Civil Remedy Notice of Insurer Violations
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Filing Number:     790121
Filing Accepted:  11/4/2024
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Complainant
Last/Business Name *  
PASCOE   First Name   MARCUS AND ANDREA
Street Address * 2420 KINGSTON DRIVE
City, State Zip * MIRAMAR, FL 33023
Email Address * WITHHELD
Complainant Type: * Insured
Insured
Last/Business Name*   PASCOE   First Name   MARCUS AND ANDREA
Policy # * KIN-HO-FL-125130078 Claim #* HO-4335046
Attorney
Attorney is Applicable
Last Name* DANIELS First Name * MONICA Initial
Street Address* 560 VILLAGE BOULEVARD, SUITE 110
City, State Zip* WEST PALM BEACH , FLORIDA 33409
Email Address * MDANIELS@THEDANIELS-LAWGROUP.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   KIN INTERINSURANCE NETWORK
NAIC Company Code 16603
 
Name of individual responsible for violation (if any):* SASHA BRAMWELL, WILLIAM WAGNER, AND ANY AND ALL OTHER ADJUSTERS, MANAGERS, SUPERVISORS, AND INDIVIDUALS ASSOCIATED WITH THE CLAIM.
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)(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)(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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

AGREEMENT We will provide the insurance described in this policy in return for the premium and compliance with all applicable provisions of this policy. COVERAGE A – Dwelling We cover: 1. The dwelling on the "residence premises" shown in the Declarations, including structures attached to the dwelling; and 2. Materials and supplies located on or next to the "residence premises" used to construct, alter or repair the dwelling or other structures on the "residence premises." 10. Loss Payment. We will adjust all losses with you.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Marcus and Andrea Pascoe (the “Insureds”) purchased an insurance policy from Kin Interinsurance Network (the “Insurer”), subscribing to policy number KIN-HO-FL-125130078 (the “Policy”), to cover property located at 2420 Kingston Drive, Miramar, Florida 33023 (the “Property”). On or about May 23, 2023, the Insureds’ property suffered damages as the result of a sudden and accidental plumbing loss which caused extensive damage to the subject property. The Insureds immediately notified the carrier, mitigated the damages, and complied with all applicable post-loss obligations. The Insureds also retained a public adjuster to assist with the handling of the damages and the claim and performed the repairs to the property. The Insurer acknowledged the loss and assigned claim number HO-4335046 (the “Claim”) and assigned a desk adjuster and a field adjuster to inspect the property. The Insured’s public adjuster promptly provided the Insurer a true and accurate estimate of the damages, extensive photographs relating to the Claim, and complied with all of the Insurer’s requests for information and documentation. It is clear that the Insureds have done everything in their power to comply with the Insurer’s requests and all applicable post-loss obligations. Despite all the above and the Insureds promptly filing this claim and mitigating all damages in compliance with the Policy, the Insurer unreasonably denied the Claim, claiming that this sudden incident was the result of long-term damage. This finding is in contrast to the clear evidence that this was a covered loss. The carrier’s field adjuster even prepared an estimate for payment to be made, however, the carrier still wrongfully denied the claim. The Insureds understandably became extremely frustrated by the Insurer’s clear delay tactics, failure to properly indemnify him for this Claim in a timely fashion, and failure to adjust the Claim in good-faith. To combat any further attempts by the Insurer to delay the Claim and its failure to make the Insureds whole, the Insureds had no choice but to retain legal counsel to assist with the Claim. Without sufficient funds to repair their property, the Insureds may continue to suffer additional damages. Despite providing all necessary documentation to the Insurer to make good on its duty to restore the Property to its pre-loss condition, insurer undreasonably denied the claim. The Insurer’s refusal to properly investigate, adjust and fully compensate the Insured for this Claim undoubtedly evidences the Insurer’s violation of Section 626.9541(1)(i)(3)(a), Florida Statutes, which requires the Insurer to “adopt and implement standards for the proper investigation of claims.” All available information leads to one conclusion – the Property was damaged by a covered cause of loss for which the Insured is entitled to full and complete compensation. The Insurer’s obligation to promptly settle the Insured’s Claim is undeniable, and therefore, the Insurer has also violated Fla. Stat. Section 624.155(1)(b)(1) and 624.155(1)(b)(3). The Insurer’s conduct continues to be egregious because the Insurer retained biased and inexperienced individuals who approached the loss with an eye towards underpayment and has repeatedly attempted to take advantage of its Insured by unilaterally applying illogical policy interpretations regarding the Policy deductible. The actions taken by the Insurer in the handling and adjustment of the Claim are willful, wanton, and in disregard for the rights of the Insured, and have occurred with such frequency as to indicate a general business practice in violation of the law. This practice includes the Insurer hiring biased and inexperienced adjusters and experts and failing to properly and timely pay for obvious damages owed to its Insureds. The Insurer’s actions amount to, but are not limited to: A. “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 the insured and with due regard for her or his interests;” B. “Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear;” C. “Failing to adopt and implement standards for the proper investigation of claims;” D. Claim Delay; E. Unsatisfactory Settlement Offers; and F. Unfair Trade Practices In addition to the above statutory violations, the Insurer’s adjuster violated the following ethical requirements of the Florida Administrative Code 69B-220.201: (3) Code of Ethics . . . An adjuster shall put the duty for fair and honest treatment of the claimant above the adjuster’s own interests in every instance. The following are standards of conduct that define ethical behavior, and shall constitute a code of ethics that shall be binding on all adjusters: (b) An adjuster shall treat all claimants equally. 2. An adjuster shall adjust all claims strictly in accordance with the insurance contract. (c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured. (d) An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation. (e) An adjuster shall handle every adjustment and settlement with honesty and integrity, and allow a fair adjustment or settlement to all parties without any remuneration to himself except that to which he is legally entitled. (f) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim. (o) An adjuster shall not undertake the adjustment of any claim concerning which the adjuster is not currently competent and knowledgeable as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster’s current expertise. To summarize, the Insureds are dutiful customers who made it a priority to pay their insurance premiums and to ensure that in such an event as the one here, the Property would be covered. The Insureds timely filed the Claim and fulfilled all post-loss obligations. The Insurer acknowledged the loss, assigned a claim number, inspected the property, and denied the claim, and has since ignored its obligations to properly or timely adjust the Claim and treat its Insured with respect. There can be no doubt that the Insurer has failed to provide the Insured with qualified representatives to ensure the Claim was initially adjusted, evaluated, and paid properly. To deny the Insured the benefit of the bargain after they haave satisfied all obligations is morally and ethically reprehensible, and reeks of Unfair Trade Practice. The Insurer is putting its profits ahead of its contractual and statutory obligations. In Florida, the work of adjusting insurance claims engages the public trust. The Insurer has failed to create and implement adequate guidelines for proper investigation to evaluate claims handling and for training and supervision of employees. The Insurer has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s insurance claim and damages. Therefore, the Insurer breached its statutory and ethical duties, and has put profits ahead of the duties it owed to its Insured when he most needed the insurance coverage he had paid premiums for. Florida Statute §624.02 defines “insurance” as a contract where the one undertakes to indemnify another or pay or allow specified amounts, or determinable benefit, upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly. This timely and prompt payment allows the insureds to mitigate their damages and place them back to the position they were in prior to the loss, as quickly as possible. The Insurer breached this duty. The Insurer has refused and failed to tender all insurance proceeds to the Insured upon demand. The Insurer’s refusal and/or failure to settle the insurance Claim when it, under all circumstances, should have done so, is wrongful conduct. The Insurer is failing to promptly settle the Insured’s Claim as it is required to do so by contract. To cure the defects outlined in this civil remedy notice, the Insurer must (1) immediately, and under no circumstances no later than sixty (60) days from the date of this civil remedy notice, tender all insurance monies due and owing to the Insured; (2) immediately, and under no circumstances no later than sixty (60) days from the date of this civil remedy notice, tender all insurance monies due and owing to the Insured for mitigation services rendered as a result of this loss; (3) ensure that payment made would be adequate to place the Insured back in his pre-loss condition; and (4) reimburse the Insured’s attorney’s fees and costs, since the Insured was forced to hire legal counsel in order to receive adequate payment. 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. This Notice is giving in order to perfect the right to pursue the civil remedy authorized by section 624.155(3)(b), Florida Statutes.
Comments
User Id Date Added Comment
kristen.henderson@kin.com 01-03-2025 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 Monica Daniels, Esq. on January 2, 2025.
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.

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DFS-10-363
Rev. 10/14/2008