Filing Number: 827942
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| Filing Accepted: 6/20/2025 |
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TIMBER OAKS FAIRWAY VILLAS CONDO IV ASSN. INC.
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First Name |
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5901 US HIGHWAY 19, SUITE 7Q |
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NEW PORT RICHEY,
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34652
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| Email Address
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PRESIDENT.FV4@GMAIL.COM |
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Insured |
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| Last/Business Name* |
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TIMBER OAKS FAIRWAY VILLAS CONDO IV ASSN. INC. |
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First Name |
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| Policy # * |
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AMC-31712-05 |
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Claim #* |
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4179479 |
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Attorney is Applicable
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| Last Name* |
HARRIS
First Name *
ASHLEY
Initial
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| Street Address* |
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777 S HARBOUR ISLAND BLVD., SUITE 950 |
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TAMPA
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FLORIDA
33602
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AHARRIS@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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AMERICAN COASTAL INSURANCE COMPANY
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,
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NAIC Company Code 12968 |
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| Name of individual responsible for violation (if any):*
TAMELA HUGHEY, AIC
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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 Denial
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Claim Delay
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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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| 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)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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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.
DECLARATIONS PAGE
COMMERCIAL PACKAGE
Named Insured:
Timber Oaks Fairway Villas Condo IV Assn Inc
DEDUCTIBLE
Sinkhole Deductible: 3% Per Occurrence
COVERAGES PROVIDED Insurance at the Described Premises Applies Only for Coverages for Which A Limit of Insurance is shown.
Described Location Premises
Loc No. Address Building
0001 8131 Braddock Circle, Port Richey, FL 34668 $508,171
0002 8141 Braddock Circle, Port Richey, FL 34668 $508,171
0003 8151 Braddock Circle, Port Richey, FL 34668 $508,171
0004 8135 Bugle Court, Port Richey, FL 34668 $508,171
0005 8131 Bugle Court, Port Richey, FL 34668 $508,171
0006 8121 Bugle Court, Port Richey, FL 34668 $508,171
0007 8111 Bugle Court, Port Richey, FL 34668 $508,171
0008 8110 Bugle Court, Port Richey, FL 34668 $508,171
0009 8130 Bugle Court, Port Richey, FL 34668 $508,171
0010 8141 Bugle Court, Port Richey, FL 34668 $508,171
0013 8150 Braddock Circle, Port Richey, FL 34668 $508,171
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CONDOMINIUM ASSOCIATION COVERAGE FORM
A. Coverage
We will pay for direct physical loss of or damage to Covered Property at the premises described in the Declarations caused by or resulting from any Covered Cause of Loss.
1. Covered Property
Covered Property, as used in this Coverage Part, means the type of property described in this section, A.1., and limited in A.2., Property Not Covered, if a limit of Insurance is shown in the Declarations for that type of property.
a. Building, meaning the building or structure described in the Declarations…
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4. Loss Payment
a. In the event of loss or damage covered by this Coverage Form, at our option, we will either:
(1) Pay the value of lost or damaged property;
(2) Pay the cost of repairing or replacing the lost or damaged property, subject to b. below;
(3) Take all or any part of the property at an agreed or appraised value; or
(4) Repair, rebuild or replace the property with other property of like kind and quality, subject to b. below.
We will determine the value of lost or damaged property, or the cost of its repair or replacement, in accordance with the applicable terms of the Valuation Condition in this Coverage Form or any applicable provision which amends or supersedes the Valuation Condition.
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FLORIDA CHANGES – RESIDENTIAL CONDOMINIUM ASSOCIATIONS
A. Building section is replaced by the following:
1. Building, meaning the building or structure described in the Declarations, including:
a. Additions, alterations and repairs;
b. Fixtures, outside of individual units, including outdoor fixtures;
c. Permanently installed:
(1) Machinery; and
(2) Equipment;
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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
FLORIDA – SINKHOLE LOSS COVERAGE
This endorsement modifies insurance provided under the following:
BUILDING AND PERSONAL PROPERTY COVERAGE FORM CONDOMINIUM ASSOCIATION COVERAGE FORM
A. The following is added to this Coverage Part as a Covered Cause of Loss…
“Sinkhole Loss”, meaning loss or damage to Covered Property when “structural damage” to the “covered building”, including the foundation, is caused by settlement or systematic weaking of the earth supporting the “covered building”, only if the settlement or systematic weakening results from contemporaneous movement or raveling of soils, sediments, or rock materials into subterranean voids created by the effect of water on a limestone or similar rock formation.
Coverage for “Sinkhole Loss” includes stabilization of the building (including land stabilization) and repair to the foundation, provided such work is in accordance with the requirements of Florida Insurance Law and in accordance with the recommendation of a professional engineer and with notice to you. The professional engineer must be selected or approved by us. However, until you enter into a contract for performance of building stabilization or foundation repair in accordance with the recommendations of the professional engineer as set forth in a report from us:
1. We will not pay for underpinning or grouting or any other repair technique performed below the existing foundation of the building; and
2. Our payment for “Sinkhole Loss” to Covered Property may be limited to the actual cash value of the loss to such property.
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Deductible
The following deductible provision applies to any loss covered by this endorsement and, in that respect, replaces any deductible provision in the policy to which this endorsement is attached:
We will pay only that part of the loss which exceeds the “Sinkhole Loss” Deductible shown on the Declarations.
This deductible will apply separately to each building and each “sinkhole loss”.
B. You must enter into a contract for the performance of building stabilization and/or foundation repair in accordance with the aforementioned recommendations, within 90 days after we notify you that there is coverage for your “Sinkhole Loss.” After you have entered into such contract, we will pay the amounts necessary to begin and perform such repairs as the work is performed and the expenses are incurred.
However, if the professional engineer determines, prior to your entering into the aforementioned contract or prior to the start of repair work, that the repairs will exceed the applicable Limit of Insurance, we must either complete the recommended repairs or pay that Limit of Insurance upon such determination. If the aforementioned determination is made during the course of repair work and we have begun making payments for the work performed, we must either complete the recommended repairs or pay only the remaining portion of the applicable Limit of Insurance upon such determination. The most we will pay for the total of all “Sinkhole Loss,” including building and land stabilization and foundation repair, is the applicable Limit of Insurance on the affected building.
The stabilization and all other repairs to the Covered Property must be completed within 12 months after entering into the contract for the performance of these repairs, unless:
1. There is a mutual agreement between you and us;
2. The claim is involved with the neutral evaluation process;
3. The claim is in litigation; or
4. The claim is under appraisal or mediation.
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E. With respect to a claim for alleged “Sinkhole Loss”, the following provision is added:
Following receipt by us of a report from a professional engineer or professional geologist on the cause of loss and recommendations for land stabilization and repair of property, or if we deny your claim, we will notify you of your right to participate in a neutral evaluation program administered by the Florida Department of Financial Services (hereinafter referred to as the Department). For alleged “Sinkhole Loss” to commercial residential or farm residential properties, this program applies instead of any mediation procedure set forth elsewhere in this policy, but does not invalidate the Appraisal Condition.
You or we may file a request with the Department for neutral evaluation; the other party must comply with such request. We will pay reasonable costs associated with the neutral evaluation, regardless of which party makes the request. But if a party chooses to hire a court reporter or stenographer to contemporaneously record and document the neutral evaluation, that party must bear the costs of those services. The neutral evaluator will be selected from a list maintained by the Department. The recommendation of the neutral evaluator will not be binding on you or us.
Participation in the neutral evaluation program does not change your right to file suit against us in accordance with the Legal Action Against Us Condition in this policy, except that the time for filing suit is extended for a period of 60 days following the conclusion of the neutral evaluation process or five years, whichever is later.
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H. The following definitions are added with respect to the coverage provided under this endorsement:
1. “Structural damage” means a “covered building”, regardless of the date of its construction, has experienced the following.
a. Interior floor displacement or deflection in excess of acceptable variances as defined in ACI 117-90 or the Florida Building Code, which results in settlement related damage to the interior such that the interior building structure or members become unfit for service or represent a safety hazard as defined within the Florida Building Code;
b. Foundation displacement or deflection in excess of acceptable variances as defined in ACI 318-95 or the Florida Building Code, which results in settlement related damage to the primary structural members or primary structural systems that prevents those members or systems from supporting the loads and forces they were designed to support to the extent that stresses in those primary structural members or primary structural systems exceed one and one-third the nominal strength allowed under the Florida Building Code for new buildings or similar structure, purpose, or location.
c. Damage that results in listing, leaning, or buckling of the exterior load bearing walls or other vertical primary structural members to such an extent that a plumb line passing through the center of gravity does not fall inside the middle one-third of the base as defined within the Florida Building Code;
d. Damage that results in the building, or any portion of the building containing primary structural members or primary structural systems, being significantly likely to imminently collapse because of the movement or instability of the ground within the influence zone of the supporting ground within the sheet plane necessary for the purpose of supporting such building as defined within the Florida Building Code; or
e. Damage occurring on or after October 15, 2005, that qualifies as substantial structural damage as defined in the Florida Building Code.
2. “Primary structural member” means a structural element designed to provide support and stability for the vertical or lateral loads of the overall structure.
3. “Primary structural system” means an assemblage of “primary structural members”.
4. “Covered building” means the Building Property at the insured location that is listed on the Schedule or Declarations. This definition does not extend to any structures that are attached to the livable square footage of this stand-alone structure, unless the structure is under the same roofline or foundation line and depth as the “covered building.”
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6. “Sinkhole” means a landform created by subsidence of soil, sediment, or rock as underlying strata are dissolved by groundwater. A “sinkhole” forms by collapse in subterranean voids created by dissolution of limestone or dolostone or by subsidence as these strata are dissolved.
7. “Sinkhole activity” means settlement or systematic weakening of the earth supporting the “covered building” only if the settlement or systematic weakening results from contemporaneous movement or raveling of soils, sediments, or rock material into subterranean voids created by the effect of water on limestone or similar rock formation.
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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 (“ACIC”), has breached this duty by its adjustment of the policyholder’s claim of loss.
ACIC has failed to create and implement adequate guidelines for proper investigation and evaluation of claims and for training and supervision of employees resulting in statutory violations as set forth herein. ACIC has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the policyholders’ insurance claim for damages based on all information available and has instead ignored relevant and obvious information that evidences that additional payment is required under the policy.
Notwithstanding the timely notification of the insurance claim, ACIC wrongfully denied coverage for and refused to tender to the policyholders all insurance proceeds due and owing under the insurance policy.
To date, notwithstanding the policyholders’ pleas otherwise, ACIC has refused to acknowledge its obligation to tender all monies due and owing or assist the policyholder in the mitigation of its damages.
The policyholder is Timber Oaks Fairway Villas Condo IV Assn Inc (“Timber Oaks”) whose property was damaged as the result of a sinkhole loss discovered in or about November 2020. Damages resulting from sinkhole loss are undisputedly covered under the relevant insurance policy.
The policyholder timely notified ACIC of the damages on November 19, 2020, and opened a claim pursuant to the terms and conditions of the insurance policy.
In response to the claim for benefits, on November 23, 2020, ACIC sent correspondence to Timber Oaks acknowledging receipt of the claim. Thereafter, the claimed damages were expanded to all 13 building locations.
ACIC retained ROL Insurance Consulting to inspect the buildings. Morgan Evans of ROL Insurance Consulting performed the inspections on February 15 and February 16, 2021, along with Timber Oak’s representatives, Dave Mast of Keys Claims Consultants and Ian Force of Qualified Property Management.
Following the inspections, on March 11, 2021, ACIC retained SDII Global to conduct a structural damage evaluation of the thirteen locations. The initial purpose of the investigation was to determine if structural damage exists at the property and, to the extent possible, the probable causes contributing to the observed damage, especially structural damage, at the property.
Following unknown communications between ACIC and SDII Global regarding the observed structural findings, ACIC authorized SDII Global to extend the scope of the investigation to include testing for sinkhole activity on June 7, 2021.
Thereafter, SDII Global performed site inspections; Ground Penetrating Radar (GPR) surveys around the perimeter and inside of the structure to identify anomalous subsurface areas within the zone of influence of the foundation and in other areas of interest; test pits were excavated to directly observe foundation construction and geometry; hand auger borings and push penetrometer soundings were advanced to determine the composition and relative penetration resistances of subsurface materials near the foundation and the upper zone of influence of the structure; Standard Penetration Test (SPT) borings were advanced in areas of interest adjacent to the foundation in order to characterize the relative stability of soils within the zone of influence of the structure and to investigate deeper geologic conditions for the presence of evidence of sinkhole activity; and soilers were tested in the laboratory.
Following this testing, SDII Global prepared reports positively identifying sinkhole activity at location 1 (8131 Braddock Circle); Location 3 (8151 Braddock Circle); Location 4 (8135 Bugle Court); Location 5 (8131 Bugle Court); Location 6 (8121 Bugle Court); Location 7 (8111 Bugle Court); Location 8 (8110 Bugle Court); Location 9 (8130 Bugle Court); Location 10 (8141 Bugle Court); and Location 13 (8150 Braddock Circle).
SDII Global went on to recommend that the subsurface soils be stabilized through compaction grout injections to densify the soils beneath the structure and to seal the top of the limestone surface to minimize future raveling; and following the compaction grout injection, due to the presence of very loose shallow soils identified in the SPT borings that may not sufficiently be densified through compaction grouting, SDII recommended a supplemental program of shallow chemical grout injection to stabilize the shallow soils around the perimeter of the structure and beneath most CMU load-bearing walls. SDII Global estimated the cost of the subsurface remediation, monitoring, and certification to be approximately $166,215 for Location 1; $174,675 for Location 3; $174,675 for Location 4; $131,835 for Location 5; $183,135 for Location 6; $195,555 for Location 7; $174,675 for Location 8; $174,675 for Location 9; $131,835 for Location 10; and $195,555 for Location 13.
While SDII Global states in its reports that structural damage as defined by §627.706(2)(k), Fla. Stat. did not exist for Locations 1, 3, 4, 5, 6, 7, 8, 9, 10 and 13, SDII Global further advised ACIC that “it is SDII’s opinion that the sinkhole activity identified at the site has been a concurrent cause of some of the observed damage” and that “the tests performed were of sufficient scope to identify sinkhole activity, as defined by §627.706, F.S.(2)(i) as a cause of damage at the building.”
Conveniently, after estimating approximately $1,702,830 in total necessary subsurface repairs to the insured buildings, SDII Global ignored obvious structural damage to “eliminate” structural damage and determine that there was no covered sinkhole loss. Essentially, ACIC misrepresented to Timber Oaks that approximately $1,702,830 of necessary subsurface repairs were not covered under the insurance policy.
In January, February, March and April 2022, ACIC sporadically provided coverage letters to Timber Oaks denying all coverage for the claimed damages.
Timber Oaks disagreed with ACIC’s blatant attempt to avoid liability for the sinkhole damages and retained its own engineer to evaluate the damages to the properties. On March 10, 2023, Timber Oaks provided reports prepared by Structural Engineering and Inspections (“SEI”) for Locations 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 and 13 to ACIC. The SEI reports detailed the observations at each of these locations and the basis for a determination that these locations DID MEET the criteria for structural damage as defined by Florida Statute §627.706(2)(k). Ultimately, SEI determined that Locations 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 and 13 all sustained covered sinkhole losses and provided repair recommendations to stabilize the land and buildings and repair the foundations.
There appears to have been little, if any, real analysis of the SEI reports before ACIC summarily rejected SEI’s findings and further delayed the resolution of the claim by invoking neutral evaluation.
On May 23, 2023, ACIC submitted its request for neutral evaluation to the Florida Department of Financial Services.
Further, rather than putting the SEI reports through a proper and unbiased peer review, ACIC chose to utilize the same outcome-oriented engineering firm, SDII Global, to in essence check their own work. ACIC was provided this “peer review” on June 30, 2023. Notably after it had already rejected the SEI reports and compelled its policyholder to participate in neutral evaluation.
On April 18, 2024, the Florida Department of Financial Services finally processed the request for neutral evaluation and Ray Jones formally accepted the assignment as neutral evaluator. Thereafter, the neutral evaluation process proceeded forward.
The numerous deficiencies in ACIC’s handling of this claim are due to its failure to adopt and implement standards for the proper investigation of claims in violation of §626.9541(1)(i)(3)(a), and its underlying intent to deprive Timber Oaks from the amounts owed under their insurance policy for the goal of maximizing its own profits.
Since the beginning of the claim, ACIC has engaged in a pattern of delay and denial that has harmed Timber Oaks. ACIC has not settled the claim when it could and should have done so had it acted fairly and honestly and has failed to take into account the information and evidence that clearly shows/ed payment is owed.
ACIC has misrepresented pertinent facts and insurance policy provisions, most notably that Locations 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, and 13 did not sustain structural damages as defined by Florida law.
ACIC has refused to pay the policyholder’s claim without conducting a reasonable investigation based upon all available information. Specifically, ACIC retained outcome-oriented personnel to perform the inspection with the goal of denying coverage for a covered sinkhole loss. Moreover, when presented with evidence of structural damage, ACIC went back to the same outcome-oriented company to re-confirm its prior findings rather than seek out an unbiased review of all the data and information.
The actions and violations noted above were either done intentionally or as the result of ACIC’s failure to adopt and implement the proper standards for the investigation and adjustment of claims.
Overall, ACIC’s investigation and handling of the claim was inadequate and contrary to its obligations under the insurance policy and Florida law.
Timber Oaks has done everything legally requested by ACIC to date. To cure the violations set forth in this Civil Remedy Notice, ACIC must now agree to acknowledge its duties and obligations under the law in adjusting its policyholder’s claim, and tender rightfully owed insurance benefits to return Timber Oaks to its pre-loss condition.
The concept of insurance is that insurance is the insurer’s granting of timely and prompt indemnity or security against a contingent loss. Florida law defines “insurance” as a contract whereby one undertakes to indemnify another or pay or allow specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that the policyholder may mitigate its damages and to put it back into the position it was in prior to the loss as quickly as possible. ACIC breached this duty.
Timber Oaks was and still is forced to expend monies to submit the insurance claim and support this dispute, e.g., retaining experts, and legal counsel, to force ACIC to honor its obligations under the insurance policy and to pay all the insurance proceeds due and owing Timber Oaks.
ACIC has refused and/or failed to tender all insurance proceeds to Timber Oaks upon demand. ACIC’s refusal and/or failure to settle the insurance claim when under all circumstances it could have and should have done so had it acted fairly and honestly towards the policyholder is wrongful conduct. Timber Oaks contends that ACIC has financially benefited from its improper withholding of due and owing insurance proceeds by profiting from the “float”. Furthermore, Timber Oaks contends that ACIC and/or its representatives financially benefit from such unfair trade practices as a part of their general business practices. Timber Oaks contends that ACIC pressures its agents and/or representatives, through financial incentives, to look for reasons to underpay or deny claims instead of fulfilling their obligations to do the opposite as a general business practice. Specifically, Timber Oaks contends that ACIC’s management and executive leadership are engaged in a scheme to minimize and delay payments on legitimate claims in order to increase the company’s loss ratios and other financial metrics.
This notice is given in order to perfect the right to pursue the civil remedy authorized by Florida Statutes, including any and all bad faith/extra contractual damages, should ACIC fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Timber Oaks also intends to seek punitive damages against ACIC as it appears that ACIC’s violations occur with such frequency as to evidence a general business practice and the violations were willful, wanton and malicious and in reckless disregard for the rights of its insureds.
While no specific “cure amount” is required for this Civil Remedy Notice to be valid,Timber Oaks will consider the allegations contained herein “cured” if ACIC:
(1) Immediately tenders $3,056,082.20.
While Timber Oaks is requesting that this be done to “cure” this Civil Remedy Notice, they are willing to consider, and may accept, any reasonable counteroffer. Therefore, if ACIC disagrees with the requests, Timber Oaks requests that ACIC make a counteroffer before the end of the “cure period” and provide supporting documentation for any such offer.
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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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