Filing Number: 789345
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| Filing Accepted: 10/30/2024 |
| Last/Business Name
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| Street Address
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2149 CALUSA LAKES BLVD. |
| City, State Zip
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NOKOMIS,
FL
34275
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| Email Address
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DGECHIJIAN@MERLINLAWGROUP.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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KELLEY |
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First Name |
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SUSAN |
| Policy # * |
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KIN-DP-FL-103469821 |
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Claim #* |
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HO-3187532 |
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Attorney is Applicable
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| Last Name* |
MARKER
First Name *
SHAUN
Initial
J
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| Street Address* |
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ONE NORTH CLEMATIS STREET, SUITE 510 |
| City, State Zip* |
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WEST PALM BEACH
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FL
33401
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| Email Address * |
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SMARKER@MERLINLAWGROUP.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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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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NAIC Company Code 16603 |
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| Name of individual responsible for violation (if any):*
OFFICERS, SUPERVISORS, AND OR MANAGEMENT OF KIN INTERINSURANCE NETWORK, AND ALL CLAIM REPRESENTATIVES, DESK ADJUSTERS, FIELD ADJUSTERS, LOSS CONSULTANTS, ENGINEERS, AND EXPERTS, JOSH JONES, CAROL MCMINN, NV5 ENGINEERING, BRUSH COUNTRY CLAIMS, JOSH WI
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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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Claim Denial
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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)(2) |
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Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
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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)(2) |
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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.
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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)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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| 626.9541(1)(i)(3)(e) |
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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.
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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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Building coverage provisions; additional coverages; duties in event of loss policy provisions; all terms and conditions of Section I of the insurance policy; the insurance policy's definition section; the insurance policy's exclusion of coverage provisions; loss payment policy provision; loss settlement provision; the declarations page; we will adjust all losses with you.
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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.
In Florida, the work of adjusting insurance claims engages the public trust. Kin Interinsurance Network has breached this duty by its handling of the Insured, Susan Kelley’s Claim of Loss (Claim Number HO-3187532; D.O.L. 09/28/2022).
Kin Interinsurance Network has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s insurance claim for damages.
On or about September 28, 2022, the Insured submitted a claim to Kin Interinsurance Network for damages sustained as a result of Hurricane Ian.
We have identified the following instances of bad faith conduct on the part of your company:
• Purposefully minimizing the value of the claim by using biased estimating software/pricing and low-balling the cost of repairs. Specifically, estimations and repair costs have been purposefully devalued to the benefit of the insurance company despite knowledge that these costs are woefully deficient.
• Failing to adopt and implement standards for the proper investigation of the claim; failing to conduct a proper investigation of all wind damage to the property, including all wind damage to the roof. Brush Country Claims field adjuster, Josh Wilson, failed to account for any peril related damage to the roof, despite obvious and apparent wind damage to the roof from Hurricane Ian and the fact that impact damage occurred from a fallen tree.
• Failure to perform a timely roof inspection. More specifically, Kin’s correspondence dated June 20, 2024 acknowledges that the “claim was reported by you 3 days after the claimed date of loss;” however, the inspection performed by Brush Country Claims did not occur until approximately June 20, 2023. This unnecessarily delayed the claim and resulted in Kin’s failure to identify relevant roof damage that occurred as a result of Hurricane Ian.
• The Brush Country Claims estimate of July 17, 2023 purposefully minimizes the damages that resulted to the property as a result of wind from Hurricane Ian. This resulted in Kin’s failure to issue full payment to the insured for the damages to their property from Hurricane Ian, including but not limited to, the roof.
• As a result of Kin’s failure to conduct a timely and complete roof inspection, a payment that was less than the full amount due and owing to the Insured was issued.
• Kin issued correspondence to the Insured misrepresenting that the damage resulted from causes other than Hurricane Ian, including mechanical damage, manufacturing deficiencies, and age-related weathering. See correspondence dated June 20, 2024.
• Kin hired biased company, Precision Claims, to inspect and evaluate the roof.
• Kin misrepresented to the Insured that the roof is in need of repair rather than replacement. See correspondence to Insured dated June 20, 2024.
• Kin has failed to account for and acknowledge damage from wind of Hurricane Ian including all fractured tiles and interlocks, right and left corner fractures, point load fracturing of the tile, de-bonded hip and ridge caps, and impact damage to the left side of the home from a fallen branch.
• Failure to account for and acknowledge that the Pioneer Brand concrete tiles installed on the structure are no longer manufactured and no longer have an active State of Florida Notice of Acceptance.
• Failure to acknowledge that the wind uplift damages cannot return the residential roofing system to its pre-loss conditions and will require the complete replacement of all roofing materials at the subject property.
• Refusing to pay for necessary repairs and attempting to coerce us into accepting a lower settlement amount by failing to properly consider all applicable statutes and building code requirements both at the state and local level.
These actions on the part of your company are unacceptable, and are in violation of our insurance policy and the duty of good faith and fair dealing that Kin Interinsurance Network owes to its policyholders. Based on conduct to date, these practices occur with such frequency as to constitute a general claims handling process/business practice imbedded within the company’s management of Hurricane Ian claims.
To date, notwithstanding the Insured’s pleas otherwise, Kin Interinsurance Network has continued to refuse to acknowledge its obligation to tender all insurance proceed monies due and owing the Insured or assist the Insured in mitigation of the damages.
The insurer has failed and refused to acknowledge coverage and restore the Insured to her pre-loss condition. Kin Interinsurance Network has sufficient information upon which to evaluate the Insured’s claim for damages, and certainly has been provided with an independent means by which to determine the amount of loss.
The Insured have otherwise fully complied with the insurer's requests for post-loss compliance. Kin Interinsurance Network has not properly paid all of the covered damages. These actions by Kin Interinsurance Network occur with such frequency to indicate a general business practice of the company.
The Insured has complied with the policy of insurance and Florida law, and Kin Interinsurance Network continues to wrongfully refuse to tender the insurance proceeds that are due and owing the Insured. The concept of insurance is the granting of timely and prompt indemnity or security against a contingent loss. Florida statute section 624.02 defines "insurance" as a contract whereby one undertakes to indemnify another or pay a specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that the Insured may be put back into the position she was in prior to the loss as quickly as possible. Kin Interinsurance Network breached this duty.
The Insured was and still is forced to expend out of pocket monies to submit the insurance claim to force Kin Interinsurance Network to honor its obligations under the insurance policy to pay all the insurance proceeds due and owing her. Kin Interinsurance Network has clearly displayed bad faith in its handling, processing, and wrongful delay of this claim. The Insured merely requests that Kin Interinsurance Network "adjust the loss" with her in accordance with the policy of insurance for which Kin Interinsurance Network has accepted a premium, and in accordance with Florida law. Kin Interinsurance Network’s conduct has been reckless and unfair to its Insured and has caused and continues to cause additional damages.
We demand that Kin Interinsurance Network immediately take steps to rectify the situation and handle this claim in a fair and appropriate manner. This includes providing full and fair compensation for the damages incurred and for any additional costs and expenses incurred as a result of Kin Interinsurance Network's bad faith conduct, including but not limited to, fees and costs related to the retention of personnel/counsel required to challenge Kin Interinsurance Network’s improper handling of this claim. [As of this moment, the damages found and evaluated by the insured(s) value at minimum $185,817.70, and we request payment in that sum as a curative measure to the conduct described herein.]
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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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