Filing Number: 785890
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| Filing Accepted: 10/4/2024 |
| Last/Business Name
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PLAZAS VEGA
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First Name |
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CAMILO |
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| Street Address
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19364 STONEBROOK STREET |
| City, State Zip
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WESTON,
FL
33332
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| Email Address
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CAMILOPLA@GMAIL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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PLAZAS VEGA |
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First Name |
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CAMILO |
| Policy # * |
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000988555494 |
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Claim #* |
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000988555494 |
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Attorney is Applicable
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| Last Name* |
VELMOSKY
First Name *
AARON
Initial
M
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| Street Address* |
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800 EAST BROWARD BLVD, STE. 510 |
| City, State Zip* |
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FT. LAUDERDALE
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FL
33301
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| Email Address * |
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AV@WEKLAW.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):*
AAPRIL THORNTON
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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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Claim Denial
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Claim Delay
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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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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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| 624.155(1)(b)(3) |
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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.
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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)(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.
Loss Payment provision;
Ensuing Loss Provision of Section I - Property Coverage;
Ensuing Loss Provision of Section I - Exclusions, Par. 2;
Loss Settlement Provision;
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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.
Camilo Plazas Vega (the "Insured") purchased an insurance policy ("Policy") from Castle Key Indemnity Company ("Castle Key"), with effective coverage on the date of the loss, on or about September 28, 2022, and policy number 000988555494 to insure his home located at 19364 Stonebrook Street, Weston, FL (the "Property"). On or about September 28, 2022, the aforementioned Property’s exterior was damaged as a result of Hurricane Ian’s dangerous winds (the “Loss”). As a result of this event, the Property sustained immediate direct damage throughout its roofing system, including the lifting and cracking of concrete tiles. As time passed, the Insured noticed ensuing water damage to the wall in a bedroom while removing a picture frame. Thereafter, the Insured promptly reported his claim to Castle Key after discovering the suspected cause of the interior damage. Castle Key acknowledged receipt of the claim by generating claim number 0715746574 PAT.
In response to receipt of notice of the Loss, Castle Key sent at least two entities to inspect the Property. The Insured suspects that one was a field adjuster and the second, an engineer, from Keystone Experts + Engineers (“KEE”). In reliance upon KEE’s findings, Castle Key denied coverage for the claimed damage to the exterior. Castle Key also denied coverage for the sustained damage to the Property’s interior even though the engineering report was silent as to the cause or origin of same.
Of note, the Insured is unaware of field adjuster’s findings. Yet, he is aware that KEE concluded that the damage to the roofing system observed at the time of its July 2023 inspection was unrelated to wind or wind borne debris. Instead, KEE identified several excluded causes of loss as the origin of the damage, including wear and tear, improper installation, thermal expansion and contraction and other mechanical means (no specific explanation was afforded). KEE’s report offered in support of the
The Insured takes issue with Castle Key’s denial of coverage for the ensuing water damage created to the Property’s interior. To begin, prior to KEE’s inspection, as per the contractual obligations imposed by Castle Key, the Insured retained a water mitigation company, who detected the presence of moisture with the affected bedroom and then tarped the roofing system at a cost of $7,377.05 for the mitigation efforts and $7,186.48 to tarp the roofing system. Said tarp had to be removed to permit KEE’s inspection. As a result, over $13,000 of mold remediation services were recommended to be performed.
Moreover, KEE did not conclude that the damage observed in the bedroom was unrelated to the reported cause of loss. Nevertheless, this damage was reported to Castle Key and the subject policy of insurance affords ensuing loss coverage for this type of sustained damage and for mitigation efforts performed the property from sustaining further damage. The Insured reasonably believes that Castle Key routinely dismisses its indemnity obligations for damage promptly reported to it that were sustained while it was “on the risk” simply because the damage to the exterior of the property was asserted to have resulted from an excluded cause of loss.
Additionally, by operation of the Section I – Conditions, Castle Key imposes an obligation upon the Insured to take effort to protect the property from further damage. Over the course of time, insurance companies such as Castle Key treat a named insured’s failure to retain a company to perform mitigation services as a failure to protect the property from further damage. Accordingly, insureds started hiring companies to perform services. These mitigation companies eventually became irritated with the long delay in recovering payment from the insureds, so they started accepting assignments of insurance benefits from the insureds to allow them to recover directly from the insurance companies for their services. As the mitigation companies started suing the insurance companies under assignment of benefits, the insurance companies banded together to lobby for legislative changes, which have since been enacted to prevent the post-loss assignment of benefits under a homeowners insurance policy. Nevertheless, the need to take action to protect the property from further damage remains. In light of this requirement, the Insured retained three entities, to perform tarping, mitigation, mold assessment and mold remediation services. In the process, the Insured incurred invoices totaling over $28,000 in services that Castle Key should be indemnifying him directly regardless of coverage for the underlying loss.
By stating the above detailed facts, it is clear that Castle Key has violated the following Florida statutes:
• 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 their interest;
• 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) 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; or
• 626.9541(1)(i)(3)(b) Failing to adopt and implement standards for the proper investigation of claims;
• 626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims, by failing to respond to the Insured’ public adjuster, and Insured’ counsel with respect to supplemental requests for payments;
• 626.9541(1)(i)(3)(f) Failing to promptly provide a reasonable explanation in writing to the Insured and/or their public adjuster of the basis in the insurance policy, in relation to the facts or applicable law, for the offer of a compromise settlement;
To date, Castle Key has failed to accept and fully perform its obligations under the operable insurance contract. The Property remains in an unsafe condition because they have not been paid the necessary, covered insurance proceeds sufficient to return the Property to its pre-loss condition. As a direct result of Castle Key’s initial insufficient investigation and handling of the claim, deficient extension of coverage and subsequent breaches of not only the policy of insurance, but also Florida Statutes, the Insured had no choice other than to seek the help of licensed professionals to assist him, including, but not limited to a public adjuster and legal counsel. Considering the aforementioned conduct, it is irrefutable that Castle Key knowingly and intentionally, and in bad faith delays the claims process in order to further disadvantage the Insured. The financial detriment caused to the Insured is a direct result of Castle Key’s dismissive, reckless treatment of the claims process. The Insured submitted all available requested documents in his custody and control in a timely fashion and repeatedly made the Property available for inspection. Notwithstanding, the breadth of its investigative efforts, Castle Key’s overall conduct from start to finish amounts to its gross mismanagement and handling of the claim.
To deny the Insured the remaining benefits clearly due and owing under the Policy, for which he has time and time again been making premium payments for and after he has satisfied all his obligations is morally and ethically reprehensible, and reeks of Unfair Claims Practice and Bad Faith. Upon information and belief, the above identified actions taken by Castle Key, among others, were made so often as to constitute a general business practice, evidencing a motive to enhance Castle Key’s profits, and designed to cause a detrimental effect to its policyholders. Such motive seems readily apparent to the participants of Castle Key’s claim investigation concerning the initial field adjuster’s comment to the Insured concerning his belief that Castle Key would not pay for the roofing system damage.
This notice is given to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should Castle Key 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, Castle Key must: (1) Immediately tender all proceeds due and owing to the Insured that are fairly owed to the Insured under the insurance policy that would reasonably compensate the Insured in order to put the loss property back to its pre-loss condition in the sum of at least $68,000; (2) Concede that the Policy affords coverage for the replacement of the roofing system; (3) Concede that the incurred water mitigation, mold remediation, tarping and mold assessment services are afforded coverage; (4) Immediately tender all proceeds due and owing to the Insured that are fairly owed to the Insured under the insurance policy that would reasonably compensate the Insured for the insured costs for water mitigation, mold remediation, tarp and mold assessment services in the sum of at least $28,000; (5) Agree to reimburse the Insured's reasonable attorneys’ fees and costs for having to become involved to resolve the claim; (6) 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.
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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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