Filing Number: 808575
|
| Filing Accepted: 2/26/2025 |
| Last/Business Name
*
|
|
|
| Street Address
*
|
|
1713 NW 29TH STREET |
| City, State Zip
*
|
|
CAPE CORAL,
FL
33993
|
| Email Address
*
|
|
JAMES.GEORGE55@AOL.COM |
| Complainant Type:
*
|
|
Insured |
|
| Last/Business Name* |
|
GEORGE |
|
First Name |
|
JAMES |
| Policy # * |
|
AGH0234823 |
|
Claim #* |
|
CHO-00181871 |
|
Attorney is Applicable
|
| Last Name* |
QUINTERO
First Name *
MICHAEL
Initial
D
|
| Street Address* |
|
P.O. BOX 60507 |
| City, State Zip* |
|
NASHVILLE
,
TENNESSEE
37206
|
| Email Address * |
|
MQUINTERO@QUINTEROFIRM.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 FIELD ADJUSTER OR DESK EXAMINER WHO HAS HANDLED THE CLAIMS FILE.
|
| Type of Insurance
*
Residential Property & Casualty
|
|
|
| Reason for Notice
*
|
|
|
Claim Delay
|
|
|
Unsatisfactory Settlement Offer
|
|
|
Claim Denial
|
|
|
*
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)(2) |
|
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.
|
|
| 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)(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.
|
|
*
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 1 - Property Coverages – Coverage A – Dwelling
Section 1 – Perils Insured Against – Coverage A – Dwelling and Coverage B – Other Structures
Section 1- Conditions – Loss Settlement
Section 1 – Conditions – Loss Payment
|
| |
*
Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
On or about October 9, 2024, James George (“Insured”), suffered damage to his property located at 1713 NW 29th Street, Cape Coral, Florida 33993-8459 caused by Hurricane Milton. Hurricane Milton was the second-most intense Atlantic hurricane ever recorded over the Gulf of Mexico.
Hurricane Milton made landfall as a Category 3 hurricane with winds of 120 mph and the Insured’s property was directly in the storm’s path. Prior to the storm, The National Weather Service issued a hurricane warning for the Cape Coral area stating that Hurricane Milton “POSES AN EXTREMELY SERIOUS THREAT TO FLORIDA” and that Milton was expected to make landfall on the gulf coast of Florida, which specifically included Cape Coral, as a “DANGEROUS MAJOR HURRICANE”. Threat to life and property was certain and widespread damage to the area occurred.
Prior to the loss, American Integrity Insurance Company of Florida, (“AIIC”) issued a policy of insurance (policy no. AGH0234823) for the Insured’s property. Said policy, which was in full force and effect on the date of loss, afforded coverage for damage caused by a hurricane including damage from wind and wind-driven rain. AIIC was immediately notified of the loss by the Insured and AIIC retained a third-party adjuster, OtterSolv, to adjust the loss. However once the claim was opened, AIIC and their third-party adjuster, OtterSolv, did not to make contact with the Insured to discuss the damages or to schedule an inspection of the property. The Insured made repeated calls to AIIC regarding the status of his claim but did not hear back from anyone at AIIC or at OtterSolv. Due to this lack of communication by AIIC regarding the Insured’s claim, Insured was forced to retain legal counsel.
On October 22, 2024, Insured’s counsel reached out to the assigned third-party adjuster, “Williams”, with the contact information that had been previously provided. Insured’s counsel was unable to make contact and left a voicemail for the adjuster. Insured’s counsel did not receive a response. On October 29, 2024, Insured’s counsel contacted AIIC and confirmed the contact information for the adjuster “Williams”. AIIC also provide an email. Insured’s counsel once again reached out to the assigned adjuster and again was not able to make contact. Insured’s counsel left another voicemail as well as emailed a copy of their Letter of Representation. Insured’s counsel did not receive a response.
On November 3, 2024, a Sunday, Insured was contacted by a separate adjuster, Ellen Douglas, regarding doing an inspection that same day. Insured provided Ms. Douglas with his counsel’s contact information in order to discuss this last minute, uncoordinated inspection. Ms. Douglas did not reach out to Insured’s counsel. When Insured’s counsel reached out to Ms. Douglas to figure out why they were contacting the Insured directly on a Sunday to perform a last minute, uncoordinated same-day inspection, Ms. Douglas stated that she was “leaving the area” and “the claim has been re-assigned a bunch of times but its going to be re-assigned again.”
On November 6, 2024, Adjuster Williams finally contacted Insured’s counsel to schedule an inspection. The inspection of Insured’s property finally took place on November 11, 2024—over an entire month after Hurricane Milton.
On November 25, 2024, Insured received a check in the amount of $6,811.66 which accounted for Insured’s $7,380.00 deductible. The check was only made out to the Insured and Insured’s mortgage company despite Insured’s request that all checks include Insured’s counsel. No estimate was provided to Insured or Insured’s counsel reflecting the basis of this payment. No call from adjuster Williams was received regarding this payment or its estimate.
On November 26, 2024, Insured’s counsel attempted to contact Adjuster Williams by phone and email regarding why the check was sent directly to the Insured when they were specifically instructed by Insured’s counsel to direct all communication and payments to Insured’s counsel. Insured’s counsel was also trying to obtain AIIC’s estimate for their undisputed payment as none was provided. No response was received.
On December 3, 2024, Insured’s counsel again attempted to contact Adjuster Williams by phone and email regarding the estimate, however, no response was received.
On December 6, 2024, Insured’s counsel once again attempted to contact Adjuster Williams by phone and email regarding the estimate, however, once again, no response was received.
That same day, Insured’s counsel reached out to AIIC directly to determine why their adjuster was not communicating with the Insured and his counsel. It was at that time that AIIC informed Insured that the claim was with a new adjuster, Demi Weaver. Prior to that call, AIIC made no attempt to inform the Insured or Insured’s counsel that the claim had been once again re-assigned to a new adjuster. This information was only acquired after pro-actively calling AIIC after repeated attempts to contact the previous adjuster went unanswered.
Insured’s counsel attempted to contact the new adjuster, Demi Weaver, by phone and email, regarding the estimate, the check and the communication issues. Insured’s counsel forwarded his previous emails to the previous adjuster to the new adjuster. It was at this time, that Insured’s counsel finally received a response. On December 10, 2024, Adjuster Weaver finally provided a copy of the estimate to Insured’s counsel. It reflected that AIIC valued the claim at $14,191.66 ACV.
On January 9, 2025, Insured provided AIIC with its estimate for repairs for damages he sustained to his property as a result of Hurricane Milton. The estimate totaled $42,788.65 and included a roof replacement and interior repairs.
On February 6, 2025, AIIC stated they were issuing a supplemental payment of $6,304.16 and provided an estimate valuing the loss at $20,495.82—an amount that is still approximately $22,000.00 less than the Insured’s estimate. AIIC failed to provide any meaningful information justifying their refusal to tender the full amount owed. In their supplemental payment letter dated February 4, 2025, AIIC stated that they “identified discrepancies in the estimate that should be re-examined” citing very generally that, “the roofing and interior costs seem to be overestimated”. Refusing to pay benefits because something “seems” to be overestimated is not an appropriate or objective adjusting standard and is an admission that AIIC is withholding benefits because they simply don’t like the amount. In any event, AIIC did not provide any evidence to support its contention that the Insured’s estimate was “overestimated”. Instead AIIC requested that we provide supporting documentation justifying our estimate, even though AIIC did not provide one shred of supporting documentation to justify their refusal to pay benefits.
In response, Insured provided AIIC with a detailed photo report of the damages to support Insured’s estimate. On February 21, 2025, AIIC’s adjuster responded by stating that AIIC still disagreed with the estimated damages and refused to engage in any kind of meaningful discussion to resolve the unpaid balance.
AIIC has violated Fla. Stat. 624.155(1)(b)(1) in their dealings with Insured by failing to attempt to settle Insured’s claims when it could and should have done so had it acted fairly and honestly towards insured. Here, AIIC failed to settle Insured’s claim because AIIC knows, or should know, that Insured’s claim qualifies for additional payment pursuant to the Policy and the law, yet AIIC has withheld the same and has refused to engage the Insured in meaningful settlement negotiations. Insured’s estimate contemplates a full roof replacement along with interior repairs. AIIC’s estimate also contemplates coverage for a full roof replacement and interior repairs. AIIC has already found coverage for the claim but is choosing to nickel and dime the Insured on the amount and the method of repairs in an attempt to escape its obligations under the policy. This is evidence that AIIC is not acting fairly and honestly towards its Insured with due regard for Insured’s interests.
Furthermore, as AIIC knows, or should know, it has failed to properly adjuster the Loss, and Fla. Stat. 624.155(1)(b)(1) requires AIIC to engage the Insured in meaningful settlement discussions. AIIC’s failure to engage in meaningful settlement discussions has resulted in conduct tantamount to Claim Denial and Claim Delay and is ultimately an Unsatisfactory Settlement Offer. Further, the failure is a quintessential Unfair Trade Practice, by which AIIC delays engaging in resolution to frustrate, annoy, and encumber its Insured with additional costs and delay to obtain the coverage acquired through the Policy.
Additionally, AIIC has violated Fla. Stat. 626.9541(1)(i)(3)(c) by failing to acknowledge and act promptly upon communications with respect to claims. This is evidenced by (1) AIIC’s failure to promptly communicate with the Insured when he first opened even after he called AIIC multiple times; (2) AIIC’s failure to respond to multiple calls and emails from Insured’s counsel between October 22, 2024 and December 6, 2024; and attempting to conduct a last minute, same day, uncoordinated inspection of the property—among other conduct.
AIIC also failed 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 pursuant to Fla. Stat. 626.9541(1)(i)(3)(f). AIIC has not provided any information as to why it is not paying the full amount of Insured’s estimate other than that the estimate “seems” to be “overestimated”. This is not a reasonable explanation as it fails to provide any objective facts or information that would explain why Insured’s estimate is “overestimated” This is merely a vague statement intended to delay and frustrate the claim process.
Pursuant to Fla. Stat. (d) 626.9541(1)(i), an AIIC must not engage in unfair claim settlement practices. Here, AIIC has engaged in unfair settlement practices by failing to properly and timely adjust the Loss which necessitated Insured obtaining representation to assist Insured in handling of the claim. AIIC’s conduct such as the constant shifting of adjusters, attempting to conduct an uncoordinated, last-minute, same-day, inspection on a Sunday and the repeated lack of communication is an attempt to artificially delay the claim and evidence of unfair claim settlement practices.
Furthermore, AIIC fails to properly adjust losses because it knows that if an insured challenges AIIC’s decision, the law now requires, through NOITL requirements, that Insured adjust Insured’s own loss, at Insured’s own expense, and that the policy and the NOITL law obligate Insured to cooperate with requests for alternative dispute resolution and must bear the costs of representation in such proceedings. In furtherance of that practice, AIIC will most likely engage in such Unfair Claim Settlement Practices here, either demanding a presuit mediation or appraisal, with the sole intention of delays in engaging in resolution to frustrate, annoy, and encumber its Insured with additional costs and delay to obtain the coverage acquired through the Policy. The conduct of using well-intended methods of alternative dispute resolution (appraisal and mediation), as a means of claim delay, is pattern and practice for AIIC. It is part of its scheme to delay correct claim payments as long as possible, if forever, to pad its own bottom line, and to punish any Insured which attempts to uncover AIIC’s bad faith conduct.
It is clear that AIIC has not acted honestly or fairly towards it’s Insured. AIIC and its adjusters have misrepresented the scope and cause of damages to the residence and failed to acknowledge obvious hurricane damage to the property. As is the case here, it has become a general business practice of AIIC to not implement proper claims handling procedures, to hire consultants that routinely ignore or intentionally misidentify relevant evidence, and to not settle claims in good faith when under all circumstances it should have. AIIC regularly undervalues claims in order to avoid issuing payment on losses that it knows are covered under the policy.
In order to cure this Civil Remedy Notice, AIIC must tender the balance owed to Insured for repairs in the amount of $22,292.83. The payment should be sent directly to the Insured’s attorney, Michael D. Quintero, Esq., P.O. Box 60507, Nashville, TN 37206. this notice is given in order to perfect the rights of the Insured to pursue civil remedies authorized by Section 624.155, Florida Statutes.
|
|
|
*
|
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
|