Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 828853

Filing Accepted: 6/25/2025

Print Filing

Complainant

Last/Business Name *

CHAMPIONS GREEN CONDOMINIUM III

First Name

Street Address *

13831 VECTOR AVENUE

City, State Zip *

FORT MYERS, FL 33907

Email Address *

SHERRY.BELCHER@ALLIANTPROPERTY.COM

Complainant Type: *

Insured

Last/Business Name*		CHAMPIONS GREEN CONDOMINIUM		First Name		MARIO
Policy # *		AMC-36898-03		Claim #*		4205251

Attorney

Attorney is Applicable

Last Name*	ENRIQUEZ First Name * MARIO Initial L
Street Address*		221 ARAGON AVENUE SUITE 200
City, State Zip*		CORAL GABLES , FL 33134
Email Address *		ME@RAMIREZENRIQUEZ.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		AMERICAN COASTAL INSURANCE COMPANY
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 12968

Name of individual responsible for violation (if any):* KATHLEEN BYERS
Type of Insurance * Commercial Property & Casualty

Reason for Notice *

	Claim Denial
	Unfair Trade Practice
	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.
	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)(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)(3)(h)		Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.

* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

A. CONCEALMENT, MISREPRESENTATION OR FRAUD This Coverage Part is void in any case of fraud by you as it relates to this Coverage Part at any time. It is also void if you or any other insured, at any time, intentionally conceal or misrepresent a material fact concerning: 1. This Coverage Part; 2. The Covered Property; 3. Your interest in the Covered Property; or 4. A claim under this Coverage Part.

* 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 (hereinafter “AM Coastal”) has violated its obligations under the above referenced statutes and has operated in bad faith by refusing to provide remuneration for obvious Hurricane Ian damage, claiming falsely that these damages occurred as a result of a prior Hurricane Irma claim and seeking to void coverage for a misrepresentation. Champions Green Condominium III Association Inc (hereinafter the “INSUREDS”) has a policy with AM Coastal. The INSUREDS suffered a loss as a result of Hurricane Ian on September 28, 2022. The INSUREDS timely and dutifully reported a claim to AM Coastal. AM Coastal sent an adjuster and engineer who confirmed they saw damages related to Hurricane Ian and initially issued payment for those losses. Those payments did not address the extensive damage observed and failed to address windows, which were damaged by the claim. who was unwilling and unable to evaluate the full extent of the damages suffered. After an Examination Under Oath, AM Coastal sought to disclaim all coverage, claiming that there were misrepresentations made with respect to a prior claim stemming from Hurricane Irma. The INSUREDS submitted documentation that conclusively demonstrated, replete with photographs, that Hurricane Irma damage was addressed with repairs were completed, inspections were performed on a quarterly basis and that the repairs performed by the INSUREDS completely resolved the issues arising from Hurricane Irma. Further, the INSUREDS paid for a full review of the cause and origin of the damages presented in the claim by an engineer, who also attributed all loss claimed to Hurricane Ian. This engineer was provided information regarding prior Hurricane Irma claims, the intervening quarterly inspection reports and determined that the damages sustained arose from Hurricane Ian and not Hurricane Irma. During the examinations in question, the INSURED through their board members openly informed the carrier of the prior claim from Hurricane Irma, admitted to the payments received and informed the carrier that the damage claimed in this case were distinct as reported by the professional roofers and engineers who were presented all the information available regarding the prior claims. AM Coastal has presented no evidence that any inspector, whether adjuster or engineer, has opined that the damage present at the property relates to any prior claim or is duplicative of any prior claim. The community has permitted multiple re-inspections, provided photographs and has been willing to provide all disclosures requested from the prior carrier to show that the damage is separate and distinct from what occurred as a result of Hurricane Irma. Despite the INSUREDS best efforts, candor and disclosure, AM Coastal has refused to evaluate clear damage to the windows, extensive and catastrophic wind damage to the roofs and has left its INSURED to bear the costs of attempting to fix the roofs alone. AM Coastal’s actions have left the INSUREDS no other option but to seek counsel and judicial intervention, costing the INSUREDS additional time, expenses and endangering further damage to the subject property and detracting from the INSUREDS right to quiet enjoyment of their property. This conduct is demonstrative of a pattern of neglectful business practices affecting similarly situated insureds as the INSUREDs. CURE: In order to rectify AM COASTAL’S breaches, AM COASTAL must provide specific information on the facts that were intentionally concealed or misrepresented by the INSUREDS. The INSUREDS have sought examinations under oath taken, but have only been provided a copy of one of the examinations. Further, AM COASTAL must produce a coverage determination regarding the windows which were damaged in this claim. Lastly, if AM Coastal has evidence that the roof damage from Hurricane Irma remained at the property or that inadequate repairs caused the damage arising from Hurricane Ian, AM Coastal should make specific representations to support their baseless allegations of fraud. Am Coastal is must issue payment immediately for the damage sustained at the property. Payment issued should account for interest, attorney’s fees and costs incurred as a result of their failure to adequately adjust the subject claim and enjoyment of the subject property. AM Coastal must withdraw the false statements presented in the denial letter and honor this claim as should have been done many years ago.

Comments

User Id		Date Added		Comment
nalcantara@hightowerlaw.net		08-22-2025		After reviewing the Civil Remedy Notice, AmCoastal conducted a thorough review of their handling of the Insured’s claim. AmCoastal handled the claim correctly and denies that it violated any statutes, administrative code provisions, or either rules or obligations in connection with their investigation and handling of the Insured’s claim. At the outset, the Civil Remedy Notice contains non-specific, boilerplate allegations that AmCoastal violated applicable statutes. None of the allegations contained in the Civil Remedy Notice have any basis in fact. AmCoastal unequivocally denies each and every allegation asserted in the Civil Remedy Notice. As outlined above, the alleged statutory violations and factual allegations set forth in the Notice are devoid and without merit. AmCoastal has abided by the policy and the coverage determination was made in accordance with the terms agreed upon by the parties. Notwithstanding the same, the parties reached an amicable settlement, and the Civil Remedy Notice has been withdrawn by the insured.

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