Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 809588

Filing Accepted: 3/5/2025

Print Filing

Complainant

Last/Business Name *

MOORE

First Name

DENNIS AND FAITH

Street Address *

28005 GROSSETTO WAY

City, State Zip *

BONITA SPRINGS, FL 34135

Email Address *

RPOWERS@KPATTORNEY.COM

Complainant Type: *

Insured

Last/Business Name*		MOORE		First Name		DENNIS AND FAITH
Policy # *		AGH0080923		Claim #*		CHO00175156

Attorney

Attorney is Applicable

Last Name*	POWERS First Name * RAYMOND Initial
Street Address*		1625 HENDRY STREET, 4TH FLOOR
City, State Zip*		FORT MYERS , FL 33901
Email Address *		RPOWERS@KPATTORNEY.COM

Violation

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):* JAMES PEREZ
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Denial
	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.
	626.9541(1)(i)(3)(a)		Failing to adopt and implement standards for the proper investigation of claims.
	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)(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.

* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Loss settlement provision of the policy and Coverage A of the Policy.

* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The carrier has not attempted in good faith to settle the insureds’ claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insureds and with due regard for their interests. The carrier has done everything possible to delay the claim and refuses to pay the complete covered loss amount due under the policy. Furthermore, the carrier is required to properly investigate and adjust claims and cannot place that burden upon the insureds. This was made clear by the appellate court and the Florida Supreme Court in Allstate Indemnity Co. v. Ruiz, 899 So. 2d 1121 (Fla. 2005) (“The Legislature has clearly chosen to impose on the insurance companies a duty to use good faith and fair dealing in processing and litigating the claims of their insureds…”). The carrier was immediately put-on notice of the insured’s Hurricane Ian claim. The carrier initially attempted to low-ball the claim. The insured subsequently submitted a detailed loss package with extensive supporting documentation in the amount of $ 48,154.00 which is needed to restore the property back to its pre-loss condition to the carrier. The carrier is aware of the entire loss package for the claim submitted by the insured and has still failed to take any meaningful ensuing action. Furthermore, since the commencement of the claim the carrier has failed to timely communicate with the insured. The carrier’s failure to respond to the insured’s communications within a timely manner is a direct violation of Florida Statute 627.70131. The carrier’s conduct makes it clear that they are attempting to intentionally downplay the extent of the damage and undervalue the damages in its estimate for the sole benefit of maximizing the company’s profits, thereby placing shareholder’s interests ahead of its insureds’ interests. It is obvious that the carrier is not attempting to pay for the clearly covered damages owed under the policy and is attempting to delay the claim. This intentional delay with the claim has led to direct prejudice of the insured. To date, the carrier has refused to pay the fully covered amount owed under the policy or even to attempt to treat the claim with good-faith. It is clear that the carrier is not treating the insureds with good faith claims conduct; failing to pay a claim clearly owed and acknowledged in writing; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insured; failing to implement proper standards for the adjustment and investigation of claims; not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company’s interests before the insured’s interests; refusing to pay the full amount owed to the insured despite the fact that the damages are covered under the policy; looking for ways to delay full recovery or any recovery to the insured; and refusing to provide coverage for the insured’s loss in a timely manner. The carrier’s actions are in violation of the Loss Settlement provision of the policy, by failing to tender all sums of money due and owing under the policy, as well as 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 her or his interests. 626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims. 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)(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 notify the insured of any additional information necessary for the processing of a claim. This notice is provided in order to perfect a right to pursue the civil remedy authorized by Florida Statute § 624.155. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1) Pay all amounts due and owing to the insured in the amount of $48,154.00 minus any prior payments and minus the applicable deductible for indemnity benefits; and 2) Review and acknowledge receipt of communication made by the insured in regards to the subject claim; 3) Pay the insured’s attorney’s fees and costs as the carrier’s actions have forced them to retain the undersigned; 4) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. Please do not hesitate to contact the undersigned or Quintaysia Goodley at 239-488-6813 if you have any questions or concerns. Sincerely, Raymond D. Powers, Jr. Attorney at Law

Comments

User Id		Date Added		Comment
swozniak@aii.com		03-28-2025		March 28, 2025 Via Electronic Submission Florida Department of Financial Services Consumer Assistance Civil Remedy Section Larson Building 200 E. Gaines Street Tallahassee, Florida 32399-0322 Raymond Powers, Esq. 1625 Hendry Street 4th Floor Fort Myers, Florida 33901 RPowers@KPAttorney.com Re: DFS File No: 809588 Complainants: Dennis and Faith Moore Insureds: Dennis and Faith Moore Policy No: AGH0080923 Insurer: American Integrity Insurance Company of Florida Claim No: CHO-00175156 To Whom It May Concern: We are in receipt of the Civil Remedy Notice (“CRN”) filed by Raymond Powers, Esq. on behalf of the above referenced Complainant and matter. The Florida Department of Financial Services (“DFS”) accepted the CRN on March 5, 2025 and assigned it DFS File No. of 809588. While American Integrity asserts that the subject CRN is legally insufficient and non-compliant with Florida law, American Integrity, without waiving any arguments regarding same, contends that it has at all times performed its obligations under the insurance policy in a prompt and diligent manner with due regard for the interest of its Insureds, Dennis and Faith Moore. The CRN contains a list of purported violations which are alleged to have been committed by American Integrity. In fact, none of the listed violations/allegations have occurred and/or are irrelevant to the alleged violations and American Integrity categorically denies any violations of §624.155 and §626.9541, Fla. Stat., as well as any and all other statutes/regulations/codes/rules contained in the CRN. In addition, American Integrity denies any and all allegations of any kind and/or any inferences therefrom referenced and/or contained in the CRN. American Integrity believes this response adequately addresses the allegations and violations contained within the CRN. Sincerely, Michael S. Sperounes Michael S. Sperounes, Esq. Senior Vice President of Litigation American Integrity Insurance Group cc: Raymond Powers, Esq. via email at: RPowers@KPAttorney.com CRN Response If this document contains an excerpt from an American Integrity Insurance Policy (“the Policy”) it is provided here for informational purposes only. This excerpt is not the official version of the Policy. The official version of the Policy is the policy issued to the Insureds on the policy effective date. In the event there is inconsistency between this document and the Policy, the Policy shall serve as the official version. Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree. F.S. 817.234

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. 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