Filing Number: 808832
|
| Filing Accepted: 2/27/2025 |
| Last/Business Name
*
|
|
|
SANDERS
|
|
First Name |
|
HOUSTON AND GAIL |
|
| Street Address
*
|
|
5131 CLARENDON ROAD |
| City, State Zip
*
|
|
JACKSONVILLE,
FL
32205
|
| Email Address
*
|
|
WITHHELD |
| Complainant Type:
*
|
|
Insured |
|
| Last/Business Name* |
|
SANDERS |
|
First Name |
|
HOUSTON AND GAIL |
| Policy # * |
|
KIN-DP-FL-208095348 |
|
Claim #* |
|
HO-3431843 |
|
Attorney is Applicable
|
| Last Name* |
DE LAS SALAS
First Name *
GABRIEL
Initial
M
|
| Street Address* |
|
1930 HARRISON STREET, SUITE 204 |
| City, State Zip* |
|
HOLLYWOOD
,
FLORIDA
33020
|
| Email Address * |
|
GMS@GMSLAWYER.COM |
|
|
| Insurer Type
*
|
|
 Authorized Insurer
 Unauthorized Insurer
|
|
|
| Insurer Name |
|
|
| Insurer Name* |
|
KIN INTERINSURANCE NETWORK
|
| Insurer Name* |
|
|
| Street Address* |
|
|
| City, State Zip* |
|
,
|
|
NAIC Company Code 16603 |
|
|
| Name of individual responsible for violation (if any):*
BETINA FOSTER, PAUL ALDRICH AND ALL OTHER ADJUSTERS INVOLVED IN THE ADJUSTMENT OF THIS CLAIM.
|
| Type of Insurance
*
Residential Property & Casualty
|
|
|
| Reason for Notice
*
|
|
|
Unsatisfactory Settlement Offer
|
|
|
Other
:
Bad Faith
|
|
|
Other
:
Unfair Claim Settlement Practices
|
|
|
Other
:
Breach(es) of the Adjuster Code of Ethics
|
|
|
*
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.
|
|
| 626.9541(1)(i)(3)(a) |
|
Failing to adopt and implement standards for the proper investigation of claims.
|
|
| 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.
Policies must be read in their entirety. Accordingly, the entire policy is relevant to the violation. Specifically:
We agree to provide the insurance coverages indicated on the Policy Declarations in return for payment of your premium when due and compliance with all policy terms and conditions. We make this agreement in reliance upon the information you have provided us and require that you inform us within 60 days of any change of title, use or
occupancy of the “described location”.
13. Loss Payment. We will adjust all losses with you. Claims payments issued for damage under Coverage A – Dwelling or Coverage
B – Other Structures will be made payable to all Named Insureds and applicable mortgagees listed on the Declarations page of
this policy and your assignee(s). In the event that any repair services were performed under the Our Option provision, KIN DP
EWR, KIN DP DRF, or KIN DP DRL, we will pay the retained contractor directly for those services or part or portion of any
services the retained contractor performs or provides. For all other claims payments we will pay you unless some other person
is named in the policy or is legally entitled to receive payment.
Loss will be payable upon the earliest of the following:
a. Only if “we” request a proof of loss from “you” pursuant to CONDITIONS 4 Your Duties After Loss a.6), twenty (20) days
after “we” receive ”our” requested written proof of loss and reach a written, executed agreement with “you” according
to the terms of the written agreement; or
b. Only if “we” request a proof of loss from “you” pursuant to CONDITIONS 4 Your Duties After Loss a.6), sixty (60) days
after “we” receive “our” requested written proof of loss and:
1) There is an entry of a final judgment; or
2) There is a filing of an appraisal award or a mediation settlement with us.
Reasonable Emergency Measures will be payable in accordance with Other Coverages 6. Reasonable Emergency Measurers.
You are responsible for all applicable deductibles.
The following form/endorsement: KIN FL DP RSP 01 23.
|
| |
*
Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Failure to act in good faith to resolve and pay the claim;
Failure to promptly and properly investigate the subject claim;
Failure to properly adjust the loss;
Failure to adopt and implement standards for the proper investigation of claims;
Failure to issue payment of undisputed amounts within 90 days of the claim being reported after an insurer determines the amount of benefits and agrees to coverage;
Placing financial interest of insurer before that of policyholders and claimants; and,
Breaches of the adjuster code of ethics.
The reasons for the foregoing 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 failed to adopt proper standards of investigation and adjustment of losses or is otherwise not implementing those standards because the insurer is not acting with honesty and integrity. The insurer’s acts and/or omissions, as detailed in this CRN, are committed and/or performed with such frequency as to indicate they are general business practices.
Houston Sanders and Gail Sanders (hereinafter the “insureds”) purchased a property insurance policy, Policy Number (hereinafter the “Subject Policy”) from Kin Interinsurance Network (hereinafter “Kin Interinsurance Network”) which, at all times material hereto, provided property insurance for the property located at 5131 Clarendon Road, Jacksonville, FL 32205 (hereinafter the “Subject Property”).
On or about September 14, 2024, , a covered cause of loss, caused direct physical loss and ensuing damages to the Subject Property.
The insureds timely notified Kin Interinsurance Network of the loss. Kin Interinsurance Network assigned claim number to the loss (hereinafter the "claim"). The insurer acknowledged coverage for the loss. However, it improperly concluded the loss did not exceed the applicable deductible. As such, there is solely a dispute as to the amount of loss. The insureds, by and through their public adjusters, attempted to reach a resolution of the dispute as to the amount of loss. However, the insurer failed to engage in conversations to amicably resolve this matter in such a manner that would result if a full and final resolution of the claim.
For these reasons, and those stated in detail above, the insurer is failing to act in good faith; specifically, failure/refusal to engage in discussions to reach full and final resolution of claim.
The adjuster(s) involved in this claim have breached the adjuster code of ethics as found in 69B-220.201, F.A.C. In addition to the statutes cited in this CRN, the adjusters involved in this claim breached the adjuster code of ethics as set forth in 69B-220.201, F.A.C. Pursuant to the code, a breach of any of provision of the ethical rules constitutes unfair claims settlement practices. They have breached the following ethical obligation as set forth in 69B-220.201, F.A.C.: an adjuster shall act with dispatch and due diligence in achieving a proper disposition of the claim.
The adjusters involved in this claim have breached this ethical obligation due to their failure to ensure payment was issued in accordance with the policy and Florida law and in an amount which reasonably restores the insured(s) to their pre-loss condition.
Due to the aforementioned facts and circumstances, and those more fully stated in detail above, the insurer’s adjusters breached the adjuster code of ethics. Accordingly, this ethical breach constitutes an unfair claims settlement practice as provided in 69B-220.201, F.A.C.
The circumstances giving rising to the violations can be cured if the insurer: (1) tenders payment to the insured in the amount $26,692.34, (2) acknowledges the insured’s entitlement to prejudgment interest and tenders payment for this interest, and (3) acknowledges and stipulates to the insured’s entitlement to attorney’s fees and costs. If the insurer disagrees with the extent of the cure requested or asserts that the payment of any of the above cure categories may not be required, the insurer should cure to the extent it believes it must under the Policy and Florida law to correct the allegations of bad faith contained herein. While it is not being requested as a cure for the bad faith alleged herein, the insured remains willing to entertain any reasonable counteroffer of settlement.
|
|
|
*
|
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
|