Filing Number: 788060
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| Filing Accepted: 10/22/2024 |
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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 |
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ORLANDO,
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32814
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| Email Address
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INFO@INHOUSEADJUSTING.COM |
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Third Party |
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FALCON |
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First Name |
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ISAYVETTE |
| Policy # * |
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P011205145 |
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Claim #* |
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257042 |
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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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SECURITY FIRST INSURANCE COMPANY
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| Insurer Name* |
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NAIC Company Code 10117 |
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| Name of individual responsible for violation (if any):*
OSCAR VAZQUES (386) 492-0108 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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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)(2) |
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Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
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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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Conditions:
5. Loss Settlement. Covered property losses are settled as follows:
b. Buildings under Coverage A or B at replacement cost without deduction for depreciation, subject to the
following:
(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 at the time of the loss, less any applicable
deductible. We will pay any remaining amounts necessary to perform repairs as work is performed
and expenses are incurred. We will pay no more than the least of the followingamounts:
(b) The reasonable and necessary cost to repair or replace the damaged, destroyed or stolen
covered property; or
13.Loss Payment. We will adjust all losses with you. We will pay you unless some other person is named in the
policy or is legally entitled to receive payment. Losses will be payable upon the earliest of the following:
a. 20 days after we receive your written proof of loss and reach a written, executed agreement of settlement
with you according to the terms of the written agreement; or
b. 60 days after we receive your written proof of loss and:
(1) There is an entry of a final judgment or, in the case of an appeal from such judgement, within 60 days
from and after the affirmance of the same by the appellate court; or
(2) There is a written, executed mediation settlement agreement with you according to the terms of the
written mediation settlement.
c. Within 90 days after we receive notice of an initial claim, “reopened claim” or “supplemental claim” from you,
we will pay or deny such claim or a portion of the claim unless the failure to pay such claim or portion of claim
is caused by factors beyond our control which reasonably prevent such payments.
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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 September 3, 2024, the insured filed a claim for wind damage with Security First Insurance Company, and coverage was initially determined on September 23. The insurer agreed to an estimate provided by East Roofing for a Replacement Cost Value (RCV) of $10,832.50, which included $6,499.50 in non-recoverable depreciation. This valuation is significantly lower than the estimate prepared by InHouse Adjusting, which accurately calculated the RCV at $22,107.44 for the dwelling, with an additional $1,888.68 for Ordinance & Law (O&L) coverage. To our knowledge, East Roofing is an arbitrary roofing company selected by the insurance carrier. They are not the roofing company who will be doing the work for the insured. We have no way of knowing how East Roofing arrived at the RCV $10,832.50 and do not know the relationship they have to the insurance company. What is fact is that our office uses Xactimate's pricing by zipcode, due to the fact that Xactimate is a vastly accepted estimating software program used by insurance carriers all over the world. The pricing is derived from inputs by contractors from all over the selected zipcode, therefore it is considered the benchmark for claims valuation. The price list downloaded was not altered, therefore the valuation that the extimating software provided rests at the 50% mark of a Bell Curve. This means that 50% of contractors out there will do the work for less, but that also means 50% of the contractors out there will charge more. The Sworn Proof of Loss we have provided is a proper adjustment of the claim; properly in that the scope is accurate to the best of all parties' knowledge and the price came from an unbiased source such as Xactimate. The refusal to accept a propertly documented and adjusted Sworn Proof of Loss, can be construed as price-fixing on behalf of the insurance company.
The stark difference between the insurer’s valuation and our independent assessment highlights the severe undervaluation of the damages. This discrepancy suggests that the insurer has failed to act in good faith, as the true cost of repairs has been inadequately considered, creating a significant financial burden for the insured. Furthermore, the insurer’s lack of transparency in providing a clear breakdown of coverage accompanying their claim payment has further complicated the insured’s ability to understand the basis for their offer.
Statutes in Question:
§ 624.155(b)(1) - The insurer has not attempted in good faith to settle the claim when it could and should have done so, failing to act fairly and honestly toward the insured.
§ 624.155(b)(2) - The claim payment was not accompanied by a proper statement setting forth the coverage under which payments were being made, hindering the insured’s ability to understand the extent of their coverage.
§ 624.155(b)(3) - The insurer has failed to promptly settle the claim when the obligation to do so became reasonably clear under one portion of the policy, potentially to influence settlements under other portions.
§ 626.9541(1)(i)3.a - The insurer has failed to adopt and implement appropriate standards for investigating the claim, as evidenced by the significant undervaluation.
§ 626.9541(1)(i)3.b - The insurer has misrepresented pertinent facts and policy provisions relating to the coverage at issue, particularly regarding the true costs involved in restoring the property.
To rectify this, we demand that Security First Insurance Company reassess the claim and issue payment in accordance with the accurate valuation of $22,107.44 (plus $1,888.68 for O&L). In addition, the insurer must provide a clear and transparent breakdown of the coverage associated with any claim payments made to ensure proper communication and understanding.
This Civil Remedy Notice is submitted in good faith to resolve the matter promptly and fairly, avoiding further legal action.
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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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