Civil Remedy Notice of Insurer Violations
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Filing Number:     809858
Filing Accepted:  3/6/2025
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Complainant
Last/Business Name *  
DELGADO CANDELARIO   First Name   NITZA
Street Address * 4628 BOSTON STREET
City, State Zip * SEBRING, FL 33872
Email Address * NITZA.DAMARIS@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   DELGADO CANDELARIO   First Name   NITZA
Policy # * ATH1068200 Claim #* AH133415
Attorney
Attorney is Applicable
Last Name* ANGELONE First Name * ANTHONY Initial
Street Address* 777 S HARBOUR ISLAND BLVD, SUITE 950
City, State Zip* TAMPA , FLORIDA 33602
Email Address * AANGELONE@MERLINLAWGROUP.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   AMERICAN TRADITIONS INSURANCE COMPANY
NAIC Company Code 12359
 
Name of individual responsible for violation (if any):* AMERICAN TRADITIONS INSURANCE COMPANY
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unfair Trade Practice
Unsatisfactory Settlement Offer
* 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)(2) A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

HOMEOWNERS DECLARATIONS POLICY NUMBER: ATH1068200 INSURED: Nitza D. Delgado Candelario LOCATION OF PROPERTY: 4628 Boston St, Sebring, FL 33872 Despite numerous written requests by the Insured and/or her representatives, American Traditions Insurance Company (“American Traditions”) has failed and otherwise refused to provide a copy of the Policy. As such, the Insured is unable to reference the specific policy language that is relevant to American Traditions’ violations giving rise to this Civil Remedy Notice. Notwithstanding, based on information and belief, American Traditions’ actions are in violation of the Agreement, Loss Payment, and Loss Settlement provisions 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.

In Florida, the work of adjusting insurance claims engages the Public Trust. American Traditions Insurance Company (“American Traditions”) has breached this duty by its adjustment of its Insured's claim of loss. American Traditions has not attempted in good faith to settle the Insured’s claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward the Insured and with due regard for her interests. American Traditions has done everything possible to delay the claim and refuses to pay the complete covered loss amount due under the Policy. American Traditions is required to properly investigate and adjust claims and cannot place that burden upon the Insured. 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…”). American Traditions has failed to create and implement adequate guidelines for proper investigation and evaluation of claims and for training and supervision of employees resulting in statutory violations set forth above. American Traditions has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s insurance claim for damages based on all information available and has instead ignored relevant and obvious information that evidences that additional payment is required under the policy. Notwithstanding the timely notification of the insurance claim, American Traditions has delayed and/or refused tendering to the Insured all insurance proceeds due and owing under the insurance policy in a timely manner. To date, notwithstanding the Insured’s pleas otherwise, American Traditions has continued to refuse to acknowledge its obligation to tender all monies due and owing the Insured, or assist her in the mitigation of all of her damages. In consideration of the premium paid to it by Nitza D. Delgado Candelario (the “Insured”), American Traditions issued a Homeowners Insurance Policy, Policy no.: ATH1068200 (“the Policy”). Despite written requests, and in violation of Fla. Stat. § 627.4137, American Traditions refuses to provide the Insured and her representatives a copy of the Policy. On or about April 4, 2022, while the Policy was in full force and effect, the Insured suffered a loss at the property located at 4628 Boston St, Sebring, FL 33872 (“the Property”) as a result of a hailstorm. Hail caused damages to the exterior of the home, including the stucco, paint, and windows, as well as significant damages to the interior. Damages resulting from hail to the Property are indisputably covered under the Policy. The Insured timely notified American Traditions of the damages, and American Traditions opened a claim pursuant to the terms and conditions of the Policy; claim number AH133415. In response to the claim for benefits, American Traditions sent an adjuster and representative to investigate and adjust the loss. American Traditions’ adjuster inspected the Property on American Traditions’ behalf. American Traditions adjuster drafted an estimate and a coverage decision was issued by American Traditions based on this estimate; however, despite numerous written requests, American Traditions has refused and otherwise failed to provide the estimate to the Insured’s representatives. The Insured is not in possession of the estimate. Notwithstanding, the estimate issued by American Traditions significantly and wrongfully undervalues the Insured’s damages, which forms a basis for this Civil Remedy Notice. As a reasonably foreseeable consequence of American Traditions’ egregious undervaluation of the Insured’s damages, the Insured retained a public adjuster. The Insured’s public adjuster submitted an estimate on the Insured’s behalf to American Traditions which totaled significantly more than American Traditions valued the Insured’s claim. American Traditions has refused to tender any additional indemnity due and owing from the hail damages. In addition, American Traditions has continuously refused and/or otherwise failed to provide the Insured’s representatives with a copy of the Policy, the original coverage decision letter, or the estimate. The Insured hired Beryl Project Engineering, LLC to perform an inspection and evaluation of the damages to her home; specifically to determine the cause and origin of the damages, as well as the proper repair method. Despite receiving evidence of significantly greater amounts of damages than American Traditions accepted coverage for, and despite receiving a report from the Insured’s engineer, American Traditions refused to adjust the loss further “with” the Insured, in violation of the Loss Settlement provision of the Policy. American Traditions’ adjuster has concluded that his estimate was the correct one, and no further adjustment is warranted. It is believed that American Traditions has taken this position in hopes that the Insured would not pursue litigation to protect her rights and interests under the Policy and instead accept a settlement of significantly less favorable terms than those contemplated by the Policy. To date, and despite the Insured’s pleas for help, American Traditions continues to refuse the payment of all sums due and owing under the Policy for the Insured’s claim. American Traditions’ decision to knowingly undervalue the Insured’s claim and deny full payment to the Insured for the covered damages appears to be a general business practice of implementing a cost-benefit analysis when determining to pay a claim clearly owed or pay claims once they have been litigated, as opposed to settling claims when the obligation to do so would be clear to a carrier acting in good faith and with due regard for the interests of its insureds. American Traditions has a duty to the Insured of honesty, fairness, and transparency. By ignoring the Insured’s pleas for help, failing to consider the estimates and photographs of the damages the Insured submitted, and refusing to issue all sums due and owing under the Policy, American Traditions has breached this duty. American Traditions’ actions, inactions, and opaque investigation of the Insured’s claim furthers the contention that American Traditions has improperly conducted a cost-benefit analysis in determining whether to settle the Insured’ claim now, as a reasonable carrier acting in good faith and with due regards for its insureds’ interest would have in these circumstances, or awaiting for litigation in hopes to settle on less favorable terms than contemplated by the Policy. Since the beginning of the claim, American Traditions has engaged in a pattern of delay and denial that has harmed the Insured. American Traditions has not settled the claim when it could and should have done so had it acted fairly and honestly and has failed to take into account the information and evidence that clearly shows additional payment is owed. Under Florida law, American Traditions has an affirmative, good faith duty to promptly settle reasonable claims. American Traditions has continuously violated this affirmative duty. To date, American Traditions has failed and refused to pay all sums due and owing under the Policy for the Insured’s claim, let alone attempt in good faith to settle the Insureds’ claim. American Traditions violated section 624.155(1)(b)1, Fla. Stat., when it failed to attempt in good faith to settle the 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 her interests. Specifically, had American Traditions acted fairly and honestly toward the Insured and with due regard for her interests, American Traditions would have promptly tendered payment for the full Actual Cash Value of the damages. Further, had American Traditions acted fairly and honestly toward the Insured and with due regard for her interests, American Traditions would not have retained outcome-oriented adjusters with minimal qualifications to be the “final” say on the value of the Insured’s damages. American Traditions violated sections 626.9541(1)(i)(2) and 626.9541(1)(i)(3)(b), Fla. Stat., when it made material misrepresentations to the Insured. American Traditions misrepresented the value of the Insured’s damages. This material misrepresentation was made for the purpose and with the intent of settling the claim on less favorable terms than those provided in, and contemplated by, the Policy. American Traditions violated section 626.9541(1)(i)(3)(a), Fla. Stat., when it failed to adopt and implement standards for the proper investigation of claims. This is evidenced by the fact that American Traditions ignored information and evidence in support the amounts due and owing under the Policy submitted by the Insured. The actions and violations noted above were done intentionally and as the result of American Traditions’ failure to adopt and implement the proper standards for the investigation and adjustment of claims. Overall, American Traditions’ investigation and handling of the claim was inadequate and contrary to its obligations under the insurance policy and Florida law. The Insured has done everything legally requested by American Traditions to date. To cure the violations set forth in this Civil Remedy Notice, American Traditions must now agree to acknowledge its duties and obligations under the law in adjusting the Insured’s claim and tender rightfully owed insurance benefits to return the Insured to her pre-loss condition. The concept of insurance is that insurance is the insurer’s granting of timely and prompt indemnity or security against a contingent loss. Florida law defines “insurance” as a contract whereby one undertakes to indemnify another or pay or allow specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that the policyholder may mitigate his/her damages and to put him/her back into the position they were in prior to loss as quickly as possible. American Traditions breached this duty. The Insured was and still is forced to expend out of pocket monies to submit the insurance claim, e.g., retaining experts, and legal counsel, to force American Traditions to honor its obligations under the insurance policy and to pay all the insurance proceeds due and owing the Insured. American Traditions has refused and/or failed to tender all insurance proceeds to the Insured upon demand. American Traditions’ 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 Insured is wrongful conduct. The Insured contends that American Traditions has financially benefited from its improper withholding of due and owing insurance proceeds by profiting from the “float.” Furthermore, the Insured contends that American Traditions and/or its representatives financially benefit by such unfair trade practices as a part of their general business practices. The Insured contends that American Traditions pressures its agents and/or representatives, through financial incentives, to look for reasons to underpay or deny claims instead of fulfilling their obligations to do the opposite as a general business practice. This notice is given in order to perfect the right to pursue the civil remedy authorized by Florida Statute, including any and all bad faith/extra contractual, should American Traditions fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. The Insured also intends to seek punitive damages against American Traditions as it appears that American Traditions’ violations occur with such frequency as to evidence a general business practice and the violations were willful, wanton, and malicious and were in reckless disregard for the rights of its insureds. While no specific “cure amount” is required for this Civil Remedy Notice to be valid, the Insured will consider the allegations contained herein “cured” if American Traditions: (1) Immediately tenders $208,669.24, less any prior payments and deductible, with no requirement for the policyholder to sign a release. While the Insured is requesting that this be done to “cure” this Civil Remedy Notice, he is willing to consider, and may accept, any reasonable counteroffer. Therefore, if American Traditions disagrees with the requests, the Insured requests that American Traditions make a counteroffer before the end of the “cure period” and provide supporting documentation for any such offer so that they may understand any discrepancies that could exist regarding the estimates.
Comments
User Id Date Added Comment
edwin@bcflalaw.com 05-05-2025 VIA EMAIL: Anthony Angelone, Esq. Merlin Law Group 777 S Harbour Island Blvd Suite 950 Tampa, Florida 33602 aangelone@merlinlawgroup.com RE: Policyholder: Nitza Delgado Candelario Claim Number: AH133415 Policy Number: ATH1068200 CRN Filing Number: 809858 Dear Mr. Angelone: This is the formal response of American Traditions Insurance Company (“American Tradition or ATIC”) to the purported Civil Remedy Notice of Insurer Violations (“Purported Notice”) that was filed on behalf of Nitza Delgado Candelario. The Florida Department of Financial Services accepted the Purported Notice, in form only, on March 6, 2025. The Purported Notice was filed in connection with Nitza Delgado Candelario’s insurance claim for property damage. The Purported Notice names ATIC and alleges claim delay, unsatisfactory settlement offer, and unfair trade practice in violation of Sections 624.155(1)(b)(1), 626.9541(1)(i)(2), 626.9541(1)(i)(3)(a), and 626.9541(1)(i)(3)(b), Florida Statutes. The Purported Notice is a legal nullity for the reasons discussed below. American Traditions reserves all (and waives none) of its rights or defenses, including its right to assert additional deficiencies in the Purported Notice. Under Section 624.155(3), Florida Statutes, a claimant must file a notice with the Florida Department of Financial Services (“the Department”) at least 60 days before filing a Statutory “bad faith” lawsuit. This notice is commonly referred to as a “civil remedy notice” (“CRN”). Section 624.155(3), Florida Statutes sets out five pieces of information which must be included in a CRN: 1. The statutory provision, including the specific language of the statute, which the authorized insurer allegedly violated; 2. The facts and circumstances giving rise to the violation; 3. The name of any individual involved in the violation; 4. Reference to specific policy language that is relevant to the violation, if any. If the person bringing the civil action is a third party claimant, she or he shall not be required to reference the specific policy language if the authorized insurer has not provided a copy of the policy to the third party claimant pursuant to written request; and 5. A statement that the notice is given in order to perfect the right to pursue the civil remedy authorized by this section. The statute also provides that, in addition to these five requirements, the CRN shall be “on a form provided by the [Department] and shall state with specificity . . . such other information as the department may require.” (emphasis added); The Florida Supreme Court has held that Section 624.155, Florida Statutes “must be strictly construed.” Talat Enterprises, Inc. v. Aetna Cas. and Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). Strict construction is appropriate as “this statute is in derogation of the common law.” Id. When interpreting a statute in derogation of the common law, “[a] court will presume that such a statute was not intended to alter the common law other than as clearly and plainly specified in the statute.” Time Ins. Co., Inc. v. Burger, 712 So. 2d 389, 393 (Fla. 1998). Accordingly, such an interpretation would mean that statutory bad faith cases cannot proceed unless the claimant has specifically complied will all statutory requirements. After the promulgation of this statute, the Department created a CRN form: Form DFS-10-363. Form DFS-10-363 lays out 15 requirements: 1. Complainants Name; 2. Complainants Address; 3. Complainants E-mail address; 4. Complainant type (Insured or otherwise); 5. Insured’s Name; 6. Insurance Policy Number; 7. Insurance Claim Number; 8. Attorney’s Name; 9. Attorney’s Address; 10. Attorney’s E-mail Address; 11. Type of Insurer (authorized or otherwise); 12. Name of Insurer; 13. Address of Insurer; 14. Type of Insurance (Commercial Property & Casualty or otherwise); and 15. Reason for Notice. As these requirements are all information required by the Department, according to Section 624.155, Florida Statutes, they each must be stated with specificity. Deficiency #1 Section 624.155(3)(b)(2), Florida Statutes, requires that the CRN state with specificity the facts and circumstances giving rise to the violation. The Purported Notice fails to allege any specific wrongdoing on behalf of ATIC. The Notice contains a recital, albeit inaccurate recital, of the facts of the claim, without any specific facts showing violations of the applicable Florida Statutes. In fact, the supplemental claim was received nearly two years after the alleged date of loss. The claim was reported as a hailstorm with a date of loss of April 4, 2022. After an inspection, ATIC found damage to the roof. Curiously, the Notice alleges there is significant damage to the exterior and interior from the date of loss. In fact, the Insured did not claim any damage to the exterior or interior at the time of the inspection. As a result of the observed damage to the roof, ATIC invoked its Option to Repair and replaced the subject roof. The Insured signed a roof completion survey with Turnkey Roofing. Over two years later, the Insured and/or her representatives claim there is further damage from the hailstorm. There is no correlation to the damages claimed by the Insured with the reported date of loss. Moreover, the Notice claims an engineering report from Beryl Project Engineering was sent to ATIC. ATIC has never received an engineering report from the Insured or her representatives. The majority of the Notice contains boilerplate language and allegations void of any teeth or actual misconduct on behalf of ATIC. Thus, the Purported Notice is invalid for noncompliance with Section 624.155(3)(b)(2), Florida Statutes. This deficiency applies to all allegations in the Purported Notice, including but not limited to claim delay, unsatisfactory settlement offer, and unfair trade practice in violation of Sections 624.155(1)(b)(1), 626.9541(1)(i)(2), 626.9541(1)(i)(3)(a), and 626.9541(1)(i)(3)(b), Florida Statutes. Deficiency #2 Section 624.155(3)(b)(4), Florida Statutes, requires the CRN to reference specific policy language that is relevant to the violation, if any. If the person bringing the civil action is a third-party claimant, she or he shall not be required to reference the specific policy language if the authorized insurer has not provided a copy of the policy to the third-party claimant pursuant to written request. Your client is not a third-party claimant; therefore, the Purported Notice must include specific language from the subject policy that is relevant to the alleged violations. It does not. The Purported Notice makes a vague reference to the “loss payment and loss settlement provision.” There is clearly a lack of specific policy language as the CRN has simply listed general policy provisions without any form of specificity. Additionally, the Notice alleges the policy was never produced to the Insured. However, the Policy was sent by ATIC on or around September 25, 2024. Thus, the Purported Notice is invalid for noncompliance with Section 624.155(3)(b)(4), Florida Statutes. This deficiency applies to all allegations in the Purported Notice, including but not limited to claim delay, unsatisfactory settlement offer, and unfair trade practice in violation of Sections 624.155(1)(b)(1), 626.9541(1)(i)(2), 626.9541(1)(i)(3)(a), and 626.9541(1)(i)(3)(b), Florida Statutes. On March 3, 2021, the Fourth District Court of Appeal issued a relevant opinion in Junior Julien v. United Property and Casualty Insurance Company, 311 So.3d 875 (Fla. 4th DCA 2021). In Julien, the insured appealed the circuit court’s dismissal of his lawsuit against his insurer, finding that the insured’s Civil Remedy Notice (“CRN”) failed to satisfy the statutory requirement that an insured “state with specificity” the policy language and the statutory provisions at issue. In his CRN, the insured cited numerous statutory provisions and listed nearly every provision in the insurance policy, as follows: Coverage A - Dwelling Coverage B - Other Structures Coverage C - Personal Property Coverage D - Loss of Use / Additional Living Expenses All Optional Coverage provisions All Additional Coverage provisions All Coverage(s) provided by Endorsement or Rider The Declarations Page Loss Payment or Settlement provision Duties in Event of Loss Policy provision The insurance policy's definition section The insurance policy's exclusion of coverage provisions All insurance policy provisions that provide coverage to the insured property All policy provisions. On appeal, the Fourth District affirmed the dismissal and agreed with the circuit court that the CRN failed to specify the statutory and policy provisions at issue. Like the CRN in Julien, the Purported Notice fails to “state with specificity” the policy language at issue. Deficiency #3 The Purported Notice fails to list the address of the Insurer, as required by Form DFS-10-363. As the applicable statute requires that all fields on the CRN form must be stated with specificity, and as this statute is strictly construed, the above-referenced deficiency independently nullifies the Purported Notice. This deficiency applies to all allegations in the Purported Notice, including but not limited to claim denial, claim delay, unsatisfactory settlement offer, and unfair trade practice in violation of Sections 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(c), 626.9541(1)(i)(3)(d), and 626.9541(1)(i)(3)(f) Florida Statutes. Deficiency #4 The Purported Notice does not supply necessary information that would allow ATIC to “cure” the alleged violations, as required by Florida law. In Talat Enter., Inc. v. Aetna Cas. and Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000), the Florida Supreme Court stated that alleged statutory violations may be “cured,” in the context of a first-party insurance claim, by payment of “the contractual amount due the insured” within the 60 days following the acceptance of a valid notice. The Purported Notice gives a cure demand of $208,669.24. However, the Insured has presented an estimate from AskAnAdjuster in the amount of $91,180.63 (RCV) and $86,809.19 (ACV). Additionally, the Insured executed a Sworn Proof of Loss in the amount of $90,180.63. It is unclear why there is a difference of over $100,000.00 between the Insured’s estimate and Sworn Proof of Loss and the cure demand. Given that the cure amount is unfounded and unsupported by the estimate and Sworn Proof of Loss presented to ATIC, ATIC is unable to determine the proper amount to cure the alleged violations. Thus, the Purported Notice is invalid. This deficiency applies to all allegations in the Purported Notice, including but not limited to claim denial, claim delay, unsatisfactory settlement offer, and unfair trade practice, supposedly in violation of Sections 624.155(1)(b)(1), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c), 626.9541(1)(i)(3)(f), and 626.9541(1)(i)(3)(g), Florida Statutes. Notwithstanding the deficiencies in, and the invalidity of, the Purported Notice, ATIC denies any wrongdoing. It specifically denies that it violated the insurance policy or Florida Statutes, as alleged in the Purported Notice. Please be advised, by this letter, ATIC neither waives, nor is estopped, from asserting any and all rights it may have in law, or, under the terms of the policy. In fact, ATIC hereby again, expressly, and specifically, reserves all of its rights, without exception or limitation. If you have any questions or concerns with this response, or, regarding any other matter, please contact me in writing. Sincerely, /s/ Matthew J. Morin Matthew J. Morin BICKFORD & CHIDNESE, LLP 1860 N. Avenida Republica de Cuba Tampa, FL 33605 (813) 771-6559 matthew@bcflalaw.com
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