Civil Remedy Notice of Insurer Violations
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Filing Number:     785272
Filing Accepted:  10/2/2024
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Complainant
Last/Business Name *  
FABY RAMIREZ, REINALDO FABIO RAMIREZ AND GETRUDIS RAMIREZ   First Name  
Street Address * 1021 WILSHIRE DR.,
City, State Zip * FORT MYERS, FL 33919
Email Address * WITHHELD
Complainant Type: * Insured
Insured
Last/Business Name*   FABY RAMIREZ, REINALDO FABIO RAMIREZ AND GETRUDIS RAMIREZ   First Name   ULYANA
Policy # * KIN-DP-FL-262188317 Claim #* HO-3996331
Attorney
Attorney is Applicable
Last Name* GRICHENER First Name * ULYANA Initial
Street Address* 800 E BROWARD BLVD, SUITE 510
City, State Zip* HOLLYWOOD , FLORIDA 33001
Email Address * UG@WEKLAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   KIN INTERINSURANCE NETWORK
NAIC Company Code 16603
 
Name of individual responsible for violation (if any):* RYAN BELL
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
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.
624.155(1)(b)(3) Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
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)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

PERILS INSURED AGAINST COVERAGE A – DWELLING and COVERAGE B – OTHER STRUCTURES We insure against risk of sudden and accidental direct physical loss to property described in Coverages A and B only if that loss is a physical loss to the property. We do not insure, however, for loss: • • • 3. Excluded under General Exclusions. Under items 1. and 2. , any ensuing loss to property described in Coverages A and B not excluded or excepted in this policy is covered. • • • GENERAL EXCLUSIONS 1. 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. • • • c. Water Damage, meaning: 1. Flood, surface water, waves, tidal waves, tsunami, tides, tidal water, overflow of any body of water, or spray from any of these, whether or not driven by wind or storm surge; 2. Water, water-borne material, sewage or any other substance which backs up through sewers or drains or which overflows or is discharged from a sump, sump pump or related equipment; 3. Water, water-borne material, sewage or any substance that overflows from a sump pump, sump pump well or other system designed for the removal of subsurface water which is drained from a foundation area of a structure; or 4. Water, water-borne material, sewage or any other substance on or below the surface of the ground, regardless of its source. This includes water which exerts pressure on or flows, seeps or leaks through a building, sidewalk, driveway, foundation, swimming pool or other structure. This exclusion c. applies regardless of whether any of the above, in c.(1) through c.(4) is caused by or results from human or animal forces or by any act of nature. This exclusion c. applies to, but is not limited to, escape, overflow or discharge, for any reason of water, waterborne material from a dam, levee, seawall or any boundary or containment system. Direct loss by fire, explosion or theft resulting from water damage is covered. • • • d. Power Failure, meaning the failure of power or other utility service if the failure takes place off the Described Location. But if the failure of power or other utility service results in a loss, from a Peril Insured Against on the Described Location, we will pay for the loss or damage caused by that Peril Insured Against. • • • p. Wind or Hail Damage to: 1. Outdoor radio and television antennas or satellite dishes and aerials including their lead in wiring, masts or towers; or 2. Awning, fences, aluminum framed screened enclosures, including pool cages and aluminum framed carports; or 3. All personal property unless it is located within the principal residence for which this policy applies. • • •
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Faby Ramirez, Reinaldo Fabio Ramirez and Getrudis Ramirez ("Insureds") purchased an insurance policy ("Policy") from Kin Interinsurance Network (“Kin”) with effective coverage on the date of loss, on or about September 28, 2022, as a result of Hurricane Ian, and Policy number KIN-DP-FL-262188317 to insure the property located at 1021 Wilshire Dr., Fort Myers, FL 33919 (the "Property").?? On or about September 28, 2022, the Property suffered severe wind and rain damage as a result of Hurricane Ian, which caused ensuing water damage to the Property, including but not limited to the interior ceilings, walls and roof ("Loss"). Upon discovery of the damages from Hurricane Ian, September 28, 2022, the Insured immediately reported the claim to Kin. The Insured retained a Public Adjuster, Monarch Claims Consultants (“Monarch”) to aid with this claim. Monarch inspected the property and determined that it was clear that the loss was a result of Hurricane Ian. Monarch acknowledged the claim and assigned the loss claim number HO-3996331. A field adjuster, Ryan Bell was assigned to the claim. Mr. Bell inspected the property on October 12, 2022. During his inspection, Mr. Bell viewed the interior and exterior of the home and the roof. Mr. Bell was deposed on August 16, 2024, wherein he testified that although he inspected the roof and the interior of the property, he did not inspect the portion of the roof that was tarped. He further testified that he located more than 25% wind damage to the front slope and more than 25% wind damage to the rear slope. He also located wind damage to the fence and garage door panel. Mr. Bell then prepared an estimate of damages for a replacement cost value of $11,491.64, and an Actual Cash Value of $10,545.35. During his deposition, when questioned about his estimate, he testified that he does not know how he came to the depreciated value, he didn’t allocate for any primer for the popcorn ceilings, he didn’t include replacement of a missing window screen, he only used one coat of paint. But most importantly, he testified that approximately 30% of the roof was tarped, that he did not inspect that area, has no knowledge of the damage to the roof under the tarp and he did not allocate anything towards that area of the roof as he had not inspected same. He testified that although he located wind damage, he allocated only for the damage caused by the tarp that was nailed down, the tarp that he again testified he did not touch, did not inspect the roof beneath and did not seek to have it removed for his inspection. On the contrary, Monarch, having performed a detailed inspection of the property, provided Kin with photos of the damage, as well as an estimate in the amount of $196,944.23 for Dwelling and $14,313.65 for other structures, in order to place the home in the pre-loss condition. As the property was damaged severely by Hurricane Ian, the Insureds did everything they could to protect the property from further damage, as required under the policy. Prior to the Field Adjuster’s inspection, the Insureds had the roof tarped by ProSource Water and Fire Restoration, LLC. To prevent further water intrusion from the roofing system. Unfortunately, the property also suffered flood damage as a result of the Hurricane. The Insureds simultaneously reported a flood loss to their flood policy, that unlike Kin, had the property inspected and promptly issued payment for all flood related damage. Despite the catastrophic damages the Insureds sustained at the property, Kin sent a letter agreeing that there was indeed coverage for the claim but that it was below deductible based upon Mr. Bell’s estimate of damages. It is clear from Mr. Bell’s deposition testimony that his inspection was incomplete and his estimate glossed over the extent and nature of damages. The very same adjuster who did not even bother to inspect at least 30% of the roof that was tarped. One of the biggest area’s of damage to the home was the roof, and conveniently, Kin failed to discuss the roof at all in their coverage determination letter. At the time that hurricane Ian made landfall, the Insureds’ roof was barely a few months old. You could say that it was brand new. Additionally, Kin was provided a 4-point inspection report right after the roof was replaced and prior to Hurricane Ian. However, despite being given this information, Kin proceeded to turn their head and try and blame the damage on anything other than the actual cause, a category 5 hurricane. Kin needs to correct their actions and provide the insureds with the funds needed to finalize placing the property back into its pre-loss condition. Kin failed to tender the full amount of monies due and owing under the terms of the policy. To date, notwithstanding the Insureds’ pleas for relief, Kin has continued to refuse to acknowledge its obligation to tender all monies due and owing to the Insureds, and to fully assist the Insureds in the mitigation of damages. The Insureds timely notified Kin of the damages and opened a claim pursuant to the terms and conditions of the insurance policy. In response to their claim for benefits, Kin sent a representative to investigate and adjust the loss. The adjuster for Kin confirmed that there was damage to the property; even though his inspection was subpar and he had not bothered inspecting over 30% of the roof that was tarped; presumably the actual portion of the roof hit with the Hurricane that required tarping in the first place. In fact, Mr. Bell testified that he assumed the roof below the tarp was damaged as a result of the wind event and agreed that his photographs shoed the houses in the neighborhood surrounding the insured residence showing damages, debris everywhere and numerous roofs tarped. Despite recognizing the severity of the damage to the property, Kin and its representatives attempted to settle the claim for far less than was owed. Kin misrepresented to the Insureds that it had performed a full and fair investigation and adjustment of the claim at that time and misrepresented that the amounts offered were the full value of the indemnity owed under the provisions of the insurance policy. These misrepresentations were either intentional, or the result of Kin failing to adequately train and supervise its adjusters and representatives. The carrier needs to be held accountable for this unilateral and unreasonable delay. Kin has violated Florida Statute §624.155(1)(b)(1) by continuously not attempting in good faith to settle this claim when it should have done so if it had acted fairly and honestly towards its insured. Kin has also violated Florida Statute §624.155(1)(b)(3) by failing to promptly settle this covered claim to influence settlement in its favor. Despite being presented all of the indisputable evidence of the amount of damage sustained by this Property. Kin violated Florida Statutes §626.9541(1)(i)(2) and §626.9541(1)(i)(3)(b) by making material misrepresentations to the Insureds for the purpose and with the intent to settle the claim on less favorable terms than those provided and contemplated by the policy. Kin was informed multiple times of the discrepancies and inconsistencies of the below value assessment of the damages. While Kin was made aware of this information for the purpose of obtaining the money contractually owed to the Insureds under its insurance policy to attempt to return their home to its pre-loss condition in a timely fashion, Kin has refused to do so and has delayed properly adjusting this claim. Kin violated §626.9541(1)(i)(3)(a) when it failed to adopt and implement standards for the proper investigations of claims. Under no circumstances is there an excuse for the lack of a proper investigation in this case. Kin and their representatives are willfully blind and grossly underqualified to handle a loss such as the one sustained by the Insureds. After being placed on notice as to the blatant underpayment of the Insureds’ claim, Kin has yet to rectify their actions and do right by the Insured by paying the money they are contractually owed. Instead they made a small payment and washed their hand of the Insureds. Kin also ignored the tarping services performed by ProSource and has failed to pay their invoice for services rendered. Kin violated §626.9541(1)(i)(3)(g) by failing to promptly notify the Insureds of any additional information necessary for processing the claim. The Insureds have more than complied with each and every request and there has still been no action by Kin. In the event Kin is in need of additional information, they have failed to promptly notify the Insureds in a timely manner. This pattern of behavior is perpetuated by Kin and their representatives undeterred by the Ethical Requirements that are imposed by law on all Adjusters. Fla. Admin. Code Ann. R. (3) explicitly states the adjustment of insurance claims engage the trust of the public, and therefore, an adjuster has a duty of fair and honest treatment of the insured throughout the insurance claim process. Several duties and responsibilities to the Insureds were violated in the handling of this claim, which are specifically listed responsibilities of an Adjuster in the Florida Administrative Code. These breached duties and responsibilities include adjusters from Kin approaching the investigation and settlement in a manner prejudicial to the Insureds, failing to allow a fair settlement with the Insureds, and acting with due diligence in achieving a proper disposition of the claim. In contrast to the legislative intent motivating the enumeration of an Adjuster’s responsibilities outlined in the Administrative Code, the Insureds were not afforded the professional duties entrusted on Kin by the public. To date, Kin has failed to adequately compensate the Insureds for the damage that occurred on September 28, 2022, despite having months to pay the Insureds’ claim in full. As a direct result of Kin’s delay, the Insureds were forced to seek the help of legal counsel to assist them. Due to the amount of time that has passed since the date of loss, this acknowledgement is evidence that Kin’s knowingly and intentionally are delaying the claims process in order to further disadvantage the Insureds. The financial detriment caused to the Insureds and their tenants is a direct result of Kin’s reckless delay of the claim process. This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should Kin fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, Kin must: (1) Immediately tender all monies due and owing to the Insured under the insurance policy that would reasonably place the Insured back to a pre-loss condition; subject to applicable deductible (2) Agree to reimburse the Insured’s reasonable attorneys’ fees and costs for having to become involved to resolve the claim; (3) Agree to reimburse the Insured for interest on the amount of benefits that was found to be due and owing to the Insured, relating back to the date of loss.
Comments
User Id Date Added Comment
ksellar@bozlegal.com 11-29-2024 A copy of the following response has been emailed to Insured's Attorney on Tuesday November 26, 2024. November 26, 2024 Insured(s): Faby Ramirez, Reinaldo Fabio Ramirez, and Gertrudis Ramirez Claim Number: HO-3996331 Policy Number: KIN-DP-FL-22188317 Insurance Co.: Kin Interinsurance Network Date of Loss: September 28, 2022 Loss Report Date: October 5, 2022 Dear Ulyana Grichener: This correspondence constitutes Kin Interinsurance Network’s response to the Civil Remedy Notice of Insurer Violation #785272 you filed on behalf of Faby Ramirez, Reinaldo Fabio Ramirez, and Gertrudis Ramirez, regarding the above-listed claim. Kin Interinsurance Network welcomes the opportunity to respond to this Civil Remedy Notice and specifically denies each and every allegation contained therein. Kin Interinsurance Network also asserts the Civil Remedy Notice fails to comply with the specific notice and information requirements set forth in both § 624.155, Florida Statutes, and Florida Case law. First the Civil Remedy Notice requires the Complainant, pursuant to § 624.155(3)(b)(1), Fla. Stat., to state with specificity the statutory provision, including the specific language of the statute, which Kin Interinsurance Network allegedly violated. The Notice includes numerous statutory provisions that could be claimed against any insurance company, regardless of whether they are relevant or applicable to the alleged facts contained in the Notice. Because the Civil Remedy Notice fails to identify any specific statutes, it does not comply with § 624.155(3)(b)(1). Second, the Notice fails to set forth any specific policy language relevant to the purported violations as required by § 624.155(3)(b)(4), Fla. Stat. The Notice states loss settlement provision of the policy. This is just a broad outline of various provisions of the insurance policy without specifying which are relevant to the purported violations. By failing to identify any specific policy provision(s), the Civil Remedy Notice does not comply with § 624.155(3)(b)(4). Third, § 624.155(3)(b)(2), Fla. Stat., requires the Notice to state with specificity the facts and circumstances giving rise to the purported violations. This notice provides template, unsupported and incorrect allegations and fails to provide the requisite specificity required by § 624.155(3)(b)(2), Fla. Stat. Without the benefit of specific facts and circumstances giving rise to the purported violations, Kin Interinsurance Network is unable to provide a detailed response and the Notice fails to satisfy § 624.155(3)(b)(2). Nevertheless, on November 7, 2024, Kin Interinsurance Network was able to resolve the claim listed above. Without Kin Interinsurance Network admitting any violation or liability, the parties agreed to resolve the claim and all allegations contained in the Civil Remedy Notice. Accordingly, pursuant to § 624.155(3)(d), Fla. Stat., Kin Interinsurance Network is providing notice of the disposition of the alleged violations contained in the Civil Remedy Notice. For the aforementioned reasons, Kin Interinsurance Network believes the Civil Remedy Notice does not comply with § 624.155, Fla. Stat. Additionally, Kin Interinsurance Network denies any and all allegations contained in the Civil Remedy Notice. However, this claim has been mutually resolved and any purported violations have been cured. Kin Interinsurance Network’s response is based on the limited information provided in the Civil Remedy Notice and the information we have to date. If Faby Ramirez, Reinaldo Fabio Ramirez, and Gertrudis Ramirez feel we do not have all the facts, we ask that he please inform us immediately. Please note that Kin Interinsurance Network’s response is not necessarily exhaustive and, as a result, it does not preclude us from asserting any other valid reasons for the lack of compliance with § 624.155, Fla. Stat. Additionally, neither this response, nor any act or failure to act on the part of Kin Interinsurance Network, or any agent or representative of Kin Interinsurance Network, should be construed as a waiver of any rights or defenses. This includes, but is not limited to, proper notice and service by Faby Ramirez, Reinaldo Fabio Ramirez, and Gertrudis Ramirez, or other defenses available by contract or at law. All such rights and defenses are hereby reserved. We believe this response addresses the allegations contained in the Civil Remedy Notice. If you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Best Regards, /s/Kevin Sellar Kevin Sellar, Esq.
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