Filing Number: 812356
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| Filing Accepted: 3/21/2025 |
| Last/Business Name
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HELTER
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First Name |
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COLLEEN & TIM |
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| Street Address
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7431 BEAR HOLLOW CIRCLE |
| City, State Zip
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FORT MYERS,
FL
33967
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| Email Address
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WITHHELD |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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HELTER |
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First Name |
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COLLEEN & TIM |
| Policy # * |
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AGH0415824 |
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Claim #* |
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CHO-00138570 |
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Attorney is Applicable
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| Last Name* |
MULLINAX
First Name *
MATTHEW
Initial
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| Street Address* |
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908 W HORATIO ST |
| City, State Zip* |
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TAMPA
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FL
33606
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| Email Address * |
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MATT@MAKRISMULLINAX.COM |
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| Insurer Type
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 Authorized Insurer
 Unauthorized Insurer
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| Insurer Name |
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| Insurer Name* |
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AMERICAN INTEGRITY INSURANCE COMPANY
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| Insurer Name* |
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| Street Address* |
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| City, State Zip* |
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,
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NAIC Company Code 12841 |
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| Name of individual responsible for violation (if any):*
JOSIE RODRIGUEZ-DOLAN A223848
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| Type of Insurance
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Residential Property & Casualty
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| Reason for Notice
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Non-renewal
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Cancellation
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Claim Delay
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Claim Denial
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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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Statutory provision(s) which the insurer allegedly violated.
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| 624.155(1)(b)(1) |
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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.
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| 624.155(1)(b)(3) |
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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.
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| 626.9541(1)(i)(2) |
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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.
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| 626.9541(1)(i)(3)(a) |
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Failing to adopt and implement standards for the proper investigation of claims.
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| 626.9541(1)(i)(3)(b) |
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Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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| 626.9541(1)(i)(3)(c) |
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Failing to acknowledge and act promptly upon communications with respect to claims.
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| 626.9541(1)(i)(3)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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| 626.9541(1)(i)(3)(e) |
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Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
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| 626.9541(1)(i)(3)(f) |
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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.
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| 626.9541(1)(i)(3)(g) |
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Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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| 626.9541(1)(i)(3)(h) |
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Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
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| 626.9541(1)(i)(3)(j) |
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Altering or amending an insurance adjuster’s report without:
(I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and
(II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or
(III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change;
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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 PERILS INSURED AGAINST SECTION.
THE LOSS PAYMENT PROVISION.
THE LOSS SETTLEMENT PROVISION.
THE POLICY PROVISIONS CITED IN AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA’S (“AIIC”) LETTERS TO THE INSURED FOR THIS CLAIM, INCLUDING THE LETTERS DATED MARCH 20, 2024.
ANY OTHER PROVISIONS OF THE POLICY WHICH AIIC BELIEVES LIMIT OR PROVIDE COVERAGE FOR THE INSUREDS’ LOSS.
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Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
ON OR ABOUT SEPTEMBER 28, 2022, WHILE THE POLICY WAS IN FULL FORCE AND EFFECT, THE SUBJECT PROPERTY SUSTAINED A COVERED LOSS TO THE PROPERTY, WHICH THE CAUSE OF LOSS INCLUDES BUT NOT LIMITED TO, WIND AND HURRICANE IAN. THIS RESULTED IN DAMAGE TO THE INSUREDS’ HOME. THE INSUREDS PROVIDED TIMELY NOTICE OF THE LOSS TO AIIC AND AIIC ASSIGNED CLAIM NUMBER CHO-00138570 TO THE CLAIM.
AIIC INSPECTED, ADJUSTED, AND IMPROPERLY UNDERPAID AND DENIED PORTIONS OF THE CLAIM. AIIC RETAINED A THIRD PARTY ADJUSTING FIRM TO HANDLE THE INSUREDS’ CLAIM ADJUSTMENT. THIS RESULTED IN NUMEROUS INSPECTIONS, DELAYED HANDLING OF THE CLAIM, AND THE CURRENT PROBLEM WHERE THE CLAIM CONTINUES TO BE UNDERPAID AND NOT FULLY RESOLVE YEARS AFTER THE LOSS OCCURRED AND WAS REPORTED.
AS PART OF ITS CLAIM ADJUSTMENT, AIIC ACCEPTED COVERAGE FOR THE INSUREDS’ LOSS UNDER THE POLICY, AND AIIC PREPARED AN ESTIMATE DATED DECEMBER 2, 2022, WHICH TOTALED A REPLACEMENT COST VALUE OF $38,711.00.
THE INSUREDS RETAINED THEIR OWN PROFESSIONALS TO BEGIN REPAIRS AND DOCUMENT THE COSTS FOR REPAIRS AND THE INSUREDS’ LEARNED THAT THE COST TO RESTORE THE PROPERTY TO ITS PRE-LOSS CONDITION WAS SIGNIFICANTLY HIGHER THAN AIIC’S PAYMENT AND ESTIMATION OF THE LOSS. THE INSUREDS PROVIDED DETAILED DOCUMENTS TO AIIC THAT TOTALED APPROXIMATELY $293,319.96 FOR REPAIRS, ADDITIONAL LIVING EXPENSES, AND DAMAGED PERSONAL PROPERTY. AIIC HAS FAILED AND/OR REFUSED TO FULLY INDEMNIFY THE INSUREDS FOR THEIR LOSS AND REACH AN AMICABLE RESOLUTION WITH THE INSUREDS FOR THE DISPUTE.
ADDITIONALLY, DESPITE THE ONGOING DISPUTE, ON NOVEMBER 10, 2023, AIIC NONRENEWED THE INSUREDS’ HOMEOWNER’S POLICY OF INSURANCE, PLACING THE INSUREDS’ IN SIGNIFICANT FINANCIAL STRESS AND IN DANGER OF NOT BEING ABLE TO KEEP THEIR HOME INSURED DUE TO THE ONGOING AND UNRESOLVED CLAIM WITH AIIC. UPON INFORMATION AND BELIEF, THE NON-RENEWAL WAS RETALIATORY AND A TACTIC TO PRESSURE THE INSUREDS TO ACCEPTING LESS OR DROPPING THEIR DISPUTE WITH AIIC SO THAT THEY COULD SAFELY OBTAIN INSURANCE THROUGH A NEW CARRIER.
THE FOLLOWING IS ALLEGED UPON INFORMATION AND BELIEF. THESE ACTIONS DESCRIBED ABOVE, AND OTHERS THAT OCCURRED IN THIS CLAIM, AMOUNT TO A FAILURE TO ADJUST THE INSUREDS’ CLAIM IN GOOD FAITH. AIIC’S REFUSAL TO CONDUCT A REASONABLE INVESTIGATION BASED UPON AVAILABLE INFORMATION AND FAILURE TO PAY THE INSUREDS FOR THE DAMAGE AND COVERED LOSS UNDER THE POLICY ISSUED BY AIIC EXHIBITS BAD FAITH. FURTHER, AIIC FAILED TO COMPLY WITH ITS LOSS SETTLEMENT PROVISION. RATHER THAN ISSUING THE PROPER PAYMENT OR ATTEMPTING TO REACH AN AGREEMENT WITH ITS INSUREDS, AIIC UNDERVALUED AND PARTIALLY DENIED THE CLAIM. UPON INFORMATION AND BELIEF, AIIC PERFORMS THE SUBJECT ACTIONS AS A BUSINESS PRACTICE, INCLUDING DELAYING THE CLAIM, UNDERVALUING THE CLAIM, AND PARTIALLY DENYING THE CLAIM IN AN ATTEMPT TO DISSUADE ITS INSUREDS FROM PURSUING THE CLAIM TO THE DETRIMENT OF ITS INSUREDS TO INCREASE FINANCIAL PROFITS.
IN THE EVENT AIIC BELIEVES THIS CIVIL REMEDY NOTICE LACKS INFORMATION NECESSARY FOR AIIC TO CURE THE DEFECTS OUTLINED IN THIS NOTICE, OR THAT IT LACKS REQUIRED SPECIFICS IN ANY WAY, AIIC SHOULD CONTACT THE FILER OF THIS NOTICE DIRECTLY AND ALERT THEM TO THAT AS SOON AS POSSIBLE, PRIOR TO ANY FORMAL RESPONSE.
THIS NOTICE IS FILED AND GIVEN TO AIIC TO PERFECT THE RIGHT TO PURSUE THE CIVIL REMEDY THAT SECTION 624.155 AUTHORIZES.
TO CURE THE DEFECTS OUTLINED IN THIS CIVIL REMEDY NOTICE, AIIC MUST:
(1). ADMIT FULL COVERAGE FOR THE INSUREDS’ LOSS;
(2). PAY IN THE PROPER AMOUNT NECESSARY TO RESTORE THE PROPERTY TO ITS PRELOSS CONDITIONS, WHICH THE INSURED BELIEVES TO BE IN ACCORDANCE WITH THE ESTIMATE PREPARED BY THE INSUREDS’ PUBLIC ADJUSTER IN THE AMOUNT OF $293,319.96, FOR THE DURATION OF THE SIXTY-DAY CURE PERIOD;
(3). PAY STATUTORY INTEREST ON THE AMOUNT OF UNPAID CONTRACT DAMAGES FROM THE DATE OF THE LOSS TO THE PRESENT TIME PURSUANT TO F.S. §627.70131.
A COPY OF THIS FORM SUBMITTED TO THE FDFS HAS BEEN PROVIDED TO THE FOLLOWING PARTIES PROVIDING THEM NOTICE OF THE FILING OF THE CIVIL REMEDY NOTICE:
AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA
VIA EMAIL TO: claimsmail@aiicfl.com
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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.
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DFS-10-363
Rev. 10/14/2008
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