Filing Number: 789099
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| Filing Accepted: 10/29/2024 |
| Last/Business Name
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YOUR PUBLIC ADJUSTER INC
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First Name |
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MICHELLE LEVITT |
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| Street Address
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619 E NEW YORK AVE |
| City, State Zip
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DELAND,
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32724
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| Email Address
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MICHELLE@YOURPUBLICADJUSTER.US |
| Complainant Type:
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Third Party |
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| Last/Business Name* |
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GARCIA |
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First Name |
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BIANCA |
| Policy # * |
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12-1056919-03 |
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Claim #* |
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12-3022656-24 |
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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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TYPTAP 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 15885 |
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| Name of individual responsible for violation (if any):*
DEAVIN HOPPAS AND RONNIE BRADDY AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, TYPTAP INSURANCE 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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Unsatisfactory Settlement Offer
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Other
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UNREASONABLE INVESTIGATION
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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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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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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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| 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)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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| 626.9541(1)(i)(3)(e) |
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Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
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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.
It is believed the language relevant to the violations includes all applicable policy coverages, valuation provisions, and other terms and conditions of the policy, including the declarations pages and all applicable endorsements to the policy. Based on available information, please refer to the following policy language:
A) Section I Property Coverages
B) Coverage A (Dwelling)
C) Loss Payment Provisions
D) Loss Settlement Provisions
E) Duties After Loss Provisions
F) All Applicable Endorsements to the Policy
G) All Terms and Conditions of the Insurance Policy Relevant to the Insured’s Claim
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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 complaint is made on behalf of the insured, BIANCA GARCIA. Further, this complaint is a statement that notice is hereby given in order to perfect the right to pursue the civil remedy pursuant to Florida Statute §624.155.
In consideration of the premium paid to it, the carrier, TYPTAP INSURANCE (“Carrier”), issued a policy, Policy No. 12-1056919-03 to BIANCA GARCIA (“Insured”) where the policy provided coverage for all losses, except those losses which were expressly excluded, for the property located at 6012 ROLAND CT, FORT PIERCE, FL 34951. The policy was in full force and effect at the time the damage occurred from WIND/HAIL and the ensuing damage as a direct result thereof, to the Insured Property, on or about JANUARY 9, 2024.
The insured hired Your Public Adjuster, Inc and the Carrier was put on notice of covered direct damages and ensuing damages and of the request that a claim be opened pursuant to the terms and conditions of the Policy. Claim number 12-3022656-24 (“Claim”) was assigned to the Loss on JUNE 5, 2024.
On June 6, 2024, Brianne called from TypTap and said the field adjuster (FA) would be contacting Your Public Adjuster, Inc within 24-48 hours. Brianne stated a desk adjuster would be assigned to the claim once the FA report was submitted. The carrier also provided a copy of the policy.
Later the same day, FA Deavin called to schedule the initial inspection. The field adjuster inspection was scheduled for June 18, 2024, at 2 pm.
On June 18, 2024, the public adjuster met with the field adjuster and completed the inspection. The public adjuster explained at the inspection that the neighboring properties to Bianca Garcia also suffered wind and hail damage and one of the homes has been paid by their insurance carrier and replaced their roof due to the covered peril.
On June 24, 2024, DA Ronnie emailed Your Public Adjuster, Inc asking for a recorded statement from the insured. Your Public Adjuster, Inc promptly answered back and provided dates of availability.
On June 25, 2024, Your Public Adjuster, Inc emailed the FA Deavin to confirm the field adjuster report was submitted. Deavin responded back stating the estimate was submitted to the carrier.
Later the same day, DA Ronnie confirmed July 1, 2024, at 2 pm was agreeable to complete the recorded statement with the insured.
On July 27, 2024, Your Public Adjuster, Inc was informed the field adjuster report would not be available until after the recorded statement was completed.
On July 1, 2024, the recorded statement was completed. DA Ronnie asked the insured why she reported the claim so late. The insured stated that she remembered the hail event taking place, but it was not until her neighbors started telling her that they had damage that she realized she also had damage and asked Your Public Adjuster, Inc to inspect for all damages.
On July 11, 2024, Your Public Adjuster, Inc emailed DA Ronnie asking for the results of the field adjuster’s report now that the recorded statement was complete. No response was received.
On July 17, 2024, Your Public Adjuster, Inc called and left a voicemail for DA Ronnie and followed up with an email for the status of the field adjuster’s report as the inspection had taken place a month prior. No response was received.
On July 22, 2024, Your Public Adjuster, Inc called and left a voicemail for DA Ronnie. Your Public Adjuster, Inc also called the claims department and received the name of the supervisor, Elaine. No other information was able to be provided. Your Public Adjuster, Inc left a voicemail for the supervisor, Elaine.
On July 23, 2024, DA Ronnie called Your Public Adjuster, Inc and stated the field adjuster report was still under review and the carrier was determining coverage.
On July 25, 2024, DA Ronnie called Your Public Adjuster, Inc and stated the field adjuster report was still under review and the carrier was determining coverage.
On July 30, 2024, Your Public Adjuster, Inc called DA Ronnie and left a voicemail and followed up with an email asking for the status of the coverage determination. DA Ronnie returned an email stating no coverage was afforded and the claim was denied.
Your Public Adjuster, Inc and the insured are unsure as to why coverage was denied when multiple neighbors directly adjacent to the insured suffered hail damage and the carrier is denying the claim stating there was not hail damage to the property. Hail does not target one house and not the house next door. Hail and wind are also covered perils under the insurance policy.
Thereafter, the Carrier determined coverage and denied coverage associated with the roof and patio roof of the covered property located at 6012 ROLAND CT, FORT PIERCE, FL 34951. The Carrier knows its aforementioned investigation is insufficient and that it has failed to provide proper payment to restore the property to its pre-loss condition. This inspection placed The Carrier on notice of the severity of the Loss.
Thereafter, YOUR PUBLIC ADJUSTER, INC, who ensured the proper estimating of the loss and compliance with all policy conditions, submitted a comprehensive estimate to the Carrier for the full scope of damages to the Insured Property. In addition, a Sworn Statement and Proof of Loss (“SPOL”) was provided, on or about AUGUST 9,2024.
Thereafter, the Carrier disregarded the public adjuster’s comprehensive estimate and SPOL and, instead, continued to deny the Claim. The Carrier has refused to reassess its payment of benefits and the basis of the payment and has refused to properly adjust and settle the Claim.
On August 15, 2024, Your Public Adjuster, Inc emailed the DA Ronnie asking if he reviewed the supplemental documents submitted. No response was received.
On August 22, 2024, Your Public Adjuster, Inc called DA Ronnie and asked for an update on the supplemental documents and a re-evaluation of the claim. DA Ronnie stated there is a full denial being sent. Your Public Adjuster, Inc received the denial letter, and it was the same letter from the first time a denial letter was provided. Your Public Adjuster, Inc called DA Ronnie and asked if this denial letter was the original letter or if this letter was based off of the review of the supplemental documents. DA Ronnie stated he received the supplemental documents but missed reviewing them. DA Ronnie requested an additional week to review the supplemental documents.
On August 29, 2024, Your Public Adjuster, Inc called and spoke to DA Ronnie. He stated he had not reviewed the documents but should have something by the beginning of the following week.
On September 3, 2024, Your Public Adjuster, Inc emailed DA Ronnie asking for an update on the claim review. No response was received.
On September 6, 2024, Your Public Adjuster, Inc called DA Ronnie for an update on the review of the supplemental documents. DA Ronnie stated the carrier was standing on their decision and he would be sending over the updated denial letter shortly.
On September 10, 2024, Your Public Adjuster, Inc called DA Ronnie asking for the Stand on Decision letter. He stated he still needed to get it written up and would send it by the end of the week.
On September 16, 2024, Your Public Adjuster, Inc called and left a voicemail for the DA Ronnie asking for the Stand on Decision letter that had not been sent to the insured or the public adjuster. No response was received.
On September 19, 2024, Your Public Adjuster, Inc called DA Ronnie, and he stated the letter was pending review by management and he would have it sent out by the end of the week.
On September 20, 2024, DA Ronnie provided the Stand on Decision letter.
On September 23, 2024, Your Public Adjuster, Inc received a Reservation of Rights (ROR) and Request for Information (RFI) letter in the mail.
The carrier is in violation of Florida Statute 627.70131(3)(b) “If such investigation involves a physical inspection of the property, the licensed adjuster assigned by the insurer must provide the policyholder with a printed or electronic document containing his or her name and state adjuster license number. An insurer must conduct any such physical inspection within 30 days after its receipt of the proof-of-loss statements.”
The insurer did not attempt to conduct any sort of inspection once the proof of loss and supplemental documents were submitted. The carrier made zero attempt to discuss the claim and see where the public adjuster was noting damages. The carrier failed to properly investigate the claim with respect to reopening the claim. The carrier did not attempt to complete a virtual inspection of the claim either. An inspection or investigation must take place when reopening a claim and the carrier did no such inspection or investigation.
The carrier also violated Florida Statute 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…”
The claim was opened on June 6, 2024, and inspected on June 18, 2024. The carrier did not determine a denial of coverage until September 6, 2024. This is 90 days since the claim was opened. The statute states the carrier has 60 days unless a Reservation of Rights letter is provided. The Reservation of Rights letter was not provided by the carrier until September 23, 2024.
The request for information that was provided to the insured and public adjuster on September 23, 2024, asked for any receipts/invoices/signed contracts from a contractor pertaining to damage to the claim. The insured did not have these as the carrier denied coverage stating the damage was due to wear and tear. To deny the claim and two weeks later request invoices from a contractor for work does not make sense.
On October 7, 2024, Your Public Adjuster, Inc responded to the Request for Information (RFI) and emailed the DA Ronnie letting him know the insured does not have any repairs and receipts.
On October 14, 2024, Your Public Adjuster, Inc emailed DA Ronnie following up on the October 7th email to find out what their next steps were as the RFI was answered.
On October 21, 2024, Your Public Adjuster, Inc called and spoke to DA Ronnie. Your Public Adjuster, Inc inquired about the RFI and if DA Ronnie received the email where the RFI was answered. DA Ronnie stated it must have been a mistake that the RFI was sent out because they are standing on their decision to deny the claim.
It is unclear how the carrier can deny blatant hail damage to an insured’s roof when hail is a covered peril. Your Public Adjuster, Inc submitted a photo report with the POL and estimate. On pages 9-11 of the photo report, photos 17-22 show clear hail damage to the metal pieces on the roof. Pages 13-29 of the photo report show hail marks circled in chalk on the roof. Pages 31-32 of the photo report show hail damage to the metal roof of the screened porch.
There is more than sufficient evidence of hail damage and the carrier continues to deny the claim and stand on their decision and create undue hardship on the insured. Wind and hail are covered perils under this insurance policy and the carrier has failed to uphold their end of the policy agreement to cover the loss.
In order to cure the conduct giving rise to the violations described herein, the Carrier must complete the proper evaluation of the damages via qualified professionals and issue payment for all the covered damages. In addition, the Carrier must issue payment to the Insured for reasonable fees, costs, and pre-judgment interest if required by the applicable Florida Statutes. As an alternative cure option, the insurance company may cure the allegations giving rise to this notice by tendering a check in the amount of $40,018.24 minus prior payments and applicable deductible within the 60-day cure period, jointly payable to BIANCA GARCIA and YOUR PUBLIC ADJUSTER, INC.
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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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