Filing Number: 800870
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| Filing Accepted: 1/14/2025 |
| Last/Business Name
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GOODREAU
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First Name |
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RICHARD AND MICHELLE |
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| Street Address
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12111 HILL STREET |
| City, State Zip
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TAMPA,
FL
33612
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| Email Address
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CFAUNTLEROY@FSATLAW.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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GOODREAU |
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First Name |
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RICHARD AND MICHELLE |
| Policy # * |
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KIN-HO-FL-295447363 |
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Claim #* |
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HO-4370768 |
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Attorney is Applicable
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| Last Name* |
FAUNTLEROY
First Name *
CHRISTOPHER
Initial
B
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| Street Address* |
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100 S ASHLEY DRIVE, SUITE 600 |
| City, State Zip* |
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TAMPA
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FLORIDA
33602
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| Email Address * |
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CFAUNTLEROY@FSATLAW.COM |
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| Insurer Type
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 Authorized Insurer
 Unauthorized Insurer
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| Insurer Name |
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| Insurer Name* |
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KIN INTERINSURANCE NETWORK
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| Insurer Name* |
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| Street Address* |
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| City, State Zip* |
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,
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NAIC Company Code 16603 |
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| Name of individual responsible for violation (if any):*
VICTOR ALVAREZ AND KIN AND ITS ADJUSTERS
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| Type of Insurance
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Residential Property & Casualty
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| Reason for Notice
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Claim Delay
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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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Statutory provision(s) which the insurer allegedly violated.
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| 624.155(1)(b)(1) |
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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.
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| 626.9541(1)(i)(3)(a) |
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Failing to adopt and implement standards for the proper investigation of claims.
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| 626.9541(1)(i)(3)(b) |
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Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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| 626.9541(1)(i)(3)(c) |
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Failing to acknowledge and act promptly upon communications with respect to claims.
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| 626.9541(1)(i)(3)(e) |
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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.
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| 626.9541(1)(i)(3)(f) |
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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.
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| 626.9541(1)(i)(3)(g) |
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Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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| 626.9541(1)(i)(3)(h) |
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Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
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| 626.9541(1)(i)(3)(i) |
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Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
COVERAGE A – Dwelling
We cover:
1. The dwelling on the "residence premises" used mainly as your private residence, including attached structures and attached wallto-
wall carpeting if damage to the dwelling is caused by a covered loss. This shall not include fences, whether attached or not
attached to the dwelling.
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."
3. Both in-ground swimming pools and above ground pools, as well as their pool-related, permanently installed equipment such as
pumps and filters; and
4. All working solar panels that are owned by you and are service or providing electricity to the “residence premises” on the date of
loss, regardless of their location on the “residence premises” or to what they provide service or electricity. We do not cover leased
solar panels.
This coverage does not apply to land, including land on which the dwelling is located.
3. Loss Settlement. Covered property losses are settled as follows:
a. Property of the following types:
1) Personal property;
2) Awnings, carpeting, household appliances, outdoor antennas and outdoor equipment, whether or not attached to
buildings; and
3) Structures that are not buildings;
at actual cash value at the time of loss but not more than the amount required to repair or replace.
b. Buildings under Coverage A or B at replacement cost without deduction for depreciation, subject to the following:
1) If, at the time of loss, the amount of insurance in this policy on the damaged building is 80% or more of the full
replacement cost of the building immediately before the loss, we will pay the cost to repair or replace, after
application of deductible and without deduction for depreciation, but not more than the least of the following
amounts:
a) The limit of liability under this policy that applies to the building;
b) The replacement cost of that part of the building damaged for like construction and use on the same
premises; or
c) The necessary amount actually spent to repair or replace the damaged building.
2) If, at the time of loss, the amount of insurance in this policy on the damaged building is less than 80% of the full
replacement cost of the building immediately before the loss, we will pay the greater of the following amounts,
but not more than the limit of liability under this policy that applies to the building:
a) The actual cash value of that part of the building damaged; or
b) That proportion of the cost to repair or replace, after application of deductible and without deduction for
depreciation, that part of the building damaged, which the total amount of insurance in this policy on the
damaged building bears to 80% of the replacement cost of the building.
3) To determine the amount of insurance required to equal 80% of the full replacement cost of the building
immediately before the loss, do not include the value of:
a) Excavations, foundations, piers or any supports which are below the undersurface of the lowest basement
floor;
b) Those supports in a) above which are below the surface of the ground inside the foundation walls, if there is
no basement; and
c) Underground flues, pipes, wiring and drains.
4) We will initially pay at least the actual cash value of the incurred loss less any applicable deductible. We will pay
the necessary amounts actually spent to repair or replace the damaged building as work is performed and
expenses are incurred. If a total loss of the covered dwelling occurs, we shall pay the replacement cost coverage
without reservation or holdback of any depreciation in value, subject to policy limits.
5) If the dwelling where loss or damage occurs has been "vacant" or “unoccupied” for more than thirty (30)
consecutive days before the loss or damage, we will not pay for any loss or damage caused by any of the following
perils, even if they are Perils Insured Against:
a) Vandalism;
b) Sprinkler leakage when caused by or arising out of the freezing of a fire protective sprinkler system, unless
you have protected the system against freezing;
c) Dwelling glass breakage;
d) Water Damage;
e) Theft; or
f) Attempted theft.
Dwellings under construction are not considered “vacant”. In the event the construction extends greater than sixty
(60) days, you must notify us.
SECTION I – Condition 10. Loss Payment
For only those payments issued pursuant to this “Endorsement”, Condition 10. Loss Payment is deleted in KIN HO PLC and replaced
by the following regarding the repair, replacement, or rebuilding of property covered under Coverage A or Coverage B provided
under this “Endorsement”, for all other payments Condition 10. Loss Payment as set forth in the policy applies:
10. Loss Payment
a. “We” will adjust all losses with “you” described in the scope of repairs for covered damages “we” or the “Contractor”
provide “you” under this “Endorsement”.
b. “We” will issue all payments and awards to only the “Contractor” and “we” will payp the “Contractor” directly.
c. In no event will “we” make duplicate payments for the same element of loss.
***ADDITIONAL STATUTORY PROVISIONS ALLEGED TO HAVE BEEN VIOLATED ARE AS FOLLOWS:***
§624.155(1)(B)(1) Any person may bring a civil action against an insurer when such person is damaged:
By the commission of any of the following acts by the insurer:
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 towards its insured and with due regard for her interests;
2. Making claims payments to insures or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made; or
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.
§624.155 (5) No punitive damages shall be awarded under this section unless the acts giving rise to the violation occur with such frequency as to indicate a general business practice and these acts are:
(a) Willful, wanton, and malicious;
(b) In reckless disregard for the rights of any insured; or
(c) In reckless disregard for the rights of a beneficiaries under a life insurance contract;
(8) The damages recoverable pursuant to this section shall include those damages which are a reasonably foreseeable result of a specified violation of this section by the authorized insurer and may include an award or judgment in an amount that exceeds the policy limits.
§627.70131 Insurer’s duty to acknowledge communications regarding claims; investigation
(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 unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer which reasonably prevent such acknowledgement. If the acknowledgement is not in writing, a notification indicating acknowledgement shall be made in the insurer’s claim file and dated. A communication made to or by an agent of an insurer with respect to a claim shall constitute communication to or by the insurer.
(4) For purposes of this section, the term “insurer” means any residential property insurer.
§626.9541(i) Unfair Claim Settlement Practices
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Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
In Florida, the work of adjusting insurance claims engages the public trust. Kin Interinsurance Network (Kin) has breached this duty in the adjustment of Richard Goodreau’s and Michelle Goodreau’s (the Goodreaus) claim.
Kin has engaged in unfair claim delay; has used business or outcome-oriented investigations and experts to determine the outcome of the claim; has wrongfully denied the claim without fully stating reasons and reserving unwritten reasons; has looked for ways to, delay payment and otherwise “stonewall” the claim; and has used improper claims practices to rush the claims process and profit from wrongful claims practices.
Kin has also failed to adopt and implement proper standards for investigation, evaluation and adjustment of claims; has failed to properly train, manage, supervise and promote claims adjusters so that policy holder receives good faith, fair, prompt adjustment of claim, service and indemnity; has failed to conduct a full and fair investigation of the claim and has failed to provide full reasons and facts to the claimant for delay of the claim resulting in statutory violations as set forth in this notice.
The Goodreaus’ claim results from wind damage to the roof of their home that occurred on April 3, 2024. In order to immediately mitigate the damages to their home, the Goodreaus contacted their insurance company, Kin, to report their claim of damages. As part of their investigation, Kin assigned a claim number HO-4370768 and desk adjuster Victoria Alvarez (Alvarez) to adjust the loss.
On July 1, 2024, Kin made a claims determination in which they did not provide payment for the Goodreaus’ loss since they found the total payable damage to be $1,773.22, which is below the $2,500.00 all perils’ deductible. In view of this coverage decision, the Goodreaus chose to retain a private contractor to further assess the damages to their home. As such, upon inspection and view of the damages, it was clear that the entire roof required extensive repair. After the inspection, the private contractor provided an estimate for repairs in the amount of $30,923.80, which is the full amount to return the Goodreaus’ home back to pre-loss condition. Kin continues to hold their stance for their claim determination concerning the Goodreaus’ loss.
The Goodreaus have complied with all conditions under the policy, nonetheless, Kin failed to properly compensate the Goodreaus for their loss. The facts of this claim show that for whatever reason, Kin not only substantially misinterpreted the scope of damages to the Goodreaus’ property but failed to conduct a thorough investigation as to the scope of damages to the roof. Upon view of Kin claims handling procedures, it is clear Kin conducted a limited and quick outcome orientated investigation in the hopes that the Goodreaus would make the required repairs with their own money. The Goodreaus now have to incur costs for assistance to obtain what should have been paid had they been treated fairly and honestly by Kin.
Florida Statute §626.9744(2) provides that “When a loss requires replacement of items and the replaced items do not match in quality color or size, the insurer shall make reasonable repairs or replacement of items in adjoining areas”. In the instance of Kin, their adjusters and the estimate provided, it is clear that Kin did not adhere to Florida law, as their estimate provides paltry repair items that would result in mismatching areas which fails to acknowledge the true extent of damage of the Goodreaus’ home as well as the surrounding areas that would need to be replaced. Florida Statute §624.02, defines “insurance” as a contract where one undertakes to indemnify another or pay or allow specified amounts, or a determinable benefit, upon determinable contingencies – inherent is the fact that payment must be made timely and promptly. The fact that payment must be made timely and promptly so that the insureds may mitigate their damages, and to put the insureds back into the position they enjoyed prior to the loss as quickly as possible. Kin has breached this duty by improperly investigating the Goodreaus’ claim and failing to properly pay the Goodreaus for their loss. Kin has refused and/or failed to tender insurance proceeds as required by the policy and/or Florida law. It has refused and/or failed to settle the claim when under all the circumstances it could have and should have done so if it had acted fairly and honestly towards the Goodreaus.
In view of the facts surrounding the Goodreaus claim it is evident that Kin has failed to create and implement adequate guidelines for proper investigations to evaluate claims handling for training and supervision of employees in violation of Fla. Stat. §624.155 and §626.9541 statutory regulations, as well as the applicable provisions in the Florida Administrative Code resulting in the statute violations set forth herein. As stated, Kin has failed and/or refused to investigate the insureds’ claim thoroughly, accurately, and completely for damages.
Furthermore, Kin has failed to adopt and implement proper standards for investigation, evaluation, and adjustment of claims; has failed to properly train, manage, supervise and promote claims adjusters so that policy holder receives good faith, fair, prompt adjustment of claim, service and indemnity; has failed to conduct a full and fair investigation of the claim.
Florida Statutes Violated by Kin are as applied to the facts in this matter is as follows: § 626.951 engaging in acts defined as “unfair trade practices” relating to the business of insurance in accordance with the intent of congress as expressed in the act of congress of March 9, 1945 (pub. L. No. 15, 79th congress), by defining, or providing for the determination of, all such practices in this state which constitute unfair methods of competition or unfair or deceptive acts or practices and by prohibiting the trade practices so defined or determined.
§ 624.155(1)(b)(1) to tender all insurance proceeds monies due and owing the insured or assist the insured in the mitigation of their damages. The insurer breached these statutory duties. Not attempting in good faith to settle claims when, under all circumstance, insurer could have and should have done so, had the insurer acted fairly and honestly toward its insured and with due regard. § 624.155(1)(b)(3) failing to promptly settle claims, when the obligation to settle the 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 investigations of claims. § 626.9541(1)(i)(3)c Failing to acknowledge and to act promptly upon communications with respect to claims.
Their actions are willful, wanton and in disregard of the rights of its insured and occur with such a frequency as to indicate a general business practice. Kin can cure this default by the following:
A. Create, adopt and implement adequate standards and/or guidelines for the proper investigation and adjustment of claims.
B. Provide sufficient training and supervision of employees and agents to avoid further violations as set forth in the paragraphs above from occurring in the future.
C. Tender payment to the Goodreaus in the amount of $30,923.80 which is the amount to return the Goodreaus’ home back to pre-loss condition.
D. Tender prejudgment interest from the date the claim was reported through today.
E. Agree to pay the Goodreaus’ reasonable attorney’s fees pursuant to Florida Statute §627.428 and all taxable costs.
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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.
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DFS-10-363
Rev. 10/14/2008
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