Filing Number: 797158
|
| Filing Accepted: 12/17/2024 |
| Last/Business Name
*
|
|
|
MELENDEZ
|
|
First Name |
|
MIGDALIA |
|
| Street Address
*
|
|
1134 FOREST GATE CIRCLE |
| City, State Zip
*
|
|
HAINES CITY,
FL
33844
|
| Email Address
*
|
|
CDP@WEKLAW.COM |
| Complainant Type:
*
|
|
Insured |
|
| Last/Business Name* |
|
MELENDEZ |
|
First Name |
|
MIGDALIA |
| Policy # * |
|
KIN-HO-FL-110931436 |
|
Claim #* |
|
HO-3374305 |
|
Attorney is Applicable
|
| Last Name* |
PAGAN
First Name *
CHRISTOPHER
Initial
D
|
| Street Address* |
|
800 EAST BROWARD BOULEVARD, SUITE 510 |
| City, State Zip* |
|
FORT LAUDERDALE
,
FL
33301
|
| Email Address * |
|
CDP@WEKLAW.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):*
CORAL MCMINN AND SASHA BRAMWELL
|
| Type of Insurance
*
Residential Property & Casualty
|
|
|
| Reason for Notice
*
|
|
|
Claim Denial
|
|
|
Claim Delay
|
|
|
Unsatisfactory Settlement Offer
|
|
|
Unfair Trade Practice
|
|
|
*
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)(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.
Property Coverages - Coverage A - Dwelling
Perils Insured Against - Coverage A - Dwelling and Coverage B - Other Structures
Conditions - 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.
Migdalia Melendez ("Insured") purchased an insurance policy ("Policy") from Kin Interinsurance Network ("KIN" or “Carrier”) with effective coverage on the date of loss, on or about May 13, 2024, and Policy number KIN-HO-FL-110931436 to insure her property located at 1134 Forest Gate Circle, Haines City, FL 33844 (the "Property").??
On or about May 13, 2024, the Property suffered severe damage as the result of a hail/windstorm event, which caused ensuing damages to the Property including but not limited to the roof and exterior of the property ("Loss"). KIN was notified of the Loss and was granted access to the property in order to complete their inspection. KIN acknowledged the claim and assigned claim HO-3374305 ("Claim") to the Loss.
After being provided plenty of evidence (including photos, estimates, and immediate access to the property upon discovery) showing that damage from hail occurred at the property that will require extensive repairs, KIN continues to refuse to provide additional money in order to complete these repairs. KIN also has the ability to determine the costs needed to fully repair this property but has not attempted to discover this information and has instead forced the Insured to pursue legal recourses for the money due and owing under the contract of insurance. KIN is trying to avoid finding any further information that would increase the amount of coverage available on this claim despite being aware that additional costs would need to be incurred by the Insured to repair her home.
The Insured has fully complied with all applicable Policy provisions requiring cooperation with the?investigation;?however, KIN has unequivocally failed to properly adjust this Claim, as elaborated above. KIN has not attempted, in good faith, to settle this claim when, under the circumstances, it could and should have done so had it acted fairly and honestly toward the policyholder and with due regard to the policyholder's interests.? Rather, KIN has acted with only its own profit and shareholders in mind.
As a direct consequence of KIN’s failure to adjust this Loss in good faith and make any additional supplemental payment, the Insured continues to be without adequate compensation for the damages sustained at the Insured’s Property more than six (6) months ago.??
By stating the above detailed?facts,?it is clear that KIN has violated the following Florida statutes:?
• 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 Insureds and with due regard for their interest.
• 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)(i) Unfair claim settlement practices.
To date, KIN has in bad faith failed to provide sufficient coverage under the Policy to the Insureds. As a direct result of KIN’s underpayment of the Claim and breach of the Florida Statutes, the Insured was?forced to seek the?help of licensed professionals to assist her, including legal counsel.?Due to the amount of time that has passed since the date of loss and the information discussed above, there is irrefutable evidence that KIN knowingly and intentionally, and in bad faith delayed the settlement process in order to further disadvantage the Insured. The financial detriment caused to the Insured is a direct result of KIN’s reckless treatment of the claims process. The Insured submitted all documents requested in a timely fashion, made the property available for inspection immediately after the discovery of the loss, submitted an estimate, and satisfied all requests. However, KIN failed at every step of the process to adequately establish or identify the basis of its gross mismanagement of the claim.?
To deny the Insured the benefits clearly due and owing under the Policy, for which they been making premium payments for and after they have satisfied all of his obligations is morally and ethically reprehensible and reeks of Unfair Claims Practice and Bad Faith. Upon information and belief, the aforementioned actions complained of, among others, were made by KIN so often?as to constitute a general business practice, evidencing a motive to enhance KIN’s profits, and designed to cause a detrimental effect to its policyholders. The above clearly depicts that KIN adjusted this claim in bad faith, continue to act in bad faith towards its Insureds and that KIN is in direct violation of Unfair Claims Practices.??
This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should KIN fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, KIN must: (1) Immediately tender all proceeds due and owing to the Insureds that are fairly owed under the insurance policy that would reasonably compensate them in order to put the loss property back to its pre-loss condition ($40,909.00); (2) Immediately afford coverage for the repairs to the subject property necessary to put the property back into its pre-loss condition and reimburse for the work already performed (3) Agree to reimburse the Insured’s reasonable attorneys’ fees and costs for having to become involved to resolve the claim; and (4) Agree to reimburse the Insureds\ for interest on the amount of benefits that was found to be?due and owing to the Insured, relating back to the date of loss.
|
|
|
*
|
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
|