Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 811983

Filing Accepted: 3/19/2025

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Complainant

Last/Business Name *

ALVARADO TAMPOA

First Name

JOSE

Street Address *

3216 ROYAL TERN DRIVE

City, State Zip *

WINTER HAVEN, FL 33881

Email Address *

JOSETAMPOA3@GMAIL.COM

Complainant Type: *

Insured

Last/Business Name*		ALVARADO TAMPOA		First Name		JOSE
Policy # *		FLA419818		Claim #*		1337589-241001

Attorney

Attorney is Applicable

Last Name*	ELAZAR First Name * SAPIR Initial
Street Address*		800 E BROWARD BLVD., STE. 510
City, State Zip*		FORT LAUDERDALE , FLORIDA 33301
Email Address *		SE@WEKLAW.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):* N/A
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)(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.
	626.9541(1)(i)(3)(c)		Failing to acknowledge and act promptly upon communications with respect to claims.
	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 Payment Provision. Loss Settlement Provision.

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

Jose Alvarado Tampoa (the "Insured") purchased an insurance policy ("Policy") from American Strategic Insurance Corp. ("American Strategic"), which was in effect at the time of the loss on or about February 24, 2024, under policy number FLA419818, to insure their home located at 3216 Royal Tern Drive, Winter Haven, FL 33881 (the "Property"). On or about that date, the Property suffered severe damage due to a sudden and devastating leak beneath the kitchen sink, causing extensive and widespread damage, including but not limited to the kitchen and interior of the home. The Insured promptly reported the claim to American Strategic, which acknowledged receipt by assigning claim number 1337589-241001. However, rather than handling the claim fairly and in accordance with its contractual obligations, American Strategic engaged in bad-faith tactics from the outset. Despite conducting an inspection, as required, American Strategic willfully ignored the full extent of the damage and deliberately undervalued the loss, offering a grossly inadequate initial payment of just $2,921.38 after applying the deductible. This blatant underpayment was a clear attempt to minimize its financial liability at the expense of its policyholder, despite the Insured providing all necessary documentation to support their claim. Facing American Strategic’s bad-faith handling of their claim, the Insured was left with no choice but to retain Restoration Control Corp. (“RC”) as their public adjuster to conduct a proper evaluation of the damage. RC thoroughly inspected the Property and prepared an estimate reflecting the true extent of the loss, valuing the damage at $29,465.75. This estimate was promptly submitted to American Strategic along with a formal request for supplemental payment. Yet, American Strategic once again failed in its duty to properly adjust the loss, issuing an insultingly low supplemental payment of just $2,561.15. American Strategic’s willful underpayment and refusal to conduct a good-faith adjustment have left the Insured in a dire situation, unable to restore their Property to its pre-loss condition. Instead of acting in accordance with its legal and contractual obligations, American Strategic has engaged in delay tactics, undervaluation, and bad-faith claim handling, further exacerbating the Insured’s hardship. Its actions demonstrate a clear and intentional disregard for the rights of its policyholder, prioritizing profit over fulfilling its promises. As a direct consequence of American Strategic’s failure to adjust this loss in good faith and pay what it owed under the policy, the Insured and their family are continuing to sustain considerable hardship. Upon information and belief, American Strategic, as part of its general business practice, initially low-balls its policyholders. American Strategic does this in a calculated and systematic scheme that begins with manipulating the software system used in estimating its property damage claims. It appears that American Strategic issues its adjusters estimating software which contains construction pricing below the fair market value. It also appears that American Strategic trains its claim adjusters to overlook and/or turn a blind eye to a number of routine costs that American Strategic knows most policyholders generally would not know to request but are actually covered under the insured’s policy. Moreover, as part of this scheme, after making one initial low-ball payment – American Strategic stalls and intentionally delays the claim, all under the false pretense that it’s “investigating” the claim. American Strategic has violated Florida Statute § 624.155(1)(b)(1) by continuously not attempting in good faith to settle this claim when it should have done so if it had acted fairly and honestly towards its Insured. American Strategic has also violated Florida Statute § 624.155(1)(b)(3) by failing to promptly settle this obviously covered claim to influence settlement in its favor. Despite being presented all of the indisputable evidence of the amount of damage sustained by this Property, it is a disgrace that the Insured have been treated in this manner by their insurance company after sustaining an obviously covered loss, submitting to every demand of American Strategic, and making a good faith effort to resolve in an attempt to amicably come to a fair resolution. American Strategic violated Florida Statutes § 626.9541(1)(i)(2) and § 626.9541(1)(i)(3)(b) by making material misrepresentations to the Insured for the purpose and with the intent to settle the claim on less favorable terms than those provided and contemplated by the policy. American Strategic was informed multiple times of the discrepancies and inconsistencies of the low-ball payment issued to the Insured. While American Strategic was made aware of this information for the purpose of obtaining the money contractually owed to the Insured under its insurance policy to attempt to return their home to its pre-loss condition in a timely fashion, American Strategic accepted that information and has used it to play the delay game with the Insured, knowing all too well the additional damage and hardship that was being placed on the Insured by its actions. American Strategic violated § 626.9541(1)(i)(3)(a) when it failed to adopt and implement standards for the proper investigations of claims. Under no circumstances is there an excuse for the lack of a proper investigation in this case. American Strategic and their representatives are willfully blind and grossly underqualified to handle a loss such as the one sustained by the Insured. In addition, after being placed on notice as to the blatant underpayment of the Insured’ claim, American Strategic has yet to rectify their actions and do right by the Insured by paying the money they are contractually owed. American Strategic violated § 626.9541(1)(i)(3)(c) by failing to acknowledge and act promptly upon the communications with respect to the claim. There still has yet to be significant action taken by American Strategic to this date, despite American Strategic being presented with the flawed rationale behind their underpayment of the Insured’ claim. American Strategic violated § 626.9541(1)(i)(3)(g) by failing to promptly notify the Insured of any additional information necessary for processing the claim. The Insured have more than complied with each and every request and there has still been no action by American Strategic. In the event American Strategic is in need of additional information, they have failed to promptly notify the Insured in a timely manner. This pattern of behavior is perpetuated by American Strategic and their representatives undeterred by the Ethical Requirements that are imposed by law on all Adjusters. Fla. Admin. Code Ann. R. (3) explicitly states the adjustment of insurance claims engage the trust of the public, and therefore, an adjuster has a duty of fair and honest treatment of the Insured throughout the insurance claim process. Several duties and responsibilities to the Insured were violated in the handling of this claim, which are specifically listed responsibilities of an Adjuster in the Florida Administrative Code. These breached duties and responsibilities include adjusters from American Strategic approaching the investigation and settlement in a manner prejudicial to the Insured, failing to allow a fair settlement with the Insured, and acting with due diligence in achieving a proper disposition of the claim. In contrast to the legislative intent motivating the enumeration of an Adjuster’s responsibilities outlined in the Administrative Code, the Insured were not afforded the professional duties entrusted on American Strategic by the public. To date, American Strategic has failed to adequately compensate the Insured for the damage that occurred on February 24th, 2024. As a direct result of American Strategic’s delay, the Insured were forced to seek the help of legal counsel to assist them. Due to the amount of time that has passed since the date of loss, this acknowledgement is evidence that American Strategic knowingly and intentionally are delaying the claims process in order to further disadvantage the Insured. The financial detriment caused to the Insured and their family is a direct result of American Strategic’s reckless delay of the claim process. The Insured are dutiful customers who made it a priority to pay their insurance premiums to ensure that in such an event as this devastating incident, their home would be covered. The Insured timely filed their claim and fulfilled all of their post-loss obligations. All requested information and documentation has been turned over to American Strategic and their representatives promptly by the Insured. However, American Strategic failed at every step of the process to adequately establish or identify the basis of its gross mismanagement of the claim, failed to inform the Insured how they may remedy any deficiencies in their claim, and failed to provide them with qualified representatives to ensure the claim was initially adjusted, evaluated, and estimated properly. To deny the Insured the benefit of their bargain after they satisfied all of their obligations is morally and ethically reprehensible, and reeks of Unfair Trade Practice. Upon information and belief, the aforementioned actions complained of, among others, were made by American Strategic so often as to constitute a general business practice, evidencing a motive to enhance American Strategic’s profits, and designed to cause a detrimental effect to its policy holders. American Strategic was aware that the Insured’ damages were covered and took advantage of its Insured in an attempt to force them into an irreparably disadvantaged position, which they hope will force the Insured to settle for less coverage than they are contractually entitled to under the policy. This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should American Strategic 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, American Strategic must: (1) Immediately tender all insurance proceeds due and owing to the Insured that are fairly owed to the Insured under the insurance policy that would reasonably place the Insured back to a pre-loss condition; (2) Agree to reimburse the Insured’ reasonable attorneys’ fees and costs for having to become involved to resolve the claim; (3) 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; (4) Although the Insured have made a demand herein and have previously provided American Strategic with all the necessary estimates, invoices, receipts, etc. in support thereof, the Insured are still willing to consider and to potentially accept any reasonable counter-offer made by American Strategic. Therefore, if American Strategic is not in agreement with the Insured’ reasonable demand for payment of their rightfully-owed insurance benefits being submitted at this time, the Insured hereby request that American Strategic now make a reasonable counter-offer before the expiration of the cure period.

Comments

User Id		Date Added		Comment
lashawna_e_nesbitt@progressive.com		03-21-2025		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 Weisser Elazar & Kantor PLLC, on March 21, 2025. Pursuant to F.S. 624.155(3)(e), please accept this notice on the disposition of the alleged violations contained in the Civil Remedy Notice occurred on June 18, 2024.

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