Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 789710

Filing Accepted: 10/31/2024

Print Filing

Complainant

Last/Business Name *

MERIDA

First Name

MARGARITA

Street Address *

2035 SOUTH STATE ROAD 349

City, State Zip *

BRANFORD, FL 32008

Email Address *

CMERIDA123@GMAIL.COM

Complainant Type: *

Insured

Last/Business Name*		MERIDA		First Name		MARGARITA
Policy # *		KIN-MH-FL-236568246		Claim #*		HO-3316844

Attorney

Attorney is Applicable

Last Name*	KRAPF First Name * GRANT Initial W
Street Address*		2790 SUNSET POINT RD
City, State Zip*		CLEARWATER , FL 33759
Email Address *		GRANT@KRAPFLEGAL.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		KIN INTERINSURANCE NETWORK
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 16603

Name of individual responsible for violation (if any):* HALEY PEARSON, JAMIE JENSEN, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, KIN INTERINSURANCE NETWORK, WHO WAS INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Delay
	Unfair Trade Practice
	Other : Not treating the Insured with good faith claims conduct
	Other : Looking for ways to deny full recovery to the Insured
	Other : Looking for ways to delay full recovery to the Insured
	Other : Failing to properly investigate the Insured's loss
	Other : Failing to provide the Insured with the full benefits awarded under the contract of insurance in a t
	Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made
	Other : Not adjusting claims and evaluating loss properly
	Other : Shifting the burden of insuring the loss to the Insured
	Other : Failing to implement proper standards for the adjustment and investigation of claims

* 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.

* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language. "It is an accepted principle of law that when parties contract upon a matter which is the subject of statutory regulation, the parties are presumed to have entered into their agreement with reference to such statute, which becomes a part of the contract, unless the contract discloses a contrary intention." Westside EKG Assocs. v. Found. Health, 932 So. 2d 214, 216 (Fla. 4th DCA 2005), aff'd, 944 So. 2d 188 (Fla. 2006).

* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Kin Interinsurance Network (the "Insurer") has committed the following in handling the Insured's claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the policyholder and the Insured; 3) looking for ways to deny benefit payments and otherwise "low ball" or "stone wall" claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; and 8) shifting the burden of investigating the loss onto the Insured. On or about August 30, 2023, while the subject policy was in full force and effect, the Insured's suffered a loss caused by Hurricane Idalia. The areas impacted include but are not limited to the roofing system, exterior surfaces, decking, living room, kitchen, hallway, closet A, master bedroom, bedroom 1, closet 1, in-law suite, in-law bathroom, in-law roofing system, carport, and contents. The Insured timely submitted a claim on September 13, 2023, to the Insurer for damages caused by Hurricane Idalia and the ensuing damage therefrom. Given the scope and nature of the damage, the Insured retained a public adjuster. After assessing the damage and the true scope of repairs, the public adjuster prepared an estimate identifying $94,641.46 in covered damage to the dwelling, $5,718.82 in covered damage to contents, and $515.24 in damage to contents. The foregoing estimate, photographs, and a letter of representation from the public adjuster were sent to the Insurer. Thereafter, the Insurer assigned claim number HO-3316844 to the loss and sent a field adjuster to inspect the property on September 16, 2023. Subsequently, in a coverage determination letter dated October 10, 2023, the Insurer notified the Insured that it was extending coverage for the loss. However, the Insurer wrongfully determined that it would only require $23,748.17 to restore the insured property to its pre-loss condition, which resulted in only $20,398.17 being issued to the Insured. The Insurer's lowball estimate is that of a classic under scope and under value of the claim. Upon receiving notice of the loss, the Insurer had the duty to provide the full benefits under the policy. This includes providing the Insured with a proper investigation and the funds necessary to return the home to its pre-loss condition. There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer's claim file and standards and procedures for the adjustment and investigation of claims. The Insurer also failed to allocate and pay for overhead and profit, pursuant to Florida Statute 627.7011(3)(a). Where the Insureds are reasonably likely to need a general contractor for the repairs, Florida Statute 626.7011(3) does not permit an Insurer to withhold overhead and profit pending the actual repair, unless absent a showing by the Insureds that it was likely to need a general contractor for the repairs. Trinidad v. Fla. Peninsula ins. Co., 121 So. 3d 433, 435 (Fla. 2013). The Insurer has implemented policies and procedures that are designed to wrongfully withhold costs associated with restoring the insured property to its pre-loss condition. This is an underhanded attempt by the Insurer to place its financial interest above those of the Insured. Additionally, Insurer shifted the burden and cost of investigating and insuring the loss onto the Insured. During their investigation, the insurer's adjuster did not use a moisture meter, despite the presence of interior water damage. A moisture meter can be purchased online from Amazon for around $40 before tax. The Insurer could purchase a moisture meter and assess thousands of properties with one meter. Instead, the Insurer would rather place its financial interests over those of the Insured by failing to provide the adjuster with the necessary tools to correctly inspect the loss. As a result of the inadequate investigation and surrounding circumstances it is apparent that the Insurer significantly underestimated the scope of the loss to the Insured's property. The Insurer and its adjuster have colluded to misrepresent the true scope of damages to the insured property and the true replacement costs of the damages. In short, the Insurer is not acting with due regard for the Insured's interests or safety. In Florida the work of adjusting insurance claims engages the public trust. The Insurer has breached this trust and its duty to the Insured. The Insurer and its agents conducted cursory and inadequate investigations and wrongfully determined that it would only require $23,748.17 to restore the insured property to its pre-loss condition. Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer's actions and inactions have continued to frustrate and delay the resolution of the Insured claim. The Insurer's actions amount to but are not limited to the following: 1. Claim delay 2. Not treating the Insured with good faith claims conduct 3. Looking for way to reduce recovery to the Insured 4. Looking for ways to deny recovery to the Insured 5. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured 6. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company's interests before the Insured's interests 7. Placing the financial interest of the Insurer over that of the health and safety of the Insured 8. Shifting the burden of investigating onto the Insured 9. Conducting inadequate investigations Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must: (1). Admit full coverage for the Insured's loss. (2). Tender full benefits owed to the Insured under the insurance contract. A copy of this form submitted to the FDFS has been sent via e-mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to badfaith@krapflegal.com. Via E-mail: Kin Interinsurance Network 222 Merchandise Mart Plaza, Suite 228 Chicago, IL 60654 claims@kin.com

Comments

User Id		Date Added		Comment
kristen.henderson@kin.com		11-22-2024		While Kin Interinsurance Network believes that the Civil Remedy Notice fails to comply with the requirements of Florida Statute §624.155 and Florida Case law, it has responded to the Notice in writing to Grant Krapf on November 22, 2024.

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