Civil Remedy Notice of Insurer Violations
Login

Filing Number:     789053
Filing Accepted:  10/28/2024
         Print Filing
Complainant
Last/Business Name *  
KEVIN HAUSER AND JULIE HAUSER   First Name  
Street Address * 8976 VALHALLA DRIVE
City, State Zip * DELRAY BEACH, FL 33446
Email Address * KEVIN@MAJIKCAP.COM
Complainant Type: * Insured
Insured
Last/Business Name*   KEVIN HAUSER AND JULIE HAUSER   First Name  
Policy # * 988 413 747 Claim #* 0770300820
Attorney
Attorney is Applicable
Last Name* GONZALEZ First Name * ANTHONY Initial
Street Address* 925 FEDERAL HWY
City, State Zip* BOCA RATON , FL 33432
Email Address * AGONZALEZ@KPATTORNEY.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):* DAKOTA HORGER
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Unfair Trade Practice
Claim Delay
* 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)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
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.
* 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 settlement provision
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The carrier was immediately put on notice of the insureds’ air conditioning leak claim. Subsequently, the insureds prepared a loss package in the amount of $233,527.26 needed to restore the property back to its pre-loss condition, plus weekly rental ALE expenses of $2,450.00 since the date of loss on September 26, 2024. Whereas, the carrier has failed to prudently inspect the insureds’ property, relying on a single cursory inspection lasting less than five minutes in the presence of the insured using an unqualified lay individual to determine causation of damages, come to a fair coverage determination and promptly pay the claim. The carrier improperly determined that the loss was not covered under the policy and wrongfully denied the claim. In turn, the insureds have complied with all of the carrier’s requests to date and the carrier has still failed to treat this claim with good faith. This intentional delay with the claim has led to direct prejudice of the insureds. About thirty-five days have passed since the original date of loss. The carrier has still refused to pay the fully covered amount owed under the policy. The carrier is aware of the damage sustained by the insured’s property and has not taken any meaningful ensuing action. It is clear that the carrier is not treating the insureds with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insureds; failing to implement proper standards for the adjustment and investigation of claims by its adjusters and placing the company’s interests before the insureds’ interests; refusing to pay the full amount owed to the insureds despite the fact that the carrier has been on notice of the damages and looking for ways to delay full recovery or any recovery to the insureds, when a reasonable carrier in a similar position would have tendered a full payment in accordance with both the policy language and statutory requirements. The carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c) and 626.9541(1)(i)(3)(f), as well as Section I- Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss; and the loss payment provision under Section I- Conditions requiring payment of a claim within 90 days. All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless disregard for the insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $233,527.26, less any prior payments and less any applicable policy deductible; and 2.) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been sent to the carrier. Please do not hesitate to contact the undersigned at agonzalez@kpattorney.com or Kimberly Morales at (561)-892-9915 if you have any questions or concerns. Sincerely, Anthony Gonzalez Attorney at Law
Comments
User Id Date Added Comment
Jennifer.Thompson@allstate.com 12-19-2024 December 19, 2024 Florida Department of Financial Services Consumer Assistance/Civil Remedy Section Larson Building, 200 Gaines Street Tallahassee, FL 32399-0322 Re: Hauser vs. Castle Key Indemnity Co CRN Filing Number: 789053 Court Number: 50-2024-CA-011124-XXXA-MB Date of Loss: September 26, 2024 Our File Number: 0770300820.1 Dear Sir or Madam: This letter is Castle Key Indemnity Company’s (“Castle Key”) response to the above-referenced Civil Remedy Notice. This response is provided on behalf of Castle Key and all of its employees, agents, officers and affiliates. The Department accepted the CRN on October 28, 2024. Therefore, this response has been timely filed within the statutory deadline. As a preliminary matter, Castle Key at all times during the handling of this claim acted fairly and honestly toward its insured. Castle Key fully and fairly considered information regarding the matters at hand and fully observed its contractual, statutory and administrative obligations. Castle Key has carefully reviewed, considered, and evaluated the alleged violations charged and believes they are completely without merit. Castle Key wholly denies any and all allegations of wrongdoing, claim delay, claim denial, unfair claims handling, unsatisfactory settlement offer, unfair trade practice, misrepresentation or bad faith in connection with the above claim. Additionally, the CRN is defective and either does not sufficiently state the circumstances at hand or does so inaccurately and should be rejected. There are requirements for a valid civil remedy notice. See Section 624.155(3), Florida Statutes. Section 624.155 mandates an insured to provide specific facts and circumstances of the alleged violations. This would necessarily include specific facts regarding the method of the investigation, the reasons the investigation was improper or otherwise inadequate, the reasons why this alleged inadequacy is due to the failure to adopt and implement standards for the proper investigation of claims, and the facts supporting these conclusions. Florida law does not allow an insured, without providing any facts, to allege that the insurer’s only option to avoid bad faith is paying whatever the insured demands. 316, Inc. v. Maryland Cas. Co., 625 F. Supp. 2d 1187, 1194 (N.D. Fla. 2008). As such, Castle Key would like this opportunity to set forth an accurate factual background, and thereby correct omissions in Insured’s CRN. A Castle Key Indemnity Company Homeowner’s Policy was issued to Kevin Hauser with an effective date of December 18, 2023, and providing coverage through December 18, 2024. Castle Key’s records reflect the first notice of loss was on September 27, 2024, with a reported date of loss of September 26, 2024. The Insured reported a claim relating to the property located at 8976 Valhalla Drive, Delray Beach, Florida 33446-9574. Specifically, the Insured reported by phone to the Castle Key that on September 26, 2024, there was standing water in the home from an air conditioner leak which caused damage to the bedrooms, ceilings, walls, and flooring within the home. On September 27, 2024, the same day the claim was reported, Castle Key sent a claim acknowledgement letter and a DFS mediation letter to the Insured advising them of their rights. Castle Key also advised the Insured on September 27, 2024, by written correspondence, of Additional Living Expense coverage terms and conditions contained in the policy. On October 2, 2024, field adjuster, Dakota Horger, inspected the premises on behalf of Castle Key. Contrary to the allegations asserted in the insured’s CRN that the inspection lasted “less than five minutes”, Mr. Horger thoroughly inspected the premises and took 134 photos of the interior and exterior of the home. A letter denying the Plaintiff’s claim was issued the same day as the inspection, stating the damages were a result of wear and tear and seepage, which are excluded under the policy. The denial letter included the specific policy language that applied: 15. a) wear and tear, aging, marring, scratching, deterioration, inherent vice, or latent defect; b) mechanical breakdown; d) rust or other corrosion; 18. Seepage, meaning continuous or repeated seepage or leakage over a period of weeks, months or years, of water, steam or fuel: a) from a plumbing, heating, air conditioning or automatic fire protection system or from within a domestic appliance; or b) from, within or around any plumbing fixtures, including, but not limited to, shower stalls, shower baths, tub installations, sinks or other fixtures designed for the use of water or steam. On November 21, 2024, the Insured filed suit in Palm Beach County. The CRN incorrectly alleges that Castle Key has intentionally delayed in the response to the Insured’s claim. The facts set forth above directly contradict these allegations. Castle Key acknowledged the Insured’s claim the same day it was submitted. Castle Key inspected and denied the claim 5 days later. The entire handling of this claim occurred in less than one week, determining it was not a covered loss pursuant to policy language that was then provided to the Insured. Contrary to the allegations that Castle Key violated provisions of Florida Statutes, the loss was promptly inspected, investigated, and properly acknowledged. Castle Key denies any and all allegations of bad faith in connection with the claim submitted by Insured. Castle Key does not consider there to have been any violation of the referenced statutory provisions or otherwise. At all times during the investigation of the subject claim, Castle Key acted diligently and in good faith to resolve same. Conclusion No evidence has been produced to substantiate the CRN’s allegations. Castle Key has fulfilled and is fulfilling its duties as provided under the terms and conditions of the insurance policy. Based on the foregoing, all allegations of wrongdoing, claim delay, claim denial, unfair claims handling, unsatisfactory settlement offer, unfair trade practice, misrepresentation or bad faith in connection with the above claim are denied. Castle Key reserves all of its rights. If anyone at the Department has any questions concerning this matter, please contact Castle Key at our office for a further response. Sincerely, Castle Key Indemnity Company
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.

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