Civil Remedy Notice of Insurer Violations
Login

Filing Number:     813774
Filing Accepted:  3/30/2025
         Print Filing
Complainant
Last/Business Name *  
PFEIFFER   First Name   MARY
Street Address * 676 BLACK EAGLE DR
City, State Zip * GROOVELAND, FL 34736
Email Address * MCOHEN@ITSABOUTJUSTICE.LAW
Complainant Type: * Insured
Insured
Last/Business Name*   PFEIFFER   First Name   MARY
Policy # * ATH1086590 Claim #* AH143100
Attorney
Attorney is Applicable
Last Name* COHEN First Name * MADISON Initial A
Street Address* 350 NORTH LAKE DESINY RD.
City, State Zip* MAITLAND , FL 32751
Email Address * MCOHEN@ITSABOUTJUSTICE.LAW
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):* HEATHER MARIE FLEMING KOSKINAS, KATHLEEN HABIB, TAMEKIA MCMILLIAN, CHEVONNE COWARD, AND ALL ADJUSTERS, AGENTS, REPRESENTATIVES, OF AMERICAN TRADITIONS INSURANCE COMPANY WHO WORKED ON THIS CLAIM
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
Other : Material Misrepresentation
Other : Failure to acknowledge and act upon communication
* 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)(2) Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
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)(d) Denying claims without conducting reasonable investigations based upon available information.
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.
626.9541(1)(i)(4) Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Policy Provisions: A certified copy of the policy is not in the Insureds’ possession, but based on information and belief, the following policy provisions are relevant to this civil remedy notice. Section 1 – Property Coverages – Coverage A – Dwelling Section 1 – Perils Insured Against – Coverage A – Dwelling and Coverage B-Other Structures Section 1 – Conditions – Loss Settlement Section 1 – Conditions – Loss Payment
 
* 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 October 9, 2024, the Insured, Mary Pfeiffer, suffered significant damage to their home located at 676 Black Eagle Dr, Groveland FL, 34736 as a result of Hurricane Milton. Hurricane Milton was a powerful Category 3 hurricane with maximum wind speed of 120 mph when it made landfall in Florida. Groveland, where the Insured resides, was in the direct path of Hurricane Milton as the storm moved inland and experienced high sustained winds and wind gusts, as well as substantial rainfall. The Insureds’ community has thousands of residents who were impacted by Hurricane Milton and who suffered severe damages. Prior to the loss, American Traditions Insurance Company (hereinafter, “American Traditions”), issued an insurance policy (Policy No.: ATH1086590) for the Insureds’ property. Said policy, which was issued prior to the loss, was in full force and effect on the date of loss and afforded coverage for damage caused by a hurricane. American Traditions was immediately notified of the loss by the Insured and assigned claim number AH143100. During the course of American Tradition’s investigation, the Insured has continued to make their property available for all inspections, provided facts and information surrounding the loss, and complied with Insurers adjustment of the claim. Upon information and belief, American Traditions routinely engages in a pattern and practice of refusing to issue benefits it knows it owes as a means to “starve” its insureds and force them to take substantially less than what they are owed. Although American Traditions acknowledged the Insureds’ property was damaged by the catastrophic storm, finding excessive wind damage to the roofing system on all directional slopes due to hurricane force wind, American Traditions inexplicably underpaid a majority of the damages claimed. American Traditions came to its coverage determination by ignoring relevant facts and information provided by the Insured and their contractors that established the substantial damages to the subject property, including the roofing system, were unquestionably the result of Hurricane Milton. Most concerning, American Traditions and its representatives intentionally downplayed and misrepresented the scope of the damages. Insurers also omitted key facts from its coverage decision and misapplied exclusions to minimize its financial exposure in the claim. American Traditions’ dilatory tactics have continued even after the Insureds' notice of intent to initiate litigation. A certified copy of the policy is not in the Insured’s’ possession, despite the formal request sent on December 17, 2024. Furthermore, Insured has pleaded with American Traditions to properly pay for the damages prior to going to the courthouse, however, American Traditions has continued to refuse to properly adjust the claim. As a result of Insurer’s flawed investigation and refusal to tender the full benefits owed under the policy, Insureds are forced to file suit against American Traditions for breach of contract. Notably, American Traditions’ “Senior Litigation Claim Examiner” Kathleen Habib, Adjuster License #A285940, materially misrepresented the facts in the response to the notice, stating ATIC’s roofer has not been permitted to complete repairs to the roof. To date, neither has Ms. Habib nor any representative with American Traditions made an attempt to contact the Insured or the Insured’s counsel to confirm, request, and or coordinate a scheduled repair. Ms. Habib’s unfounded assertion that the Insured refused to allow American Traditions to exercise “Our Option” clause is completely inaccurate and blatantly untrue, as in fact the Insured continued to make their property available upon all requests for entry exposing the falsity of such statements. This is further confirmed in the letter dated December 7, 2024 issued by American Traditions’s “Claims Examiner” Tamekia McMillian, Adjuster License #W911041, indicating the completed inspection of Insured’s property and acknowledging Insured’s courtesy to the adjuster during the inspection. Furthermore, Insured and Insured’s contractor, both of which were present, witnessed the adjuster physically present on the roof for approximately 1-2 minutes total in what was then considered a complete investigation of the property. The field adjuster did not speak with the Insured or Insured’s contractor to confirm the damaged areas of the property, nor request to inspect the interior or enter the attic space of the home. Insured’s counsel politely tried to contact multiple representatives handling the claim including those mentioned above as well as “Claims Adjuster” Chevonne Coward, Adjuster License #W780271. Insured’s counsel was advised in a written email correspondence that American Tradition’s attorney, Heather Marie Fleming Koskinas, would be reviewing the Civil Remedies Notice of Insurer Violations filed on February 5, 2025. February 28, 2025, Ms. Fleming Koskinas appeared unprepared for the initial telephone conference as she stated she had not had time to review the previously filed CRN nor any of the claim documents. As a professional courtesy, Insured’s counsel agreed to provide additional time to review despite the significant amount of time passed from the filing of the claim. A scheduled telephone conference was confirmed for Friday, March 7, 2025, where Ms. Fleming Koskinas failed to appear, issue correspondence detailing an effort to contact and or provide Insured’s counsel with justification for failure to appear prepared on the rescheduled date/time. These events further confirm the facts of delay as carefully outlined in the initial Civil Remedy Notice. Additionally, Ms. Fleming Koskinas has yet to provide any estimates,invoices,quotes from the contractor elected under the policy provision as previously requested. There is a woeful under adjustment of the claim, including but not limited to the roofing system, interior damages, and additional damage to the property resulting from Hurricane Milton. Insured’s counsel has made several attempts to contact Ms. Habib and Ms. Fleming Koskinas, via telephone and email correspondence, in an effort to reach a fair and proper resolution to the claim in light of the significant amount of loss dispute. As we sit here today, as evidenced in written email chain, neither Ms. Habib nor Ms. Fleming Koskinas has provided any meaningful response to resolve the dispute or made any effort to communicate with the Insured’s counsel. Refusal to acknowledge any and all correspondence has continued notwithstanding Insured's counsel's pleads and multiple professional requests. American Traditions has not acted honestly or fairly towards its Insureds during the adjustment of its claim. American Traditions and its representatives have failed to conduct a proper investigation of the loss, misrepresented the cause and scope of damages at the residence, and misapplied exclusions in the policy in order to wrongfully underpay the Insureds’ claim. It has become a general business practice of Insurers to not implement proper claims handling procedures, to hire consultants that routinely ignore or intentionally misidentify relevant evidence, and to not settle claims in good faith when under all the circumstances it should have. American Traditions capriciously denies coverage or otherwise refuses to tender full payment owed under their policies without conducting reasonable investigations based on information available to it. American Traditions insured this property against a hurricane loss knowing full and well that such a catastrophic event was statistically likely and collected insurance premiums from Insurers but has failed to honor its obligation to Insureds when it needed American Traditions. As such, American Traditions has once again put its corporate profits ahead of the interests of its insureds. As evidenced here, it is a pattern and practice for American Traditions to arbitrarily undervalue claims without conducting reasonable investigations based upon information and evidence available to it. It is also a general business practice of American Traditions to not respond to claim communications, to not explain what information is necessary to process the claim, and to not explain why benefits are continuing to be withheld under the policy. American Traditions’ actions are part of a broader scheme to delay claims and avoid issuing payment that ASI knows is owed to its insureds. In order to cure this civil remedy notice, American Traditions must immediately acknowledge in writing that the damages claimed by the Insured were caused by Hurricane Milton and that replacement of the roofing system, and any other damages caused by Hurricane Milton, are covered under the insurance policy. The written acknowledgement and payment should be issued to the Insureds’ counsel, Madison Cohen, Esq., Cohen Law Group, at 350 N. Lake Destiny Road, Suite 300, Maitland, FL 32751.
Comments
User Id Date Added Comment
hfleming@tlsslaw.com 05-29-2025 AS to the Cure: …They did on December 7, 2024, when it issued a coverage determination letter advising of payment, providing an estimate and explaining what was covered and not covered. No payment can be issued to “Madison Cohen” as no additional payments are owed. The Insured has a $15,900.00 hurricane deductible and a depreciating roof payment endorsement, again no mention of this in the Notice.
hfleming@tlsslaw.com 05-29-2025 Addendum (was a different format when prior info was uploaded : 12/23/24 - All Pro contacted the attorney and spoke with Ashley and provided dates for inspection. Confirmed inspection for 1/9 @ 2PM. 1/9/25 - All Pro showed up and waited until 2:15PM but the atty never showed. Went ahead and inspected the roof. 3/6/25 - Called the attorney and spoke to Kayla. She took our info and let us know she'd have to call us back. We were not listed anywhere on the file as the contractor so she needed permission from the customer to speak to us. 3/20/25 - Called atty again, this time they stated the customer is already working with another contractor and that was about all the info she was able to provide me with since again they had no permission from the customer to give us any info.
hfleming@tlsslaw.com 05-29-2025 This will respond to the Civil Remedy Notice of Insurer Violations (“Notice”) filed against American Traditions Insurance Company (“ATIC”). The Notice alleges Claim Denial,” “Claim Delay,” “Unfair Trade Practice,” “Material Misrepresentations,” Failure to Acknowledge and Act Upon Communications and “Unsatisfactory Settlement Offer” as well as violations of Florida Statute § 624.155(1)(b)(1), (2), and (3); as well as § 626.9541(1)(i)(2), (3)(a),(b), (c) , (d), (f), (g) and (4). The allegations contained in the Notice are wholly without merit, and lack sufficient legal and factual support. Accordingly, ATIC denies each and every alleged violation of Florida statutory and administrative law as alleged in the Notice. As an initial matter, the Notice is deficient and fails to comply with the requirements of the Florida Statutes. Florida Statute § 624.155(3)(b) requires that a Civil Remedy Notice “state with specificity” the statutory provisions allegedly violated, the facts and circumstances giving rise to the violation, the name of any individual involved in the violation, and the specific policy language relevant to the violation. Rather than include the specifics required by Statute regarding the facts and circumstances giving rise to the statutory provisions allegedly violated, the Notice makes general, boilerplate conclusions. Additionally, the Notice does not provide an explanation as to how ATIC failed to comply with the terms of the policy with specific factual support pertaining to the alleged incident or how ATIC failed to comply with the statutory provisions allegedly violated. Making general conclusions, without providing further analysis, or discussion of how ATIC violated the policy and/or statutory provisions, is in direct contradiction to Florida Statute § 624.155(3)(b) and renders the Notice defective. See Julien v. United Property & Casualty Insurance Company, 2020 WL 5652364 (Fla. 4th DCA 2020). As stated by the Florida Supreme Court, the purpose of a Notice is to put the insurer on notice of an alleged violation, the circumstances surrounding same, and indicate the details of the alleged violation in order to provide an insurer with 60 days to “cure” the alleged claim defects. See Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So.2d 1278 (Fla. 2000). The purpose of Fla. Stat. § 624.155 is to provide the insurer with an opportunity to resolve a first-party coverage dispute and otherwise avoid litigation. See Talat Enterprises, Inc.; see also Lane v. Westfield Ins. Co., 862 So.2d 744 (Fla. 5th DCA 2003). Further, a Notice must be sufficiently specific to provide the insurer with an opportunity to cure the alleged violations. This would include i) identifying the specific policy provision(s) at issue, ii) citing specific language of the statutory provision(s) the insurer allegedly violated, and iii) specifically identifying what actions the insurer must take to remedy the alleged violations. Rousso v. Liberty Surplus Ins. Corp., 2010 WL 7367059 (S.D. Fla. Aug. 13, 2010); Heritage Corp. of South Florida v. National Union Fire Ins. Co. of Pittsburgh, PA, 580 F. Supp. 2d 1294, 1299-1300 (S.D. Fla. 2008). Your Notice does not comply with the requirements of Florida law. Additionally, the “facts and circumstances” section of the Notice does not comply with Florida law. Contrary to the requirements of Florida Statutes, the Notice makes false, boilerplate accusations. For example, the Notice alleges that ATIC violated Florida Statute § 626.9541(1)(i)(3)(a)—failing to adopt and implement standards for the proper investigation of claims. However, the body of the Notice fails to describe how ATIC failed to adopt and implement standards to investigate the Insured’s claims. Similarly, the Notice does not provide factual support for various allegations listed above, including but not limited to how ATIC’s investigation was conducted in bad faith, or how ATIC has engaged in unfair trade practices. Contrary to the allegations in the Notice, ATIC acted promptly, responsibly, and in good faith at every opportunity in connection with this claim. The failure to provide any factual support for the alleged violations of Florida statutory and administrative law and otherwise comply with the requirements of Florida Statute § 624.155, renders the Notice deficient and in violation of Florida Statute § 624.155. The Notice does not have the correct facts. The true facts regarding the investigation and handling of this claim are as follows: A claim for damage related to hurricane Milton was reported on October 14, 2024. The claim was acknowledged that same day and TSI Adjusters was assigned. Contact was made with the Insured and an inspection was set for October 28, 2024. The insured and a contractor from Big Sky were present during the inspection. The Notice takes exception with the amount of time that the field adjuster spent on the roof, however coverage was afforded for the roof because it was so obviously damaged by wind that a quick visual inspection is all that was needed. However, a review of the photographs revealed that there was more than a quick inspection of the roof, and that the adjuster walked the roof and took photos all over the roof of the damage. American Traditions has advised that a full roof replacement was needed and there is not dispute. The Notice further alleged that the adjuster did not inspect the interior or enter the attic space of the home, yet there are 210 photographs of the property. The photos include all exterior elevations, the screen enclosure, and every room of the interior of the property and garage. The photos also indicate that the adjuster used a moisture meter to determine if areas of the interior were found to show any evidence of increased moisture, none did. The allegations in the Notice are not true with respect to the inspection that was conducted. The Notice also focuses on misrepresentations made by American Traditions that its roofer had not been permitted to complete repairs The Notice alleged that American Traditions failed to contact the Insured or the Insured’s attorney about the roofer attempting to access the property. Again, another incorrect or false allegation. First the Insured did not have counsel when the option to repair was invoked, and American Traditions communicated directly with the Insured both by phone and in writing at the beginning of December 2024. A letter of representation was received from Cohen Law Group on December 17, 2024. An additional letter was sent to the Insured on December 23, 2024, providing the name of the roofing company and its contact number, All Pro Contracting. At that point all communication efforts would have been directly between the Insured, her counsel and the roofer. We know All Pro was permitted to inspect the roof on January 9, 2025 and prepared an estimate for the replacement of the roof which totaled $26,204.85. American Traditions did indicate that the Insured were not complying with the “option to repair” because American Traditions was advised that the Insured now had an attorney and were refusing to sign the work authorization. This came from All Pro. It should also be noted that to date there has not been a signed work authorization with All Pro so there have been no misrepresentations or false statements made by ATIC. Additionally, the Insured’s counsel is and has been aware of All Pro’s involvement since our early conversations and the prior CRN but STILL there has been no contact with All Pro on the Insured’s behalf. Let’s now address the allegations regarding communications failures with counsel. There has been communication between counsel but counsel for ATIC does not engage in claim adjustment. Although, the Insured’s counsel choose to paint a distorted picture of reality, her actual emails do not. Counsel is well aware that the adjuster was very ill and tried to come back and then got worse all due to an expected issue, this outage is acknowledged in counsel’s emails but selectively omitted from the Notice. Additionally, the Notice makes it appear as if the Undersigned has failed to communicate or been “unprepared” or “made excuses.” During the initial call, I had just received the file, due to the adjuster’s illness and counsel was advised of that at the onset. As a professional courtesy, which counsel claims she extended, I extended the courtesy by taking a call without the full opportunity to review all the documentation and piece the facts together…so yes, I was not prepared and advised counsel of same. As for a call on March 7, 2025, there was no call set, no emails about a call being set and no emails about that call being missed. This is untrue. Counsel claims she has made, “several attempts to contact Ms. Habib and Ms. Fleming Koskinas, via telephone and email correspondence, in an effort to reach a fair and proper resolution to the claim in light of the significant amount of loss dispute.” Here, is another fact omitted from the Notice, despite being advised that the undersigned is representing ATIC, the Insured’s counsel has included ATIC on emails to ATIC’s counsel despite the Florida Bar Rules requiring contact with counsel and not the person or corporation. In fact, the undersigned removed ATIC and K. Habib from emails upon receiving the file in late February. For some reason Insured’s counsel added Ms. Habib and ATIC back on emails in March, in violation of the rules governing the Florida Bar. If Ms. Habib did not respond, it is because it was an inappropriate communication. It is alleged that the undersigned has failed to provide, “estimates, invoices, quotes from the contractor elected under the policy provision” but if the Insured’s counsel has paid attention to anything related to All Pro up an until this point in time…not the Insured or her representatives, including counsel have cooperative, so there is nothing to provide. Additionally, there is no damage to the interior caused by Milton. There is evidence of the drywall joint tape separating but that is not storm damage. Additionally, the public adjuster or loss consultant, with Cardinal Claims, who took photographs indicated that some of the interior damage around a door was the result of wind driven rain. This would also not be covered under the policy of insurance as the opening, the door, was not the result of the storm. American Traditions did make one mistake with respect to this claim, it covered the roof monetarily and invoked the option to repair. This policy has an endorsement called a Roof Surfaces Payment Schedule (“RSPS”) which provides that a roof replacement will be paid on a sliding scale based upon the age of roof so there is no coverage for a full roof replacement under this policy unless the roof is less than 1 year old. Here the roof was around 4 years at the time of Milton. American Traditions initially wrote an estimate and included a full roof replacement less the deductible and application of the depreciation as outlined in the RSPS. The Insured’s counsel alleges that she has been trying to resolve the claim, but has been unsuccessful in doing so with the American Traditions representatives. However, that is likely because the Insured’s counsel is asking for things that are not covered under the policy of insurance like damage to the screen enclosure or solar panel removal. There is no coverage for the screen enclosure or removal and resetting of solar panels under the policy of insurance. The policy explains that there is no coverage for the screen enclosure UNLESS an additional premium is paid for the coverage via purchase of an additional endorsement. The policy also contains an endorsement for solar panels including the costs to remove and reset the panels. Nothing has changed from the prior CRN or response as the Insured is still seeking recovery for the removal and replacement of the solar panels (excluded), the replacement of screens on the enclosure (excluded), full roof replacement (covered but at a percentage for the RSPS), and interior damage which was not related to hurricane Milton. Of note, is that a video and additional photographs have been provided since the initial reporting of the claim and inspections. The damage depicted in the video from the Insured and photos by Cardinal Claims was not present at the time ATIC inspected AND acknowledged coverage for a roof replacement, which has not been completed. Any new damage since ATIC acknowledged the roof replacement, would not be covered as the policy excludes damage cause by failing to mitigate a loss or neglect, like replacing a roof when it has been agreed by all that it needs to be replaced. American Traditions then exercise the “option to repair” provision where it would have paid for the roof replacement, less the deductible and the removal and replacement of the solar panels. This would have put the Insured in a much better position and afforded more coverage. Without waiving its rights to contest the validity of the subject defective and improper Civil Remedy Notice, as the facts clearly demonstrate, ATIC has, and continues to comply with both Florida law and the applicable Policy throughout the entire handling of this claim. With regard to the investigation and handling of this claim, ATIC’s actions were prompt, thorough, and conducted in good faith. Therefore, ATIC specifically denies each and every violation alleged in the Notice.
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