Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 790842

Filing Accepted: 11/7/2024

Print Filing

Complainant

Last/Business Name *

WADE

First Name

JUSTIN

Street Address *

7122 EMILY DRIVE

City, State Zip *

FT MYERS, FL 33908

Email Address *

JUSTINWADE79@GMAIL.COM

Complainant Type: *

Insured

Last/Business Name*		WADE		First Name		JUSTIN
Policy # *		GIC02630408492A		Claim #*		026304084-014

Attorney

Attorney is Applicable

Last Name*	POWELL First Name * CORY Initial J
Street Address*		5701 PARK BLVD N
City, State Zip*		PINELLAS PARK , FLORIDA 33781
Email Address *		CORY@HERMANWELLS.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		USAA GENERAL INDEMNITY COMPANY
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 18600

Name of individual responsible for violation (if any):* JOSE
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Denial
	Claim Delay
	Unsatisfactory Settlement Offer
	Unfair Trade Practice

* 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)(2)		A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
	626.9541(1)(i)(3)(a)		Failing to adopt and implement standards for the proper investigation of claims.
	626.9541(1)(i)(3)(b)		Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
	626.9541(1)(i)(3)(d)		Denying claims without conducting reasonable investigations based upon available information.
	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)(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.

Section 1 coverage A; which includes damage caused by wind and named storms to the insured property as listed on the declarations page. Additionally, the carrier violated clauses under the Duties After Loss, Loss Settlement, and Loss Payment provisions of the applicable policy. USAA failed to adequately adjust and pay the claim covered under the subject insurance policy. Specifically, but not limited to, USAA failed to properly apply the declaration pages of the policy, Loss Settlement and Loss Payment provisions of the policy, and all provisions of the policy providing coverage for the damage caused by wind from a named storm and the ensuing damage to the insured property as a result of the covered loss. In addition to the policy sections specifically cited herein, any endorsements or changes to said sections are relevant to the Insureds’ claim for civil remedy. USAA has failed to timely adjust and pay the contractual amount owed the Insureds for a covered loss, has failed to communicate adequately with the insureds and the insureds’ representatives, and has mishandled Insureds’ claim on multiple occasions. There may be additional policy language relevant to this violation and the other violations set forth in the policy that may be discovered. USAA has violated the statutory requirement that they act fairly and honestly toward the Insureds and with due regard for the Insured’s interests.

* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

A loss occurred on September 28, 2022, during which the property was damaged due to wind caused by Hurricane Ian, which caused ensuing damages to the insureds; property. The insureds reported the loss to USAA immediately following the hurricane. On October 19, 2022, USAA partially denied the claim, wrongfully alleging that some damages—particularly windows and drywall—were not covered due to policy exclusions for wear and tear, marring, and deterioration, without sufficient evidence to back their assertion for partial denial. USAA also drastically underestimated the scope and costs of the repairs necessary to make the property whole after the damages sustained from a covered loss, and misappropriated attached structures as other structures under the policy. On November 14, 2022, the insureds provided USAA with a contractor’s estimate to repair the damages caused by Hurricane Ian. This estimate greatly exceeded the scope and cost of the estimate generated on behalf of USAA. Upon submitting the estimate, the insureds informed USAA that they were seeking to amicably resolve this claim without the need for getting third parties involved. USAA requested reinspection, to which the insureds immediately agreed, and USAA reinspected and continued to underpay the claim. The insured subsequently sought representation by the undersigned counsel, who communicated with USAA via Letter of Representation. On May 20, 2024, undersigned counsel submitted a request for payment letter on behalf of the insureds. The request for payment detailed the areas in which USAA undervalued the claim, and provided USAA with supporting documents and 14 days to respond. On May 28, USAA informed undersigned counsel that they are not able to access the link provided for supporting documents for the request for payment letter. Undersigned counsel’s office then tried to email all supporting documents to the claim email assigned by USAA, but received notifications that the email could not be delivered. Undersigned’s office then made multiple calls to attempt to discern how supporting documents should be submitted, and on June 11, undersigned’s office was informed that the only way to do so was to send each document individually through many emails. Despite this frustrating process, undersigned counsel’s office submitted ten separate emails on June 12, 2024, to provide all the necessary documents to support the insureds request for payment, and provided a week extension to review the documents and respond to the request for payment letter. On July 10, 2024, after receiving no response from USAA, undersigned sent an email to the address assigned to the claim by USAA explaining that the request for payment letter was sent two months prior, and that supporting documents were provided again on June 12, and requested an update on a response to the request for payment letter. On July 23, 2024, undersigned counsel emailed USAA once again to advise that it had been another two weeks since the request for status update, and USAA still had not responded to the letter or undersigned’s emails. The email explained that the insureds are actively attempting to resolve the claim without the need for litigation, and asked USAA to respond before undersigned had no choice but to elevate the claim toward litigation. Undersigned counsel did not receive a response to the July 23, 2024, email, in which undersigned provided USAA with every opportunity to discuss the claim prior to seeking litigation; as such, on August 21, 2024, undersigned counsel file a Notice of Intent to Initiate Litigation with the DFS, in an attempt to have USAA recognize the claim and to put USAA on notice that the insureds intended to file a lawsuit, based on the poor adjustment of their claim and the lack of response from USAA when the insureds were attempting to resolve the claim in good faith. On August 30, 2024, USAA responded to the Notice of Intent to Litigate in an email, stating that USAA is standing on its prior decision. USAA’s email response to the Notice of Intent did not include a formal response on letterhead, any supporting documents, and did not give any indication that the multiple supporting documents submitted by undersigned counsel were taken into consideration, or even reviewed. The insured then filed suit on September 27, 2024. The insureds contend that USAA has failed to properly adjust this claim and has failed to issue the payment due under the applicable policy of insurance. USAA has mishandled this claim in multiple ways, including failing to adequately adjust the claim and failing to adequately communicate with the insureds and the insureds’ representatives at multiple times during the adjustment of this claim. Despite asserting otherwise, USAA has had all relevant information to properly adjust this claim. USAA initially undervalued the claim, and then ignored subsequent documents submitted by the insureds. USAA then ignored the request for payment letter and supporting documents submitted by undersigned counsel on behalf of the insureds. USAA then responded to the Notice of Intent to Litigate by simply sending a brief email standing on its initial position and without providing any supporting documents or reasoning for its decision, and without any indication that USAA reviewed the supplemental documents and request for payment letter submitted by undersigned counsel on behalf of the insureds. USAA has violated Florida law (Section 626.9541(1)(i)(3)(a)) by failing to adopt and implement standards for the proper investigation of claims. Had USAA adopted and implemented standards for the proper investigation of claims, it would have recognized that the Insureds’ property required a great deal more repairs due to the damage it sustained on the date of loss, it would have hired adjusters who are properly trained to identify and correctly estimate hurricane and/or wind damages, it would have recognized that the Insureds’ damage estimates are reasonable and should be paid, and it would have already paid the Insureds the amount reasonably necessary to bring the Insureds’ property to its pre-loss condition subject to the terms of the policy. Instead, USAA has taught its adjusters how to deny or low-ball claims by delaying a claim by any means possible and then ignoring obvious covered damage. USAA has violated Florida law (Section 626.9541(1)(i)(3)(b)) by misrepresenting pertinent facts and insurance policy provisions relating to coverages at issue. Specifically, USAA’s coverage decision is a misrepresentation of the scope of the damage to the property payable under the Policy. Further, USAA’s October 19, 2022, correspondence to the Insureds violates Section 626.9541(1)(i)(3)(b) because the carrier misrepresents the amount of damages to the insureds’ property that are covered under the applicable policy. USAA has violated Florida law (Section 626.9541(1)(i)(3)(d)) by denying the Insureds’ claim without conducting a reasonable investigation based upon available information. USAA’s investigation is unsatisfactory and unreasonable given that it undervalued the claim. USAA has ignored obvious facts, including substantial water damage. USAA has violated Florida law (Section 626.9541(1)(i)(3)(f)) by failing to promptly provide a reasonable explanation in writing to the Insureds of the basis in the insurance policy, in relation to the facts and applicable law, as well as for not paying the amount reasonably necessary to bring the property to its pre-loss condition. USAA has violated Florida law (Section 626.9541(1)(i)(3)(g)) by failing to promptly notify the Insureds of any additional information necessary for the processing of its claim. USAA was informed at multiple intervals by the insureds’ representatives that all obtainable and relevant documents had been provided, per USAA’s request, and USAA failed to specify the specific documents it thought was in the insured’s care, custody, or control, that USAA believed was necessary to properly adjust the claim. USAA has violated Florida law (Section 624.155(1)(b)(1.)) by not attempting in good faith to settle the insureds’ claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward the insureds and with due regard for the insureds’ interests. USAA’s undervaluation of this claim is evidence that it is not acting fairly or honestly with due regard for the insureds’ interests. Further, because USAA is ignoring and disregarding the insureds’ damage estimates, USAA is showing that they are not attempting in good faith to settle the insureds’ claim. Rather, USAA is putting its own financial interests above the insureds’ even though it knows or should know that the insureds’ damage estimates are reasonable. USAA has violated Florida law (Section 626.9541(1)(i)(2) by misrepresenting the policy provisions in order to attempt to resolve the claim under less favorable terms for the insureds. By improperly undervaluing the claim and by erroneously continuing to request documents, and subsequently erroneously standing on its prior determination without any indication that the provided documents were reviewed and take into account during adjustment of the claim, USAA is seeking to unreasonably delay this claim and ultimately attempt to force the insureds to attempt to resolve the claim for an amount less than the cost to return the property to its pre-loss condition. Rather than carrying out its contractual, statutory, regulatory, and ethical duties that it owed to the Insureds, USAA committed acts which were not in good faith and were in violation of Florida Statute § 624.155(1) (b)(1) and Florida Statute § 626.9541(1)(i). These acts include: a. Not attempting in good faith to settle the insureds’ claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward the Insureds and with due regard for the Insureds’ interests. b. Failing to properly investigate the insureds’ claim. c. Unsatisfactory settlement offers. d. Attempting to find ways to delay and improperly deny the insureds’ claim rather than providing prompt and proper indemnity to the Insureds for ithe claim. e. Creating a hostile and adversarial investigation and adjustment of the insureds’ insurance claim. f. Failing to properly train, supervise, or otherwise manage adjusters, representatives, and investigators to properly, promptly, and in good faith, investigate and adjust claims so that a prompt and fair evaluation of the claim can be made, and proper indemnity paid, resulting in the failure to timely pay the insureds’ covered claim. g. Failing to adopt and implement standards for the proper investigation of the insureds’ claim, resulting in the aforementioned conduct. h. Retaining outcome-oriented adjusters and experts. i. Misrepresenting, ignoring, and/or omitting pertinent facts relating to the coverages and/or facts of the loss at issue, so as to provide an illegitimate, unjustified, and/or unfounded basis for denying, delaying, and/or underpaying the insureds’ claim. j. Denying and delaying the insureds’ claim without conducting a reasonable investigation based upon available information. k. Failing to promptly provide a reasonable explanation in writing to the insureds of the basis in the Policy, in relation to the facts and/or applicable law, for the denial of the insureds’ claimed damages. l. Failing to timely pay the contractual amount owed the insureds under the Policy for the claim in a manner consistent with the Policy and Florida law. m. Failing to promptly notify the insureds of information necessary for the processing of the claim. n. Training, evaluating, and promoting adjusters and claims management based on reduction of claim payments rather than promptly and fully paying the contractual amount owed to the insureds under the Policy for its claim. USAA has not attempted in good faith to settle the Insureds’ claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward the insureds and with due regard for the insureds’ interests. This is a violation of Florida law. USAA has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the insureds’ insurance claim for damages. Instead, USAA is relying upon adjusters and claims representatives who are biased, untrained, and unable to properly and timely investigate and pay claims. USAA has failed to pay for covered property damage caused by a Covered Cause of Loss, namely, substantial wind and ensuing damage caused by a named storm. By not completing a proper investigation of the insureds’ claim in a timely manner and paying the insureds the amount reasonably necessary to bring the insured building to its pre-loss condition by fully paying for damages, USAA has effectively denied the insureds’ claim. USAA has failed to complete a thorough and unbiased evaluation of the insureds’ damage and claim, and that failure has caused additional damages and financial harm to the insureds, including refusing to pay for damage caused by a covered cause of loss. USAA has ignored important information that would benefit the insureds. The insureds sustained a covered loss as a result of wind and ensuing damages caused by a named storm. The Insureds timely reported the damage to USAA. USAA has failed to tender all insurance monies due and owing the insureds for the damage. USAA charged the insureds a premium for property insurance but has refused and/or failed to tender all insurance monies under the policy, when under all circumstances it could have and should have done so had it acted fairly and honestly towards the insureds. Additionally, the insureds contend this is done company-wide and that other insureds have been refused insurance monies under USAA’s policies in the same or similar circumstances. USAA has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the insureds’ insurance claim for damages. USAA has refused and/or failed to tender all insurance proceeds to the insureds upon demand as required by the policy and/or law. USAA commits this practice only to keep claims adjustment process open and pending so they do not have to pay fully on the claim. This is wrong. Therefore, to cure the defects outlined in this Civil Remedy Notice, USAA must: 1. Immediately tender the amount reasonably necessary to bring the insureds’ property to its pre-loss condition, subject to the terms of the policy, which includes full repair and/or replacement to all covered damages, including corresponding interior damages; 2. Act fairly and honestly towards the Insureds and with due regard for the insureds’ interests in attempting to settle the insureds’ claim; 3. Pay statutory interest on the amount of unpaid contract damages from the date of the loss to the date of its payment of outstanding damages owed under the insurance policy; 4. Cease and desist all present and future bad faith actions with regard to the insureds’ claim. Failure to cure all defects may result in additional extra-contractual damages. This notice is given in order to preserve and perfect the right to pursue the civil remedy authorized by Florida Statutes, including any and all bad faith/extra contractual and punitive damages, should USAA fail to cure the violations set forth in this Civil Remedy Notice within the given cure period.

Comments

User Id		Date Added		Comment
jose.coss@usaa.com		12-18-2024		We acknowledge receipt of a Civil Remedy Notice of Insurer Violation submitted to the Fla. Dept. of Financial Services your office filed on behalf of your clients, Justin Wade. A more abbreviated response to your CRN has also been issued via the Florida Department of Financial Services CRN website. As an initial matter, the CRN lacks the specificity required by §624.155(3)(b), Fla. Stat. The Department of Financial Services should have rejected and returned the CRN based upon that deficiency. Further, the CRN fails to provide certain facts and circumstances giving rise to your stated allegations. Notwithstanding the lack of specificity, and without waiving any objections to, or remedies or defenses available to USAA because of those deficiencies or otherwise, USAA denies each and every allegation of insurer violation or wrongdoing set forth in the CRN. USAA has complied with the provisions of its policy and Florida law in addressing the above referenced claim.
jose.campos@csklegal.com		12-11-2024		LAKESIDE OFFICE CENTER, SUITE500 600 NORTH PINE ISLAND ROAD PLANTATION, FLORIDA 33324 TELEPHONE (954) 473-1112 FACSIMILE (954) 474-7979 DIRECT LINE (954) 703-3797 sean.sabogal@csklegal.com December 11, 2024 VIA EMAIL Cory J. Powell, Esq. 5701 Park Blvd N Pinellas Park, FL 33781 Re: Complainant: Justin Wade and Judith Wade Insurer: Claim No.: Policy No.: DFS No.: USAA General Indemnity Company 026304084-014 GIC02630408492A 790842 RE: CRN Response Dear Mr. Powell: The undersigned attorneys represent USAA General Indemnity Company (hereinafter “USAA” ) with respect to the above-referenced Civil Remedy Notice of Insurer Violation (hereinafter referred to as “CRN”). This response is provided on behalf of USAA and all of its employees, agents, officers, and affiliates. The Department of Financial Services accepted the CRN on November 07, 2024. Therefore, this response has been timely filed within the statutory deadline. At all times during the investigation and adjustment of the Insured, Justin Wade and Judith Wade’s, claim, USAA has acted in good faith. USAA has also acted fairly and honestly towards the claim and has acted with due regard for the insured’s and the insured’s beneficiaries’ interests. Moreover, USAA has acted in conformity with all other requirements set forth in §624.155, Florida Statutes. Further, USAA has investigated and adjusted the claim pursuant to the appropriate standards governing the investigation of claims. I. Specificity Requirement Justin Wade and Judith Wade violate multiple requirements set forth in the Florida courts’ jurisprudence for civil remedy notices, and it fails to meet the requirements of the Statute. Respectfully, USAA requests the Department return the CRN and instructs that the insureds provide the facts required for civil remedy notices. See Section 624.155(3)(c), Florida Statutes. These requirements arise from the provisions of Section 624.155: (3)(a) As a condition precedent to bringing an action under this section, the department and the authorized insurer must have been given 60 days' written notice of the violation. If the department returns a notice for lack of Cole, Scott & Kissane www.csklegal.com Miami \| Fort Lauderdale West \| Fort Lauderdale East \| West Palm Beach \| Orlando \| Jacksonville North Jacksonville South \| Tampa \| Bonita Springs \| Pensacola \| Fort Myers \| Tallahassee \| Key West Mr. Powell December 11, 2024 Page 2 specificity, the 60-day time period shall not begin until a proper notice is filed. (b) The notice shall be on a form provided by the department and shall state with specificity the following information, and such other information as the department may require (emphasis added): 1. The statutory provision, including the specific language of the statute, which the authorized insurer allegedly violated. 2. The facts and circumstances giving rise to the violation. 3. The name of any individual involved in the violation. 4. Reference to specific policy language that is relevant to the violation, if any. If the person bringing the civil action is a third-party claimant, she or he shall not be required to reference the specific policy language if the authorized insurer has not provided a copy of the policy to the third- party claimant pursuant to written request. 5. A statement that the notice is given in order to perfect the right to pursue the civil remedy authorized by this section. In interpreting this statute, courts have emphasized the importance of filing specific civil remedy notices. The civil remedy notice is “crucial to the procedural integrity of an action” under the Statute. Allstate Ins. Co. v. Clohessy, 32 F.Supp.2d 1328, 1333 (M.D. Fla. 1998). “It is, without a doubt, a condition that must be satisfied in order for one to perfect the right to sue under the statute.” Id. “In creating this statutory remedy for bad-faith actions, the Legislature provided this sixty day window as a last opportunity for insurers to comply with their claim-handling obligations when a good-faith decision by the insurer would indicate that contractual benefits are owed.” Talat Enterprises, Inc. v. Aetna Cas. & Sur. Co., 753 So.2d 1284 (Fla. 2000). Thus, the CRN cannot be “vague and ‘shotgun’ in nature,” rather than “the type of specific notice required by the statute that would allow [the insurer] an opportunity to cure.” Heritage Corp. of South Florida v. National Union Fire Ins. Co. of Pittsburgh, PA, 580 F. Supp. 2d 1294, 1299 (S.D. Fla. 2008). Because it is in derogation of the common law, Section 624.155(1)(b), Florida Statutes must be strictly construed. Talat, 753 So.2d at 1283 (citing Baxter v. Royal Indem. Co., 285 So.2d 652 (Fla. 1st DCA 1973). To perfect the right to sue under the statute, the insured must specifically notify the insured of any and all alleged violations claimed. Talat Enterprises, Inc. v. Aetna Casualty & Surety Co., 952 F.Supp. 773, 776 (M.D. Fla. 1996) (“Talat I”). In Valenti, the District Court for the Middle District of Florida considered the practical consequences of an insured’s non-specific civil remedy notice. Valenti v. Unum Life Ins. Co. of America, 2006 WL 1627276 (M.D. Fla. 2006). The plaintiff’s civil remedy notice included allegations that the defendant conducted an inadequate investigation. The plaintiff, however, failed to identify with the requisite specificity the defendant’s actions that were inadequate. The Mr. Powell December 11, 2024 Page 3 Middle District held that the plaintiff’s civil remedy notice was insufficient, and stated the following: [T]he civil remedy notice must be specific enough to provide insurers notice of the wrongdoing so the insurer can cure the same within sixty days. … Plaintiff’s counsel, during the hearing in this matter, argued a civil remedy notice that states “you denied my claim” should be sufficient to place the insurer on notice of what was needed to be cured. Plaintiff’s counsel further argued that it was up to the insurer, as the insurance expert, to decipher what actions needed to be cured. This argument, in this Court's estimation, is illogical and is counter to the purpose of the civil remedy notice. If a simple “you denied my claim” was sufficient to put insurers on notice, the sixty-day cure period would be little more than a guessing game with the insurer attempting to correctly guess what errors the insured claimed it made in the claims handling process, or risk defending a bad faith action. This surely is not what the legislature had in mind when it created the civil remedy notice. Accordingly, this Court finds that Plaintiffs allegation that Defendant failed to conduct an adequate investigation is insufficient to provide Defendant an opportunity to cure. Id. at 2. The guidance for an insured could not be clearer. “The purpose of the civil remedy notice is to give the insurer one last chance to settle a claim with its insured and avoid unnecessary bad faith litigation.” Lane v. Westfield Insurance Co., 862 So.2d 774, 779 (Fla. 5th DCA 2004). Its purpose is not “to give the insured a right of action to proceed against the insurer even after the insured’s claim has been paid or resolved.” Id. Ultimately, conclusory allegations without facts fail to perfect a statutory bad faith claim. Merely alleging the bare minimum allegations is insufficient pursuant to Florida courts’ interpretations of Section 624.155, Florida Statutes. II. The Elements of a Valid Civil Remedy Notice There are at least eight requirements for a valid civil remedy notice. Pursuant to Section 624.155(3)(c)’s requirement that a civil remedy notice must set forth the “facts and circumstances giving rise to the violation,” a valid civil remedy notice must contain the following: 1. “explain how the [insurer] violated [the statutes],” Heritage Corp., 580 F.Supp. 2d at 1299; 2. “explain the amounts of damage at issue caused by the [insurer’s] alleged statutory violations,” rather than caused by the loss itself, Id.; 3. provide the facts showing “knowledge and/or delay on the insurance company’s part,” 316, Inc. v. Maryland Cas. Co., 625 F. Supp. 2d 1187, 1192 (N.D. Fla. 2008). 4. provide the facts supporting the specific contractual damages allegedly owed rather than merely the policy limits, Id. at 1193; Mr. Powell December 11, 2024 Page 4 5. if an inadequate investigation is alleged, the civil remedy notice must be specific enough to allow the insurer to conduct an additional investigation, Nowak v. Lexington Ins. Co., 464 F.Supp.2d 1248, 1252 (S.D. Fla. 2006). Additionally, subsections (3)(a)1., 3., and 4. require: 6. “the statutory provision, including the specific language of the statute, which the authorized insurer allegedly violated;” 7. “the name of any individual involved in the violation;” and 8. “reference to specific policy language that is relevant to the violation.” As noted, the first five requirements mandate the insured to provide specific facts and circumstances of the alleged violations. This would necessarily include specific facts regarding the method of the investigation; the reasons the investigation was improper or otherwise inadequate; the reasons why this alleged inadequacy is due to the failure to adopt and implement standards for the proper investigation of claims, and the facts supporting these conclusions. To allege an inadequate investigation, the Notice must include specific facts regarding the method, rather than merely the results. Valenti, 2006 WL 1627276, at 1. Florida law does not allow an insured, without providing any facts, to allege that the insurer’s only option to avoid bad faith is paying whatever the insured demands. 316, Inc., 625 F.Supp.2d at 1194. Requirements two and four regarding the alleged damages must also be specifically provided in the civil remedy notices. Importantly, the Talat court held that payment of undisputed damages within the cure period is sufficient to preclude a statutory bad faith action. In that circumstance, the insurer has “timely paid ‘the damages’ and has corrected ‘the circumstances giving rise to the violation’ within the meaning of [Section 624.155(2)(d), Florida Statutes].” Id. at 1281. The insurer is not required to pay any compensatory damages that flow from any alleged delay in settling the claim. Importantly, only the contractual benefits are owed during the 60-day cure period. To provide an insurer with the notice of the contractual and extra-contractual damages, Florida law clearly requires facts supporting the amount. Merely requesting policy limits without any basis renders the civil remedy notice invalid. If the civil remedy notice does not satisfy each of the eight elements, it cannot be considered valid pursuant to the Florida case authority cited above. The Insureds’ CRN is deficient for a number of reasons. The CRN fails to include necessary facts that provide context to their statutory allegations. Insureds simply listed a laundry list of statutory violations and alleged USAA committed the violations, just to see which ones stick. The aggregate of the CRN’s deficiencies causes the CRN to fall woefully short of providing notice to USAA of any alleged wrongdoing, and these glaring deficiencies deny USAA the ability to cure the alleged wrongdoing within sixty (60) days. Mr. Powell December 11, 2024 Page 5 III. Summary of Facts On September 28, 2022, the insureds, Judith Wade and Justin Wade, initially reported a claim for damage to the roof and interior of their property that occurred on September 28, 2022. USAA promptly acknowledged the claim on September 28, 2022, and even made contact with the Insureds in the days after. The field adjuster inspection took place on October 07, 2022, and November 18, 2022, in two good faith inspections. USAA also issued various settlement letters and made supplemental payments. The partial payment letters stated, in detail, what damages were found and what policy provisions applied. The Insureds were subsequently advised of the determinations in detail. USAA has always been in contact with the insured via phone or promptly responded to correspondence. USAA has always been transparent with its coverage decisions and provided estimates to the Insureds and their representatives. All valuations were made in good faith and USAA works with Insureds on supplementals. IV. The Statutory Allegations Are Without Merit The CRN alleges several statutory violations without adequate facts to support the same. Rather, than stating the required specific underlying facts, the CRN simply alleges that any and all actions taken by USAA were wrongful. The factual analysis above, however, implicitly addresses many of the unsupported statutory allegations set forth in the CRN, making it clear that USAA acted fairly in evaluating and investigating the claim. Consequently, allegations of non-renewal, unsatisfactory settlement offer, unfair trade practice, as well as the following statutory allegations are unsupported and largely without merit: 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. Insureds fail to allege facts that support this statutory allegation. USAA has been honest and fair in the evaluation of the claim, and therefore demands that Insureds provides documentation to support this statutory allegation other than just a mere disagreement with the carrier’s repair estimations. 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. Insureds fail to allege facts that support this statutory allegation. USAA has been honest and fair in the evaluation of the claim, including promptly resolving the claim and working with Insureds on additional supplemental payments, never to influence settlement under other portions of the insurance policy coverage, and therefore Mr. Powell December 11, 2024 Page 6 demands that Insureds provide documentation to support this statutory allegation other than just a mere disagreement with the carrier’s repair estimations. 626.9541(1)(i)(2) A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy. Insureds have not provided a single fact to support this allegation, which is hereby denied. This allegation is simply baseless. USAA completed a thorough investigation of Insured’s documentation and completed inspections of the property in a timely manner. USAA issued its various coverage determinations to the Insured based off supporting facts and applicable policy language. USAA never made a representation to the Insured to gain an advantage or place the Insured in a less favorable position. USAA demands that Insured provide documentation to support this statutory allegation, other than just mere disagreement with the factual findings from USAA. 626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims. Insureds fail to allege facts that support this statutory allegation. USAA implemented standards for the proper investigation of claims, and therefore demands that Insureds provide documentation to support this statutory allegation. 626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. Insureds failed to allege facts that support this statutory allegation. USAA has been honest and fair in the evaluation of the claim, including as to pertinent facts and interpretation of policy provisions, and therefore demands that Insureds provide documentation to support this statutory allegation. Nothing about the facts or insurance policy provisions are misrepresented and the policy provisions are clear and well defined which Insureds signed onto. 626.9541(1)(i)(3)(d): Denying claims without conducting reasonable investigations based upon available information. Insureds fail to allege facts that support this statutory allegation. USAA conducted reasonable investigations based upon the Mr. Powell December 11, 2024 Page 7 information in this claim, and therefore demands that USAA provide documentation to support this statutory allegation. 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. Insureds failed to allege facts that support this statutory allegation. USAA opened up partial coverage for the claim in its detailed coverage determinations to the Insureds and estimates provided for repairs. As such, USAA has given a reasonable explanation of the basis of its repair estimations. Therefore, USAA demands that Insureds provide documentation to support this statutory allegation. 626.9541(1)(i)(3)(g): Failing to promptly notify the insured of any additional information necessary for the processing of a claim. Insureds fail to allege facts that support this statutory allegation, and therefore demands that USAA provide documentation to support this statutory allegation. USAA has promptly communicated and exchanged correspondence with the Insureds and has spoken to Insureds repeatedly on various occasions. 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). Insureds fail to allege facts that support this statutory allegation, and therefore demand that Insureds provide documentation to support this statutory allegation. Moreover, this is not a claim for which PIP benefits apply and there were no personal injuries. The carrier, USAA, also denies the Insureds baseless general statutory violation allegations of Fla. Stat. 624.155(1)(b)(1) and Fla. Stat. 626.9541(1)(i) that Insureds are including as an inappropriate “catch all,” to encompass further violations. USAA demands strict proof thereof and more specificity for the Insureds’ baseless allegations more than just mere general assertions. USAA has thoroughly investigated the Insureds’ claims and provided coverage pursuant reasonable investigations. V. Conclusion The facts referenced in the CRN are inaccurate, incomplete, and premature. Simply because your client disagrees with USAA does not establish that USAA acted in bad faith. You have not produced any evidence to substantiate the aforementioned allegations. Furthermore, the bare nature of the CRN does not allow for a more specific response to the alleged violations. USAA Mr. Powell December 11, 2024 Page 8 will provide a further response and consider the same if and when any additional information is provided relative to any alleged violation. USAA continues to reserve all of its rights. We trust this fully and adequately responds to any inquiry regarding the claim of Justin Wade and Judith Wade. If you have any questions or require further clarification with regard to the above, please do not hesitate to contact us. Sincerely, /s/ Sean Sabogal, Esq. Alexander S. Bistritz Sean Sabogal

Acknowledgement
*	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.

DFS-10-363
Rev. 10/14/2008