Filing Number: 825472
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| Filing Accepted: 6/5/2025 |
| Last/Business Name
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INTERNATIONAL VILLAGE ASSOCIATION, INC.
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First Name |
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| Street Address
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3700 INVERRARY DRIVE #101 |
| City, State Zip
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LAUDERHILL,
FL
33319
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| Email Address
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2023PRES@IVCONDO.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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INTERNATIONAL VILLAGE ASSOCIATION, INC. |
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First Name |
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SHAUN |
| Policy # * |
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AMC-37925-01 |
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Claim #* |
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4233687 |
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Attorney is Applicable
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| Last Name* |
MARKER
First Name *
SHAUN
Initial
J
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| Street Address* |
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ONE NORTH CLEMATIS STREET, SUITE 510 |
| City, State Zip* |
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WEST PALM BEACH
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FL
33401
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| Email Address * |
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SMARKER@MERLINLAWGROUP.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 COASTAL 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 12968 |
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| Name of individual responsible for violation (if any):*
OFFICERS, SUPERVISORS, AND OR MANAGEMENT OF AMERICAN COASTAL INSURANCE COMPANY, INCLUDING ALL ADJUSTERS, CLAIM REPRESENTATIVES, FIELD ADJUSTERS, ENGINEERS AND OTHER EXPERTS, AND CLAIM REPRESENTATIVES/ADJUSTERS AND ACCOUNT MANAGERS OF SEDGWICK DELEGAT
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| Type of Insurance
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Commercial Property & Casualty
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| Reason for Notice
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Claim Delay
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Claim Denial
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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)(2) |
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Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
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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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Building coverage provisions; additional coverages; duties in event of loss policy provisions; all terms and conditions of Section I of the insurance policy; the insurance policy's definition section; the insurance policy's exclusion of coverage provisions; loss payment policy provision; loss settlement provision; the declarations page; we will adjust all losses with you.
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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.
In Florida, the work of adjusting insurance claims engages the public trust. American Coastal Insurance Company (“American Coastal”) has breached this duty by its handling of the Insured’s, International Village Association, Inc.’s Claim of Loss (Claim Number 4233687; D.O.L. 4/13/23).
American Coastal Insurance Company has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s insurance claim for damages.
On or about April 13, 2023, the Insured submitted a claim to American Coastal for damages sustained as a result of wind and hail.
We have identified the following instances of bad faith conduct on the part of your company:
• Refusing to pay for necessary repairs and attempting to coerce us into accepting a lower settlement amount by failing to properly consider all applicable statutes and building code requirements both at the state and local level.
• Implementing a claim handling process geared solely to the minimization of roof, interior and exterior related damages. Specifically, taking a hardline stance against full payment for all damages despite evidence supporting the need for same. This scheme is meant solely to benefit the carrier while hindering the insured from obtaining just compensation for the loss.
• Purposefully minimizing the value of the claim by using biased estimating software/pricing and low-balling the cost of repairs. Specifically, estimations and repair costs have been purposefully devalued to the benefit of the insurance company despite knowledge that these costs are woefully deficient.
• Failing to provide full payment for wind damage to the roof, interior and exterior when there was obvious and apparent damage to the roof, exterior and interior due to wind/hail that occurred on April 13, 2023 to the subject property.
• Misrepresenting that the roof coverings are all damaged from “age related deterioration, prior repairs, pre-existing damages, mechanical damage, manufacturing imperfections and improper installation to the flat build-up and shingle roofing,” and that “there were no damages to the building enclosure elements caused by wind or hail on or about the reported date of loss.” See correspondence to Insured dated October 11, 2024 from Sedgwick Delegated Authority.
• Failure to acknowledge and take into account all evidence of damage resulting from wind and hail that occurred to the subject property on April 13, 2023.
• Failure to acknowledge that the low sloped roofing systems installed on the Bordeaux, Nottingham, Orleans and Yorkshire buildings have experienced wind and hail impact damage as a result of the severe thunderstorm event of April 13, 2023. Based upon expert training, visual and physical observations, and a reasonable degree of certainty, proper remediation of the damaged roofs cannot return each roof to pre-loss conditions and require the complete replacement of all shingles, underlayment and flashing on Bordeaux, Nottingham, Orleans and Yorkshire.
• American Coastal performed underwriting inspections of the subject property and knew and was aware of the condition of these buildings’ roofs before this loss occurred. American Coastal decided to accept the risk, write coverage and accepted a premium of $786,334.00.
These actions on the part of your company are unacceptable, and are in violation of our insurance policy and the duty of good faith and fair dealing that American Coastal owes to its policyholders. Based on conduct to date, these practices occur with such frequency as to constitute a general claims handling process/business practice imbedded within the company’s management of wind/hail claims.
To date, notwithstanding the Insured’s pleas otherwise, American Coastal has continued to refuse to acknowledge its obligation to tender all insurance proceed monies due and owing the Insured or assist the Insured in mitigation of the damages.
The insurer has failed and refused to acknowledge coverage and restore the Insured to pre-loss condition. American Coastal has sufficient information upon which to evaluate the Insured’s claim for damages, and certainly has been provided with an independent means by which to determine the amount of loss.
The Insured has otherwise fully complied with the insurer's requests for post-loss compliance. American Coastal has not properly paid all of the covered damages. These actions by American Coastal occur with such frequency to indicate a general business practice of the company.
The Insured has complied with the policy of insurance and Florida law, and American Coastal continues to wrongfully refuse to tender the insurance proceeds that are due and owing the Insured. The concept of insurance is the granting of timely and prompt indemnity or security against a contingent loss. Florida statute section 624.02 defines "insurance" as a contract whereby one undertakes to indemnify another or pay a specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that the Insured may be put back into the position the Insured was in prior to the loss as quickly as possible. American Coastal breached this duty.
The Insured was and still is forced to expend out of pocket monies to submit the insurance claim to force American Coastal to honor its obligations under the insurance policy to pay all the insurance proceeds due and owing the Insured. American Coastal has clearly displayed bad faith in its handling, processing, and wrongful delay of this claim. The Insured merely requests that American Coastal "adjust the loss" with them in accordance with the policy of insurance for which American Coastal has accepted a premium, and in accordance with Florida law. American Coastal’s conduct has been reckless and unfair to its Insured and has caused and continues to cause additional damages.
We demand that American Coastal immediately take steps to rectify the situation and handle this claim in a fair and appropriate manner. This includes providing full and fair compensation for the damages incurred and for any additional costs and expenses incurred as a result of American Coastal 's bad faith conduct, including but not limited to, fees and costs related to the retention of personnel/counsel required to challenge American Coastal’s improper handling of this claim. [As of this moment, the damages found and evaluated by the insured(s) value at minimum of $3,950,000.00 in new monies to settle all issues of this claim in exchange for a release. This amount is for replacement of the mansard roofs on the residential buildings and some flat roof coatings. We request payment in that sum as a curative measure to the conduct described herein.]
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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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