Filing Number: 800695
|
| Filing Accepted: 1/13/2025 |
| Last/Business Name
*
|
|
|
| Street Address
*
|
|
4330 EL MAR DR., UNIT 6 |
| City, State Zip
*
|
|
LAUDERDALE BY THE SEA,
FL
33308
|
| Email Address
*
|
|
FERN@FERNKOHN.COM |
| Complainant Type:
*
|
|
Insured |
|
| Last/Business Name* |
|
KOHN |
|
First Name |
|
FERN |
| Policy # * |
|
988 464 697 |
|
Claim #* |
|
00683914345 |
|
Attorney is Applicable
|
| Last Name* |
MAMMEL
First Name *
CHRISTOPHER
Initial
N
|
| Street Address* |
|
ONE NORTH CLEMATIS STREET, SUITE 510 |
| City, State Zip* |
|
WEST PALM BEACH
,
FL
33401
|
| Email Address * |
|
CMAMMEL@MERLINLAWGROUP.COM |
|
|
| 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):*
ADJUSTERS, SUPERVISORS, MANAGEMENT AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY CASTLE KEY INDEMNITY COMPANY (HEREINAFTER CASTLE KEY) INVOLVED IN THIS CLAIM.
|
| Type of Insurance
*
Residential Property & Casualty
|
|
|
| Reason for Notice
*
|
|
|
Claim Delay
|
|
|
Claim Denial
|
|
|
Unfair Trade Practice
|
|
|
Other
:
Failure to properly investigate claim and with due regard to Insured’s interest. Failure to acknowle
|
|
|
*
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)(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)(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)(e) |
|
Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
|
|
| 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.
|
|
| 626.9541(1)(i)(3)(h) |
|
Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
|
|
| 626.9541(1)(i)(4) |
|
Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
|
|
*
Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Specific policy language that is relevant to the violations includes, but is not limited to, the following: Declarations – Liability/Other Coverages – Loss Assessment $177,000.00
***
Section II – Optional Protection. Loss Assessments - Coverage G.
Optional Coverages
The following Optional Coverages may supplement coverages found in Section I or Section II and apply only when they are indicated on the Policy Declarations. The provisions of this policy apply to each Optional Coverage in this section unless modified by the terms of the specific Optional Coverage.
Loss Assessments–Coverage G
A. Except as limited or excluded in Section I of this policy, we will pay up to the Limit of Liability shown on the Policy Declarations for Loss Assessments–Coverage G or $2,000, whichever is greater, for your share of any special assessments charged by the association that are:
1. charged against you and:
a) all other members of the condominium association; or
b) all other shareholders of the co-op association;
when the assessment is made as a result of an occurrence that results in sudden and accidental direct physical loss to the shared property.
In the event of an assessment, this coverage is subject to all the exclusions applicable to Section I of this policy and the Section I Conditions, except as otherwise noted.
2. a) charged against you and:
1) not all other members of the condominium association; or
2) not all other shareholders of the co-op association;
when the assessment is made as a result of an occurrence resulting in sudden and accidental direct physical loss to shared property.
b) if an occurrence resulting in sudden and accidental direct physical loss to shared property is caused by an insured person. We will pay to repair, rebuild or replace such damaged shared property, but only if such property:
1) is damaged by a peril covered under this policy; and
2) is the insurance responsibility of the association as expressed under its governing rules.
This coverage is subject to all the exclusions applicable to Section I of this policy and the Section I Conditions, except as otherwise noted.
B. We will pay up to the Limit of Liability shown on the Policy Declarations for Loss Assessments–Coverage G or $2,000, whichever is greater, for your share of any special assessments charged against you to cover any portion of the association’s master insurance policy deductible if:
1. the assessment is charged as a result of a loss to shared property and such loss is covered under the association’s master insurance policy; and
2. the loss to such property was a sudden and accidental direct physical loss which we would cover under Building Property Protection–Coverage A, if such property qualified as property we cover under Building Property Protection–Coverage A of this policy.
The amount we will pay under this protection for assessments as a result of a single occurrence resulting in loss to shared property will not exceed the Limit of Liability displayed on your Policy Declarations for Loss Assessments–Coverage G regardless of the number of assessments charged.
For assessments made under this item B only, “assessment” includes the association’s failure to or unwillingness to submit an otherwise covered claim under the association’s master insurance policy for sudden and accidental direct physical loss to shared property which comprises a part of the residence premises.
C. We will pay up to the Limit of Liability shown on the Policy Declarations for Loss Assessments–Coverage G or $119,000, whichever is greater, for your share of any special assessments charged by the association against:
1. all of the condominium unit owners; or
2. all shareholders of the co-op association;
when the assessment is made as a result of an occurrence covered under Section II of this policy that occurred at your residence premises or on the grounds, related structures, or private approaches to the building structure of which your residence premises is a part.
In the event of an assessment, this coverage is subject to all the exclusions applicable to Section II of this policy and the Section II Conditions, except as otherwise noted.
The date the assessment was levied against the insured person is the date of the loss for the purpose of determining coverage under this policy. The actual damage does not have to occur during the policy period for coverage to apply.
For the purposes of this coverage, your limit of any assessment will be determined as of one day before the date of the loss to the condominium property. Any changes to your limit of any assessment made on or after the day of the loss to the condominium property will not apply to such loss.
If we do not believe an assessment charged is reasonable, you agree to cooperate with us in contesting such assessment.
No deductible applies to this protection.
If applicable, the protection provided by Loss Assessments–Coverage G shall apply to the following entities as if they were “you”:
1. the LLC indicated on the Additional Insured For Condominium Limited Liability Company endorsement, if such endorsement is part of your policy; or
2. the Trust indicated on the Additional Insured–Trust endorsement, if such endorsement is part of your policy.
|
| |
*
Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
§627.70131(1)(a) Upon an insurer’s receiving a communication with respect to a claim, the insurer shall, within 14 calendar days, review and acknowledge receipt of such communication. If the acknowledgment is not in writing, a notification indicating acknowledgment shall be made in the insurer’s claim file and dated.
§627.70131(2) Such acknowledgment shall be responsive to the communication. If the communication constitutes a notification of a claim, unless the acknowledgment reasonably advises the claimant that the claim appears not to be covered by the insurer, the acknowledgment shall provide necessary claim forms and instructions, including an appropriate telephone number.
§627.70131(5) Within 90 days after an insurer receives notice of a property insurance claim from a policyholder, the insurer shall pay or deny such claim.
FLORIDA ADMINISTRATIVE CODE SECTIONS VIOLATED (ADJUSTER’S CODE OF ETHICS)
69B-220.201(3) An adjuster shall put the duty for fair and honest treatment of the claimant above the adjuster’s own interests in every instance.
69B-220.201(3)(a) An adjuster shall: not directly or indirectly refer or steer any claimant needing repairs or
other services in connection with a loss to any person with whom the adjuster has an undisclosed financial interest, or who will or is reasonably anticipated to provide the adjuster any direct or indirect compensation for the referral or for any resulting business.
69B-220.201(3)(b) An adjuster shall treat all claimants equally. (1) An adjuster shall not provide favored treatment to any claimant. (2) An adjuster shall adjust all claims strictly in accordance with the insurance contract.
69B-220.201(3)(b)2 An adjuster shall adjust all claims strictly in accordance with the insurance contract.
69B-220.201(3)(c) An adjuster shall never approach investigations, adjustments, and settlements in a manner prejudicial to the insured.
69B-220.201(3)(d) An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.
69B-220.201(3)(e) An adjuster shall handle every adjustment and settlement with honesty, integrity, and allow fair adjustment or settlement to all parties without any remuneration to himself except to that which he is legally entitled.
69B-220.201(3)(f) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition thereof.
69B-220.201(3)(m) An adjuster shall not knowingly fail to advise a claimant of the claimant’s rights in accordance with the terms and conditions of the contract and applicable laws of the state of Florida.
627.70131(1)(a) Upon an Insurer’s receiving a communication with respect to a claim, the insurer shall, within fourteen 14 calendar days, review and acknowledge receipt of such communication. If the acknowledgment is not in writing, a notification indicating acknowledgment shall be made in the insurer’s claim file and dated.
627.70131(2) Such acknowledgment shall be responsive to the communication. If the communication constitutes a notification of a claim, unless the acknowledgment reasonably advises the claimant that the claim appears not to be covered by the insurer, the acknowledgment shall provide necessary claim forms and instructions, including an appropriate telephone number.
627.70131(5) Within 90 days after an insurer receives notice of a property insurance claim from a policyholder, the insurer shall pay or deny such claim.
1) Failure to pay claim in full;
2) Failure to promptly investigate claim;
3) Failure to properly investigate claim;
4) Failure to adjust loss;
5) Failure to act in due diligence and good faith to resolve claim;
6) Placing financial interest of insurer before that of policy holders and claimants;
7) Failure to properly train, evaluate and manage adjusters;
8) Looking for ways to deny coverage, pay less, delay payment and otherwise “low ball” or “stone wall” claim;
9) Failing to pay undisputed funds;
10) The reasons for this may be attributed to improper training, supervision, and/or motivation of adjusters and claims supervisors to promptly and fairly investigate, adjust and pay full benefits available to all beneficiaries. The insurer may have failed to adopt proper standards of investigation and adjustment of losses, or is otherwise not implementing those standards because full payment and prompt payment for the loss is not occurring.
The Insured who has been subject to CASTLE KEY INDEMNITY COMPANY’s (“CASTLE KEY”) improper adjustment is FERN KOHN (“MS. KOHN”), who purchased a Residential Policy of Insurance, policy number 988 464 697 (the “Policy”) with CASTLE KEY for the property located at 4318 El Mar Drive, Unit 203, Lauderdale by the Sea, FL 33308. The property is within the ORIANA AT LAUDERDALE BY THE SEA CONDOMINIUM ASSOCIATION (“ORIANA”) and subject to its organizational documents. On or about September 10, 2017, a rain and wind storm, namely Hurricane Irma, caused property and ensuing water damage to the property insured under ORIANA’s policy. The damages were due to a covered peril; wind, rain, and ensuing water damage to the exterior and interior of the Property. ORIANA specially assessed the property owners for the damage under Special Assessment letters July 31, 2024 and August 1, 2024.
MS. KOHN was charged a special assessment in the amount of $28,237.70. MS. KOHN submitted a claim for Coverage G (Loss Assessment) benefits under their Policy with a limit of $143,125.00 under Coverage G. In response, CASTLE KEY assigned claim number 00683914345. CASTLE KEY purported to review the claim, but conducted a superficial investigation, and consequently denied the claim entirely and refused to issue payment for any of the covered assessment citing that “Castle Key has previously addressed a Loss Assessment under this policy on claim 00683914345 for this same occurrence and issued the full limit of liability under your Loss Assessments coverage; therefore, no additional assessments can be considered. Additionally, neither this assessment nor any other supplemental damage resulting from this loss can be addressed as the three-year filing deadline from the date the hurricane made landfall has expired.” This denial was wrong under the Policy since the “Loss Assessment” noted in the denial letter occurred during a prior policy period. The July 31, 2024 and August 1, 2024 Special Assessments for which MS. KOHN made a claim occurred during the following Policy period and was covered by that Policy. The purported “three-year filing deadline” referenced in the denial letter was based on a statute that was enacted and took effect after the inception date of the policy under which the claim was made, and did not apply to the claim made under that policy.
A Notice of Intent to Initiate Litigation was filed on January 13, 2025. On or about September 5, 2024, Castle Key denied the claim and provided a denial letter.
CASTLE KEY has failed to create and implement adequate guidelines for timely, proper, and consistent interpretation of its unambiguous Policy provisions, including its Coverage G benefits in the Policy.
CASTLE KEY failed to assure uniformity in interpretation of its Policy by its adjusters to honor similar claims among all insureds, forcing some insureds, such as MS. KOHN, to litigate in order to obtain benefits clearly owed under the circumstances. CASTLE KEY has received claims for Loss Assessments in 2021, 2022 and 2023 from this insured and other insured owners that owned residential condominium units that were subject to the requirements of ORIANA, under policies issued by CASTLE KEY with identical policy language, which had also been subject to identical Loss Assessments by ORIANA. CASTLE KEY has paid all those claims under its policies. Castle Key has denied Ms. Kohn’s claim made under identical policy language as the other claims previously paid for these assessments by Oriana. Castle Key has forced Ms. Kohn to retain counsel in order to obtain benefits due under the Policy.
This pattern and practice of inconsistency in interpretation and honoring identical claims made under identical policy language but dishonoring the claim made by MS. KOHN is an unfair claim handling practice. Additionally, reliance upon a statute that does not, as a matter of existing law in the State of Florida, apply to limit the claim made under the policy with an inception date preceding the policy is an unfair claim practice and misrepresentation of coverage. CASTLE KEY has allowed its adjusters to misrepresent the terms of MS. KOHN’s Policy in order to deny coverage and prefer its interests in minimizing claim payments over the interests of its Insureds to receive the benefits paid for when the Policy was purchased. investigation to evaluate claims handling and for training and supervision of employees resulting in the statutory violations as set forth above. CASTLE KEY has failed, and/or refused, to thoroughly, accurately, and completely investigate and evaluate the Insured’s insurance claim. To date, notwithstanding the Insured’s full cooperation with the investigation, CASTLE KEY has refused to acknowledge its obligation to tender all insurance proceeds due and owing the Insured. CASTLE KEY has failed and/or refused to act promptly upon communication of its Insured with respect to their insurance claim.
As a direct and foreseeable result of CASTLE KEY’s failure to investigate, misrepresentations, inconsistent interpretation of identical policy language and its conduct forcing its Insureds to initiate litigation to obtain payments owed beyond reasonable dispute, MS. KOHN continues to be harmed. CASTLE KEY’s continuing failure to pay the assessment has prevented MS. KOHN from being put back to her pre-loss condition.
As of this date, MS. KOHN has personally paid the Loss Assessment made by ORIANA despite denial and nonpayment of the claim, which is a benefit due under the insurance policy purchased from CASTLE KEY
As a result of CASTLE KEY’s actions, MS. KOHN has no choice but to file this Civil Remedy Notice. CASTLE KEY engages in this type of conduct consistently and has certainly engaged in this type of conduct in the past as a pattern of misconduct in violation of Florida law, Ethical Requirements, and Industry Good Faith Claims Practice Standards.
Since the beginning of this claim, the representatives on behalf of CASTLE KEY have approached this investigation in a manner prejudicial to its Insureds. CASTLE KEY is using either untrained or improperly trained adjusters and consultants in connection with this claim. CASTLE KEY should have been reviewing the loss with its Insureds from the beginning, but instead, was looking for ways not to pay the claim. If CASTLE KEY handles all the claims in the manner in which it handled MS. KOHN’s claim, then it is improperly handling all claims.
CASTLE KEY must immediately tender to MS. KOHN the full amount of its insurance assessment claim that is due and owing to him, $28,237.70 without any deductible, plus interest, and applicable attorneys’ fees; this amount is fairly owed to it under its insurance policy and would reasonably place it back to its pre-loss condition.
|
|
|
*
|
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
|