American Integrity: the engineer sees the damage, the letter sees exclusions

A Civil Remedy Notice is a formal complaint filed against an insurance company with Florida's Department of Financial Services. Filing one is the step Florida law requires before a policyholder can sue an insurer for bad faith. It is a public record, and the insurer gets 60 days to fix the problem before that right opens up.

So this is the policyholder's side of a dispute, written by their side, and it is an allegation rather than a finding. The insurer answered it, and its answer is published below alongside the complaint. Read both. Names, addresses, and policy and claim numbers have been removed here; everything else is quoted from the filing.

American Integrity Insurance Company of Florida (the "Insurer") has committed the following in handling the Insured's claim: 1) failing to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the Insured; 3) looking for ways to deny benefit payments and otherwise "low ball" or "stone wall" claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; 8) denying a claim which it knew or should have known the policy and Florida law provided coverage for; 9) failing to provide an estimate that complies with the Florida Building Codes; 10) making material misrepresentations; and 11) failing to render a claims determination within ninety (90) days. On or about September 28, 2022, while the subject policy was in full force and effect, the Insured's property was severely damaged by Hurricane Ian. The areas impacted include but are not limited to the roofing system, exterior, pool area, kitchen, master bedroom, master bathroom, garage, and bedroom. The Insured timely submitted a claim on October 17, 2022, to the Insurer for hurricane damage and the ensuing damage therefrom. Thereafter, the Insurer assigned claim no. [redacted] to the loss and sent a field adjuster to inspect the property on November 1, 2022. Then in a letter dated February 11, 2023, the Insurer notified the Insured that it was extending partial coverage for the loss. However, the Insurer wrongfully determined that it would only require $4,128.31 to restore the insured property to its pre-loss condition, which failed to exceed the policy deductible. The Insurer's lowball estimate is that of a classic under scope and under value of the claim. The Insurer erroneously denied coverage for some of the Insured's roof damage as well as the Insured's interior damage. Given the partial denial, the Insured's disagreement with the coverage decision, and the scope and nature of the damage resulting from Hurricane Ian, the Insured retained a general contractor. After assessing the damage and the true scope of repairs, the general contractor produced an estimate identifying $144,753.94in covered damage to the dwelling. Upon receiving notice of the loss, the Insurer had the duty to provide the full benefits under the policy. This includes providing the Insured with a proper investigation and the funds necessary to return the home to its pre-loss condition. However, when the Insurer conducted its inspection of the insured property, the Insurer's adjuster failed to conduct a thorough and adequate investigation, or the adjuster intentionally ignored the damage observed and failed to make truthful and unbiased reports of the facts after investigating. As a result, the Insurer breached the policy by failing to fully indemnify the Insured for the covered loss. The Insurer misrepresented the loss and wrongfully denied coverage for the damage sustained to the Insured's property. According to the claims determination letter, the Insurer's engineer observed damage to the roof and interior, but attributed the cause of this damage causes excluded under the policy. However, the Insurer knows or should know that when independent perils converge and no single cause can be considered the sole or proximate cause, it is appropriate to apply the concurring cause doctrine. Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016). The concurring cause doctrine states that coverage may exist where an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause. Id. at 698. A covered peril that meets with an uncovered peril may still provide for coverage under a policy when the covered peril triggered the events that eventually led to the loss. Id. at 697. The Insurer intentionally ignored covered damage to deny the reported loss and wrongfully fail to pay the Insured. This is an underhanded attempt to place the financial interests of the Insurer over those of the Insured and to delay and frustrate the Insured's ability to have his claim adjusted promptly to begin restoring his property. Furthermore, the Insurer observed damaged to the roof but concluded no storm created openings were observed. The term "opening" is not defined by the policy. [name redacted] dictionary defines opening as "a hole or space that something or someone can pass through." https://dictionary.cambridge.org/us/dictionary/english/opening. Here, subsequent water damage was observed to the interior of the property, including the ceiling, of the Insured's home. As a result, the very simple question arises of "where did the water come from?" Utilizing the definition cited, the roof was damaged in a way that allowed something, here the water, to pass through the roofing structure and subsequently damaging the interior of the Insured's property. However, the Insurer is instead interpreting the ambiguous term "opening" in a method most against the Insured's interest, often utilizing it as a provision that requires a visible opening or even to the extent of a hole in which one can see through. When faced with this ambiguity in the policy the Insurer should err on the side of the Insured and not its bottom-line as is apparent in this matter and other claims like it. This duty is further emphasized by the Supreme Court of Florida who re-iterated in Berkshire Life Ins. Co. v. Adelberg, 698 So. 2d 828, 830 (Fla. 1997), that ""[i]t has long been a tenet of Florida insurance law that an insurer, as the writer of an insurance policy, is bound by the language of the policy, which is to be construed liberally in favor of the insured and strictly against the insurer. [name redacted] Fund Ins. Co. v. Boyd, 45 So.2d 499, 501 (Fla.1950)." The Insurer is undoubtedly aware of this precedent and is handling the claims in abrogation of said case law. Rather than the Insurer pay for a roof replacement consistent with all laws and ordinances, the Insurer contends the roof is repairable which is not true. All repairs to the roofing system must be done in accordance with applicable Florida Building Codes which require all repairs be done consistent with the manufacturer's specifications and warranties which this Insurer clearly did not account for. The Insurer has placed obstacles to its Insured's ability to have the claim adjusted promptly to begin restoring the home by waiting more than ninety (90) days after receiving notice of the Insured's claim to make a claims determination. The Insured reported the loss on October 17, 2022, but the Insurer did not render a claims determination until February 11, 2023. Under Fla. Stat. 627.70131(5)(a), "[w]ithin 90 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer which reasonably prevent such payment." There were no factors outside of the Insurer's control. As the Insurer has failed to make a timely determination, it has violated this code. As such, in addition to the below requirements to cure this CRN, any payment made to the Insured must contain interest for the damage as a result of the loss from the date the Insurer received first notice of the loss. The conduct outlined above is done within the Insurer's routine course of the business. There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer's claim file and standards and procedures for the adjustment and investigation of claims. In short, the Insurer is not acting with due regard for the Insured's interests or safety. In Florida the work of adjusting insurance claims engages the public trust. The Insurer has breached this trust and its duty to the Insured. The Insurer and its agents conducted cursory and inadequate investigations and wrongfully determined that it would only require $4,128.31 to restore the insured property to its pre-loss condition. Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer's actions and inactions have continued to frustrate and delay the resolution of the Insured claim. The Insurer's actions amount to but are not limited to the following:

1. Claim denial

2. Claim delay

3. Not treating the Insured with good faith claims conduct

4. Looking for way to reduce recovery to the Insured

5. Looking for ways to deny recovery to the Insured

6. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured

7. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company's interests before the Insured's' interests

8. Placing the financial interest of the Insurer over that of the health and safety of the Insured

9. Failing to provide an estimate that complies with the Florida Building Codes 10. Shifting the burden of investigating onto the Insured 11. Conducting inadequate investigations 12. Failing to render a written claims determination to the Insured within [address redacted]atute 627.70131 13. Making material misrepresentations Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must: (1). Admit full coverage for the Insured's loss. (2). Tender full benefits owed to the Insured under the insurance contract. A copy of this form submitted to the FDFS has been sent via e-mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to [email redacted]. Via E-mail: American Integrity Insurance Company of Florida [address redacted]ive, Suite 650 Tampa, FL 33609 [email redacted]

(1). Admit full coverage for the Insured's loss. (2). Tender full benefits owed to the Insured under the insurance contract.

Florida DFS Civil Remedy Notice, filing number 794984. Read the filing on the state's site ↗

A Civil Remedy Notice records an allegation, not a finding. Nothing here has been decided by a court or by the Department. Not legal advice; consult an attorney about your specific claim.

Fla. DFS Civil Remedy Notice, Filing No. 794984 (Manners v. American Integrity), Cape Coral, FL · public record ↗

Quotes are verbatim from the cited public record. Case status and statute summaries drafted August 2026; verify against the current docket and statute. Not legal advice; consult an attorney about your specific claim.