Filing Number: 801762
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| Filing Accepted: 1/17/2025 |
| Last/Business Name
*
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REYES CINTRON AND REYES
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First Name |
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OSCAR AND MIGDALIA |
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| Street Address
*
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4510 FICUS TREE ROAD |
| City, State Zip
*
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KISSIMMEE,
FL
34758
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| Email Address
*
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SMERILLO@FORTHEPEOPLE.COM |
| Complainant Type:
*
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Insured |
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| Last/Business Name* |
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REYES CINTRON AND REYES |
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First Name |
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OSCAR AND MIGDALIA |
| Policy # * |
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KIN-HO-FL-268169625 |
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Claim #* |
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HO-4616751 |
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Attorney is Applicable
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| Last Name* |
KIMMEL
First Name *
GINA
Initial
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| Street Address* |
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20 N. ORANGE AVE STE 1600 |
| City, State Zip* |
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ORLANDO
,
FLORIDA
32801
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| Email Address * |
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SMERILLO@FORTHEPEOPLE.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):*
MCWELL M. HOGUE
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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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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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| 624.155(1)(b)(3) |
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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.
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| 626.9541(1)(i)(2) |
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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.
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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)(4) |
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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).
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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.
SECTION I – PERILS INSURED AGAINST
Under Coverage A – Dwelling and Coverage B – Other Structures, the introductory paragraph is replaced by:
We insure for sudden and accidental direct loss to property described in Coverages A and B only if that loss is a physical loss to covered property.
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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.
On or about September 29 and 29, 2022, Insured, Oscar Reyes Cintron and Migdalia Reyes’ (“Insured”) home belonging to Complainant was damaged during the policy period as a result of Hurricane Ian. Insured filed a claim to her Insurer, Kin Interinsurance Network (“Insurer”). Despite having extensive knowledge of the foregoing information, Insurer has failed to adjust the claim in a manner favorable to the Insured, despite having the opportunity to inspect the damaged property and there being sufficient evidence of damage. This systematic underpayment and/or denial of claims is believed to be a business practice of this insured.
Insurer investigated the claim, inspected the property, and rendered an erroneous claims decision. As a result of Insurer’s insufficient payment, Insured provided Insurer with notice to re-open and/or supplement the claim and a copy of an itemized supporting estimate of damages and photographs. Insured also advised of its amenability to attend a pre-suit DFS Mediation.
Accordingly, Insured filed a Notice of Intent to Initiate Litigation based upon a supporting estimate of damage. In response, Insurer relayed a settlement offer which amounted to less than what is necessary to restore the property its pre-loss condition.
Bad faith discovery will likely reveal that it is a business practice of Insurer to treat insureds who are unrepresented at the time of making a claim, or through the initial claim adjustment process, unfairly. Those insureds regularly receive a calculated denial of the claim and/or low ball offers until after counsel is retained on the insured’s behalf.
Further, Bad faith discovery will also likely reveal Insurer has a team of individuals it pays to conduct inspections and prepare reports and estimates that attempt to deny claims, and limit or minimize coverage for the insured’s loss. Insurer’s reliance on these estimates and reports benefits the Insurer as they are biased by not addressing the full scope or cost of the loss and the appropriate coverage.
To cure this violation, insurer should agree, in writing, to completely bring the property to its pre-loss condition pursuant to the damage estimate attached to the insureds’ Notice of Intent to Litigate filed on May 21, 2024, subject to the terms and conditions of the policy of insurance and applicable Florida law. As a result, if the Insurer pays the damages alleged herein, any further claims for additional insurance proceeds will be submitted to the Insurer pursuant to the policy's loss settlement provision.
This payment is exclusive of Insured’s claims for statutory attorney fees, costs, and interest pursuant to Florida law. This matter and Insurer’s business practices with respect to loss adjustment and claims handling should be investigated further by the Office of the Insurance Consumer Advocate.
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*
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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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