Filing Number: 804111
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| Filing Accepted: 1/29/2025 |
| Last/Business Name
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BUNJAJ
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First Name |
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ANGJELINA AND ALEKS |
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| Street Address
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203 WOODFIELD LANE |
| City, State Zip
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SAINT JOHNS,
FL
32259
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| Email Address
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ANGELABUNJAJ4@YAHOO.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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BUNJAJ |
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First Name |
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ANGJELINA AND ALEKS |
| Policy # * |
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988447756 |
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Claim #* |
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0734813629 |
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Attorney is Applicable
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| Last Name* |
ZANAKOS
First Name *
CHRISTINA
Initial
N
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| Street Address* |
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20283 FL 7 SUITE 422 |
| City, State Zip* |
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BOCA RATON
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FL
33498
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| Email Address * |
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CHRISTINA@ELITELEGALPA.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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CASTLE KEY INDEMNITY COMPANY
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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 10835 |
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| Name of individual responsible for violation (if any):*
HANCOCK CLAIMS ON BEHALF OF CASTLE KEY INDEMNITY, MICHAEL BROSNAHAN ON BEHALF OF CASTLE KEY, AND ALL OTHER ADJUSTERS, ENGINEERS, SUPERVISORS, MANAGERS, AND INDIVIDUALS ASSOCIATED WITH THE HANDLING OF THEIR CLAIM.
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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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Claim Denial
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Unfair Trade Practice
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Other
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Disregarding Covered peril damage
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Other
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Placing Unreasonable Requirements on the Insured to Properly Adjust the Claim
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Other
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Failure to Respond to the Insured in a Timely Manner
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Other
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Ignoring information that would benefit the Insured, such as hail reports
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Other
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Disregarding information from Hancock claims (its own representative) advising the roof needed to be
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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)(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)(j) |
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Altering or amending an insurance adjuster’s report without:
(I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and
(II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or
(III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change;
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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.
In addition to the above statutory provisions that have been violated, the following provisions of the Florida Administrative Code regarding ethical requirements for adjusters have also been violated:?
69B-220.201(3)(B) – An adjuster shall treat all claims equally.
69B-220.201(3)(C) – An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured.
69B-220.201(3)(E) – An adjuster shall handle every adjustment and settlement with honesty and integrity, and allow a fair adjustment or settlement to all parties.
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 of the claim
Despite request, including in writing from the Public Adjuster on July 9, 2024, Castle Key has failed and refused to provide a certified copy of the Insured’s insurance policy. The Insured is not required to provide policy language when the carrier refuses to provide the certified policy. Notwithstanding, to the best of the Insured’s information and belief, the following policy provisions were violated by CASTLE KEY in the improper handling of the claim, pursuant to Policy Number 988447756:
COVERAGE A – DWELLING
1. We cover:
a. the dwelling on the “residence premises” shown in the Declarations, including structures attached to the dwelling;
SECTION I – PERILS INSURED AGAINST
COVERAGE A – DWELLING AND COVERAGE B – OTHER STRUCTURES
1. We insure against direct physical loss to property described in Coverages A and B
SECTION I – CONDITIONS
3. Loss Settlement
10. Loss Payment
Including all definition sections, coverage sections, and loss payment provision sections of the Policy.
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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.
This notice is given in order to perfect the right to pursue the civil remedy authorized by section 624.155, Florida Statutes. In Florida, the work of adjusting insurance claims engages the public trust. The insurance company has breached this duty in the adjustment of the Insured’s claim of loss. Insurance company has failed to create and implement adequate guidelines for proper investigation of claims handling and for training and supervision of employees resulting in statutory violations (as set forth above). Further, insurance company has failed and/or refused to thoroughly, accurately, and completely investigate, evaluate, and pay the Insured’s insurance claim for damages. Insurance company has also ignored important information that would benefit the Insured, as described in further detail below. Though the Insured sustained a loss that, pursuant to the terms of the policy, should be covered by CASTLE KEY, the carrier has failed to tender all monies due and owing to the Insured for the damage caused to the insured property. The entire concept of insurance promises the Insured timely and prompt indemnity in exchange for the Insured’s premium payments to the Insurance company.?
Florida Statute section 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that the insurance company must issue payment for a covered loss in a timely manner so that the Insureds may mitigate their damages and put them back in the position they were in prior to the loss as quickly as possible. Insurance company has breached this duty by refusing and failing to tender all insurance proceeds due and owing to the Insureds upon their proper and timely submission of a claim. Insurance company charged the Insureds a premium for coverage under the policy of insurance but refused and/or failed to fulfill its obligations per the Policy, when under all circumstances it could and should have done so had it acted fairly and honestly towards the Insureds.
Furthermore, the Insureds believe Insurance Company repeatedly and as a standard business practice engages in this behavior to deprive its Insureds of their rightful insurance proceeds when they experience a covered loss. Insureds contend other Insureds have been refused insurance proceeds due and owing under the policy in the same or similar circumstances, and have been provided inadequate insurance monies under the same or similar facts or circumstances. The Insured further contends that Insurance company commits this standard business practice only to keep the claims adjustment process open and pending so that it does not have to pay fully on the claim. The Insureds also contend the carrier sends its representatives (Hancock, in the instant matter) who advises the carrier the roof needs a replacement due to legitimate damage, yet Castle Key ignores this recommendation and still denies coverage to save itself money. This is wrongful conduct and directly violates the purpose of insurance coverage. Insurance company’s wrongful conduct and omissions include, but are not limited to: claim delay, not conducting a full and prompt investigation, not treating the policyholder with good faith claims conduct, looking for ways to deny recovery to Insured; not responding to the Insured or her representatives; failing and refusing to review documents sent by the Insured; looking for ways to delay full recovery to Insured; wrongfully denying the claim; holding back and failing to pay portions of claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the Insured; not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company’s interests before the policyholder’s interests; establishing severity control initiatives and otherwise establishing a culture of not fully and promptly paying claims following losses; failing and refusing to tender payment for the roof replacement despite the recommendation to do so by Hancock Claims (its own representative) and failing to pay the full amount of the Insureds’ damage despite knowing it must do so.
In Florida, the work of adjusting insurance claims engages the public trust. CASTLE KEY has breached this trust by its adjustment of the Insureds’ claim of loss by refusing to properly indemnify the Insureds for their wind and hail loss per the terms of the Policy and Florida Statutes.
On or about July 4, 2023, the Insureds (Angjelina and Aleks Bunjaj) suffered damage to their Property, located at 203 Woodfield Ln, Saint Johns, FL 32259, caused by a hail and windstorm. At the time of the loss, the Insured Property was insured by Castle Key Indemnity Company, which provides coverage for damages suffered as the result of a hail and wind event. Following the hail and windstorm, the Insureds contacted a roofing company to come out and inspect the Property. To the Insureds’ information and belief, the name of the roofing company that came out was Trinity Roofing. Trinity inspected the roof and advised the Insureds it needed to be replaced due to the hail and wind damage. After receiving this information from the roofing company, the Insureds promptly notified their insurance company, pursuant to their Policy. Following its inspection, Castle Key denied the claim and noted “we’re unable to provide payment for the claim because: the anomalies on the shingle are the result of blistering and age-related wear and tear. Storm data for the date of loss show maximum size .5-inch hail which would not have caused damage to the shingles.”
In disagreement with Castle Key’s denial letter, especially after the roofing company’s inspection and Castle Key’s own admission per the denial letter that the roof has “anomalies,” the Insureds retained Christian Reed, a licensed and insured public adjuster with River City Claims, who inspected the Property and provided an XACTIMATE estimate to return the Property to its pre-loss condition. The Public Adjuster’s estimate totals $44,027.26 (after the application of the $2,500 deductible) and was provided to the carrier, as well as a sworn statement in proof of loss based on the damage amount. Mr. Reed thoroughly documented the roof with photographs showing extensive damages to the roof, including dents on the gutters, chimney, and AC, as well as extensive wind and hail damage on the roof.
Mr. Reed also attended another inspection of the Property with Hancock claims on behalf of the Insureds. Hancock advised the public adjuster to stop marking during this inspection, stating there is so much damage to this roof to support a replacement that there was no need to continue, and that Castle Key would need to replace it. The creased shingles made wind damage clear, as well as obvious hail dents to the roof and exterior of the property. Despite this inspection and Hancock’s opinion regarding a roof replacement (on behalf of Castle Key), Castle Key stood by its denial and stated the roof was denied for blistering and wear and tear, ignoring the public adjuster’s request for a review of the claim as shingles are not creased from wear and tear. The hail damages are clear and extensive, as are the wind damages. Notwithstanding, Castle Key has failed and refused to further review or properly adjust the loss.
Despite multiple inspections and receipt of extensive documentation provided by the Insureds’ public adjuster, including a recommendation from Hancock Claims (Castle Key’s own representative) to replace the roof which was ignored, Castle Key has continued to fail and refuse to properly tender insurance proceeds to the Insureds for their covered loss. Castle Key also failed and refused to investigate the loss thoroughly and determined coverage was denied for false reasons.
Pursuant to Florida Statute §624.155(1)(b)(1), the Insurer, CASTLE KEY, has a duty to attempt, 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 the Insureds and with due regard for their interests. CASTLE KEY has breached these duties in the handling of the Claim for financial gain and profit. CASTLE KEY did so when it refused to properly adjust the claim, purposefully delayed the claim process, and ignored information from the Insured that would assist the Insureds in resolving their claim. Consequently, CASTLE KEY has violated Florida Statute §624.155(1)(b)(1). It would seem that CASTLE KEY is indifferent to the needs of its loyal customers, whose insurance premiums it did not hesitate to collect. CASTLE KEY had the duty to investigate and settle the Insureds’ Claim in an honest manner and according to the coverage provided under the Policy. To be clear, CASTLE KEY and its representatives had a duty to investigate the Claim and pay the Insureds the benefits they would be entitled to for the repairs under the terms and conditions outlined in the Policy and under Florida law. It has not done so to date, despite the Insureds and their representatives making every effort to resolve the claim in the meantime. What CASTLE KEY did was wrongfully and intentionally deny the Claim without conducting a reasonable investigation with qualified and competent adjusters and experts, despite the fact that the evidence clearly shows the property was damaged by a covered cause of loss, resulting in significant damage. Castle Key also ignored its own representatives’ recommendations to replace the roof. This unfair and unsupported underpayment of the Claim is evidence that CASTLE KEY has mishandled the Claim and its conduct is nothing less than common bad faith claims handling practices.
Pursuant to Florida Statute §626.9541(1)(i)(3)(a), CASTLE KEY had a duty to adopt and implement standards for the proper investigation and settlement of claims. It is clear from the facts in this case that CASTLE KEY was ill equipped to handle the Claim. The first representative sent to the Property by CASTLE KEY failed to correctly attribute the cause of loss and proper scope of damages resulting from the hail and windstorm, and the second representative’s recommendation to replace the roof was ignored.
To date, the Insureds still have not been properly compensated for their loss. The Insureds are at a loss of how to proceed, as CASTLE KEY has failed and refused to properly assist the Insureds with their covered loss despite its ethical, contractual, and statutory obligation to do so.
There may be further wrongful conduct which has not yet been made known to the Insureds at this time. For example, certain conduct or actions cannot be verified without a complete review of CASTLE KEY’s claim file and claim guidelines. The Insureds therefore retain the right to address additional concerns as they become known.?
CASTLE KEY improperly shifted the burden of proving the loss onto the Insureds before adequately tendering insurance proceeds (which CASTLE KEY still has not done). This completely defeats the purpose of insurance, as the insurance company should adequately compensate its Insureds for covered losses properly at the outset of a claim, not after months of being chased by and sent multiple pages of documentation by the Insureds and their representatives, fighting to have their covered loss properly compensated.
Pursuant to Florida Statutes, Section 624.155, punitive damages may be awarded against an insurance company if 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 beneficiary under a life insurance contract.?
It is the Insureds’ position that Insurance Company engages in the practice of wrongfully denying or underpaying insurance claims as a general business practice in a willful effort to increase profits and in reckless disregards for the Insured’s rights. This is wrongful conduct. This can be determined from a brief review of DFS’ Civil Remedy Notice website and the extensive filings against Castle Key for similar conduct, as well as a brief search of the Florida Court dockets which show the same behavior resulting in unnecessary litigation, which would not have occurred but for Castle Key’s mishandling of covered property losses in an effort to save itself money and deny or undervalue payment to its Insureds.
Notwithstanding the above, to cure the defects outlined in this Civil Remedy Notice, CASTLE KEY must do the following:?
(1) CASTLE KEY must act promptly, fairly and honestly towards the Insureds and with due regard for their interests in attempting to resolve the Insureds’ claim;
(2) CASTLE KEY must timely tender all insurance proceeds due and owing the Insureds for the fair value of their claim which is fairly owed under the insurance policy that would reasonably place the Insureds back to pre-loss condition, which is the full amount of the Insureds’ estimate previously provided in the amount of $44,027.36 after the application of the $2,500 deductible;
(3) CASTLE KEY must agree to reimburse the Insureds for the unnecessary expenses incurred by having to retain legal counsel and their own experts to present their claim, which will be provided upon request to counsel based on the fees and costs accrued at the time of the request;
(4) CASTLE KEY must timely tender statutory pre-judgment interest pursuant to Florida Statute Section 627.70131 and/or Section 55.03.
The Insureds still hope that this claim can be resolved amicably. Failure to cure the defects as described herein will result in additional extra-contractual damages.
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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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