Filing Number: 663406
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| Filing Accepted: 12/20/2022 |
| Last/Business Name
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HUSSAINI
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First Name |
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MOHAMMAD |
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| Street Address
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10502 BERMUDA ISLE DRIVE |
| City, State Zip
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TAMPA,
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33647
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| Email Address
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MMHUSSAINI@HALALFOUNDATION.ORG |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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HUSSAINI |
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First Name |
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MOHAMMAD |
| Policy # * |
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000988834601 |
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Claim #* |
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0677129926 |
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Attorney is Applicable
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| Last Name* |
KRAPF
First Name *
GRANT
Initial
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| Street Address* |
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2790 SUNSET POINT ROAD |
| City, State Zip* |
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CLEARWATER
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FLORIDA
33759
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| Email Address * |
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GRANT@KRAPFLEGAL.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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| Insurer Name* |
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CASTLE KEY INDEMNITY COMPANY
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| Insurer Name* |
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| Street Address* |
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| City, State Zip* |
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,
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NAIC Company Code 10835 |
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| Name of individual responsible for violation (if any):*
ALLISON RIVERA, DANIEL DALENE, KARA SCHEETS, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, CASTLE KEY INDEMNITY COMPANY WHO WAS INVOLVED IN THE CLAIM.
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| Type of Insurance
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Residential Property & Casualty
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| Reason for Notice
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Unfair Trade Practice
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Claim Delay
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Claim Denial
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Other
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Not treating the policyholder with good faith claims conduct
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Other
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Looking for ways to deny full recovery to the Claimant
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Other
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Not training, supervising, or managing adjusters properly so that prompt and full payments are made,
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Other
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Failing to provide the Claimant with the full benefits awarded to him under the contract of insuranc
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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)(c) |
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Failing to acknowledge and act promptly upon communications with respect to claims.
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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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| 626.9541(1)(i)(3)(f) |
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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.
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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.
627.70131(5)(a) – failing to make any payment of an initial or supplemental claim or portion of such claim within 90 days after the Insurer receives notice of the claim or made more than 15 days after there are no longer factors beyond the control of the insurer which reasonably prevented such payment, whichever is later, bears interest.
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Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language.
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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.
Castle Key Indemnity Company, (the “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) not adjusting the claims promptly and fairly; 4) not attempting in good faith to settle claims; 5) looking for ways to delay benefit payments; 6) shifting the burden of investigating the loss onto the Claimant; 7) conducting inadequate investigations; 8) making material misrepresentations of the coverages afforded under the insurance policy; 10) denying a claim which it knew or should have known the policy and Florida law provided coverage for; 11) failing to make a claims determination within 90 days; and 12) failing to promptly acknowledge the Claimant’s communications.
The Claimant timely submitted a claim to the Insurer for wind and hail damage sustained to the above-referenced Claimant property on or about July 12, 2022, including the ensuing damage therefrom. On July 28, 2022, the Insurer sent an email correspondence denying coverage for the Claimant’s roof and interior damage. Notably, the email correspondence failed to include any policy language and merely concludes no coverage exists. Given the scope and nature of the damage, the Claimant retained a public adjuster who prepared an estimate dated August 15, 2022, detailing $121,250.37 in covered damage. The public adjuster sent the Insurer this estimate on August 25, 2022. The public adjuster sent several emails and left several voicemails confirming the Insurer received the estimate and requesting a status update. Specifically, the public adjuster sent emails on September 9. 15, 22, 29, October 3, and November 7, 2022. Finally, the Insurer acknowledged receipt of the estimate and requested a letter of representation on November 8, 2022. The public adjuster left two voicemails on November 11 and November 14, 2022, again requesting a status updated. The Insurer finally responded on November 15, 2022, acknowledging the public adjuster’s communications and advising the claim was still under review. On November 19, 2022, the Insurer’s desk adjuster claimed he never received the public adjuster’s phone calls and attached an estimate. The desk adjuster now advised that, “the claim was partially denied and determined that there were no storm damages to the roof. The clay tiles that have slid down are from install and over time the clay tile has slid due to gravity. The claim was under deductible, and no payment was made.” Aside from ignoring the Claimant’s representatives for months, the Insurer failed to comply with its obligation to continue its investigation and adjustment of the Claimant’s claim. The Insurer never requested a reinspection, retained any experts, or took any affirmative steps to adjust the claim after the public adjuster sent his estimate. The desk adjuster merely re-sent the same estimate it sent in July 2022. Moreover, the Insurer has failed to provide a proper explanation of the benefits here, with their November 2022 contradicting their July 2022 email as to the whether they assert that the claim was denied or under the deductible amount.
The Insurer misrepresented the loss and issued a wrongful denial. According to the Insurer’s July 28, 2022, email correspondence, two clay tiles “on your roof that have cracks in them are unfortunately not from wind damage, it looks like mechanical damage from someone stepping on the wrong spots. For there to be wind damage, the clay tiles would have to be ripped off completely. There were some tiles (Under the vent and under a wall) that were sliding down, this is from long term aging due to gravity. Clay tiles are very heavy and overtime the stickiness that holds them up wears down causing the tiles to slide down like on your roof. We cannot cover any long term or non sudden damages and because of this we cannot cover your roof and your interior leak due to wind driven rain which is not covered under policy.” Notably, the Insurer never retained an engineer to determine the cause of the Claimant’s loss. 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 Insurer’s field adjuster knew or should have known that over 25 percent of the Claimant’s roof was damaged as a result of a covered peril, and presumably did. The Insurer also knows that the Claimant needs a new roof in order to comply with the Florida Building Code, because more than 25 percent of the Claimant’s roof is damaged and matching roofing cannot be purchased. The Insurer did not allocate enough coverage to pay for a full re-roof despite knowing it is obligated to do so. According to Florida Statute s. 627.7011(1)(b), Insurers have a duty to cover all costs necessary to meet applicable laws and ordinances regulating the repair of any property and Florida Statute s. 626.9744 requires that the Insurer make reasonable repairs or replacement that match the quality, color or size of the items that needs repair. This has further delayed the Claimant from being able to restore the property to its pre-loss condition and is an underhanded attempt to place the financial interest of the Insurer over 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.
The Insurer has placed obstacles to its Claimant’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 Claimant’s claim to make a claims determination. 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." The Claimant’s public adjuster sent an estimate on August 25, 2022, and the Insurer has failed to render a claims determination in response to this estimate. There are currently no factors outside of the Insurer’s control. As the Insurer has failed to make a timely determination, they have violated this code. As such, in addition to the below requirements to cure this CRN, any payment made to the Insured(s) must contain interest for the damage as a result of the loss from the date the Insurer received first notice of the loss.
Further, the Insurer failed to respond within 14 days to Claimant, and his agents’ requests. Notably, the Insurer sent a request for confirmation that the Insurer received its estimate on September 9. 15, 22, 29, October 3, and November 7, 2022. The Insurer failed to acknowledge any of these communications until November 8, 2022. Upon an Insurer’s receiving a communication with respect to a claim, the Insurer is required, within fourteen (14) calendar days, to review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer which reasonably prevents such acknowledgement. There has been no response within the fourteen (14) calendar days of receipt of the Insureds’ communication and the Insurer has not alleged any factors beyond their control that would make such communication impossible. Insurers have a duty to settle claims in good faith when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its Insureds and with due regard for her interests. The Insurer has failed or refused to promptly acknowledge the Claimant’s communications in an attempt to frustrate and delay the resolution of Claimant’s claim.
In short, Insurer is not acting with due regard for the Claimant’s interests. In Florida, the work of adjusting insurance claims engages the public trust. The Insurer has breached this duty. The Insurer has conducted inadequate inspections and misrepresented the Claimant’s loss so that it may render less than the full benefits due under the contract of insurance.
The Insurer’s actions amount to but are not limited to the following:
1. Claim denial.
2. Claim delay
3. Not treating the policyholder with good faith claims conduct
4. Looking for ways to deny recovery to the Claimant
5. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Claimant
6. 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
7. Placing the financial interest of the Insurer over that of the Claimant
8. Shifting the burden of investigating the loss onto the Claimant
9. Conducting inadequate investigations
10. Making material misrepresentations of the coverages afforded under the insurance policy.
11. Failing to render a claims determination within 90 days
12. Failing to timely acknowledge the Claimant’s communications
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 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 badfaith@krapflegal.com.
Via Electronic Mail:
Castle Key Indemnity Company
P.O. Box 672041
Melbourne, FL 32394-7276
claims@claims.allstate.com
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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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