Filing Number: 785224
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| Filing Accepted: 10/1/2024 |
| Last/Business Name
*
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GOMEZ III
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First Name |
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FERNANDO |
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| Street Address
*
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4 MULLIGAN CT |
| City, State Zip
*
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OCALA,
FL
34472
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| Email Address
*
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FVGOMEZ0509@GMAIL.COM |
| Complainant Type:
*
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Insured |
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| Last/Business Name* |
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GOMEZ III |
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First Name |
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FERNANDO |
| Policy # * |
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1482926495A |
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Claim #* |
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14829264-014 |
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Attorney is Applicable
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| Last Name* |
STRUBLE
First Name *
MATTHEW
Initial
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| Street Address* |
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325 FIFTH AVENUE, SUITE 103 |
| City, State Zip* |
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INDIALANTIC
,
FLORIDA
32903
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| Email Address * |
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SERVICE@STRUBLECOHEN.COM |
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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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UNITED SERVICES AUTOMOBILE ASSOCIATION
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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 25941 |
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| Name of individual responsible for violation (if any):*
AND ALL ADJUSTERS, SUPERVISORS, MANAGEMENT AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY UNITED SERVICES AUTOMOBILE ASSOCIATION RELATED TO THIS CLAIM
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| Type of Insurance
*
Residential Property & Casualty
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| Reason for Notice
*
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Claim Denial
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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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| 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)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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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.
There are no policy provision specifically at issue or in dispute, the policy provides coverage resulting from Hail and Wind but United Services Automobile Association has failed to extend coverage for repairs needed for the insured 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.
Insurer issued an insurance policy bearing policy number 1482926495A with effective dates of coverage from May, 31, 2022 to May 31, 2023, which insured the property located at 4 Mulligan Ct, Ocala, Florida 34472. The policy was in effect when the property sustained damage on or about March 18, 2023, when damage was caused by Hail and Wind.
United Services Automobile Association (“Insurer”) received notice of the claim for property damage resulting from Hail and Wind, and related damages on or about March 18, 2023. The damage was reported to Insurer which assigned Claim Number 14829264-014 to the claim and investigated the claim. Insurer failed to retain the experts needed to perform the inspection and needed to address the damage at issue and determine the repairs needed to restore the property. Insurer has been provided with documents establishing that the claim is covered, despite this being apparent from the condition of the property alone. Insurer has failed to extend coverage for payments owed and has refused to attempt to settle the claim with its insured.
Insurer’s delay in issuing payment is causing and will cause the insured to sustain extra-contractual damages not covered by the property, including loss of use and enjoyment of the property and related damages, costs associated with hiring adjusters and experts, among other damages and these uninsured damages would not have occurred but for the insurer ’s failure to timely issue payments owed. In this claim and as a business practice, insurer fails to retain experts needed to investigate claims, ignores evidence establishing coverage and avoids covered repairs to attempt to avoid issuing payments owed pursuant to the insurance policy.
Insurer can cure these violations by attempting to settle the claim in good faith and issuing payment for the remaining contractual damages owed. As Insurer is aware, issuing payment for contractual damages owed will preclude recovery of extra-contractual damages already incurred, and that will be incurred, and the contractual damages should immediately be paid and be paid within 60 days from the date of this notice. Due to applicable Florida Statutes, and the insurance policy’s payment provisions, the payment issued should also include interest. If insurer contends there is somehow more information needed that was not already provided, it should immediately advise the insured’s attorney what information is needed.
Insurer has been provided with information establishing that the claim is covered but has failed to extend coverage for the claim. Insurer’s denial of the claim and refusal to issue payment is a breach of the insurance policy.
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*
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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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