Civil Remedy Notice of Insurer Violations
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Filing Number:     818262
Filing Accepted:  4/29/2025
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Complainant
Last/Business Name *  
OMEGA CONDOMINIUM NO 2 INC   First Name  
Street Address * 7000 NORTHWEST 17TH STREET
City, State Zip * PLANTATION, FL 33313
Email Address * KENZIE9994@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   OMEGA CONDOMINIUM NO 2 INC   First Name   EDUARDO
Policy # * AMC-32366-07 Claim #* 4233240
Attorney
Attorney is Applicable
Last Name* STRUBLE First Name * MATTHEW Initial
Street Address* 325 FIFTH AVENUE, SUITE 103
City, State Zip* INDIALANTIC , FLORIDA 32903
Email Address * SERVICE@STRUBLECOHEN.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   AMERICAN COASTAL INSURANCE COMPANY
NAIC Company Code 12968
 
Name of individual responsible for violation (if any):* J. MARSHALL PEMBERTON, SR., ANGELINA BAINS, P.E., AND ANY AND ALL SPECIFIC REPRESENTATIVES OF INSURER RESPONSIBLE FOR THE VIOLATIONS HEREIN BUT UNKNOWN TO THE INSUREDS AT THIS TIME
Type of Insurance * Commercial Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
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)(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)(d) Denying claims without conducting reasonable investigations based upon available information.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

There are no policy provision specifically at issue or in dispute, the policy provides coverage resulting from wind/hail storm but American Coastal Insurance Company has failed to extend coverage for repairs needed for the insured property. The Policy also provides a 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.

American Coastal Insurance Company (“Insurer”) r issued an insurance policy bearing policy number AMC-32366-07 with effective dates of coverage from June 5, 2022- June 5, 2023, which insured the property located at 7000 Northwest 17th Street, Plantation, FL 33313. The policy was in effect when the property sustained damage on or about 2023-04-13, when damage was caused by wind/hail storm. The damage was not immediately apparent to the Insured. On or about May 7, 2024, the damage was reported to Insurer thereby Insurer received noticed of the claim and which assigned Claim Number 4233240 to the claim and investigated the claim. Insurer retained a field adjuster and an engineer from EFI Global, Inc. (an engineering company almost always hired by insurance companies). Based on their investigation, Insurer denied full coverage for the loss - misrepresenting the factual causes of the claimed damages. EFI Global misrepresents the true weather details over the subject property on or about the date of loss. Insured retained an expert meteorologist, Glenn Richards Gajownik, who created a report and confirmed the following: A severe thunderstorm moved across Broward county traveling northeast at 25 mph and moved over the subject property with warnings issued by the National Weather Service; Nexrad Reflectivity Data confirms a severe thunderstorm impacted the subject property from 4:07 pm to 5:02 pm with a maximum intensity of 58 dbz indicating “very heavy rainfall”; Nexrad Velocity Data confirms that the strongest winds up to 67 mph impacted the subject property from 4:13 pm to 4:25 pm from the west-southwest direction; Nexrad Volume Velocity & Reflectivity Data at 4:19 pm confirms that a downburst wind moving over the subject property enhancing surface wind speeds; The National Weather Service issued a Severe Thunderstorm Warning at 4:15 pm for Broward county, including the subject property, for “60 mph wind gusts” and “Expect damage to roofs, siding and trees”; and NWS Local Storm Reports and Storm Survey across South Florida confirms a downburst wind gusts up to 70 mph were generated by this severe thunderstorm 11 miles southwest of the subject property at 4:04 pm, prior to moving over the subject property. Insured was forced to retain a public adjuster, Ask an Adjuster, Inc., which provided Insurer with photographs of the damages and an estimate for $941,239.96 replacement cost value ("RCV") and $908,663.21 actual cash value ("ACV"). Insurer refused to provide or issue any coverage. On or about August 13, 2024, Insured provided to Insurer a Sworn Proof of Loss based on the public adjuster's estimate. Insurer again refused to issue coverage. Insured has provided to Insurer its governing association documents, meeting minutes, incident reports, photographs, and other documents/information as requested in its possession at the time. Insured was forced to retain an attorney, StrubleCohen, to assist with the claim. Insured's attorney again provided to Insurer the Proof of Loss on or about April 18, 2025. Insurer has failed to respond or acknowledge the communication as of the date of this filing. Insurer failed to retain the experts needed to perform the inspection and needed to address the damage at issue and determine the repairs needed to restore the property. Insurer has been provided with documents establishing that the claim is covered, despite this being apparent from the condition of the property alone. Insurer has failed to extend coverage for payments owed and has refused to attempt to settle the claim with its insured. Insurer’s delay in issuing payment is causing and will cause the insured to sustain extra-contractual damages not covered by the property, including loss of use and enjoyment of the property and related damages, costs associated with hiring adjusters and experts, among other damages and these uninsured damages would not have occurred but for the insurer ’s failure to timely issue payments owed. In this claim and as a business practice, insurer fails to retain experts needed to investigate claims, ignores evidence establishing coverage and avoids covered repairs to attempt to avoid issuing payments owed pursuant to the insurance policy. Insurer can cure these violations by attempting to settle the claim in good faith and issuing payment for the remaining contractual damages owed. As Insurer is aware, issuing payment for contractual damages owed will preclude recovery of extra-contractual damages already incurred, and that will be incurred, and the contractual damages should immediately be paid and be paid within 60 days from the date of this notice. Due to applicable Florida Statutes, and the insurance policy’s payment provisions, the payment issued should also include interest. If insurer contends there is somehow more information needed that was not already provided, it should immediately advise the insured’s attorney what information is needed. Insurer has been provided with information establishing that the claim is covered but has failed to extend coverage for the claim. Insurer’s denial of the claim and refusal to issue payment is a breach of the insurance policy. This notice is being given in order to perfect the right to pursue the civil remedy authorized by this section.
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jbright@amcoastal.com 06-26-2025 RE: Civil Remedy Notice Filing No: 818262 Filing Accepted: 4/29/2025 Complainant: Omega Condominium No. 2, Inc. Insured: Omega Condominium No. 2, Inc. Policy No: AMC-32366-07 Claim No: 4233240 June 26, 2025 Dear Omega Condominium No. 2, Inc., and Mr. Struble, American Coastal Insurance Company (“AmCoastal”) has received the Civil Remedy Notice of alleged Insurer Violations referenced above (“Notice”). This correspondence constitutes AmCoastal’s response to the Notice. As a preliminary matter, AmCoastal objects to the libelous and defamatory nature of the factually unsupported allegations in the Notice. AmCoastal rejects these allegations and hereby reserves all rights, including legal action. AmCoastal must correct certain mistakes of fact and intentionally misleading characterizations in the summary provided in the Notice. First, the notice of loss on May 7, 2024, was sent to AmCoastal by the Insured’s public adjuster, Ask an Adjuster, Inc. (“PA”). Thus, the Insured was not “forced to retain a public adjuster” as indicated in paragraph 3 of the Notice. The Insured retained the PA even before it notified AmCoastal of the Claim. The notice of loss was not accompanied by any supporting materials, documentation, or repair invoices but included only a letter of representation from the PA, its W9, and a direction to pay. AmCoastal has, through the life of the Claim, responded to questions from the PA and provided requested documentation to the PA in a timely manner. Second, the summary included in the Notice suggests that AmCoastal was ignoring evidence in making its coverage determination and delaying a final decision. This is a mischaracterization of the facts of the Claim. Briefly, the Claim proceeded as follows: On May 7, 2024, AmCoastal received the first notice of loss from the Insured’s PA. On May 9, 2024, AmCoastal sent a reservation of rights letter to the Insured and its PA, requesting supporting documentation and all available materials to support the Claim. On May 20, 2024, AmCoastal’s field adjuster, Eberl Claims Service, inspected the insured location with the PA and a member of the Insured’s association present. The field adjuster’s report finalized on June 11, 2024, noted no “single event damages” and the damage observed appeared to the direct result of long-term “deterioration of an aging roof system” (replaced in 2006) and did not observe damage to the soft metals or satellite dishes which would be evident after a hailstorm. Wind reports showed that wind did not exceed 40mph on the purported date of loss the day before, or the day after. The field adjuster also observed multiple instances of long-term water leakage which “several of the unit owners / tenants confirmed predated the loss.” Additionally, most of the water damage was likely a result of the original 1974 jalousie windows, which were in severely aged condition. On July 26, 2024, AmCoastal still had not received any of the supporting documentation requested in the first reservation of rights letter, so it sent another. Finally, on July 28, 2024, and August 1, 2024, AmCoastal received a weather report, a damage estimate, and photos from the PA along with some of the other items requested in the two previous letters. The PA’s photos of the Insured’s roof were dated April 12, 2024. In other words, the PA had photos related to the Claim nearly a month before it even reported the Claim but did not submit them nearly three months. The PA provided a sworn proof of loss (“SPOL”) on August 13, 2024, claiming $936,239.96. In continuing its investigation, AmCoastal retained EFI Global (“EFI”), a third-party building engineering firm, to opine on the cause of the observed damage. EFI reinspected the insured location on September 12, 2024. EFI’s final report conclusions were largely in line with the field adjuster’s findings: 1. There were no wind damages observed to the roof. 2. There were no wind/storm created openings observed to the building. 3. There were multiple causes of loss observed to the reported interior damages. 4. The reported leak near the elevated on the fourth floor was the result of aged roofing material. 5. The reported cracks in the windows were the result of thermal stress and not the result of wind or windborne debris. 6. There was no evidence collected that indicated windows or doors had become displaced as a result of the reported date of loss. The windows and doors were observed to be in an aged condition. 7. The evidence collected indicated the reported water intrusion through windows was the result of aged window seals. The water would intrude intermittently during wind-driven rain events. This was not the result of a one-time storm event. 8. The condensation observed between windowpanes was the result of aged seals. The seals were allowing hot humid air to become trapped between the windowpanes, causing the observed condensation. 9. There was no evidence collected to indicate windborne debris had impacted any windows on the date of loss. As such, the reported damage to window/balcony/patio screens was not the result of the reported date of loss. 10. The reported water damage to the ceilings and walls in the living rooms and balconies/patios was the result of intermittent water intrusion at the interface with the concrete balcony slabs and living room slab during normal wind-driven rain events. Water was able to intrude at the corners of the building and/or through screens of balconies/patios due to a lack of overhangs and gutters. This was not the result of the reported date of loss. 11. There was evidence collected that indicated water had intruded through some units through stucco cracks intermittently during normal wind-driven rain events over a long-period of time. These were horizontal cracks as a result of normal shrinkage cracking. 12. There was stair step stucco cracking observed in the CMU wall on the left staircase of the interior that was the result of normal long-term settlement of the building. This was not the result of a one-time weather event or roof leak, as reported. As of the date of this response, the Insured has not addressed the engineer’s findings or provided additional information that contradicts the field adjuster’s report or EFI’s report. Based on the field adjuster report and the reinspection by EFI, together with the lack of any meaningful evidence to the contrary, AmCoastal issued a coverage determination letter on November 14, 2024, stating the “Policy does not provide coverage for this loss” and closed the Claim. Nearly five months later, on April 3, 2025, AmCoastal received a letter of representation from the law firm Struble Cohen, and on April 18, 2025, AmCoastal received a copy of the SPOL from August 13, 2024. No additional claim information was provided. Put simply, the Insured disagrees with AmCoastal’s coverage determination but has not provided any support for its position. AmCoastal has thoroughly investigated the Claim and communicated consistently with the Insured and its representatives throughout. AmCoastal has not paid the Insured the amount claimed because that amount is not remotely supported by AmCoastal’s investigation or the documentation the Insured has provided. With an accurate timeline of the claim established, AmCoastal now turns to the validity of the Notice and the alleged statutory violations. The Notice is invalid on its face because it fails to strictly comply with the requirements of Section 624.155, Florida Statutes. Specifically, the Notice fails to comply with subsections 624.155(3)(b)(2) and 624.155(3)(b)(4). First, the Notice does not comply with the requirement of subsection 614.155(3)(b)(4), to “state with specificity … specific policy language that is relevant to the violation, if any.” Specificity requires more than a general reference. The Notice states, “there is no policy provision at issue or in dispute” and then in the next sentence states, the “policy also provides a Loss Settlement Provision.” AmCoastal is unable to determine whether the loss settlement provision is disputed, based on this statement. If it is, AmCoastal is forced to guess as to which part of the loss settlement provision the allegation is referring to. The summary provided in the Notice does not include facts amounting to a breach of any specific policy provision. Second, the Notice fails to comply with the requirement of Section 624.155(3)(b)(2) to “state with specificity… the facts and circumstances giving rise to the violation.” The Notice lists four statutes allegedly violated: sections 624.155(1)(b)(1), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), and 626.9541(1)(i)(3)(d). The allegations in the Notice do not remotely support any claimed violation, and in fact demonstrate AmCoastal’s compliance with these provisions. Each alleged violation is addressed in turn: 1. Section 624.155(1)(b)(1), Florida Statutes, states, “Any person may bring a civil action against an insurer when such person is damaged: by the commission of any of the following acts by the insurer: … 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.” Therefore, the Notice must state with specificity the facts showing AmCoastal did not act in good faith in settling the claim. Put simply, the Notice is entirely void of any, let alone specific, information that points to AmCoastal operating in a manner other than good faith. AmCoastal reviewed each paragraph in the Notice attempting to locate information which would support an allegation of violating Section 624.155(1)(b)(1). The first paragraph of the Notice details the Policy, Claim number, and date of loss. These are not disputed. The second paragraph jumps months into the claim to AmCoastal’s retention of EFI and alleges that EFI misrepresented the weather details. The Notice then provides a county weather summary with time stamps but without a date, and with data collected 11 miles from the insured property. There is no further analysis or description of the alleged misrepresentation of factual causes of the claimed damage. The third paragraph then states the Insured “was forced to retain a public adjuster,” which is easily demonstrated to be false, as the Insured retained the PA before it even reported the Claim to AmCoastal. The paragraph continues to state the PA supplied AmCoastal with an estimate and photos. Again, as corrected above, this information was supplied months into the Claim, after AmCoastal had completed a field inspection of the property, even though the photos were captured prior filing the Claim. The fourth paragraph states the Insured “was forced” to retain Struble Cohen to assist with the claim and that Struble Cohen provided the SPOL to AmCoastal on April 18, 2025. Again, this SPOL is not new or revised, but a copy of what had been provided in 2024. Struble Cohen provided no additional or supplemental information to support the demand following AmCoastal’s then-completed investigation. The remaining fifth, sixth, seventh, and eighth paragraphs in the Notice contain zero facts relating to the Claim, specific or otherwise. They are conclusory without support and fail on their face to meet the minimum requirements of Section 624.155, Florida Statutes. Based on the Notice, the actual timeline of events, and the foregoing analysis, AmCoastal cannot locate specific facts in the Notice or otherwise to support a claim that it violated Section 624.155(1)(b)(1). Accordingly, AmCoastal denies that it violated this statutory section. 2. Section 626.9541(1)(i)(3)(a), Florida Statutes, defines the following as an unfair claim settlement practice: “Committing or performing with such frequency as to indicate a general business practice any of the following: … failing to adopt and implement standards for the proper investigation of claims.” AmCoastal refers to the above description of each of the paragraphs contained in the Notice, as well as the corrected summary of the Claim. The Notice at no point addresses a business practice or frequency of AmCoastal’s alleged failure to properly investigate claims. In fact, the Notice concedes that AmCoastal asked a third-party civil engineer to opine on the cause of loss. The Notice does not indicate how AmCoastal’s investigation fell short of, or even what standards constitute, “proper” investigation principals. Additionally, the Notice lacks a single sentence that speaks to a generalized AmCoastal business practice. Accordingly, AmCoastal denies that it violated this statutory section. 3. Section 626.9541(1)(i)(3)(b), Florida Statutes, defines the following as an unfair claim settlement practice: “Committing or performing with such frequency as to indicate a general business practice any of the following: … misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.” The only allegation of misrepresentation contained in the Notice is that “EFI misrepresents the true weather details over the subject property on or about the date of loss.” AmCoastal sent EFI’s report, unedited, to the Insured and relied on the report, in part, in its coverage determination. The fact that EFI relied on different weather data than the Insured’s hired expert does not amount to a misrepresentation on AmCoastal’s part. Additionally, AmCoastal provided the weather information the insured provided, which was prepared by Glen “Richard” Gajownik of WeatherSource and dated May 28, 2024 (“WeatherSource Report”), to EFI’s forensic engineer who peer reviewed the report. EFI’s forensic engineer observed that 1) the WeatherSource Report does not contain a methodology used to reach the conclusion that winds reached 67 mph at the Insured’s property (indeed the only supporting wind speed reading was at a location 11 miles from the loss location); 2) the WeatherSource Report omits surface observations that were much closer to the Insured’s property and are a key aspect in any site specific analysis; 3) the WeatherSource Report did not utilize the closest available radar to the Insured’s property; and 4) available doppler radar showed the strongest winds occurred to the south of the Insured’s property. Given the lack of factual support in the Notice, the fundamental errors contained in the WeatherSource Report, and the lack of substantive conflicting information provided by the Insured or available to AmCoastal, AmCoastal denies that it violated this statutory section. 4. Section 626.9541(1)(i)(3)(b), Florida Statutes, defines the following as an unfair claim settlement practice: “Committing or performing with such frequency as to indicate a general business practice any of the following: … denying claims without conducting a reasonable investigation based upon available information.” This allegation is wholly unsupported by the contents of the Notice and reality. AmCoastal inspected with field adjuster days after first notice of loss, and, after receiving a repair estimate and weather report from a PA, asked a third-party civil engineer to confirm the cause of loss. By contrast, the Insured has not provided documents or information contradicting the engineering report. Accordingly, AmCoastal denies that it violated this statutory section. The allegations in the Notice do not amount to violations of any statutory requirements or Policy provisions by AmCoastal. Instead, they boil down to nothing more than the Insured refusing to accept the results of AmCoastal’s investigation of this Claim. The Insured, its PA, and the Insured’s counsel have consistently refused to acknowledge even the most basic explanations of why AmCoastal does not accept the Insured’s demands. In summary, the Notice is invalid because it does not meet the specificity requirements of Section 624.155, Florida Statutes. To the extent the Notice contains allegations capable of being responded to, AmCoastal categorically denies the allegations. While this response is meant to be comprehensive, it is based upon the limited information provided in the Notice and the information known to date. This response or any act or failure to act on the part of AmCoastal or any agent or representative of AmCoastal should not be construed as a waiver of any rights or defenses, including but not limited to proper notice and service by the complainants, available to it by contract or at law as all such rights and defenses are hereby specifically reserved. We trust the foregoing addresses all questions and concerns raised by the Notice. Please contact us if we can be of any further assistance. Justin Bright Assistant General Counsel American Coastal Insurance Corporation jbright@amcoastal.com (727) 425-8087
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