investigation of the claim. Pursuant to Florida Statute §624.155(1)(b)(1), the carrier has failed to settle the claim in good faith when it could and should have done so. The Insured reported the Loss as soon as they were aware of the damage and the Property was presented for inspection. The damage to the Insured’ property was clearly caused by a covered peril under the Policy, but the carrier intentionally turned a blind eye to the damage, low-balled the Claim, and callously delayed the claim process. It was the carrier’s hope that the insured would not seek more after receiving the payment of $3,409.28. The carrier has not shown a good faith intention to pay what was owed but rather has underpaid the claim for financial gain and profit. Pursuant to Florida Statute §626.9541(1)(i)(3)(a), American has a duty to adopt and implement standards for the proper investigation of claims. The first adjuster who went out to the property wrote up an estimate in the amount of $4,904.70 and then an umpire entered a binding appraisal award of $72,332.86. It is clear that the first adjuster sent out displayed a lack of knowledge, improper training, and/or intent to underpay the claim. Additionally, Will Marulando is not refusing to pay the mold award of $7,898.24, which he states the public adjuster sneaked into the award. However, this mold amount was awarded in a binding appraisal award and Mr. Marulando should not take out personal grievances with a public adjuster against the insureds. In Florida, the work of adjusting insurance claims engages the public trust. Universal has breached this trust in the improper adjustment of the Insured’s claim. Though the Insured sustained a loss that, pursuant to the terms of his policy, should be covered by the policy of insurance, Universal refused to properly indemnify the Insured for his loss in direct contradiction of the terms of the Policy and Florida Statutes. From the very start, ASI did not act in good faith during its adjustment of the Claim as evidenced by the violations noted above. This notice is provided in order to perfect a right to pursue the civil remedy authorized by Florida Statute §624.155. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1) Pay all amounts due and owing to the insured in the amount of $7,898.24 minus any applicable deductibles, for indemnity benefits; 2) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. Should you have any questions please do not hesitate to contact me at 561-892-9988. We appreciate your attention to this matter. Alexis E. Altman, Esq.
Comments
User Id Date Added Comment
lashawna_e_nesbitt@progressive.com 02-26-2025 While ASI Preferred Insurance Corp believes that the Civil Remedy Notice fails to comply with the requirements of Florida Statute §624.155 and Florida Case law, it has responded to the notice in writing to Alexis Altman, on February 26, 2025.
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