Filing Number: 809432
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| Filing Accepted: 3/4/2025 |
| Last/Business Name
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| Street Address
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6354 DUNBARTON ST |
| City, State Zip
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NORTH PORT,
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34291
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| Email Address
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BIGDAVEW545@GMAIL.COM |
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Insured |
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| Last/Business Name* |
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WILKINS |
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First Name |
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DAVID |
| Policy # * |
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AGH0303684 |
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Claim #* |
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CHO-00175905 |
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Attorney is Applicable
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| Last Name* |
INNOCENT
First Name *
KIMBERLY
Initial
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| Street Address* |
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1580 SAWGRASS CORPORATE PARKWAY, SUITE 130 |
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SUNRISE
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FL
33323
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| Email Address * |
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KIMBERLY@INNOCENTLAWFIRM.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 INTEGRITY INSURANCE COMPANY OF FLORIDA
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| Insurer Name* |
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| Street Address* |
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,
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NAIC Company Code 12841 |
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| Name of individual responsible for violation (if any):*
ELI HASTINGS
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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 Denial
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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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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)(b) |
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Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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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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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
COVERAGE A – Dwelling
1. We cover:
The dwelling on the “residence premises,” shown in the Declarations, including attached structures and attached wall-towall carpeting if damage to the dwelling is caused by a covered loss.
Materials and supplies located on or next to the “residence premises” used to construct, alter or repair the dwelling or other structures on the “residence premises.”
SECTION I – PERILS INSURED AGAINST
COVERAGE A – Dwelling and COVERAGE B – Other Structures 1. We insure for sudden and accidental direct loss to property described in COVERAGE A - Dwelling and COVERAGEB- Other Structures only if that loss is a physical loss to covered property.
b. Caused directly or indirectly by:
(6) Any of the following:
(a) Wear and tear, “marring”, deterioration, scratching;
(b) Inherent vice, latent defect, defect or mechanical breakdown;
If any of these cause water damage not otherwise excluded or limited elsewhere in the policy, from plumbing, heating, air conditioning or automatic fire protective sprinkler system or household appliance, we cover loss caused by the water including the cost of tearing out and repairing only that part or portion of a building or only that part or portion of another structure covered under Coverage A or B on the “‘residence premises” necessary to access and repair the system or appliance.
The cost that we will pay for the tear out and repair above is only that cost necessary to access and repair only that part or portion of the system or appliance that caused the covered loss, whether the system or appliance, or any part or portion of the system or appliance, is repairable or not. However, such tear out and replacement coverage only applies if the water or steam causes actual damage to a covered building on the “residence premises.” In the event that additional tear out and repair are required beyond the coverage provided for access and repair in the provision immediately above, we will still pay only for our portion of the access and repair cost required to repair only that portion or only that part of the system or appliance that caused the covered loss as described above.
Under items 1. and 2. any ensuing loss to property described in COVERAGE A - Dwelling and COVERAGE B - Other Structures not excluded or excepted in this policy is covered.
Special Limits of Liability for Matching of Undamaged Property
We will repair or replace undamaged property due to mismatch between undamaged material and new material in adjoining areas if repairs or replacement are reasonable. In determining the extent of the repairs or replacement of items in adjoining areas, we will consider:
1. The cost of repairing or replacing the undamaged portions of the property; and
2. The degree of uniformity that can be achieved without such cost; and the remaining useful life of the undamaged portion; and
3. The remaining useful life of the undamaged portion; and
4. other relevant factors
The total limit of liability for Coverages A and B is 1% of the Coverage A limit of liability for repairs or replacements of any undamaged part of the building or its components solely to match repairs made to damage as a result of a covered loss.This limitation does not increase the Coverage A or Coverage B limits of liability shown on the Declarations page, nor does it apply to damage otherwise limited or excluded.
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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.
In Florida, the work of adjusting insurance claims engages the public trust. American Integrity Insurance Company of Florida (“INSURER”) has breached the public’s trust by its adjustment of David Wilkins and Donna Wilkins’s (“INSUREDS”) claim of loss. INSURER’S principal address is 5426 Bay Center Drive, Suite 600, Tampa, FL 33609. INSURER has failed to create and implement adequate guidelines for the proper investigation and evaluation of claims, claims handling, and for training and supervision of employees resulting in statutory violations as set forth above. INSURER has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the INSUREDS' insurance claim for damages. INSURER has failed to promptly settle the INSUREDS’ insurance claim when the obligation to settle the insurance claim had become reasonably clear. To date, notwithstanding the INSUREDS' pleas otherwise, INSURER has continued to refuse to acknowledge its obligation to conduct a proper investigation, and to tender the full amount of insurance monies due and owing its INSUREDS under the policy.
This claim involves the INSUREDS' property located at 6354 Dunbarton St, North Port, FL 34291, which sustained significant water damage from a plumbing failure on or around August 19, 2024. Specifically, a slab leak occurred which caused water damage and damage to building materials needed to access and repair the leak. INSURER acknowledged the claim and assigned a field adjuster to inspect the loss.
In correspondence dated August 28, 2024, Field Claim Adjuster Eli Hastings acknowledged that a covered loss occurred but misapplied the Special Limits of Liability for Matching of Undamaged Property endorsement, artificially capping the claim at 1% of Coverage A and failing to provide adequate funds to restore the property to its pre-loss condition.
The plain language of the policy states that the 1% limit only applies to repairs made “solely to match” undamaged property. However, the insurer wrongfully extended this cap to repairs necessary for functional restoration, violating the policy’s clear terms.
Mr. Hastings on behalf of the INSURER, misapplied the Special Limits of Liability for Matching of Undamaged Property by:
- Capping coverage at 1% of Coverage A despite the fact that the necessary repairs were not solely for matching undamaged property but were required for functional restoration.
- Inconsistently applying the matching standard, acknowledging the need to replace continuous tile flooring in certain areas while refusing to extend that same reasoning to adjacent, continuous spaces.
- Omitting or underpaying essential repairs required for the property’s structural integrity, including baseboard replacements, necessary cabinetry and countertop modifications, subfloor repairs, and the labor required for proper removal and reinstallation of appliances and fixtures.
This approach violates the plain language of the policy. The Special Limits of Liability for Matching of Undamaged Property endorsement states that the 1% cap only applies to repairs made solely to match undamaged property. It explicitly requires the insurer to consider:
1. The cost of repairing or replacing undamaged portions of the property
2. The degree of uniformity that can be achieved without such cost
3. The remaining useful life of the undamaged portion
4. Other relevant factors
The policy does not grant the insurer the authority to cap coverage at 1% for repairs necessary to restore the property to its pre-loss condition—yet, that is precisely what the insurer has done. By applying the 1% matching cap to necessary structural repairs, the INSURER has ignored these key policy provisions and failed to conduct the proper evaluation required under the policy. This resulted in a wrongful limitation of coverage, leaving the insured with insufficient funds to complete the necessary repairs.
The inconsistent application of the matching standard resulted in a significant underpayment for essential repairs that extend beyond mere cosmetic uniformity. Even where the INSURER acknowledged that certain repairs fell outside of the matching limitation, it still omitted or underfunded necessary work in critical areas such as the kitchen, dining room, and other living spaces where full material replacement was required to ensure structural integrity.
The INSURER's estimate for lower cabinet replacement is insufficient as it does not include countertop modifications. The omission of countertop modifications could result in misalignment and an unusable workspace. The INSURER's estimate also omits essential floor leveling and moisture barrier applications after tile removal, which are industry standards. Omitting these steps could lead to long-term structural issues. Additionally, the INSURER's estimate does not account for adequate labor costs to reinstall appliances and plumbing fixtures to accommodate the changes made, which could result in incomplete or unstable repairs. Furthermore, the INSURER's estimate only allows for a single coat of paint in multiple areas, which is insufficient and will necessitate additional repairs. Finally, the INSURER's estimate does not include sufficient post-construction cleanup, which could compromise indoor air quality.
Rather than properly funding necessary repairs to restore the property to its pre-loss condition, the INSURER has misapplied the 1% Matching Endorsement to wrongfully limit coverage. The repairs omitted or underfunded by the INSURER are not solely for matching undamaged property—they are critical for restoring the property to industry-standard functionality and structural integrity.
The insurer’s proposed repairs fail to comply with the Florida Building Code (FBC), which establishes the minimum construction and safety standards required for structural integrity, durability, and occupant safety. The insurer’s omission or undervaluation of critical repairs violates key provisions of the FBC, resulting in an incomplete and defective scope of work that leaves the property noncompliant with state-mandated standards.
Additionally, the INSURER has acted in bad faith by:
- Misrepresenting the Matching Endorsement to justify capping coverage at 1% of Coverage A, despite the fact that many of the required repairs are essential for functionality—not just cosmetic uniformity.
- Failing to conduct a reasonable investigation by selectively applying continuity standards to certain areas while denying coverage for the same issue in others.
- Arbitrarily determining which repairs are “reasonable” despite clear evidence that full replacement of flooring, cabinetry, and countertops is necessary.
- The insurer’s actions deviate from industry norms and best practices, demonstrating a failure to adjust the claim in good faith.
The insurer’s actions are not only inconsistent with industry standards but also directly contradict the policy language governing matching and reasonable repairs. The Special Limits of Liability for Matching of Undamaged Property does not allow the INSURER to cap coverage at 1% for repairs that are necessary to restore the property to a functional state.
By wrongfully applying this limitation, the INSURER has left the INSUREDS without the resources needed to properly repair their home, exposing them to further deterioration, safety hazards, and financial hardship. The INSURER must immediately reevaluate its adjustment of the claim, issue payment for the necessary repairs, and comply with the policy’s plain language regarding reasonable restoration.
To date, it has been one hundred and ninety seven (197) days since the INSUREDs suffered this loss and the INSURER has failed to fully indemnify its INSUREDS for this loss. The INSUREDS, of course, are very disappointed with INSURER’s poor investigation and nonpayment of the claim. The INSUREDS have retained a public adjuster, Adam Donatelle of Donatelle Claim Advisors, who has prepared an estimate of the INSUREDS' damages, which totals $92,966.38. Therefore, demand is hereby made as follows: Estimate $92,966.38 Less Deductible $1,000.00 Less Prior Payments $10,071.85 TOTAL $81,894.53.
The fundamental concept of insurance is that the insurer will investigate and grant 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 a specified amount or a determinable benefit upon determinable contingencies. Inherent in that definition is the fact that payment must be made timely and promptly so that the insureds may mitigate their damages and be restored to the position they were in prior to the loss as quickly as possible. The insurer has breached this duty.
The insureds were and still are, forced to expend out-of-pocket monies to submit their insurance claim, e.g., retaining a public adjuster, an attorney, and other experts to compel the insurer to honor its obligations under the insurance policy and to pay all the insurance proceeds due and owing to them.
The insurer has refused and/or failed to tender all the insurance proceeds due and owing to the insureds. The insurer’s refusal and/or failure to settle the insurance claim when, under all circumstances, it could have and should have done so had it acted fairly and honestly towards the insureds constitutes wrongful conduct. Furthermore, the insureds contend that the insurer’s adjusters and/or representatives financially benefit from such wrongful conduct. Therefore, to cure the defects outlined in this Civil Remedy Notice, the insurer must tender to the insureds $81,894.53 as set forth above plus interest. The purpose of this notice is to perfect the right to pursue the civil remedy authorized by Fla. Stat. §624.155.
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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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