Filing Number: 809465
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| Filing Accepted: 3/4/2025 |
| Last/Business Name
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ZUNIGA AND RODRIGUEZ
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First Name |
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LUIS AND LILIANA |
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| Street Address
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5740 LAKESIDE LANDINGS BOULEVARD |
| 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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ZUNIGA AND RODRIGUEZ |
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First Name |
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LUIS AND LILIANA |
| Policy # * |
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ARK158063 |
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Claim #* |
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1324780-241013 |
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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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ASI PREFERRED 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 13142 |
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| Name of individual responsible for violation (if any):*
TRACY S. BROWN, GLENESHA ANDERSON, JEFF EBERLY
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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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Claim Delay
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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)(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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
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.
***
COVERAGE B – Other Structures
We cover other structures on the "residence premises"
set apart from the dwelling by clear space. This
includes structures connected to the dwelling by only
a fence, utility line, or similar connection.
This coverage does not apply to land, including land
on which the other structures are located.
We do not cover other structures:
1. Used in whole or in part for "business"; or
2. Rented or held for rental to any person not a tenant
of the dwelling, unless used solely as a private
garage.
The limit of liability for this coverage will not be more
than 10% of the limit of liability that applies to Coverage
A. Use of this coverage does not reduce the
Coverage A limit of liability.
***
DEFINITIONS
The following definition is revised:
12. “Fungi” means any type or form of fungus, including mold or mildew, and any mycotoxins, spores, scents, or
by-products produced or released by fungi.
Under Section II, this does not include any fungi that are on, or are contained in, a good or product intended
for consumption.
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.
c. The Each Covered Loss amount shown in the Schedule for this coverage is the most we will pay for
the total of all loss or costs payable under this Additional Coverage resulting from any one covered
loss; and The Policy Aggregate amount shown in the Schedule for this coverage is the most we will pay for the
total of all loss or costs payable under this Additional Coverage for all covered losses, regardless of
the number of locations insured under this endorsement or number of claims-made.
d. If there is a covered loss or damage to covered property, not caused, in whole or in part, by “fungi”,
mold, wet or dry rot, or bacteria, loss payment will not be limited by the terms of this Additional
Coverage, except to the extent that “fungi”, mold, wet or dry rot, or bacteria causes an increase in the
loss. Any such increase in the loss will be subject to the terms of this Additional Coverage.
This coverage does not increase the limit of liability applying to the damaged covered property.
***
3. Loss Settlement. Covered property losses are
settled as follows:
Under Form HO 00 03, item b.(4) is replaced by the
following:
b.(4) We will pay at least the actual cash value of
the damage, less any applicable deductible,
until actual repair is performed. We will pay
any remaining amounts necessary to
perform such repairs as the work is
performed and the expenses are incurred
and according to the provisions of b.(1) and
b.(2) above.
However, if the cost to repair or replace the
damage is both:
(a) Less than 5% of the amount of
insurance in this policy on the building;
and
(b) Less than $2500;
we will settle the loss according to the
provisions of b.(1) and b.(2) above whether
or not actual repair or replacement is
complete. If a total loss, we will pay the
replacement cost amount without deduction
for depreciation.
***
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.
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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.
Insureds, Luis Zuniga and Liliana Rodriguez ("Insureds"), reported a claim for wind damage that occurred on April 26, 2023, while their policy was in full force and effect. ASI Preferred Insurance Corp. assigned Claim No. 1324780-241013 and conducted an inspection on April 12, 2024 through field adjuster Jeff Eberly. After its field inspection, ASI Preferred produced an estimate of only $10,625.56 RCV ($7,090.17 ACV) for roof repairs, despite acknowledging wind damage warranting a full roof replacement in its May 19, 2024 coverage determination letter. However, the insureds' independent rebuild estimate assessed the true cost of the damage at $48,839.64, including: Full roof replacement, Interior damage from water intrusion and a vinyl fence replacement. ASI Preferred’s lowball estimate and failure to properly assess the full extent of damage resulted in an unreasonable underpayment of the claim. Further, ASI Preferred has engaged in inconsistent and unreasonable claims handling by failing to fully indemnify the insureds while selectively issuing partial payments:
- Water Mitigation: The insureds’ water mitigation provider, Restoration Control (RC), submitted an invoice of $6,222.89, but ASI Preferred only issued $3,000, leaving $3,222.89 unpaid without justification.
- Mold Testing: The insureds submitted a mold testing invoice for $2,650, but ASI Preferred arbitrarily paid only $1,200, leaving $1,450 unpaid without justification.
These partial and unexplained payments demonstrate bad faith and unfair claims handling practices, as ASI Preferred failed to provide a clear or rational explanation for these significant underpayments, failed to adjust the loss and failed to fully indemnify the Insureds for the claim.
Additionally, ASI Preferred’s claims handling is contradictory and illogical; the carrier approved coverage for water mitigation, meaning it acknowledged that water damage occurred. However, the carrier denied coverage for necessary interior repairs caused by that same water damage, forcing the insureds to live with unrepaired damage. This failure to fully indemnify the insureds further proves ASI Preferred’s unreasonable and bad-faith conduct. It also appears that ASI Preferred’s field adjuster, Jeff Eberly provided to ASI a photo report that consisted of blurry, low-quality images. Despite the poor documentation, ASI Preferred relied on this inadequate inspection and blurry photographs to issue a grossly undervalued estimate, further demonstrating an improper investigation and failure to adopt reasonable claims handling standards.
Likewise, ASI Preferred’s actions have resulted in unreasonable delays in reaching a fair claims resolution. The insureds’ attorney sent multiple follow-up emails pre-suit requesting a coverage determination (on April 26, 2024, May 7, 2024, and May 20, 2024), but ASI Preferred provided only vague responses and continued to delay payments. These delays have unnecessarily prolonged the claim and forced the insureds to seek legal representation to obtain the benefits rightfully owed under the policy.
Moreover, ASI Preferred denied coverage for fence repairs, claiming the damage was due to “improper installation”—yet provided no engineering report, supporting documentation, or detailed explanation for this denial. This constitutes an arbitrary and baseless denial, in violation of Florida’s Unfair Insurance Trade Practices Act.
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, 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 Insureds have 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 adequate payment, the Insureds continue to be without compensation for the damages sustained at the Insureds’ Property more than a year ago.
By stating the above detailed facts, it is clear that ASI has violated numerous Florida statutes, including but not limited to:
• 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;
To date, ASI has in bad faith failed to provide coverage for all covered damage under the Policy to the Insured. As a direct result of ASI’s underpayment of the claim and breach of the Florida Statutes, the Insureds were forced to seek the help of licensed professionals to assist them, 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 Insureds. The financial detriment caused to the Insureds is a direct result of ASI’s reckless treatment of the claims process. The Insureds submitted supporting documents, 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 Insureds 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 Insureds 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 ($48,839.65 minus the prior rebuild payment); (2) Immediately afford coverage for the repairs to the subject property necessary to put the property back into its pre-loss condition; (3) pay all outstanding Restoration Control invoices in full; (4) Agree to reimburse the Insureds’ reasonable attorneys’ fees and costs for having to become involved to resolve the claim; and (5) Agree to reimburse the Insureds 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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