Civil Remedy Notice of Insurer Violations
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Filing Number:     809514
Filing Accepted:  3/4/2025
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Complainant
Last/Business Name *  
ZUNIGA AND RODRIGUEZ   First Name   LUIS AND LILIANA
Street Address * 5740 LAKESIDE LANDINGS BOULEVARD
City, State Zip * WINTER HAVEN, FL 33881
Email Address * WITHHELD
Complainant Type: * Insured
Insured
Last/Business Name*   ZUNIGA AND RODRIGUEZ   First Name   LUIS AND LILIANA
Policy # * ARK158063 Claim #* 1324788-241013
Attorney
Attorney is Applicable
Last Name* SIGEL First Name * MELANIE Initial
Street Address* 800 E. BROWARD BLVD. STE. 510
City, State Zip* FORT LAUDERDALE , FL 33301
Email Address * MDS@WEKLAW.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):* AUBREY WILLIAMS; TRACY BROWN; JEFF EBERLY; VENITTA ROBINSON
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
* 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)(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.
* 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. *** 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. *** 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. *** 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.
 
* Facts and circumstances giving rise to the violation.
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On March 15, 2024, the insureds reported a water damage claim resulting from a sudden direct physical loss on February 12, 2024. The insurer’s field adjuster grossly undervalued the damages, with ASI issuing a total payment (based on the field adjuster's estimate) of $1,520.77, with a maximum recoverable claim of $3,762.81, despite extensive damage requiring $21,891 in repairs per the insureds' contractor estimate. The insurer’s independent adjuster’s estimate ($6,262.81) failed to account for a full scope of necessary repairs and the replacement of damaged materials rather than minor repairs, and contained a significant underestimation of labor and material costs. The insureds submitted a supplemental request on May 17, 2024, seeking payment for all of their covered damages, but have not received further payment. Additionally, the insureds submitted an estimate for $8,740.51 in mold remediation costs. The insurer’s failure to recognize and pay for this critical remediation creates unnecessary health hazards and exacerbates property damage, in direct contradiction to their obligations under the policy. Further, after the insureds submitted their contractor's rebuild estimate, which established that the carrier's rebuild payment was not sufficient to repair their home and return it to pre-loss condition, the carrier responded on May 31, 2024 that "At this time, we are reviewing your estimate and request for supplemental payment. After review, we will contact your office to discuss our differences and how we can reach an amicable resolution to our client’s claim." However, no further rebuild payments were issued for rebuild and it appears that ASI Preferred did not discuss the differences between the two estimates, conduct a re-inspection, send out a plumber, general contractor, or other specialist, conduct a complete investigation or make any effort to reach an amicable resolution as promised, despite the fact that more than 60 days had passed since the insureds reported the claim. In fact, compounding the delay, the desk adjuster Ms. Williams admitted on June 10, 2024, via email that "the remaining invoices ,mold remediation and mold test, have yet to be reviewed." Again, on August 5 2024, Ms. Williams reiterated "I have not yet reviewed the invoices for mold and mold remediation. I will take a look this week and get back with you." It is not clear if, to date, if the mold remediation documents were ever reviewed. The remediation was certainly not paid, as the carrier failed to fully adjust the claim. By stating the above detailed facts, it is clear that ASI Preferred 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, by failing to respond to the Insured’ public adjuster, and Insured’ counsel with respect to supplemental requests for payments; • 626.9541(1)(i)(3)(f) Failing to promptly provide a reasonable explanation in writing to the Insured and/or their public adjuster of the basis in the insurance policy, in relation to the facts or applicable law, for the offer of a compromise settlement; To date, ASI Preferred has failed to accept and fully perform its obligations under the operable insurance contract. The Insureds have not been paid the necessary, covered insurance proceeds sufficient to return the Property to its pre-loss condition. As a direct result of ASI Preferred’s initial insufficient investigation and handling of the claim, failure to extend coverage for all covered damage and subsequent breaches of not only the policy of insurance, but also Florida Statutes, the Insureds had no choice other than to seek the help of licensed professionals to assist them, including, but not limited to legal counsel. Considering the aforementioned conduct, it is irrefutable that ASI Preferred knowingly and intentionally, and in bad faith delays the claims process in order to further disadvantage the Insured. The financial detriment caused to the Insured is a direct result of ASI Preferred’s dismissive, reckless treatment of the claims process. The Insureds submitted all available requested documents in their custody and control in a timely fashion, made their property available for inspection and submitted additional documentation in support of the insurance proceeds sought under their insurance contract. Nevertheless, ASI Preferred failed to properly assess this information and reach the logical conclusion resulting in its gross mismanagement of the claim. To deny the Insureds the remaining benefits clearly due and owing under the Policy, for which they have time and time again been making premium payments for and after they have satisfied all their obligations is morally and ethically reprehensible, and reeks of Unfair Claims Practice and Bad Faith. Upon information and belief, the above identified actions taken by ASI Preferred, among others, were made so often as to constitute a general business practice, evidencing a motive to enhance ASI Preferred’s profits, and designed to cause a detrimental effect to its policyholders. This notice is given to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should ASI Preferred 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 Preferred must: (1) Immediately tender all proceeds due and owing to the Insured that are fairly owed to the Insured under the insurance policy that would reasonably compensate the Insured in order to put the loss property back to its pre-loss condition; (2) pay all due and owing outstanding Restoration Control invoices in full for services performed due to the loss; (3) Agree to reimburse the Insured' reasonable attorneys’ fees and costs for having to become involved to resolve the claim; (4) 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.
Comments
User Id Date Added Comment
mds@weklaw.com 07-03-2025 This CRN is hereby withdrawn.
lashawna_e_nesbitt@progressive.com 04-28-2025 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 Melanie Sigel, Esq, on April 25, 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.

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DFS-10-363
Rev. 10/14/2008