Filing Number: 809282
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| Filing Accepted: 3/3/2025 |
| Last/Business Name
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ABREU
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First Name |
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FRANCISCO |
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| Street Address
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316 ALEXZANDER WAY |
| City, State Zip
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WINTER HAVEN,
FL
33881
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| Email Address
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WITHHELD |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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ABREU |
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First Name |
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FRANCISCO |
| Policy # * |
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FLA438137 |
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Claim #* |
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1264887-231001 |
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Attorney is Applicable
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| Last Name* |
SIGEL
First Name *
MELANIE
Initial
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| Street Address* |
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800 E. BROWARD BLVD. STE. 510 |
| City, State Zip* |
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FORT LAUDERDALE
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FL
33301
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| Email Address * |
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MDS@WEKLAW.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 STRATEGIC INSURANCE CORP.
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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 10872 |
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| Name of individual responsible for violation (if any):*
ASHLEY WEISS, ARLEY LONDONDO, CASH CUTLER
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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 Delay
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Unfair Trade Practice
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Unsatisfactory Settlement Offer
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Other
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Failure to Properly Investigate Claim and with Due Regard to Insured’s Interests
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Statutory provision(s) which the insurer allegedly violated.
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| 624.155(1)(b)(1) |
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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.
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| 624.155(1)(b)(3) |
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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.
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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)(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)(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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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 – PERILS INSURED AGAINST
COVERAGE A – DWELLING and COVERAGE B –
OTHER STRUCTURES
We insure against risk of direct loss to property described
in Coverages A and B only if that loss is a
physical loss to property.
***
SECTION I – CONDITIONS
Under 3. Loss Settlement, item b.(1) is deleted and replaced by the following:
(1) If, at the time of loss, the amount of insurance in this policy on the damaged building is
80% or more of the full replacement cost of the building immediately before the loss, we
will pay the cost to repair or replace, after application of deductible and without deduction
for depreciation, but not more than the least of the following amounts:
(a) For buildings covered under Coverage B, the limit of liability shown on the
Declarations Page; for buildings covered under Coverage A, the limit of liability
shown on the Declarations Page, increased by 20%.
(b) The replacement cost of that part of the building damaged for equivalent construction
and use on the same premises.
(c) The amount actually and necessarily spent to repair or replace the damaged building.
This coverage is intended to protect you from unforeseen increases in construction costs.
We will not increase the stated limit to cover loss caused by ordinances or laws that
regulate the construction, repair, or demolition of this property.
***
10. Loss Payment. We will adjust all losses with you.
We will pay you unless some other person is
named in the policy or is legally entitled to receive
payment. Loss will be payable upon the earlier of
the following:
a. 20 days after:
(1) We receive your proof of loss and reach
written agreement with you; or
(2) Written executed mediation settlement
with you according to the terms of the
written mediation settlement; or
b. 60 days after we receive your proof of loss
and:
(1) There is an entry of a final judgment or, in
the case of an appeal from such
judgment, within 60 days from and after
the affirmance of the same by the
appellate court; or
(2) There is a filing of an appraisal award or,
in the case of an appeal from such award,
within 60 days from and after the
affirmance of the same by the appellate
court; or
c. Within 90 days after we receive notice from
you of an initial, reopened, or supplemental
property insurance claim, we shall pay or deny
such claim or a portion of the claim unless the
failure to do so is caused by factors beyond
our control which reasonably prevent such
payment. However, failure to pay or deny
within 90 days does not form the sole basis for
a private cause of action.
Any payment made by us shall not constitute a waiver
of our rights within the policy.
***
SECTION I-PROPERTY COVERAGES
ADDITIONAL COVERAGES
The following Additional Coverage is added:
11. “Fungi”, Mold, Wet Or Dry Rot, Or Bacteria
a. We will pay up to the amount stated in the Declarations for Limit of Liability for “Fungi” Coverage for:
(1) The total of all loss payable under Section I – Property Coverages caused by or resulting directly
or indirectly from “fungi”, mold, wet or dry rot, or bacteria;
(2) The cost to remove “fungi”, mold, wet or dry rot, or bacteria from property covered under Section I
- Property Coverages.
(3) The cost to tear out and replace any part of the building or other covered property as needed to
gain access to the “fungi”, mold, wet or dry rot, or bacteria; and
(4) The cost of testing of air or property to confirm the absence, presence or level of “fungi”, mold, wet
or dry rot, or bacteria whether performed prior to, during or after removal, repair, restoration or
replacement. The cost of such testing will be provided only to the extent that there is a reason to
believe that there is the presence of “fungi”, mold, wet or dry rot, or bacteria.
b. The coverage described in a. only applies when such loss or costs are a result of a Peril Insured
Against that occurs during the policy period and only if all reasonable means were used to save and
preserve the property from further damage at and after the time the Peril Insured Against occurred.
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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.
On August 31, 2023, while the policy was in full force and effect, the insured property located at 316 Alexzander Way, Winter Haven, FL 33881, sustained damage as a result of Hurricane Idalia. The insured promptly reported the loss to American Strategic Insurance Corp. (ASI), and a claim was opened under Claim No. 1264887-231001. Despite having unfettered access to inspect the home, and inspecting twice in connection with the claim, and having numerous documents submitted by the insured and/or his representatives in support of the loss, ASI failed to issue a coverage determination until December 12, 2023 — over 90 days after the claim was reported, violating both Florida Statute §627.70131 and the policy's Loss Payment provision.
Further, ASI failed to issue any funds directly to the insured until January 23, 2024, nearly five months after the loss occurred. The only payment issued to the insured was for $2,993.02, which was based on an outdated and inadequate estimate that did not account for full repairs. Even if ASI disputed the full repair costs, it had a duty to issue partial, undisputed amounts to the insured much earlier. The five-month delay in issuing any repair funds violates Florida’s Unfair Insurance Trade Practices Act under §626.9541(1)(i).
Additionally, instead of issuing claim payments to the insured, ASI diverted the entire initial payment of $4,778.03, issued in December 2023, to the mitigation and tarp company, Restoration Control, leaving the insured without any funds for actual roof or interior repairs. The carrier's estimate attached to the coverage/payment letter listed roof repairs, but per the payment/coverage letter, and the check issued, the payment was issued only for Restoration Control's services. ASI misled the insured about the scope of the payment, and did not issue any payment for roof repairs to the insured in December 2023 despite the line items in its own estimate for same.
Moreover, ASI’s final estimate grossly undervalued the loss at $11,177.19, despite the insured submitting a rebuild estimate of $46,121.25, as well as numerous vendor invoices from Restoration Control, which largely remain unpaid.
To the extent ASI has made additional payments to Restoration Control, it has not informed the insureds of same.
After being provided evidence (including photos, an estimate/proposal, and immediate access to the property upon discovery) showing that damage from this wind event occurred at the property that will require extensive repairs, specifically a full roof replacement, interior repairs, mold remediation, water mitigation and tarping, ASI continues to refuse to extend coverage in order to complete these repairs. ASI also has the ability to determine the true costs needed to fully repair this property but has not attempted to discover this information and has instead forced the Insureds to pursue legal recourses for the money due and owing under the contract of insurance. ASI is trying to avoid finding any further information that would increase the amount of coverage available on this claim despite being aware that additional costs would need to be incurred by the Insured to repair their home.
The Insured has fully complied with all applicable Policy provisions requiring cooperation with the investigation; however, ASI has unequivocally failed to properly adjust this Claim. ASI has not attempted, in good faith, to settle this claim when, under the circumstances, it could and should have done so had it acted fairly and honestly toward the policyholder and with due regard to the policyholder's interests. Rather, ASI has acted with only its own profit and shareholders in mind.
As a direct consequence of ASI’s failure to adjust this Loss in good faith and make any payment, the Insured continues to be without adequate compensation for the damages sustained at the Insured's Property more than a year ago.
By stating the above detailed facts, it is clear that ASI has violated the following Florida statutes:
• 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 their interest.
• 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;
• 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.
• 626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
To date, ASI has in bad faith failed to provide coverage under the Policy to the Insured. As a direct result of ASI’s denial of the Claim and breach of the Florida Statutes, the Insured was forced to seek the help of licensed professionals to assist him, including legal counsel. Due to the amount of time that has passed since the date of loss and the information discussed above, there is irrefutable evidence that ASI knowingly and intentionally, and in bad faith delayed the settlement process in order to further disadvantage the Insured. The financial detriment caused to the Insureds is a direct result of ASI’s reckless treatment of the claims process. The Insured submitted all documents requested in a timely fashion, made the property available for inspection after the discovery of the loss, submitted an estimate, and satisfied all requests. However, ASI failed at every step of the process to adequately establish or identify the basis of its gross mismanagement of the claim.
To deny the Insured the benefits clearly due and owing under the Policy, for which they been making premium payments for and after they have satisfied all of his obligations is morally and ethically reprehensible and reeks of Unfair Claims Practice and Bad Faith. Upon information and belief, the aforementioned actions complained of, among others, were made by ASI so often as to constitute a general business practice, evidencing a motive to enhance ASI’s profits, and designed to cause a detrimental effect to its policyholders. The above clearly depicts that ASI adjusted this claim in bad faith, continue to act in bad faith towards its Insured and that ASI is in direct violation of Unfair Claims Practices.
This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should ASI fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, ASI must: (1) Immediately tender all proceeds due and owing to the Insured that are fairly owed under the insurance policy that would reasonably compensate them in order to put the loss property back to its pre-loss condition ($46,121.25 in new money minus the prior payment issued directly to the insureds); (2) pay all outstanding invoices to Restoration Control for services performed in connection with the claim, in full; (3) Immediately afford coverage for the repairs to the subject property necessary to put the property back into its pre-loss condition (4) Agree to reimburse the Insured's reasonable attorneys’ fees and costs for having to become involved to resolve the claim; and (5) Agree to reimburse the Insured for interest on the amount of benefits that was found to be due and owing to the Insured, relating back to the date of loss.
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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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