Filing Number: 786552
|
| Filing Accepted: 10/11/2024 |
| Last/Business Name
*
|
|
|
| Street Address
*
|
|
3081 NW 47TH TER. #101 |
| City, State Zip
*
|
|
LAUDERDALE LAKES,
FL
33313
|
| Email Address
*
|
|
UXSUNN@URAMIREZLAW.COM |
| Complainant Type:
*
|
|
Insured |
|
| Last/Business Name* |
|
GLADE |
|
First Name |
|
TRINA |
| Policy # * |
|
9888823057 |
|
Claim #* |
|
0765077805 |
|
Attorney is Applicable
|
| Last Name* |
RAMIREZ
First Name *
UXSUNN
Initial
|
| Street Address* |
|
9555 SW 175TH TER. SUITE #217 |
| City, State Zip* |
|
PALMETTO BAY
,
FLORIDA
33157
|
| Email Address * |
|
UXSUNN@URAMIREZLAW.COM |
|
|
| Insurer Type
*
|
|
 Authorized Insurer
 Unauthorized Insurer
|
|
|
| Insurer Name |
|
|
| Insurer Name* |
|
CASTLE KEY INSURANCE COMPANY
|
| Insurer Name* |
|
|
| Street Address* |
|
|
| City, State Zip* |
|
,
|
|
NAIC Company Code 30511 |
|
|
| Name of individual responsible for violation (if any):*
ALL ADJUSTERS, INSPECTORS, SUPERVISORS, MANAGEMENT AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY THE INSURER IN RELATION TO THIS CLAIM.
|
| Type of Insurance
*
Residential Property & Casualty
|
|
|
| Reason for Notice
*
|
|
|
Claim Denial
|
|
|
Unsatisfactory Settlement Offer
|
|
|
Unfair Trade Practice
|
|
|
*
Statutory provision(s) which the insurer allegedly violated.
|
|
|
|
| 624.401(4)(b)(1) |
|
However, any person acting as an insurer without a valid certificate of authority who violates this section commits insurance fraud, punishable as provided in this paragraph. If the amount of any insurance premium collected with respect to any violation of this section is less than $20,000, the offender commits a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084, and the offender shall be sentenced to a minimum term of imprisonment of 1 year.
|
|
| 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)(c) |
|
Failing to acknowledge and act promptly upon communications with respect to claims.
|
|
| 626.9541(1)(i)(3)(d) |
|
Denying claims without conducting reasonable investigations based upon available information.
|
|
| 626.9541(1)(i)(3)(e) |
|
Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
|
|
| 626.9541(1)(i)(3)(f) |
|
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.
|
|
| 626.9541(1)(i)(3)(g) |
|
Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
|
|
| 626.9541(1)(i)(3)(h) |
|
Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
|
|
| 626.9541(1)(x)(1) |
|
Refusal to insure, or continue to insure, any individual or risk solely because of race, color, creed, marital status, sex, or national origin.
|
|
| 626.9541(1)(x)(2) |
|
Refusal to insure, or continue to insure, any individual or risk solely because of the residence, age, or lawful occupation of the individual or the location of the risk.
|
|
| 626.9541(1)(x)(3) |
|
Refusal to insure, or continue to insure, any individual or risk solely because of the insured's or applicant's failure to agree to place collateral business with an insurer.
|
|
| 626.9541(1)(i)(3)(i) |
|
Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
|
|
*
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 Insurer has failed to provide a certified copy of the policy in violation of Florida Statute, despite numerous requests for same.
It is anticipated that the Coverage A provision or the Loss Payment provision would be relatively the same with most carriers and it is the section breached by the Insurer.
|
| |
*
Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
The instant claim results from the damages covered by the Insured’s policy for damages sustained by a sudden and accidental loss. On or about August 1, 2024, while the policy was in full force and effect, the subject property sustained a sudden and accidental covered loss as a result of a severe water loss unknown to the Insured. Damages as a result of the subject loss is covered by the insured’s policy; however, the Insurer has improperly denied same. In compliance with the conditions and obligations of the policy, the insured immediately made efforts to mitigate the loss and damages and protect the home from further damage in addition to timely reporting the subject loss. The Insurer improperly undervalued and/or denied the subject loss despite having documented evidence of the subject loss, including but not limited to photos, videos and more. All evidence the Insurer requested was provided to the Insurer; however, the Insurer decided to deny the subject loss in bad faith. Worse still, despite numerous calls and conversations from the insured directly to the insurer contesting its improper denial in order to reopen or supplement the subject claim, the insurer ignored all of its insured’s request for information and continued evaluation.
The insurer performed a cursory inspection of the property, failing to retain the experts necessary to identify the repairs necessary to restore the property to its pre-loss condition. The insured retained a representative to assist with the claim, and this representative performed a comprehensive investigation identifying covered damages the insurer knew existed, but failed to address. The Insurer has failed to properly advise or confirm whether the damages are covered pursuant to the subject policy or what damages in the Insured’s competing estimates are not covered. The Insurer has failed to properly investigate and adjust the claim, a claim covered under the policy. The Insurer has refused to properly indemnify the insured for the subject loss, which is a claim covered under the policy. The Insurer failed to properly investigate and adjust the claim and has failed to request any extension to complete its investigation. The Insurer has failed and refused to go to mediation and/or negotiate any settlement with the insured’s public adjuster. The Insurer has not fulfilled its duty to its Insured in refusing to properly adjust this claim. The Insurer has done everything in its power to delay this claim and issue proper payment. The Insurer has failed to restore the insured’s home back to its pre-loss condition and properly indemnify the insured for the subject loss. The Insurer failed to conduct a thorough investigation and failed to properly scope the entirety of the insured’s damages. The insured failed to comply with Section 627.70152, Florida Statute by failing to respond to the Insureds request and by failing to provide documentation the insurer is statutorily obligated to produce.
By failing to issue proper payment for the claim, the insurer is failing to comply with its loss settlement provision. Rather than issuing the proper payment or attempting to reach an agreement with its insured, the insurer is delaying the claim. Specifically, the Insured has complied with all his post-loss obligation and duties after loss. The Insurer continues to request additional inspection, which the Insured coordinates, but the inspections are later canceled by the individuals retained by the Insurer. The individuals retained have still not reached out to the Insured or their representative in order to reschedule same.
Upon information and belief, the insurer performs the subject actions as a business practice, including delaying the claim, and improperly denying or frustrating the claim and claims process in an attempt to dissuade its insureds from pursuing the claim to the detriment of its insureds to increase financial profits. As explained in detail below, the insurer can cure the violations contained herein by issuing a payment for all contractual damages owed
INSURER’s cursory inspection failed to encompass or consider all of the Insured’s covered damages. INSURER knew its cursory and deficient investigation is contrary to the policy coverages and that it has failed to provide proper payment to restore the property to its pre-loss condition. By failing to issue proper payment for the claim, INSURER is failing to comply with its loss settlement provision of the subject policy. Rather than issuing the proper payment or attempting to reach an agreement with its insured, INSURER is delaying the claim and has engaged in a campaign of erroneous accusations of its own client and its client’s covered loss. Notably, the Insurer has yet not offered a single dollar for settlement purposes, further breaching its obligations. Upon information and belief, INSURER performs the subject actions as a business practice, including delaying the claim, conducting a deficient investigation, providing low-ball settlement offers (or no offers at all) and denying or underpaying the claim in an attempt to dissuade its insured from pursuing the claim, to the detriment of its insured to increase financial profits.
All post-loss obligations, apparently to the detriment of the Insured, were complied with and the insurer still refused to properly adjust the claim. The insured timely provided documentation to allow the insurer to know that insured’s scope and valuation of the loss, but the insurer failed to timely respond and failed to make a payment pursuant to the documentation provided. The insurer refuses to timely adjust this loss and instead continues to fail to respond to the insured in efforts to delay this claim. All payments must include interest.
Therefore, to cure the defects outlined in this civil remedy notice, the insurer must, in addition to the steps previously noted, also: (1) create and implement adequate guidelines for proper investigation and evaluation of claims; (2) create and implement adequate guidelines for the training and supervision of the insurer’s employees, which will avoid future statutory violations such as the ones set forth above in paragraph 5; (3) immediately tender all undisputed proceeds to its Insured; (4) act fairly and honestly towards the insured, with due regard for the Insured’s interests as the insurer attempts to settle the Insured’s claim; (5) immediately, and under no circumstances no later than sixty days from the date of this civil remedy notice, tender all insurance monies due and owing the Insured; (6) ensure that payment made would be adequate to place the Insured back in his or her pre-loss condition, minus all appropriately applicable deductibles; (7) reimburse the Insured’ attorney’s fees and costs, since the Insured were forced to hire legal counsel in order to receive adequate payment; and (8) cease the use of outcome-oriented engineers/experts/specialists (if any) who seek to find reasons to deny Insured’ claim, rather that independently assessing the loss presented. Should the insurer fail to comply with the demands set forth in this civil remedy notice, the insurer must prepare to pay the full cost of its failure to rightfully indemnify the Insured, including all future damages that come about as a result of the insurer’s failure to comply with the demands set forth in this civil remedy notice, including but not limited to payment of policy limits should the Insured’ home become structurally unsound as a result of the insurer’s refusal to adhere to the terms of its own policy.
|
|
|
*
|
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
|