Filing Number: 788862
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| Filing Accepted: 10/26/2024 |
| Last/Business Name
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TOMLINSON
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First Name |
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RAY AND CHERYL |
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| Street Address
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262 COVERED BRIDGE DR |
| City, State Zip
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OCOEE,
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34761
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| Email Address
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RTOMLINSON@CROWNEINC.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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TOMLINSON |
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First Name |
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RAY AND CHERYL |
| Policy # * |
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KIN-HO-FL-248577955 |
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Claim #* |
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HO-4089459 |
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Attorney is Applicable
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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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KIN INTERINSURANCE NETWORK
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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 16603 |
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| Name of individual responsible for violation (if any):*
CHRIS BOWERS
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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 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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| 626.9541(1)(i)(3)(g) |
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Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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| 626.9541(1)(i)(3)(h) |
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Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
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| 626.9541(1)(i)(3)(j) |
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Altering or amending an insurance adjuster’s report without:
(I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and
(II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or
(III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change;
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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.
“We will provide the insurance described in this policy in return for the premium and compliance with all applicable provisions of this policy.” The facts above apply as the insured as paid the premium and complied with all applicable provisions and company has not provided the insurance described. “We insure against risk of direct loss to property described in Coverages A and B only if that loss is a physical loss to property.” “any ensuing loss to property described in Coverages A and B not excluded or excepted in this policy is covered.” “We will adjust all losses with you.” “This policy and any performance there under shall be construed with and governed by the laws of the State of Florida.”
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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.
This notice is given in order to perfect the right to pursue the civil remedy authorized by 624.155. The policy language at issue includes but is not limited to the terms of the Building coverage form, including but not limited to the terms of the Coverage section, the Duties After Loss Section, the Loss payment and settlement conditions, the policy’s exclusions and limitations, and all other policy provisions. At the time of this filing there was no Attorney retained for representation on this claim.
Ray Tomlinson and Cheryl Tomlinson (hereinafter Policy Holder) are homeowners insured with a policy issued by Kin Interinsurance Network (hereinafter Company) The insured property or home is located at 262 Covered Bridge Dr, Ocoee, FL 34761. The facts of this notice are specifically related to Coverage A and B. In August of 2023, a Fire caused significant damage to the Policy Holder’s home. The entire home was damaged. Policy Holder timely reported a claim for these damages and immediately began mitigation of the damages so no further losses would occur. The Policy Holder then fully cooperated with Company for all requests for inspections and they provided all requested documentation, if any, and complied with any and all other post loss policy conditions.
After reporting the claim, Company assigned field adjuster George Heard to inspect the loss. To start this notice, it has been over 1 year and policyholder has provided receipts for $616,996.32 and in over a year Kin has only paid $328,183.64. This next fact alone sets the tone for how company is treating this policyholder whose entire home was damaged. To emphasize the facts of this notice for what type of claims handling policyholder is dealing with, George Heard’s original estimate dated 9/19/2023 allowed for two 40 yard dumpsters. Please be reminded this was a fire loss that destroyed an entire home. Per desk examiner Chris bowers and Kin, Mr. Heard’s estimate was altered and replaced with Kin’s estimated dated 10/25/2023 which was changed to only ONE single 20 yard dumpster. Thousands of claims will show that Company’s standard amount for a roof loss only or even less damages will show one single 20 yard dumpster. Please be reminded this was a fire loss that destroyed the entire home including the roof and every inch of drywall in the home was removed etc. and company specifically made it a point to take it from two 40 yard dumpsters to one single 20 yard dumpster. We are only talking dumpsters here that Kin already is clearly making an effort to save every single penny they can on this insured. For the record, a total of 19 dumpsters were needed. Chris Bowers has been aware of this for months. As of this filing Chris Bowers has been asked several times for several months how he is not able to find ONE single line item between the insureds invoices and Kin’s estimate that could be adjusted and supplemented for the insured. As of this filing not one single penny more has been released by Kin for supplement items as simple as this. To date Kin has still only paid for one single 20 yard dumpster. Here is another example that helps show the entirety of this claim. This fire destroyed the pool equipment for this home. Company agreed with this and paid for $1891.36 worth of pool equipment. The insureds pool equipment cost $18,984.42 and this receipt was provided to company. Company questioned if there were upgrades made. On 10/1/2024 company was provided an email from the insured stating “I spoke to our pool company and they replaced all our damaged equipment with no upgrades. In fact, we left off the wired control system (saved $599.99 + tax, labor) and chose to use the handheld remote-control system.” As of this filing company refuses to accept their estimate is simply wrong with regard to many specialty items and as of this filing company has not released one single penny more for the pool equipment. Company has not even asked for any more information it just simply has been ignored. These simple facts that are all documented by time stamped emails are impossible to be denied and if attempted to do so will simply further illustrate the reason for this notice.
Here are the facts of this loss after field adjuster George Heard inspected the property. George Heard provided company with an estimate for all damages that totaled $354,839.37. Per a subsequent letter dated 9/29/2023 from Company, this bad faith adjusting clearly became evident. Despite Company finding coverage for their claim, they unreasonably underpaid the Policy Holder only $262,293.80 for their claim and repair of damages. This is an undeniable fact that company NEVER provided a reasonable or even unreasonable explanation in writing of the difference the policyholder. Statue 627.70131(7)(a) states “If the insurer’s claim payment is less than specified in any insurer’s detailed estimate of the amount of the loss, the insurer must provide a reasonable explanation in writing of the difference to the policyholder.” 626.9541(1)(i)(3)(j) Also states “Altering or amending an insurance adjuster’s report without: (I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and (II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or (III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change;” Company then had George Heard reinspect the loss and later provided an estimate dated 2/8/24 which totaled $331,584.68. The insured started repairs right away. It is important to note that all receipts and invoices are 100% actually INCURRED, these are not quotes or estimate, these are the invoices and the receipts from the insured’s actual contractor, not a Public Adjuster or any other entities estimate. Since at least June of 2024 company was notified that the insured had paid $442806.90 out of pocket so far, provided all of the project totals for $$601,464.44, and that kin had only paid out $328,183.64 so far. The insured at this point is out of their own pocket $114,623.26 and the project cost is nearly double Kin’s payout so far. On 8/1/2024 one of company’s questions to these numbers provided was “Lighting and equipment, which lights were replaced? Does this only include lights? What equipment is being included?” Company was asked back per the burden of proof to please provide which lights would not be covered per the policy and why. Nearly 3 more months go by and company does not release or find ONE single dollar in the several hundred thousand dollar difference. On 9/5/2024 company is emailed that the total ACTUAL payments from the insured to their contractor now total $598,996.32. Kin has paid $328,183.64 leaving the insured $270,812.68 out of their own pocket. Nearly another month goes by with nothing from Kin and on 10/1/2024 company is emailed again “Total actual payments made now equal $598,011.90 + $18,984.42 pool equipment below. Kin has paid $328,183.64 leaving the insured $288,812.68 out of their own pocket.” Company has every single receipt and invoice as well as direct explanations from the insured contractor on a lists of requests that totaled 39 questions from company. To emphasize the previous facts stated, on 9/5/2024 Chris Bowers was emailed “KIN ORIGINALLY WROTE FOR 2 40 X 7 DUMPSTERS AND KIN HAD THE ADJUSTER REMOVE THAT AND CHANGE IT TO ONE 20 YARD DUMPSTER FOR $612 ON A FIRE LOSS THAT DESTROYED AN ENTIRE HOUSE.” He never responded to this. On 10/1/2024 he was asked again “Please respond about the dumpsters and why you removed multiple dumpsters from the original estimate and changed it to 1 single dumpster that is even smaller for this Fire loss.
a. The contractor advised they have used 14 20 yard dumpsters and somehow you are still at 1.
b. We are still trying to figure out how you have not been able to find a single dollar to release to this insured for the indemnity as they are out of pocket $288,812.68 more than what Kin has paid so far.
c. The roofing company alone used 1 full dumpster in addition to this.
18 dumpsters for this loss so far + the one for the roof so 19.” As you may have guessed, he did not respond to this. On 10/14/24 he was emailed again “Please get back to us on this one.” On 10/16/2024 he finally responded with requests further delaying payments to the insured.
As of this email company has been provided every single invoice and receipt, itemized responses to 39 questions by company which included from the contractor responses such as confirmation that the flooring SF is the same, the paint SF is the same, the drywall SF is the same, the bathroom vanities re exactly the same, all interior finishes are exactly the same, quantity of doors exactly the same, kitchen backsplash SF exactly the same, the only big difference was the insured added a kitchen island and not expected to be covered, photos before, during, and after repairs have all been made. As of this filing company has not paid ONE SINGLE penny more than their estimate amount and payments of $328,183.64. Please be reminded this was based on and ESTIMATE and the insured’s actually incurred invoices have all been ignored. As of this filing the insured is OUR OF THEIR OWN POCKET $288,812.68 and company still has yet to acknowledge or find literally ONE single penny including the fact that 19 dumpsters were used and they still have only paid for ONE single 20 yard dumpster.
Due to the aforementioned actions, Policy Holder has not been able to permanently repair their home and even though the Policy Holder has done their best to mitigate damages the home is continuing to sustain further damage. It is also negatively impacted the Policy Holder’s ability to use their home in a normal manner. Based on these facts, it is clear Company unreasonably denied full coverage for the Policy Holder’s claim in bad faith through its extremely low and unreasonable payment. Company underpaid the claim without conducting a reasonable investigation based upon the available information. It misrepresented pertinent policy provisions and facts, and did not act fairly and honestly towards Policy Holder in due regard for their interests. Company also failed to adopt and implement standards for the proper investigation and settlement of this claim. As a result, without further payment Policy Holder will have no choice but to retain counsel and file a lawsuit against Company for both bad faith and breach of contract. Company has had access to more than enough information and cooperation but is still refusing to accept full coverage for this claim. Multiple attempts to contact Company via phone and Email/mail to discuss and settle this claim have gone unanswered. This continued and repeated reckless claim delay and denial of full coverage will result in a significant punitive damage award. Company can cure this CRN and avoid a lawsuit for bad faith and breach of contract by immediately accepting full coverage under the subject insurance policy for the claim, and by immediately paying the total amount incurred of $616,996.32, plus applicable interest, to the Policy Holder.
Applicable policy language would be “We will provide the insurance described in this policy in return for the premium and compliance with all applicable provisions of this policy.” The facts above apply as the insured as paid the premium and complied with all applicable provisions and company has not provided the insurance described. “We insure against risk of direct loss to property described in Coverages A and B only if that loss is a physical loss to property.” “any ensuing loss to property described in Coverages A and B not excluded or excepted in this policy is covered.” “We will adjust all losses with you.” “This policy and any performance there under shall be construed with and governed by the laws of the State of Florida.”
Multiple attempts to settle the claim in good faith have either been rejected by the Company or completely ignored in an obvious delay tactic designed to avoid a compromised settlement and in violation of 624.155(1)(b)1, 626.9541(1)(i)3c. In an obvious violation of 626.9541(1)(i)3c, multiple requests for documents supporting the desk adjuster’s claim went unanswered. Several other requests, phone calls, and emails to the desk adjuster have gone completely unanswered. This reckless lack of acknowledgement in respect to communications is not acting fairly and honestly with due regard for the Policy holder’s interests. Company has failed to honor the Contract of Indemnification in which The insurance contract will restore the insured to the financial position previously held before the loss. Company has also failed to honor The Doctrine of Utmost Good Faith in which To form an insurance contract, each party to the contract must substantially rely on the honesty and integrity of the other party.
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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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