April 21, 2015
Pauline and Rod Woodbury
98 Daisy Street
Homosassa, FL. 34446
RE:American Integrity Claim Number: ACH122982
American Integrity Policy Number: AGD263439
Date of Loss: 05/25/2014
Cause of Loss: Hail
Insured Location:32 Golfview Ct, Homosassa, FL 34446
Dear Mr. and Mrs. Woodbury:
On 3/4/15 you reported to American Integrity Insurance Company that you had hail damage to your roof which you attributed to a hail storm which you state occurred on 5/25/14, some 10 months after the reported date of loss. Your delay in reporting this damage has severely prejudiced us in the investigation of your loss. We are unable to determine if the damage claimed was sudden and accidental and/or if there were multiple loss events to which separate deductibles would apply to each event. Weather data reveals that, within the period 1/1/10 to 3/16/15, 6 separate hailstorm events occurred within a 15 mile radius of your property. Your policy inception with American Integrity Insurance Company was 11/19/13.
Among other things,American Integrity Insurance Company retained an engineer to conduct an investigation and analysis with regard to the cause and extent of the damage.The investigation revealed that there was no hail damage to the shingles on your roof or to the skylight. While some missing and displaced shingles were noted, these were not from wind events. A loose ridge vent section above the living room was in evidence with unsealed vent edges and a corroded protruding nail. Damage from rodents gnawing all rooftop plumbing vent terminations was noted.
Blemishes and missing granules are cosmetic and have not impaired the functionality of your roof.
Please refer to your DP 01 07 88 Basic Form policy as amended by AIIC 01 DP1 SP 09 13 SPECIAL PROVISONS FOR FLORIDA – DP1 – SPECIAL FORMwhich states:
AGREEMENT
Based upon the information you have given us, we agree to provide the insurance coverages indicated on the Policy Declarations. In return, you must pay the premium when due and comply with the policy terms and conditions and immediately inform us of any change of title, use or occupancy of the “Described Location.”
Your policy provides coverage only for the perils specifically named in your policy under PERILS INSURED AGAINST:
1A. / Fire or lightning / 1B. / Internal Explosion2. / Windstorm or hail
This peril does not include loss: / 3. / Explosion
a. / to the inside of a building or the property contained in a building caused by rain, snow, sleet, sand or dust unless the direct force of wind or hail damages the building causing an opening in a roof or wall and the rain, snow, sleet, sand or dust enters through this opening; or
b. / to the following property when outside of the building:
(1) / Awnings, signs, radio or television antennas or aerials including lead-in wiring, masts or towers; or
(2) / canoes and rowboats
4. / Riot or civil commotion / 5. / Aircraft
6. / Vehicles / 7. / Smoke
8. / Volcanic Eruption / 9. / Vandalism or malicious mischief
The interior staining on the living room ceiling is not covered under your policy as no opening made by the force of wind was found to your roof.
Please refer to your policy under CONDITIONSwhich states:
4.Your Duties After Loss
In case of loss to a covered property, you must see that all of the following are done:
a.Give prompt notice to us or our agent:
b. / (1) / Protect the property from further damage. If repairs to the property are required, you must:(2) / Make reasonable and necessary repairs to protect the property; and;
(3) / Keep an accurate record of repair expenses
Your delay in reporting the damage claimed has severely prejudiced us in the investigation of this loss. As indicated above, 6 separate and distinct hail events have occurred around your property since 2010. The damage that you claim resulted during the American Integrity policy period may have occurred prior to the inception of the American Integrity policy. Further, the engineer identified three hailstorm events that occurred in the area of your property during the applicable American Integrity policy period. Any covered damage caused by each separate event would be subject to the application of a separate deductible.
Your policy further states under GENERAL EXCLUSIONS:
A.We do not insure for loss caused directly or indirectly by any of the following. Such loss is excluded regardless of any other cause or event contributing concurrently or in any sequence to the loss.
5. Neglect, meaning your neglect to use all reasonable means to save and preserve property at and after the time of a loss.
12.Existing Damage
a.Damages which occurred prior to policy inception regardless of whether such damages were apparent at the time of the inception of this policy or discovered at a later date; or
b.Claims or damages arising out of workmanship, repairs or lack of repairs arising from damage which occurred prior to policy inception
We will therefore be unable to honor your claim. We expressly reserve our right to assert all other rights or defenses that we may have to this claim even though not enumerated above. We do not waive or relinquish any of our rights under the policy of insurance.
This denial has occurred after a good faith evaluation of the total circumstances involved. If you know of any reason why our evaluation of the facts is not correct, please advise us in writing to the address below or by email to
Sincerely
Tracey Cassaway
Claim Adjuster
American Integrity Claims Services
Telephone: 866-277-9871, Ext. 2166
Proof of Mailing
Cc:
Brice Insurance Agency
3633 East Gulf to Lake Hwy
Inverness, FL34453
Hightower Restoration
8110 S. Suncoast Blvd
Homosassa FL 34446
If this document contains an excerpt from your Insurance Policy (“the Policy”) it is provided here for informational purposes only. This excerpt is not the official version of the Policy. The official version of the Policy is the policy issued to the insured on the policy effective date. In the event there is inconsistency between this document and the Policy, the Policy shall serve as the official version.
Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree. F.S. 817.234