Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 797903

Filing Accepted: 12/23/2024

Print Filing

Complainant

Last/Business Name *

ZAPATA

First Name

JOSE & KATHLEEN

Street Address *

11492 MARVELWOOD ROAD

City, State Zip *

WEEKI WACHEE, FL 34614

Email Address *

WITHHELD

Complainant Type: *

Insured

Last/Business Name*		ZAPATA		First Name		JOSE & KATHLEEN
Policy # *		988 833 472		Claim #*		0772074068

Attorney

Attorney is Applicable

Last Name*	WALLACE First Name * BLAKE Initial
Street Address*		8635 W. HILLSBOROUGH AVE., STE. 401
City, State Zip*		TAMPA , FLORIDA 33615
Email Address *		BLAKE@KLINGLAW.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		CASTLE KEY INDEMNITY COMPANY
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 10835

Name of individual responsible for violation (if any):* NICHOLAS GUNTER & DEAN KREMENTZ
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)(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)(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.

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

The specific policy provisions the carrier violated are the loss payment provision, the loss settlement provision, and the coverage provisions. Specifically, the loss payment provision states “we will adjust all losses with you.” Yet, the carrier did not consult the homeowner in deciding who would investigate the cause or amount of damages, and what the ultimate payment should be. The other provisions are pasted on the pages following the signature block. Florida Hurricane Deductible Endorsement - AP5004 It is agreed that your policy is changed as follows: I. In the General section of the policy, under Definitions Used In This Policy, the following definitions are added: Calendar year-means a twelve-month period beginning January 1 and ending December 31. Hurricane-means a storm system declared to be a hurricane by the National Hurricane Center of the National Weather Service. The duration of the hurricane includes the following time period in Florida: 1. beginning at the time a hurricane warning is issued for any part of Florida by the National Hurricane Center of the National Weather Service; and 2. ending 72 hours following the termination of the last hurricane watch or hurricane warning issued for any part of Florida by the National Hurricane Center of the National Weather Service. Hurricane loss-means sudden and accidental direct physical loss to covered property caused by hurricane. Hurricane loss includes ensuing damage to the interior of a building, or to covered property inside a building, caused by rain, snow, sleet, hail, sand or dust if the direct force of the hurricane first damages the building, causing an opening through which rain, snow, sleet, hail, sand or dust enters and causes damage. II. In Section I Conditions, item 1. Deductible is replaced by the following: 1. Deductible We will pay when a covered loss exceeds the applicable deductible shown on the Policy Declarations. We will then pay only the excess amount, subject to any applicable co-payment provisions, unless we have indicated otherwise in this policy. Hurricane Deductible: A hurricane deductible shall apply on a calendar year basis to all covered hurricane loss(es) that occur during the same calendar year that are covered under one or more policies issued to you by us (or one of our affiliated insurance companies) that insure a dwelling located at the same Location of Property Insured shown on the Policy Declarations of this policy. a. For the first covered hurricane loss during the calendar year, we will pay when the covered hurricane loss exceeds the applicable hurricane deductible shown on the Policy Declarations. We will then pay only the excess amount. subject to any applicable co-payment provisions, unless we have indicated otherwise in this policy. b. Except as provided in paragraph c. below, in the event there is (are) prior hurricane loss(es) in the same calendar year, we will only pay for a covered hurricane loss when that hurricane loss exceeds the greater of: 1. an amount equal to the Hurricane Deductible shown on the Policy Declarations, less the total amount of any hurricane deductible(s) applied to any other prior hurricane loss(es) that occurred during the same calendar year that were covered under one or more policies issued to you by us (or by one of our affiliated insurance companies) that insured a dwelling located at the same Location of Property Insured shown on the Policy Declarations for this policy; or 2. the amount of the Other Peril Deductible shown on the Policy Declarations. We will then pay only the excess amount. subject to any applicable co-payment provisions, unless we have indicated otherwise in this policy. c. In the event that two or more covered hurricane losses occur in the same calendar year under more than one policy issued to you by us (or one of our affiliated insurance companies) which insure a dwelling located at the same Location of Property Insured shown on the Policy Declarations for this policy, and the Hurricane Deductibles shown on the Policy Declarations applicable to those hurricane losses differ, we will only pay for a covered hurricane loss when that hurricane loss exceeds the greater of: 1. an amount equal to the highest Hurricane Deductible shown on any applicable Policy Declarations, less the total amount of any hurricane deductible(s) applied to any other prior hurricane loss(es) that occurred during the same calendar year that were covered under one or more policies issued to you by us (or by one of our affiliated insurance companies) that insured a dwelling located at the same Location of Property Insured shown on the Policy Declarations of this policy; or 2. the amount of the Other Peril Deductible shown on the Policy Declarations. Losses We Cover Under Coverage A: Your policy generally covers sudden and accidental direct physical loss to the property described in Dwelling Protection- Coverage A coverage, except as limited or excluded by your policy. Losses We Cover Under Coverage B: Your policy generally covers sudden and accidental direct physical loss to the property described in the Other Structures Protection Coverage B coverage, except as limited or excluded by your policy. Losses We Do Not Cover Under Coverages A And B: Section I-Your Property, does not provide Dwelling Protection-Coverage A or Other Structures Protection-Coverage B coverages for loss consisting of, or caused by: - Flood - Hurricane o This exclusion applies only to: a) loss in excess of $50,000 to pool enclosures, carports, Florida rooms, sun rooms and patio enclosures that have any aluminum supporting frames or studs. Loss in excess of $50,000 is excluded regardless of the number of pool enclosures, carports, Florida rooms, sun rooms and patio enclosures involved in the loss. This exclusion applies whether or not the pool enclosure, carport, Florida room, sun room or patio enclosure is fastened or attached to, or a part of, a building structure; b) loss to screens for pool enclosures, carports, Florida rooms, sun rooms or patio enclosures that have any aluminum supporting frames or studs; c) loss to fences, whether or not fastened or attached to, or a part of, a building structure; and d) loss to above ground outdoor pools, awnings and outdoor antennas, whether or not fastened or attached to a building structure.

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

Sent Via Email CASTLE KEY INDEMNITY COMPANY claims@claims.allstate.com RE: Insureds : JOSE ZAPATA & KATHLEEN ZAPATA (hereinafter, “Insureds”) Policy # : 988 833 472 Claim # : 0772074068 Property Address : 11492 Marvelwood Rd, Weeki Wachee, FL 34614 Persons most knowledgeable of facts giving rise to the Violations: Nicholas Gunter, Dean Krementz Dear CASTLE KEY INDEMNITY COMPANY: Please find enclosed the civil remedy notice filed for the above referenced claim. This notice is given in order to perfect the right to pursue the civil remedy authorized by Florida Statute §624.155 As discussed in greater detail in the notice, the carrier has not attempted in good faith to settle the claimant’s claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its claimant and with due regard for its interests. The carrier has done everything possible to delay the claim and refuses to provide any sort of status of the claim. Furthermore, the carrier is required to properly investigate and adjust claims and cannot place that burden upon the insured. This was made clear by the appellate court and the Florida Supreme Court in Allstate Indemnity Co. v. Ruiz, 899 So. 2d 1121 (Fla. 2005) (“The Legislature has clearly chosen to impose on the insurance companies a duty to use good faith and fair dealing in processing and litigating the claims of their insured…”). The carrier was put on notice of the insured’s Hurricane Milton claim on October 10, 2024. Since the commencement of the claim the carrier has failed to timely communicate with the insured. It is obvious that the carrier is not attempting to pay for the clearly covered damages owed under the policy. The carrier assigned Nicholas Gunter, who is not an engineer, to inspect the loss. On October 16, 2024, and reiterated on October 21, 2024, the carrier made the unilateral determinations that A) the damages to the property, including the interior would be excluded under the policy and therefore be denied and that B) the damages that were covered failed to exceed the deductible on the policy and that the insured would be entitled to $0 after the application of the deductible. It was clear that the damages exceeded the deductible. Moreover, in reaching those conclusions, Castle Key failed to adopt and implement standards for the proper investigation of claims. There was no explanation whatsoever as to how Castle Key determined which items of damage were caused by covered or excluded perils. Furthermore, the carrier’s failure to assign a qualified and experienced engineer further violates F.S. §626.9541(1)(i)(3)(a). Moreover, as the carrier denied coverage without conducting a reasonable investigation based upon available information, the carrier violated F.S. §626.9541(1)(i)(3)(d). Additionally, its failure to state why the damages it found were denied was in violation of F.S. §626.9541(1)(i)(3)(f) as the carrier had a duty to 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. The insured has been compelled to obtain an independently adjusted estimate totaling in the amount of $84,928.64 that would be needed to repair the property back to its pre-loss condition. The insured has complied with all the carrier’s requests to date. The carrier has still refused to pay the fully covered amount owed under the policy, instead electing to stand by its unilaterally determined deficient valuation of the loss while denying the rest of the loss. Additionally, on October 21, 2024, the carrier, through Mr. Brett Krementz, stated that the claimed damages had been considered under a separate distinct loss that occurred prior to the cause of loss rather than adjusting current Milton loss, standing by its prior insufficient under deductible coverage determination. This is in violation of F.S. §624.155(1)(b)(1) and §624.155(1)(b)(3) as State Farm Florida is not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, and has failed to promptly settle claims in order to influence the settlement of said claim under other portions of the policy. Furthermore, in his adjustment of the Hurricane Milton claim, the carrier applied the hurricane deductible. This deductible should not have been applied to the Milton loss as it was already previously applied to the Hurricane Helene loss, this is in further violation of F.S. §626.9541(1)(i)(3)(b) as the carrier is misrepresenting the policy provisions for the claim. It is clear that the carrier is not treating the claimant with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the claimant; failing to implement proper standards for the adjustment and investigation of claims and placing the company’s interests before the claimant’s interests; not training, supervising or managing adjusters properly so that prompt and full payments are made; refusing to pay the full amount owed to the insured despite the fact that the damages are covered under the policy; looking for ways to delay full recovery or any recovery to the insured; and refusing to provide coverage for the claimant’s loss in a timely manner. The Carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(d), 627.4137(1), and Fla. Stat. §627.70131. The actions taken by Castle Key in the handling/adjustment of the insured’s claim were willful, wanton, malicious, and in reckless disregard for the rights of any insureds and occur with such frequency as to indicate a general business practice, and further are in violation of Florida Statutes §624.155 and F.S. §626.954. Indeed, when performing a search on the Florida Department of Financial Services website’s Civil Remedy Notice of Insurer Violation page the results of searches of violations of the statutes referenced herein by the carrier returned the following results thereby indicating that the number of times they occur rise to the level of a general business practice, and warrant punitive damages: §624.155(1)(b)(1) = 3,497 §624.155(1)(b)(3) = 2,425 §626.9541(1)(i)(3)(a) = 3,362 §626.9541(1)(i)(3)(b) = 2,562 §626.9541(1)(i)(3)(d) = 2,231 §626.9541(1)(i)(3)(f) = 2,149 Based upon the above-referenced acts and omissions, the carrier has breached the insurance contract by failing to pay the amount due to the insured, by denying coverage which existed under the insurance contract with the insured in the instant dispute, by failing to adjust the loss with the insureds, and by failing to perform an adequate investigation. These are violations and breaches of the policy language cited above. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1) Pay the complete covered loss in the amount of $84,928.64 less any applicable policy deductible; and 2) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been emailed to the carrier. The specific policy provisions the carrier violated are the loss payment provision, the loss settlement provision, and the coverage provisions. Specifically, the loss payment provision states “we will adjust all losses with you.” Yet, the carrier did not consult the homeowner in deciding who would investigate the cause or amount of damages, and what the ultimate payment should be. The other provisions are pasted on the pages following the signature block. If you have any questions or concerns, please send all correspondence via email to Blake@klinglaw.com and Jorlyn@KlingLaw.com to ensure a prompt response. We ask that all correspondence be done via email rather than regular mail. Should you need to send something regular mail, please advise us prior to sending same via the emails above. Sincerely, Blake M. Wallace, Esq. Blake M. Wallace Attorney at Law Enclosed: Civil Remedy Filing Florida Hurricane Deductible Endorsement - AP5004 It is agreed that your policy is changed as follows: I. In the General section of the policy, under Definitions Used In This Policy, the following definitions are added: Calendar year-means a twelve-month period beginning January 1 and ending December 31. Hurricane-means a storm system declared to be a hurricane by the National Hurricane Center of the National Weather Service. The duration of the hurricane includes the following time period in Florida: 1. beginning at the time a hurricane warning is issued for any part of Florida by the National Hurricane Center of the National Weather Service; and 2. ending 72 hours following the termination of the last hurricane watch or hurricane warning issued for any part of Florida by the National Hurricane Center of the National Weather Service. Hurricane loss-means sudden and accidental direct physical loss to covered property caused by hurricane. Hurricane loss includes ensuing damage to the interior of a building, or to covered property inside a building, caused by rain, snow, sleet, hail, sand or dust if the direct force of the hurricane first damages the building, causing an opening through which rain, snow, sleet, hail, sand or dust enters and causes damage. II. In Section I Conditions, item 1. Deductible is replaced by the following: 1. Deductible We will pay when a covered loss exceeds the applicable deductible shown on the Policy Declarations. We will then pay only the excess amount, subject to any applicable co-payment provisions, unless we have indicated otherwise in this policy. Hurricane Deductible: A hurricane deductible shall apply on a calendar year basis to all covered hurricane loss(es) that occur during the same calendar year that are covered under one or more policies issued to you by us (or one of our affiliated insurance companies) that insure a dwelling located at the same Location of Property Insured shown on the Policy Declarations of this policy. a. For the first covered hurricane loss during the calendar year, we will pay when the covered hurricane loss exceeds the applicable hurricane deductible shown on the Policy Declarations. We will then pay only the excess amount. subject to any applicable co-payment provisions, unless we have indicated otherwise in this policy. b. Except as provided in paragraph c. below, in the event there is (are) prior hurricane loss(es) in the same calendar year, we will only pay for a covered hurricane loss when that hurricane loss exceeds the greater of: 1. an amount equal to the Hurricane Deductible shown on the Policy Declarations, less the total amount of any hurricane deductible(s) applied to any other prior hurricane loss(es) that occurred during the same calendar year that were covered under one or more policies issued to you by us (or by one of our affiliated insurance companies) that insured a dwelling located at the same Location of Property Insured shown on the Policy Declarations for this policy; or 2. the amount of the Other Peril Deductible shown on the Policy Declarations. We will then pay only the excess amount. subject to any applicable co-payment provisions, unless we have indicated otherwise in this policy. c. In the event that two or more covered hurricane losses occur in the same calendar year under more than one policy issued to you by us (or one of our affiliated insurance companies) which insure a dwelling located at the same Location of Property Insured shown on the Policy Declarations for this policy, and the Hurricane Deductibles shown on the Policy Declarations applicable to those hurricane losses differ, we will only pay for a covered hurricane loss when that hurricane loss exceeds the greater of: 1. an amount equal to the highest Hurricane Deductible shown on any applicable Policy Declarations, less the total amount of any hurricane deductible(s) applied to any other prior hurricane loss(es) that occurred during the same calendar year that were covered under one or more policies issued to you by us (or by one of our affiliated insurance companies) that insured a dwelling located at the same Location of Property Insured shown on the Policy Declarations of this policy; or 2. the amount of the Other Peril Deductible shown on the Policy Declarations. Losses We Cover Under Coverage A: Your policy generally covers sudden and accidental direct physical loss to the property described in Dwelling Protection- Coverage A coverage, except as limited or excluded by your policy. Losses We Cover Under Coverage B: Your policy generally covers sudden and accidental direct physical loss to the property described in the Other Structures Protection Coverage B coverage, except as limited or excluded by your policy. Losses We Do Not Cover Under Coverages A And B: Section I-Your Property, does not provide Dwelling Protection-Coverage A or Other Structures Protection-Coverage B coverages for loss consisting of, or caused by: - Flood - Hurricane o This exclusion applies only to: a) loss in excess of $50,000 to pool enclosures, carports, Florida rooms, sun rooms and patio enclosures that have any aluminum supporting frames or studs. Loss in excess of $50,000 is excluded regardless of the number of pool enclosures, carports, Florida rooms, sun rooms and patio enclosures involved in the loss. This exclusion applies whether or not the pool enclosure, carport, Florida room, sun room or patio enclosure is fastened or attached to, or a part of, a building structure; b) loss to screens for pool enclosures, carports, Florida rooms, sun rooms or patio enclosures that have any aluminum supporting frames or studs; c) loss to fences, whether or not fastened or attached to, or a part of, a building structure; and d) loss to above ground outdoor pools, awnings and outdoor antennas, whether or not fastened or attached to a building

Comments

User Id		Date Added		Comment
msosg@allstate.com		02-12-2025		Please allow this correspondence to serve as Castle Key Insurance Company’s (hereinafter referred to as “Castle Key”) response to your Civil Remedy Notice of Insurer Violations filing number 797903. This response was uploaded to the DFS CRN website on 12/23/2024 ?.- Castle Key Insurance Company specifically denies the allegations set forth in the Civil Remedy Notice of Insurer Violations. At all times, Castle Key has acted in good faith. Castle Key wholly denies all allegations of wrongdoing, unsatisfactory settlement offer & Unfair Trade Practice on the above claim. .- Castle Key does not consider there to have been any manner of violation and questions the validity of the Notice as it fails to meet the requirements set forth in Section 624.155, Florida Statutes and Florida law and thus fails to perfect the insured’s right to pursue civil remedies. The potential statutory violations and information submitted are nothing more than unsupported, baseless allegations. .- Castle Key investigated this loss, and a full roof replacement was addressed on a previous claim 0772074068 with a date of loss of 09/26/2024 and this current claim was filed 9 days later with the same damages as the previous claims date of loss. As per our 2 inspections the damage to the interior is from ground water which is not a covered peril. The pool enclosures damage was not provided coverage as the policy does not offer coverage for pool enclosures. A Florida Mediation letter was also sent to the insured. .- At all times, Castle Key Insurance Company has acted in good faith in investigating and handling the claim. Castle Key Insurance Company has not breached any duty owed to you. .- ? Nothing herein constitutes, nor should it be construed as, a waiver of any of Castle Key’s rights of under its policy of insurance, nor is it the purpose of this letter to waive any of the policy’s terms and conditions. Further, no action or inaction by Castle Key should be construed as a waiver of any of its legal defenses, including but not limited to the right to be served with a compliant Notice. ?

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