Filing Number: 793100
|
| Filing Accepted: 11/19/2024 |
| Last/Business Name
*
|
|
|
HERNANDEZ
|
|
First Name |
|
MELANIE |
|
| Street Address
*
|
|
1332 PURITAN STREET |
| City, State Zip
*
|
|
DELTONA,
FL
32725
|
| Email Address
*
|
|
TEXIDOR1930@GMAIL.COM |
| Complainant Type:
*
|
|
Insured |
|
| Last/Business Name* |
|
HERNANDEZ |
|
First Name |
|
MELANIE |
| Policy # * |
|
KIN-DP-FL-24611496 |
|
Claim #* |
|
HO-3800944 |
|
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 |
|
|
| 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):*
SASHA BRAMWELL, KRYSTIANNA CLOUSE, JACQUELINE HARRIS, JEFF WILEMON, DONALD E. NEHRIG, 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 Denial
|
|
|
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
:
Intentionally misstating the terms, conditions, and benefits of the insurance policy to the insured
|
|
|
Other
:
Failing to implement proper standards for the adjustment and investigation of claims
|
|
|
Other
:
Making material misrepresentations
|
|
|
*
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.
|
|
| 626.9541(1)(i)(2) |
|
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.
|
|
| 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)(d) |
|
Denying claims without conducting reasonable investigations based upon available information.
|
|
| 626.9541(1)(i)(3)(i) |
|
Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
|
|
*
Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
627.70131(7)(a) Within 90 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer which reasonably prevent such payment. The insurer shall provide a reasonable explanation in writing to the policyholder of the basis in the insurance policy, in relation to the facts or applicable law, for the payment, denial, or partial denial of a claim. 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. Any payment of an initial or supplemental claim or portion of such claim made 90 days after the insurer receives notice of the claim, or made more than 15 days after there are no longer factors beyond the control of the insurer which reasonably prevented such payment, whichever is later, bears interest at the rate set forth in s. 55.03. Interest begins to accrue from the date the insurer receives notice of the claim. The provisions of this subsection may not be waived, voided, or nullified by the terms of the insurance policy. If there is a right to prejudgment interest, the insured must select whether to receive prejudgment interest or interest under this subsection. Interest is payable when the claim or portion of the claim is paid. Failure to comply with this subsection constitutes a violation of this code. However, failure to comply with this subsection does not form the sole basis for a private cause of action.
627.444(2)(a) Notwithstanding any other law, an insurer shall provide to an insured within 15 calendar days after an individual or entity designated by the insurer receives the insured's written request, either: A loss run statement.
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) failing to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of 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; 8) denying a claim which it knew or should have known the policy and Florida law provided coverage for; 9) failing to provide an estimate that complies with the Florida Building Codes; 10) artificially inflating depreciation; 11) failing to provide a loss run statement; 12) making material misrepresentations; and 13) failure to render a claims determination within 90 days.
On or about September 28, 2022, while the subject policy was in full force and effect, the Insured's property was severely damaged by Hurricane Ian. The areas impacted include but are not limited to the porch, living room, hallway, master bedroom, master bathroom, dining room, kitchen, family room, garage, HVAC, pool, and the roofing system as well as contents therein. The Insured timely submitted a claim on November 9, 2022, to the Insurer for hurricane damage and the ensuing damage therefrom. Thereafter, the Insurer assigned claim number HO-3800944 to the loss and sent a field adjuster to inspect the property. The Insurer also retained an engineer to inspect the property on April 4, 2023. Then in a letter dated May 19, 2023, the Insurer notified the Insured that it was extending partial coverage for the loss. However, the Insurer wrongfully determined that it would only require $15,377.00 to restore the insured property to its pre-loss condition. The Insurer's lowball estimate is that of a classic under scope and under value of the claim. The Insurer denied coverage for several damaged areas of the insured property.
Given the partial denial, the Insured's disagreement with the coverage decision, and the scope and nature of the damage resulting from Hurricane Ian, the Insured retained a public adjuster. After assessing the damage and the true scope of repairs, the public adjuster produced an estimate identifying $153,071.71 in covered damage to the dwelling. The foregoing estimate, photographs, and a letter of representation from the public adjuster were sent to the Insurer. The public adjuster also sent videos of the damage during Hurricane Ian. In response, the Insurer requested its engineer re-evaluate the claim. Then the Insurer sent a letter dated October 16, 2024, advising it was standing by its original evaluation of the loss.
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. However, when the Insurer conducted its inspections of the insured property, the Insurer's representatives failed to conduct a thorough and adequate investigation, or the representatives intentionally ignored the damage observed and failed to make truthful and unbiased reports of the facts after investigating. As a result, the Insurer breached the policy by failing to fully indemnify the Insured for the covered loss.
The Insurer misrepresented the loss and wrongfully denied coverage for the damage sustained to the Insured's property. According to the claims determination letter, the Insurer's engineer observed damage to the insured property, but attributed the cause of this damage to several causes excluded by the policy. However, the Insurer knows or should know that when independent perils converge and no single cause can be considered the sole or proximate cause, it is appropriate to apply the concurring cause doctrine. Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016). The concurring cause doctrine states that coverage may exist where an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause. Id. at 698. A covered peril that meets with an uncovered peril may still provide for coverage under a policy when the covered peril triggered the events that eventually led to the loss. Id. at 697. The Insurer intentionally ignored covered damage to deny the reported loss and wrongfully fail to pay the Insured. As its own engineer opined in the claims determination letter, "NV5 acknowledged the roof leakage in our previous assessment but also presented evidence of prior roof leakage, existing roof damage that preceded the claimed storm and loss date, and overlapping/commingled interior damage from causes not related to the claimed storm." This is an underhanded attempt to place the financial interests of the Insurer over those of the Insured and to delay and frustrate the Insured's ability to have his claim adjusted promptly to begin restoring his property.
Furthermore, the Insurer misrepresented the terms of the policy. The Insurer accused the Insured of violating the policy by removing the damaged pool pump. The Insurer conveniently overlooked the policy language stating, "To the degree reasonable possible." The Insurer's claims determination letter failed to explain whether it was reasonable possible for the Insured to keep the damage pool pump prior to the Insurer's inspection of the property. The Insurer equates removing the damaged pool pump with an automatic violation of the policy thereby voiding coverage, which is contrary to the policy and Florida law.
Additionally, although there was interior water damage the adjuster did not use a moisture meter. 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 Insurer significantly underestimated the scope of the loss to the Insured's property. 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. This is an underhanded attempt to place the financial interest of Insurer over those of the Insured, to delay the Insured's claim, and to delay the Insured in restoring his property to its pre-loss condition.
The Insurer has placed obstacles to its Insured's ability to have the claim adjusted promptly to begin restoring the home by waiting more than ninety (90) days after receiving notice of the Insured's claim to make a claims determination. The Insurer reported the claim on November 10, 2022. The Insurer failed to render a claims determination until May 19, 2023. Under Fla. Stat. 627.70131(5)(a), "[w]ithin 90 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer which reasonably prevent such payment." There were no factors outside of the Insurer's control. As the Insurer has failed to make a timely determination, it has violated this code. As such, in addition to the below requirements to cure this CRN, any payment made to the Insured must contain interest for the damage as a result of the loss from the date the Insurer received first notice of the loss.
Moreover, the Insurer unreasonably inflated the amount of depreciation in this case, thereby artificially lowering the Insured's recoverable value, to the detriment of its Insured. Per the claims determination letter, the Insurer calculated the replacement cost value of the loss at $15,377.00 but withheld $10,456.36, which represents approximately 70% of the entire claim. Thus, the has Insurer withheld an exorbitant amount of the net claim determined by the Insurer as depreciation. The Insurer has attempted to gain an unreasonable financial benefit by inflating the depreciation because it knows that it is unlikely, or at least less likely, that the Insured can actually complete the repairs. In other words, the Insurer pays an unreasonable amount less on the front end of a claim, which makes it more difficult for the Insured to restore the property to its pre-loss condition and recover the withheld depreciation from the Insurer. Withholding an inflated amount of depreciation is a creative, sneaky, and deceptive practice that is employed as to limit the amount the Insurer will ever have to pay out on a claim and essentially make the homeowner a self-insured.
Lastly, the Insurer and its agents failed to comply with Fla. Stat. 627.444 by not providing the Insured and the Insured's representatives with a loss run statement. On October 31, 2024, the Insured's legal counsel provided the Insurer with a letter of representation. Within the letter, legal counsel requested a copy of a loss run statement. The Insurer and its agents have not acknowledged the request for a loss run statement nor has a loss run statement been provided. Upon an Insurer receiving a written request for a loss run statement, the Insurer is required, within fifteen (15) calendar days, to provide either a loss run statement or information on how to obtain a loss run statement at no charge through a consumer reporting agency. There has been no response within fifteen (15) calendar days of the Insured's written request and the Insurer has not provided information on how to obtain a loss run statement at no charge through a consumer reporting agency. This Insurer has breached its duty to settle claims in good faith when, under all the circumstances, it could and should have done so. The Insurer and its agents have not acted fairly and honestly toward the Insured and the Insured's representatives. Lastly, the Insurer has failed or refused to promptly acknowledge the Insured's communications in an attempt to frustrate and delay the resolution of the Insured's claim.
The conduct outlined above is done within the Insurer's routine course of the business.
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.
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 extended partial coverage for the loss.
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 denial
2. Claim delay
3. Not treating the Insured with good faith claims conduct
4. Looking for way to reduce recovery to the Insured
5. Looking for ways to deny recovery to the Insured
6. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured
7. 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
8. Placing the financial interest of the Insurer over that of the health and safety of the Insured
9. Failing to provide an estimate that complies with the Florida Building Codes
10. Shifting the burden of investigating onto the Insured
11. Conducting inadequate investigations
12. Failing to render a written claims determination to the Insured within 90 days pursuant to Florida Statute 627.70131
13. Failing to provide a loss run statement
14. Making material misrepresentations
15. Artificially inflating depreciation
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
55 W. Monroe St., Suite 2200
Chicago, IL 60603
claims@kin.com
|
|
|
*
|
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
|