Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 811941

Filing Accepted: 3/19/2025

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Complainant

Last/Business Name *

CAPIZZI

First Name

CHRISTOPHER & BRIDGET

Street Address *

2796 STAR CORAL LANE

City, State Zip *

NEW SMYRNA BEACH, FL 32168

Email Address *

WITHHELD

Complainant Type: *

Insured

Last/Business Name*		CAPIZZI		First Name		CHRISTOPHER & BRIDGET
Policy # *		FLA375469		Claim #*		1435000-241001

Attorney

Attorney is Applicable

Last Name*	WALLACE First Name * BLAKE Initial
Street Address*		8635 W. HILLSBOROUGH AVE., STE. 401
City, State Zip*		TAMPA , FLORIDA 33615
Email Address *		BLAKE@KLINGLAW.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		AMERICAN STRATEGIC INSURANCE CORP.
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 10872

Name of individual responsible for violation (if any):* CIERA OATES
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.
	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.

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

The specific policy provisions the carrier violated are the loss payment provision, the loss settlement provision, and the coverage provisions. Specifically, the loss payment provision states “we will adjust all losses with you.” Yet, the carrier did not consult the homeowner in deciding who would investigate the cause or amount of damages, and what the ultimate payment should be. On February 5, 2025, a certified copy of the policy was requested by counsel of the insured. To date of the filing of this civil remedy notice the policy has not been provided by the carrier. This is in violation of F.S. §626.9541(1)(i)(3)(c) as the carrier has failed to acknowledge and act promptly upon communications with respect to claims. F.S. §627.70131(1)(a) provides that upon an insurer’s receiving a communication with respect to a claim, the insurer shall, within 7 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer.

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

March 19, 2025 Sent Via Email/Portal AMERICAN STRATEGIC INSURANCE CORP. claims@email.americanstrategic.com RE: Insureds : Christopher Capizzi & Bridget Maloney Capizzi (hereinafter, “Insureds”) Policy # : FLA375469 Claim # : 1435000-241001 Property Address : 2796 Star Coral Ln., New Smyrna Beach, FL, 32168-5320 Persons most knowledgeable of facts giving rise to the Violations: Ciera Oates Dear AMERICAN STRATEGIC INSURANCE COMPANY: Please find enclosed the civil remedy notice filed for the above referenced claim. This notice is given in order to perfect the right to pursue the civil remedy authorized by Florida Statute §624.155 As discussed in greater detail in the notice, the carrier has not attempted in good faith to settle the claimant’s claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its claimant and with due regard for its interests. The carrier has done everything possible to delay the claim and refuses to provide any sort of status of the claim. Furthermore, the carrier 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 insured…”). The carrier was put on notice of the insured’s Hurricane Milton claim on October 13, 2024. Since the commencement of the claim the carrier has failed to timely communicate with the insured. It is obvious that the carrier is not attempting to pay for the clearly covered damages owed under the policy. The carrier assigned Ciera Oates, who is neither an engineer nor a registered contractor, to inspect the loss and write an estimate of the damages to the property. On October 25, 2024, the carrier made the unilateral determinations that the damages that were covered would total to the amount of $56,924.34 for repairs after the application of the deductible. In reaching those conclusions, American Strategic failed to adopt and implement standards for the proper investigation of claims. There was no explanation whatsoever as to how American Strategic determined the valuation of the damage caused by the covered peril. Moreover, the carrier’s failure to assign a qualified and experienced engineer further violates F.S. §626.9541(1)(i)(3)(a) as the carrier failed to adopt and implement standards for the proper investigation of claims. Florida Statute 627.70131(3)(e) requires the carrier to provide an estimate within 7 days after the estimate is generated by the insurer’s adjuster. However, it is clear that American Strategic took ten (10) days from when the estimate was entered to provide the copy to the insured with the coverage determination. The insurer must send the policyholder a copy of any detailed estimate of the amount of the loss within 7 days after the estimate is generated by an insurer’s adjuster. The carrier’s failure to produce the estimate generated by Ms. Oates, in a timely manner is in further violation of F.S. §626.9541(1)(i)(3)(c) as the carrier failed to acknowledge and act promptly upon communications with respect to the claim. The insured has been compelled to obtain an independently adjusted estimate totaling in the amount of $39,645.13 that would be needed to repair the property back to its pre-loss condition. The insured has complied with all the carrier’s requests to date. The carrier has still refused to pay the fully covered amount owed under the policy, instead electing to stand by its unilaterally determined deficient valuation of the loss. This is in violation of F.S. 624.155(1)(b)(1) and 624.155(1)(b)(3) as the carrier is clearly placing the company’s interests before the claimant’s interests and not attempting in good faith to settle claims. It is clear that the carrier is not treating the claimant with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the claimant; failing to implement proper standards for the adjustment and investigation of claims and placing the company’s interests before the claimant’s interests; not training, supervising or managing adjusters properly so that prompt and full payments are made; 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 claimant’s loss in a timely manner. The Carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(d), 627.4137(1), and Fla. Stat. §627.70131. The actions taken by American Strategic in the handling/adjustment of the insured’s claim were willful, wanton, malicious, and in reckless disregard for the rights of any insureds and occur with such frequency as to indicate a general business practice, and further are in violation of Florida Statutes §624.155 and F.S. §626.954. Indeed, when performing a search on the Florida Department of Financial Services website’s Civil Remedy Notice of Insurer Violation page the results of searches of violations of the statutes referenced herein by the carrier returned the following results thereby indicating that the number of times they occur rise to the level of a general business practice, and warrant punitive damages: §624.155(1)(b)(1) = 1,159 §624.155(1)(b)(3) = 789 §626.9541(1)(i)(3)(a) = 1,104 §626.9541(1)(i)(3)(c) = 756 Based upon the above-referenced acts and omissions, the carrier has breached the insurance contract by failing to pay the amount due to the insured, by denying coverage which existed under the insurance contract with the insured in the instant dispute, by failing to adjust the loss with the insureds, and by failing to perform and adequate investigation. These are violations and breaches of the policy language cited above. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1) Pay the complete covered loss in the amount of $39,645.13 less any applicable policy deductible; 2) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made; and 3) Provide the insureds and insureds counsel with the requested documentation as put forth within the Letter of Representation sent to the carrier on or about February 5, 2025. A copy of this letter and filed form submitted to the FDFS has been emailed to the carrier. The specific policy provisions the carrier violated are the loss payment provision, the loss settlement provision, and the coverage provisions. Specifically, the loss payment provision states “we will adjust all losses with you.” Yet, the carrier did not consult the homeowner in deciding who would investigate the cause or amount of damages, and what the ultimate payment should be. On February 5, 2025, a certified copy of the policy was requested by counsel of the insured. To date of the filing of this civil remedy notice the policy has not been provided by the carrier. This is in violation of F.S. §626.9541(1)(i)(3)(c) as the carrier has failed to acknowledge and act promptly upon communications with respect to claims. F.S. §627.70131(1)(a) provides that upon an insurer’s receiving a communication with respect to a claim, the insurer shall, within 7 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer. If you have any questions or concerns, please send all correspondence via email to Blake@klinglaw.com and Jorlyn@KlingLaw.com to ensure a prompt response. We ask that all correspondence be done via email rather than regular mail. Should you need to send something regular mail, please advise us prior to sending same via the emails above. Sincerely, Blake M. Wallace, Esq. Blake M. Wallace Attorney at Law Enclosed: Civil Remedy Filing

Comments

User Id		Date Added		Comment
lashawna_e_nesbitt@progressive.com		05-05-2025		While American Strategic 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 Kling Law, on May 5, 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. 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