Filing Number:     279574

Filing Accepted:  2/15/2015

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Complainant

Last/Business Name *   WHIDDEN   First Name   THEODORE Street Address * P.O. BOX 158 City, State Zip * CHIPLEY, FL 32428 Email Address * TEDWHIDDEN@GMAIL.COM Complainant Type: * Insured

Insured

Last/Business Name*   WHIDDEN   First Name   THEODORE Policy # * 0316-07-13U Claim #* 0316-07-13U

Attorney

Attorney is Applicable

Violation

Insurer Type *   Authorized Insurer Unauthorized Insurer   Insurer Name Insurer Name*   UNITED SERVICES AUTOMOBILE ASSOCIATION Insurer Name* Street Address* City, State Zip* , NAIC Company Code 25941   Name of individual responsible for violation (if any):* KRISTEN VAN DER LINDE, KATHRYN MERKER OUGHTON, SARA SEPULVEDA, DEBORAH CAKOUROS Type of Insurance * Auto

Reason for Notice * Other : Section 817, Commercial Conspiracy to Defraud Other : Complicity (Criminal Complicity) Other : Aiding and Abetting Other : Fraud and other criminal concealment, as well as destruction/disposal of documents Other : Intentional Infliction of Emotional Distress Other : Negligent Infliction of Emotional Distress Claim Delay Unsatisfactory Settlement Offer Other : A commercial scheme to defraud including but not limited to patterns of fraud Other : Insurance Fraud in partnering with a provider to liquidate assured's benefit package Other : Deliberate acts to deceive and delay the assured, Insurance Commissioner, and third parties Other : Criminal Mischief Other : Intentional dishonest and deceitful and delayed responses & handling to previous Civil Remedy filing Other : Deliberate acts to delay and deceive proceedings and processes Other : Inequitable Doctrine use of legal counsel to abuse the assured * 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. 624.155(1)(b)(3) 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. 626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims. 626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims. 626.9541(1)(i)(3)(e) 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. 626.9541(1)(i)(3)(f) 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. 626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim. 626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. 626.9541(1)(i)(3)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b). * Specific policy language that is relevant to the violation. Enter all words or phrases (one at a time) that should be used to filter. 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. 624.155(1)(b)(3) 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. 626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims. 626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims. 626.9541(1)(i)(3)(e) 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. 626.9541(1)(i)(3)(f) 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. 626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim. 626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. 626.9541(1)(i)(3)(i) Unfair claim settlement practices Other : Section 817, Commercial Conspiracy to Defraud Other : Complicity (Criminal Complicity) Other : Aiding and Abetting Other : Fraud and other criminal concealment, as well as destruction/disposal of documents Other : Intentional Infliction of Emotional Distress Other : Negligent Infliction of Emotional Distress Claim Delay Unsatisfactory Settlement Offer Other : Conspiracy to Defraud Other : A commercial scheme to defraud including but not limited to patterns of fraud Other : Insurance Fraud in partnering with a provider to liquidate assured's benefit package Other : Abuse of Process Other : Deliberate acts to deceive and delay the assured, Insurance Commissioner, and third parties Other : Criminal Mischief Other : Intentional dishonest and deceitful and delayed responses & handling to previous Civil Remedy filing Other : Deliberate acts to delay and deceive proceedings and processes Other : Inequitable Doctrine use of legal counsel to abuse the assured It is almost five years since my accident of 8/29/2010. The insurance company (USAA) never sent anyone to look at my vehicle or any of the vehicles in the accident. USAA and their agents have committed a host of dubious actions and inactions to avoid clear cut responsibility in my loss. USAA has committed numerous heinous stunts to delay, deny, and avoid their responsibility under policy and Florida Law. USAA has tabled several severely unreasonable offers to the assured, in that they keep repeating the same crooked offers. It has been demonstrated in previous Civil Remedy filings that their attempts to settle and their means to attempt settlement have been twisted and are in direct violation of Florida Insurance Ethics requirements. USAA has repeatedly taken undue advantage of someone they know to be hampered by this accident. They have caused undue delay, and have forced the assured/victim to endure abnormal stresses and pressures. USAA knew at the outset this was potentially an “Uninsured Motorist” case. USAA confirmed the vehicle was not insured with Aequicap Casualty Company as stated in the loss report by FHP. Aequicap Casualty failed financially and under went bankruptcy liquidation with the knowledge of USAA. (USAA was notified in Civil Remedy filings of this). USAA filed written response to their assured (Fraud) stating they had discussed issues with the company, yet phone call was made one year after the company had been liquidated based on the Commissioner of Insurances electronic notices and website which were forwarded to USAA and their agents. USAA and their agents have lied numerous times and have tried dubious (unlawful) tactics seemingly at every encounter. Now, approaching five years after a rear end collision that proved to be nearly fatal to the assured, USAA has an offer of $15,000 on the table. $15,000 as an offer is an insult and is clearly unreasonable, as USAA’s own records show they have owed the assured $15,000 for 4 years. $15,000 as an offer would barely cover the mileage alone in this accident as USAA and their representatives know Whidden (the assured) has driven some 26,000 miles as a result of this loss alone in 5 years. $15,000 as an offer is clearly unlawful and unreasonable as USAA and their representatives owed the assured $15,000 in November 2012 when the crooked claims handling team attempted to short pay the impaired assured. (See Civil Remedy filings in reference to November 19, 20, 2012 correspondence regarding Bryan Krueger and Deborah Cakouros unlawful offer.) (Note the unlawful offer and mishandling referred to in November 2012 was USAA fake attempt to respond to a Civil Remedy filing some 2 months earlier.) The magnitude and multitude of their Conspiracy to Defraud multiplies at each juncture. $15,000 as an offer would not even cover the physical property damage at the scene. USAA has failed in 4+ years to send adjuster to examine vehicles. USAA and their representatives have committed numerous criminal deceptions and unlawful delays. USAA has clearly not made a Good Faith effort at any time. Failing to examine the wreckage for some 5 years is truly upsetting. Making offers more than 90% below the values represented before them in numerous presentations is unreasonable. Making offers for unspecified damages is unlawful. Making wild unsupported assertions to the Commissioner of Insurance alleging issues which have not been brought to the attention of the assured is unlawful. Failure of USAA and their representatives to respond properly, acknowledge or adjust documents is unlawful. Failure of USAA to specify what they need to complete their “investigation” is unlawful. USAA clearly are not, and have not committed to any form of delay or they would have audited and adjusted the accident vehicles 4+ years ago. USAA and their agents have committed numerous “Civil” violations, and have compounded it with numerous CRIMINAL attempts to avoid, deny, and delay their responsibility, while harassing the assured. When does USAA intend to examine and adjust the vehicles involved in a wreck 5 years ago? How on earth can $15,000 be considered “reasonable” by a group so incompetent and bent on distressing the assured?   * Facts and circumstances giving rise to the violation. Enter all words or phrases (one at a time) that should be used to filter. 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. 624.155(1)(b)(3) 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. 626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims. 626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims. 626.9541(1)(i)(3)(e) 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. 626.9541(1)(i)(3)(f) 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. 626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim. 626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. 626.9541(1)(i)(3)(i) Unfair claim settlement practices Other : Section 817, Commercial Conspiracy to Defraud Other : Complicity (Criminal Complicity) Other : Aiding and Abetting Other : Fraud and other criminal concealment, as well as destruction/disposal of documents Other : Intentional Infliction of Emotional Distress Other : Negligent Infliction of Emotional Distress Claim Delay Unsatisfactory Settlement Offer Other : Conspiracy to Defraud Other : A commercial scheme to defraud including but not limited to patterns of fraud Other : Insurance Fraud in partnering with a provider to liquidate assured's benefit package Other : Abuse of Process Other : Deliberate acts to deceive and delay the assured, Insurance Commissioner, and third parties Other : Criminal Mischief Other : Intentional dishonest and deceitful and delayed responses & handling to previous Civil Remedy filing Other : Deliberate acts to delay and deceive proceedings and processes Other : Inequitable Doctrine use of legal counsel to abuse the assured It is almost five years since my accident of 8/29/2010. The insurance company (USAA) never sent anyone to look at my vehicle or any of the vehicles in the accident. USAA and their agents have committed a host of dubious actions and inactions to avoid clear cut responsibility in my loss. USAA has committed numerous heinous stunts to delay, deny, and avoid their responsibility under policy and Florida Law. USAA has tabled several severely unreasonable offers to the assured, in that they keep repeating the same crooked offers. It has been demonstrated in previous Civil Remedy filings that their attempts to settle and their means to attempt settlement have been twisted and are in direct violation of Florida Insurance Ethics requirements. USAA has repeatedly taken undue advantage of someone they know to be hampered by this accident. They have caused undue delay, and have forced the assured/victim to endure abnormal stresses and pressures. USAA knew at the outset this was potentially an “Uninsured Motorist” case. USAA confirmed the vehicle was not insured with Aequicap Casualty Company as stated in the loss report by FHP. Aequicap Casualty failed financially and under went bankruptcy liquidation with the knowledge of USAA. (USAA was notified in Civil Remedy filings of this). USAA filed written response to their assured (Fraud) stating they had discussed issues with the company, yet phone call was made one year after the company had been liquidated based on the Commissioner of Insurances electronic notices and website which were forwarded to USAA and their agents. USAA and their agents have lied numerous times and have tried dubious (unlawful) tactics seemingly at every encounter. Now, approaching five years after a rear end collision that proved to be nearly fatal to the assured, USAA has an offer of $15,000 on the table. $15,000 as an offer is an insult and is clearly unreasonable, as USAA’s own records show they have owed the assured $15,000 for 4 years. $15,000 as an offer would barely cover the mileage alone in this accident as USAA and their representatives know Whidden (the assured) has driven some 26,000 miles as a result of this loss alone in 5 years. $15,000 as an offer is clearly unlawful and unreasonable as USAA and their representatives owed the assured $15,000 in November 2012 when the crooked claims handling team attempted to short pay the impaired assured. (See Civil Remedy filings in reference to November 19, 20, 2012 correspondence regarding Bryan Krueger and Deborah Cakouros unlawful offer.) (Note the unlawful offer and mishandling referred to in November 2012 was USAA fake attempt to respond to a Civil Remedy filing some 2 months earlier.) The magnitude and multitude of their Conspiracy to Defraud multiplies at each juncture. $15,000 as an offer would not even cover the physical property damage at the scene. USAA has failed in 4+ years to send adjuster to examine vehicles. USAA and their representatives have committed numerous criminal deceptions and unlawful delays. USAA has clearly not made a Good Faith effort at any time. Failing to examine the wreckage for some 5 years is truly upsetting. Making offers more than 90% below the values represented before them in numerous presentations is unreasonable. Making offers for unspecified damages is unlawful. Making wild unsupported assertions to the Commissioner of Insurance alleging issues which have not been brought to the attention of the assured is unlawful. Failure of USAA and their representatives to respond properly, acknowledge or adjust documents is unlawful. Failure of USAA to specify what they need to complete their “investigation” is unlawful. USAA clearly are not, and have not committed to any form of delay or they would have audited and adjusted the accident vehicles 4+ years ago. USAA and their agents have committed numerous “Civil” violations, and have compounded it with numerous CRIMINAL attempts to avoid, deny, and delay their responsibility, while harassing the assured. When does USAA intend to examine and adjust the vehicles involved in a wreck 5 years ago? How on earth can $15,000 be considered “reasonable” by a group so incompetent and bent on distressing the assured?

Comments

User Id   Date Added   Comment kvanderlinde@boyd-jenerette.com 04-14-2015 A letter was sent to the Complainant on 4/14/2015 in response to the Civil Remedy Notice.