Filing Number: 787935
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| Filing Accepted: 10/22/2024 |
| Last/Business Name
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INHOUSE ADJUSTING
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First Name |
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| Street Address
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4767 NEW BROAD STREET |
| City, State Zip
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ORLANDO,
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32814
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| Email Address
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INFO@INHOUSEADJUSTING.COM |
| Complainant Type:
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Third Party |
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| Last/Business Name* |
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GROGAN |
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First Name |
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MICHAEL |
| Policy # * |
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713349 |
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Claim #* |
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12091 |
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Attorney is Applicable
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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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VYRD INSURANCE 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 17153 |
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| Name of individual responsible for violation (if any):*
GEDDES BROWN (727) 335-1351 AND ALL ADJUSTERS AND ASSOCIATES WHO HANDLED THIS 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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Unsatisfactory Settlement Offer
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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)(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)(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.
COVERAGE A – DWELLING and COVERAGE B – OTHER STRUCTURES
1. 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.
...
3. Loss Settlement. Covered property losses are settled as follows:
b. Buildings under Coverage A or B at replacement cost without deduction for depreciation:
(1) Subject to:
(b) The replacement cost of that part of the building damaged for like construction and use
on the same premises;
(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.
(4) We will initially pay at least the actual cash value of the insured loss less any applicable
deductible. We shall pay any remaining amounts necessary to perform such repairs as work
is performed and expenses are incurred or we will pay a licensed contractor after the insured
signs a contract and as repairs are made to the 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 August 5, 2024, Michael and Miyuki Grogan filed a claim with VYRD, reporting wind damage to their roof. Following the assignment of an adjuster on August 6 and an inspection on August 16, it was determined that the damage was significant and required a full roof replacement. However, the insurance company's coverage determination on October 7 fell short of addressing the full extent of the financial burden incurred.
The carrier's Replacement Cost Value (RCV) for this claim was calculated at $29,502.88. This policy has a Roof Surface Payment Schedule, therefore a non-recoverable depreciation amounting to $16,930.20 exists on this claim. The Grogan's demand for RCV, however, stands at $51,282.70. While the insurance company agreed to cover the full roof replacement, including essential components such as shingles, felt, drip edge, valley metal, and exhaust caps, it has unjustly excluded crucial items and fair market value from the coverage. Specifically, the water barrier and joint tape were removed from the estimate under the pretext that they did not exist prior to the loss. Furthermore, the insurance company denied coverage for the mastic around vent pipes and caulking, also claiming these items were absent before the incident.
Despite the clear evidence of extensive wind damage to the Grogan's roof, the insurance company has significantly undervalued their claim. The calculated Replacement Cost Value (RCV) of $29,502.88, does not accurately reflect the true costs necessary for a complete and proper roof replacement. The Grogan family’s demand for $51,282.70 is based on a thorough assessment of the damage, which includes critical components essential to the integrity and functionality of their home AND fair market value for contractors in the area. By failing to recognize the true value of the damage and scope of repairs, the insurer has inadequately addressed the Grogan's rightful claim, leading to unnecessary financial strain and hardship.
Statutes In Question:
§ 624.155(b)(1) - The insurer has not attempted in good faith to settle the claim, as it should have, given the circumstances, thus failing to act fairly and honestly toward its insured.
§ 624.155(b)(3) - The insurer has failed to promptly settle the claim when the obligation to do so was reasonably clear, attempting to influence settlements under other portions of the policy coverage.
§ 626.9541(1)(i)3.a - The insurer has not adopted and implemented standards for the proper investigation of claims. The denial was issued without a full and thorough investigation, overlooking pertinent facts regarding the damage.
§ 626.9541(1)(i)3.b - The insurer has misrepresented key facts and provisions related to coverage, particularly regarding the extent of the damages and items that should have been covered under the policy.
§ 626.9541(1)(i)3.f - The insurer has failed to provide a reasonable written explanation to the insured regarding the basis for the denial of the claim or the offer of a compromise settlement.
To remedy this, we demand payment of the full amount of $51,282.70, representing the proper estimate of the cost to repair the wind damage as confirmed by relevant industry standards and contractors engaged by the Grogan family. Additionally VYRD must reassess its internal claims handling practices to ensure that future investigations are conducted fairly and in compliance with Florida law.
This Civil Remedy Notice is submitted in good faith with the intent of reaching a swift and amicable resolution.
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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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