Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 660490

Filing Accepted: 12/8/2022

Print Filing

Complainant

Last/Business Name *

BUTTERFIELD

First Name

CHARLES

Street Address *

2868 VALENCIA WAY S

City, State Zip *

ST. PETERSBURG, FL 33705

Email Address *

CHARLES.M.BUTTERFIELD@GMAIL.COM

Complainant Type: *

Insured

Last/Business Name*		BUTTERFIELD		First Name		CHARLES
Policy # *		KIN-HO-FL-205475004		Claim #*		HO-0006521

Attorney

Attorney is Applicable

Last Name*	KRAPF First Name * GRANT Initial
Street Address*		2790 SUNSET POINT ROAD
City, State Zip*		CLEARWATER , FLORIDA 33759
Email Address *		GRANT@KRAPFLEGAL.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		KIN INTERINSURANCE NETWORK
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 16603

Name of individual responsible for violation (if any):* TIFFANY SOARD, AND ANY INDIVIDUAL FROM KIN INTERINSURANCE NETWORK WHO WAS INVOLVED IN THE CLAIM AND UNKNOWN TO CLAIMANT.
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Unfair Trade Practice
	Claim Denial
	Claim Delay
	Other : Not treating the policyholder with good faith claims conduct
	Other : Placing the company’s financial interests before the policyholder’s interests
	Other : Looking for ways to deny full recovery to the Claimant
	Other : Failing to implement proper standards for the adjustment and investigation of claims
	Other : Looking for ways to delay full recovery to the Claimant
	Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made,
	Other : Misrepresenting the terms of the insurance policy

* 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.
	626.9541(1)(i)(2)		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.
	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)(d)		Denying claims without conducting reasonable investigations based upon available information.

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

Reference to specific policy language… The violations alleged are statutorily based and do not rely on any specific policy language.

* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Kin Interinsurance Network, (“Insurer”) has committed the following in handling the Claimant’s claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the Policy Holder and Claimant; 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) failing to implement proper standards for the adjustment and investigation of claims; 6) looking for ways to delay benefit payments; 7) misrepresenting the terms of the policy issued by the Insurer; 8) conducting inadequate investigations; and 9) denying a claim which it knew or should have known the policy and Florida law provided coverage for. The Claimant timely submitted a claim on August 4, 2022, to the Insurer for the damage sustained to the above-referenced insured property as a result of water, which occurred on July 4, 2022. At the Insurer’s inspection of the insured property, the Insurer’s representative failed to conduct an adequate investigation. Due to the extent of damage sustained to the roof and exterior, the Claimant retained a public adjuster who provided an estimate dated July 25, 2022, for $46,505.46 in covered damages. On September 9, 2022, the Insurer sent a claims determination letter denying coverage for the Claimant’s claim. The Insurer misrepresented the loss and issued a wrongful denial. In the claims determination letter, the Insurer offers two reasons why it denied the Claimant’s claim. The first reason provided is “the damage is the result of age-related wear and tear causing the drain line to collapse, and causing water damage to your home.” Notably, the Insurer never retained an expert to ascertain the scope and cause of the Claimant’s damage. But was able to conveniently determine the cause of the Claimant’s damage stemmed from excluded causes in the policy. The adjuster intentionally ignored the damage observed and has failed to make truthful and unbiased reports of the facts after making an investigation. 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 Claimant. This is an underhanded attempt to place the financial interests of the Insurer over those of the Claimant and to delay and frustrate the Claimant’s ability to have his claim adjusted promptly to begin restoring his property. The second reason the Insurer provided for denying the Claimant’s claim in the claims determination letter related to a policy exclusion. Specifically, the Insurer noted, “your policy has the Water Damage Exclusion and does not cover any damages caused by water.” The letter continues to copy and paste the Water Damage Exclusion from the policy. However, the Insurer conveniently failed to include the first sentence of the Water Damage Exclusion, which states, “For a premium credit, your policy is changed as follows…” As the Insurer is aware, it failed to apply a premium credit for the Water Damage Exclusion and is now seeking to unjustly enrich itself by refusing to pay for damage covered by the policy and pocketing the excess premium paid by the Claimant. Additionally, although there was interior water damage the adjuster did not use a water meter. A water meter can be purchased online from Amazon for around $40 before tax. The Insurer could purchase a water meter and assess thousands of properties with one meter. Instead, the Insurer would rather place its financial interests over those of the Claimant by failing to provide the adjuster with the necessary tools to correctly inspect the loss. As a result of the inadequate investigation and surrounding circumstances it is apparent that Insurer significantly underestimated the scope of the loss to the Claimant’s property. Insurer and its adjuster have colluded to misrepresent the true scope of damages to the insured property and the true replacement costs of the damages. This is an underhanded attempt to place the financial interest of Insurer over those of the Claimant, to delay the Claimant’s claim, and to delay the Claimant in restoring his property to its pre-loss condition. In short, the Insurer is not acting with due regard for the Claimant’s interest. In Florida, the work of adjusting insurance claims engages the public trust. The Insurer has breached this duty. The Insurer has conducted poor and inadequate investigations and has wrongfully denied coverage for the Claimant’s claim. The Insurer is placing their financial interests over those of the Claimant and the Claimant’s safety. The foregoing has only delayed the Claimant’s ability to begin restoring his home to its pre-loss condition. The Insurer’s actions amount to but are not limited to the following: 1. Claim delay 2. Claim denial 3. Not treating the Policyholder with good faith claims conduct 4. Looking for ways to reduce recovery to the Claimant 5. Looking for ways to deny recovery to the Claimant 6. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Claimant 7. Failing to implement proper standards for the adjustment and investigation of claims 8. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company’s interests before the policyholder’s interests 9. Misrepresenting the terms of the policy issued by the Insurer 10. Conducting inadequate investigations Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must: (1) Admit full coverage for the Claimant’s loss. (2) Tender full benefits owed to the Claimant under the insurance contract. (3) Pay all attorney’s fees, costs, and interest. A copy of this form submitted to the FDFS has been sent via Electronic Mail to the following parties providing them notice of the filing of the civil remedy notice. Please email any response to this civil remedy notice to badfaith@krapflegal.com Via Electronic Mail: Kin Interinsurance Network 222 Merchandise Mart Plaza, Suite 228 Chicago, IL 60654 claims@kin.com

Comments

User Id		Date Added		Comment
kala.regalia@kin.com		12-22-2022		While Kin Interinsurance Network believes that the Civil Remedy Notice fails to comply with the requirements of Florida Statute §624.155 and Florida Case law, it has responded to the Notice in writing to Grant Krapf on December 22, 2022.

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