Filing Number: 808332
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| Filing Accepted: 2/25/2025 |
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| Street Address
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4470 INDIGO SKY LANE |
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KISSIMMEE,
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34744
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| Email Address
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RICKPENACWI@GMAIL.COM |
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Insured |
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| Last/Business Name* |
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PENA |
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First Name |
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RICK |
| Policy # * |
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KIN-HO-FL-135355940 |
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Claim #* |
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HO-3648276 |
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Attorney is Applicable
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| Last Name* |
KRAPF
First Name *
GRANT
Initial
W
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| Street Address* |
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2790 SUNSET POINT RD |
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CLEARWATER
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FL
33759
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| Email Address * |
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GRANT@KRAPFLEGAL.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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NAIC Company Code 16603 |
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| Name of individual responsible for violation (if any):*
ANTHONY TAYLOR, DOMINIC NGUYEN, TONY THOMPSON, PHIL FREEMAN, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, KIN INTERINSURANCE NETWORK WHO WAS INVOLVED IN THE 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 Denial
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Claim Delay
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Unfair Trade Practice
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Other
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Misrepresenting the terms of the insurance policy
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Other
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Not treating the Insured with good faith claims conduct
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Other
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Looking for ways to deny full recovery to the Insured
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Other
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Looking for ways to delay full recovery to the Insured
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Other
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Failing to properly investigate the Insured's loss
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Other
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Failing to provide the Insured with the full benefits awarded under the contract of insurance in a t
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Other
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Not training, supervising, or managing adjusters properly so that prompt and full payments are made
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Other
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Not adjusting claims and evaluating loss properly
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Other
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Shifting the burden of insuring the loss to the Insured
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Other
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Intentionally misstating the terms, conditions, and benefits of the insurance policy to the insured
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Other
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Failing to implement proper standards for the adjustment and investigation of claims
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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)(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)(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)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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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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Specific policy language that is relevant 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 7 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. If the acknowledgment is not in writing, a notification indicating acknowledgment shall be made in the insurer's claim file and dated. A communication made to or by a representative of an insurer with respect to a claim shall constitute communication to or by the insurer.
627.70131 (3)(e) The insurer must send the policyholder a copy of any detailed estimate of the amount of the loss within 7 days after the estimate is generated by an insurer's adjuster. This paragraph does not require that an insurer create a detailed estimate of the amount of the loss if such estimate is not reasonably necessary as part of the claim investigation.
627.70131(7)(a)Within 60 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer. The insurer shall provide a reasonable explanation in writing to the policyholder of the basis in the insurance policy, in relation to the facts or applicable law, for the payment, denial, or partial denial of a claim. If the insurer's claim payment is less than specified in any insurer's detailed estimate of the amount of the loss, the insurer must provide a reasonable explanation in writing of the difference to the policyholder. Any payment of an initial or supplemental claim or portion of such claim made 60 days after the insurer receives notice of the claim, or made after the expiration of any additional timeframe provided to pay or deny a claim or a portion of a claim made pursuant to an order of the office finding factors beyond the control of the insurer, whichever is later, bears interest at the rate set forth in s. 55.03. Interest begins to accrue from the date the insurer receives notice of the claim. The provisions of this subsection may not be waived, voided, or nullified by the terms of the insurance policy. If there is a right to prejudgment interest, the insured must select whether to receive prejudgment interest or interest under this subsection. Interest is payable when the claim or portion of the claim is paid. Failure to comply with this subsection constitutes a violation of this code. However, failure to comply with this subsection does not form the sole basis for a private cause of action.
Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language. "It is an accepted principle of law that when parties contract upon a matter which is the subject of statutory regulation, the parties are presumed to have entered into their agreement with reference to such statute, which becomes a part of the contract, unless the contract discloses a contrary intention." Westside EKG Assocs. v. Found. Health, 932 So. 2d 214, 216 (Fla. 4th DCA 2005), aff'd, 944 So. 2d 188 (Fla. 2006).
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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.
Kin Interinsurance Network (the "Insurer") has committed the following in handling the Insured's claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the policyholder and the Insured; 3) looking for ways to deny benefit payments and otherwise "low ball" or "stone wall" claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; 8) denying a claim which it knew or should have known the policy and Florida law provided coverage for; 9) failing to provide an estimate that complies with the Florida Building Codes; 10) shifting the burden of investigating the loss onto the Insured; 11) failing to render a claims determination within sixty (60) days; 12) failing to acknowledge and act promptly upon communications with respect to claims; 13) misrepresenting the terms of the insurance policy; 14) 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; and 15) failing to provide a copy of the field adjuster's estimate within 7 days.
On or about October 9, 2024, while the subject policy was in full force and effect, the Insured's property was severely damaged by Hurricane Milton. The areas impacted include but are not limited to the roofing system and exterior. The Insured timely submitted a claim to the Insurer on October 10, 2024, for hurricane damage and the ensuing damage therefrom. Thereafter, the Insurer assigned claim number HO-3648276 to the loss and sent a field adjuster to inspect the property on November 4, 2024. The field adjuster completed his repair estimate on November 17, 2024. The Insurer violated Fla. Stat. 627.70131 (3)(e) by failing to provide a copy of this estimate to the Insured within 7 days.
Given the scope and nature of the damage resulting from Hurricane Milton, the Insured retained a public adjuster. On December 3, 2024, the public adjuster sent the Insurer a letter of representation. He additionally requested all communications regarding the claim, a certified copy of the policy, any field adjuster estimated previously generated as well as confirmation as to whether the Insurer amended or altered the field adjuster's report. In violation of Fla. Stat. 627.70131 (1)(a), the Insurer failed to acknowledge or respond to this communication within 7 days. On December 12 and 14, 2024, the public adjuster sent the Insurer photographic evidence of the damage as well as repair estimate calculating the replacement cost value of the loss at $54,035.
Then in a letter dated January 9, 2025, the Insurer notified the Insured that it was extending partial coverage for the loss. However, the Insurer wrongfully determined that it would only require $1,833.60 to restore the insured property to its pre-loss condition. The Insurer's lowball estimate is that of a classic under scope and under value of the claim. The Insurer erroneously denied coverage for the damage to the Insured's right and front slope shingles. This coverage decision is incorrect. Denying coverage for the damage was wrongful as the damages are covered under the policy. The claims determination letter failed to comply with Fla. Stat. 626.9541(1)(i)(3)(f) as it did not include a reasonable explanation of the basis in the insurance policy, in relation to the facts, for the denial. The letter simply states, "the damage to the roofs right and front slope shingles caused by fasteners used to hold tarp down [sic.], is not covered by your policy" and copies several policy exclusions with no explanation.
In response, on January 16, 2025, the public adjuster sent the Insurer an email seeking clarification as to its denial of a roof replacement. The public adjuster advised a roof replacement was required because: (1) the underlayment had been damaged in multiple areas; (2) the decking had been damaged; and (3) the repaired shingles would not match the existing shingles. He included a thorough explanation with citations to the Florida Building Code to justify a roof replacement. The Insurer responded with an email dated January 29, 2025, advising it was standing by its original claims determination. Initially, the Insurer violated Fla. Stat. 627.70131 (1)(a) again by failing to acknowledge and respond to the public adjuster's email within 7 days. Second, the Insurer improperly shifted the burden of investigating the claim onto the Insured by stating it would only review its position if the Insured provided a failed permit or failed repair video. The Insurer failed to address any of the arguments advanced by the public adjuster as to why a roof replacement is justified.
Upon receiving notice of the loss, the Insurer had the duty to provide the full benefits under the policy. This includes providing the Insured with a proper investigation and the funds necessary to return the home to its pre-loss condition. However, when the Insurer conducted its inspection of the insured property, the Insurer's adjuster failed to conduct a thorough and adequate investigation, or the adjuster intentionally ignored the damage observed and failed to make truthful and unbiased reports of the facts after investigating. As a result, the Insurer breached the policy by failing to fully indemnify the Insured for the covered loss.
The Insurer misrepresented the loss and wrongfully denied coverage for the damage sustained to the Insured's property. According to the claims determination letter, the Insurer's field adjuster observed damage to the front and right slope shingles but attributed the cause of this damage to several causes excluded under the policy. However, the Insurer never retained a professional engineer to determine the cause of this damage. Instead, the Insurer relied upon the causation opinions of a lay witness who will likely testify that the Insurer never retained him to provide any causation opinions. Rather, the Insurer defaulted to deny coverage based on a faulty and inadequate investigation.
Also, the Insurer knows or should know that when independent perils converge and no single cause can be considered the sole or proximate cause, it is appropriate to apply the concurring cause doctrine. Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016). The concurring cause doctrine states that coverage may exist where an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause. Id. at 698. A covered peril that meets with an uncovered peril may still provide for coverage under a policy when the covered peril triggered the events that eventually led to the loss. Id. at 697. The Insurer intentionally ignored covered damage to deny the reported loss and wrongfully fail to pay the Insured. This is an underhanded attempt to place the financial interests of the Insurer over those of the Insured and to delay and frustrate the Insured's ability to have his claim adjusted promptly to begin restoring his property.
Rather than the Insurer pay for a roof replacement consistent with all laws and ordinances, the Insurer contends the roof is repairable which is not true. All repairs to the roofing system must be done in accordance with applicable Florida Building Codes which require all repairs be done consistent with the manufacturer's specifications and warranties which this Insurer clearly did not account for.
The Insurer has placed obstacles to its Insured's ability to have the claim adjusted promptly to begin restoring the home by waiting more than sixty (60) days after receiving notice of the Insured's claim to make a claims determination. The Insured first reported the loss on October 10, 2024. The Insurer rendered a claims determination on January 9, 2025. Under Fla. Stat. 627.70131(7)(a), "[w]ithin 60 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer." There were no factors outside of the Insurer's control. The Insurer had inspected the property and received a repair estimate as well as photographic evidence of the damage. As the Insurer has failed to make a timely determination, it has violated this code. As such, in addition to the below requirements to cure this CRN, any payment made to the Insured must contain interest for the damage as a result of the loss from the date the Insurer received first notice of the loss.
There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer's claim file and standards and procedures for the adjustment and investigation of claims.
In short, the Insurer is not acting with due regard for the Insured's interests or safety. In Florida the work of adjusting insurance claims engages the public trust. The Insurer has breached this trust and its duty to the Insured. The Insurer and its agents conducted cursory and inadequate investigations and wrongfully denied coverage for a roof replacement as well as wrongfully determining that it would only require $1,833.60 to restore the insured property to its pre-loss condition. Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer's actions and inactions have continued to frustrate and delay the resolution of the Insured claim.
The Insurer's actions amount to but are not limited to the following:
1. Claim denial
2. Claim delay
3. Not treating the Insured with good faith claims conduct
4. Looking for way to reduce recovery to the Insured
5. Looking for ways to deny recovery to the Insured
6. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured
7. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company's interests before the Insured's interests
8. Placing the financial interest of the Insurer over that of the health and safety of the Insured
9. Failing to provide an estimate that complies with the Florida Building Codes
10. Shifting the burden of investigating onto the Insured
11. Conducting inadequate investigations
12. Failing to render a written claims determination to the Insured within 60 days
13. Making material misrepresentations
14. Failing to acknowledge and act promptly upon communications with respect to claims
15. 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.
16. Failing to provide a copy of the field adjuster's estimate within 7 days.
Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must:
(1). Admit full coverage for the Insured's loss.
(2). Tender full benefits owed to the Insured under the insurance contract.
A copy of this form submitted to the FDFS has been sent via e-mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to badfaith@krapflegal.com.
Via E-mail:
Kin Interinsurance Network
55 W. Monroe St., Suite 2200
Chicago, IL 60603
claims@kin.com
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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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