Civil Remedy Notice of Insurer Violations
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Filing Number:     785233
Filing Accepted:  10/1/2024
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Complainant
Last/Business Name *  
MIGUEL AYUSO AND ELIA AYUSO   First Name  
Street Address * 4625 KALISPELL ROAD
City, State Zip * KISSIMMEE, FL 34758
Email Address * CLAY@THEKRFIRM.COM
Complainant Type: * Insured
Insured
Last/Business Name*   MIGUEL AYUSO AND ELIA AYUSO   First Name  
Policy # * 988706862 Claim #* 0740701149
Attorney
Attorney is Applicable
Last Name* KUHN First Name * CLAYTON Initial
Street Address* 2110 WEST PLATT STREET
City, State Zip* TAMPA , FLORIDA 33606
Email Address * CLAY@THEKRFIRM.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   CASTLE KEY INDEMNITY COMPANY
NAIC Company Code 10835
 
Name of individual responsible for violation (if any):* ANY AND ALL PERSONS ASSOCIATED WITH THE CLAIMS HANDLING FROM CASTLE KEY INDEMNITY COMPANY
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unsatisfactory Settlement Offer
Unfair Trade Practice
* 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)(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.

THE POLICY LANGUAGE RELEVANT TO THE VIOLATIONS INCLUDES ALL APPLICABLE LOSS PAYMENT AND COVERAGE PROVISIONS OF POLICY NUMBER 988706862 INCLUDING THE DECLARATIONS PAGE AND ALL ENDORSEMENTS TO THE POLICY, WITH RESPECT TO COVERAGES A, B, C, AND D. ADDITIONALLY, ANY SECTIONS RELIED UPON BY THE INSURER IN ITS DENIAL TO FULLY PAY THE CLAIM, INCLUDING THE DUTIES IN THE EVENT OF LOSS PROVISIONS AND THE POLICY'S EXCLUSION OF COVERAGE PROVISIONS.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Miguel Ayuso and Elia Ayuso (hereinafter “Insureds”) are homeowners insured with an all-risks policy issued by Castle Key Indemnity Company (hereinafter “Carrier”). On or about November 29, 2023, Insureds’ home located at 4625 Kalispell Road, Kissimmee, Florida 34758 sustained significant damage as a result of a water event. Specifically, Insureds’ property sustained water damage due to a plumbing failure in the kitchen. The discharge of water caused damage to Insureds’ property including, but not limited to, the entryway, hallway, and living room. The Loss is covered under Insureds’ policy issued by Carrier. The Insureds mitigated damages by contacting Eco-Pro Restoration SA LLC who performed mold testing and Loss Restorations LLC who performed mitigation services on the subject property. All of the relevant documents were provided to Carrier. Insureds promptly reported the claim and fully cooperated with all requests for inspections. Carrier assigned Claim No. 0740701149 to the loss. The Insureds have fully cooperated with Carrier’s investigation of the claim, including providing all requested documentation and complying with all post-loss policy conditions. Specifically, the Insureds, with assistance from their public adjuster, submitted an estimate for $48,038.21, which was a fair and reasonable assessment for the repair/replacement of damages. Carrier failed to retain qualified experts necessary to identify the repairs necessary to restore the property to its pre-loss condition. Despite Insureds providing Carrier with a detailed estimate, Carrier failed to pay Insureds the amount necessary to repair/replace the damaged property, less the applicable deductible. Instead, Carrier gave Insureds a lowball estimate that failed to encompass all covered damages. The carrier only offered to pay $1,614.71, a gross underpayment for all the damage associated with this claim. This has become a common business practice for Carrier. Under the circumstances surrounding this claim, had Carrier acted fairly and honestly toward the Insureds and with due regard for the Insureds’ interests, Carrier could and should have attempted in good faith to settle this claim. Carrier did not and, instead, dishonestly, and unfairly placed its own interests well ahead of those of the Insureds. In doing so, Carrier violated Section 624.155(1)(b)(1), Florida Statutes. Carrier’s use of unqualified and biased adjusters, and failure to retain experts necessary to identify the repairs necessary to restore the property to its pre-loss condition, evidence Carrier’s failure to adopt and implement standards for the proper investigation of claims in violation of Section 626.9541(1)(i)(3)(a), Florida Statutes. Carrier’s use of unqualified and biased adjusters, and failure to retain experts necessary to identify the repairs necessary to restore the property to its pre-loss condition, evidence Carrier’s failure to conduct a reasonable investigation based upon available information. In denying full coverage for this claim without conducting reasonable investigations based upon available information, Carrier has violated Section 626.9541(1)(i)(3)(d), Florida Statutes. By representing to Insureds that the Policy does not afford full coverage for this loss, Carrier is misrepresenting pertinent facts and/or insurance policy provisions relating to coverages at issue, in violation of Section 626.9541(1)(i)(3)(b), Florida Statutes. When applying the facts present here to Florida law, it is clear that Carrier is acting in bad faith. Florida Statute § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit based on determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. Carrier has breached this duty by refusing to properly and timely adjust the loss. Moreover, Section 69B-220.201 of the Florida Administrative Code defines Carrier’s adjusters conduct here as an unfair claims settlement practice. Specifically, Section 69B-220.201(3) provides that “[a]n adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured” and that “[a]n adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.” As detailed above, Carrier’s investigation and adjustment of this claim was done in a manner prejudicial to Insureds, was incomplete, and lacked truthful and unbiased reports of the facts. Carrier has more than enough information and is still refusing to accept coverage for the Insureds’ claim. This continued and repeated reckless claim delay and denial of coverage will result in a significant punitive damage award if a bad faith lawsuit is filed. Carrier can cure the defects outlined in this Civil Remedy Notice and avoid a lawsuit for bad faith by immediately accepting full coverage under the subject insurance policy for this claim and by paying Insured’s estimate of $48,038.21, less applicable deductible and prior payments, which is the reasonable amount of the covered loss pursuant to the policy. A copy of this form has been submitted to the Florida Department of Financial Services who has transmitted the same to the following parties providing them notice of the filing of this Civil Remedy Notice: Castle Key Indemnity Company.
Comments
User Id Date Added Comment
dbuuk@allstate.com 11-19-2024 RESPONSE TO CIVIL REMEDY NOTICE OF INSURER VIOLATION Castle Key Indemnity Company (“Castle Key”) submits this response to the Civil Remedy Notice of Insurer Violation (“CRN”) filed on behalf of Miguel and Elia Ayuso (“Complainants”) pursuant to Fla. Stat. §624.155. Castle Key denies all allegations of statutory violations, bad faith, or claims-handling misconduct as alleged in the CRN. At all times, Castle Key has handled this claim in good faith, in compliance with the policy of insurance, and consistent with Florida law. ________________________________________ FACTUAL BACKGROUND On or about November 29, 2023, the Complainants reported a water damage loss at their property located at 4625 Kalispell Road, Kissimmee, Florida 34758, which was promptly assigned Claim No. 0740701149. Castle Key immediately began an investigation into the reported loss, including assigning an adjuster to inspect the property and assess the reported damages. During the investigation, Castle Key determined that the damages fell within the coverage provided under the policy, subject to the deductible and applicable exclusions. A payment of $1,614.71 was issued based on the damages observed and verified through the investigation. Castle Key further reviewed the estimate of $48,038.21 submitted on behalf of the Complainants and found discrepancies and unsupported line items that did not align with the damages observed during the inspection or the terms of the policy. Castle Key has continued to act in good faith throughout the handling of this claim. Efforts to resolve the matter amicably have been extended, including a recent settlement offer of $16,000 new money for a full release. ________________________________________ RESPONSE TO ALLEGATIONS 1. §624.155(1)(b)(1) – Failure to Settle in Good Faith Castle Key denies this allegation. At all times, Castle Key has handled this claim in good faith. The claim was investigated promptly, and a settlement payment was issued based on the observed damages and the terms of the policy. Castle Key continues to engage in good faith negotiations with the Complainants and their representatives in an effort to resolve this matter. 2. §626.9541(1)(i)(3)(a) – Failure to Implement Proper Standards for Claims Handling Castle Key denies this allegation. The claim was handled in accordance with applicable standards and best practices. Qualified professionals reviewed the damages, and the investigation was conducted with diligence and thoroughness. 3. §626.9541(1)(i)(3)(b) – Misrepresentation of Policy Provisions Castle Key denies this allegation. No misrepresentation of policy provisions has occurred. All decisions regarding coverage, payments, and settlement offers have been clearly communicated to the Complainants and their representatives. 4. §626.9541(1)(i)(3)(d) – Denying Claims Without Reasonable Investigation Castle Key denies this allegation. The claim was investigated promptly, thoroughly, and fairly. The decision to issue payment was based on the damages observed during the inspection and the policy provisions applicable to the claim. ________________________________________ POLICY AND COVERAGE The subject policy provides coverage for sudden and accidental water damage, subject to the terms, conditions, and exclusions outlined in the policy. In this case, Castle Key determined that portions of the damages fell within the scope of coverage, while others were excluded or unsupported by the evidence provided. Castle Key has provided a copy of the policy to the Complainants and their representatives, and all decisions have been communicated clearly and in compliance with the policy terms. ________________________________________ GOOD FAITH EFFORTS TO RESOLVE Castle Key has acted in good faith throughout the handling of this claim. In an effort to bring this matter to resolution, Castle Key has extended an offer of $21,500 new money for a full release. This offer reflects Castle Key’s commitment to resolving the claim fairly while adhering to the terms of the policy. Castle Key remains open to reviewing any additional documentation that supports further damages or necessary repairs related to the covered loss. ________________________________________ CONCLUSION Castle Key Indemnity Company has handled this claim in good faith and in compliance with Florida law and the terms of the policy. The allegations set forth in the Civil Remedy Notice are without merit. Castle Key continues to engage in good faith efforts to resolve this matter and encourages the Complainants to review the settlement offer extended. This response serves as Castle Key’s formal reply to the Civil Remedy Notice filed by the Complainants. Castle Key reserves all rights under the policy and applicable law.
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.

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DFS-10-363
Rev. 10/14/2008