Filing Number: 796889
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| Filing Accepted: 12/15/2024 |
| Last/Business Name
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| Street Address
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221 KILEY DR |
| City, State Zip
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MONTICELLO,
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32344
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| Email Address
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ALFRITHSR@GMAIL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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USAA |
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First Name |
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ALFRED |
| Policy # * |
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008002075-95A |
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Claim #* |
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801-803 |
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Attorney is Applicable
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| Last Name* |
FRITH
First Name *
ALFRED
Initial
L
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| Street Address* |
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221 KILEY DR |
| City, State Zip* |
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MONTICELLO
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FL
32344
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| Email Address * |
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ALFRITHSR@GMAIL.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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USAA CASUALTY 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 25968 |
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| Name of individual responsible for violation (if any):*
TIM CALHOUN, JOHN ROMERO, CHESLEA WHITESIDE, DAMON LAWRENCE AND USAA MGMT
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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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Claim Denial
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Unfair Trade Practice
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Other
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Improper Claims Handling
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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)(2) |
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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.
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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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| 626.9541(1)(i)(3)(f) |
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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.
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| 626.9541(1)(i)(3)(g) |
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Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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| 626.9541(1)(i)(3)(h) |
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Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
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| 626.9541(1)(i)(3)(j) |
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Altering or amending an insurance adjuster’s report without:
(I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and
(II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or
(III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change;
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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.
Not attempting in good faith to settle claims. Except as to liability coverages, failing to promptly settle claims. Material misrepresentation. Failing to adopt and implement standards for the proper investigation of claims. Misrepresenting pertinent facts or insurance policy provisions relating to coverages. Denying claims without conducting reasonable investigations - in this case closing claims. Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy. Failing to promptly notify the insured of any additional information necessary- in this case waited almost 60 days, asked for duplicate information that USAA already has. Failing to clearly explain the nature of the requested information. Altering or amending an insurance adjuster’s report - both Mr. Hunter and Mr. Romero.
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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.
NOTICE OF INTENT TO SUE AND REQUEST FOR MEDIATION
This is a Notice of Intent to Sue and Request for mediation pursuant to Sections 624.155 and 626.9541, and IAW proceeds set in Section 627.70152, of the Florida Statutes against USAA pursuant to two property claims filed by the undersigned insureds in the aftermath of Hurricane Debby and Hurricane Helene. The statutory basis for this claim are listed on this form. What follows is the factual basis for the lawsuit. USAA has engaged in a practice of unfair and deceptive trade practice as to this claim as to the mishandling and intentional actions taken against my wife and I.
1. My wife and I are insureds under a Homeowners policy, 008002075-95A, with USAA for property located at 221 Kiley Drive, Monticello, Florida 32344. We purchased an endorsement that provided we would receive the replacement value for any damages should we ever file a claim. We are retired. I am an AV rated construction lawyer who has practiced law throughout the state, often defending construction claims on behalf of insurers. My wife is a retired project manager who has worked for insurance carriers during her career. We both are familiar with how a good insurance company should handle valid claims. Never have we seen a more clear instance of bad faith that USAA has inflicted upon us. Our home is a custom home with many features that are made of premium materials. Before USAA would consent to insure our home, they sent their own appraiser in early 2023 to determine the replacement value of our home as it was deemed high value, and to determine if they would insure this property. USAA has documentation as to the house, how it’s constructed, already knowing the quality material. USAA issued the original policy with endorsements effective 1/1/23 and then renewed it on 1/1/24 with endorsements and determined the replacement value to be approximately $1.4 Million in a market that is significantly less than the great majority of the state of Florida.
2. On August 5, 2024, Hurricane Debby hit our property. A giant pecan tree destroyed 1/3 of our home by falling on the east side of the house where our kitchen and dining room is located. The tree itself penetrated the roof in eight places and water poured into our house causing damage to our custom bamboo floors, custom ceiling, lighting, custom kitchen cabinets, and other interior areas. The tree landed on our balcony and completely crushed it. One limb penetrated the roof, attic, ceiling and came through into our dining area ceiling. 21 pecan trees fell altogether throughout our 15-acre property destroying iron and vinyl fences; two of these trees completely blocking our driveway preventing us from leaving the property via the drive; the remainder preventing access through the yard should we needed emergency vehicles. In a driving rain in the middle of the hurricane, my neighbors and I, cut a narrow pathway through the driveway allowing us an emergency exit. I have a serious heart condition and a pacemaker that forced my retirement. I have a video of this effort, as we left the trunk, limbs and debris for after the storm. We immediately filed a claim with USAA which was labeled Claim #801. Ultimately, I paid $18,600 to have the trees removed from my home and other structures because USAA refused to pay the full value of the claim.
3. In order comply with our homeowner’s responsibility to protect our home from further damage, I hired a laborer who manually cut back the tree to a point where the roof was accessible to be tarped and we tarped it. On 8/9/24 USAA sent an independent adjuster, Mr. Brandon Hunter, to assess the damage. We also retained Clayton Bozeman, a public adjuster, to represent our interests. Mr. Bozeman and I accompanied Mr. Hunter, the independent adjuster, as he assessed the damage. Ultimately, the independent adjuster assessed the damage at over $200,000. We have not seen that original report, nor any alterations made by USAA. Both our public adjuster and ourselves have asked for the original report and alterations on several occasions and we have been ignored. Florida Statutes, s.627.7142 , provides that the carrier is obligated to provide that report. That failure alone is bad faith.
4. USAA originally assigned the claim to Chelsea Whiteside. On 9/5/24 we received a settlement. On 9/9/24 we wrote to Ms. Whiteside and rejected that settlement after which the claim was reassigned to Mr. Calhoun in the USAA in the catastrophic claims area. Mr. Calhoun has failed to communicate with us directly, and only after repeated attempts does he even speak to our Public Adjuster. My Calhoun has failed to properly adjust our claim and his complacence been allowed by USAA. Our calls to Mr Calhoun’s supervisor Mr. Damon Lawrence were intercepted by a fellow staff member.
USAA intentionally ignored the report of damages by their independent adjuster and altered that report to “low ball” the insureds (my wife and I) in the hope that we would accept a settlement of less than the actual damage incurred. We immediately advised that their bad faith check was unacceptable and requested a copy of the independent adjusters report as well as the names of all persons at USAA who doctored the report which we are by statute entitled to receive. Again, we were ignored. I worked with the construction industry for 35 years, often with insurance carriers, and know that the damages was at least $250,000 at that point. One example is appropriate. I installed a custom shingled roof approximately 1 year before Hurricane Debby with a lifetime warranty. I know exactly what that roof cost to install as well as the square footage and the pitch. USAA estimated the replacement cost for the damaged area to be $7,000. Meanwhile, we were ignored. In an effort to mitigate damages, I entered into a contract with the original roofer, Smith Roofing to replace the roof (but not the gutters), so that my roof would be watertight as there could be other storms. That contract was for $15,000, which was for the ultimate cost. USAA deliberately undervalued each and every item of damage as a normal business practice in order to defraud us. This is especially egregious given they had appraised them home THEMSELVES some 20 months prior.
5. Per Florida Statute 627.70131 7(a):
"If the insurer’s claim payment is less than specified in any insurer’s detailed estimate of the amount of the loss, the insurer must provide a reasonable explanation in writing of the difference to the policyholder."
We submitted to USAA a detailed Proof of Loss signed 9/23/24 in the amount of $265,005.69 for the Loss from Hurricane Debby. According to the statute cited USAA has failed to provide to us a detailed explanation of the differences. In that proof of loss we provided a multitude of photographs including drone coverage of the damage. We have photos of water pouring into our house, photos to the custom tin ceiling in our kitchen. We have a $28,000 deductible. We have knowledge that the independent adjuster’s report had been altered by USAA.
6. The materials for the CertainTeed Belmont shingle roof were ordered immediately, but they did not arrive before Hurricane Helene hit on September 25/26, 2024. Damage from the prior storm was now exacerbated and we suffered more significant damage to our home. Tarps were shredded in the storm’s 140 mph wind. Water poured through the ceiling further damaging the interior of our property. Our garage where we park our cars was completely blocked by a large oak tree. I used a chain saw to allow us to finally exit our home. On the day before the storm, at my own expense, I had a large pecan tree leaning toward the middle of our house taken down to prevent further damage to our home as had I not done that our entire home would have been destroyed. We lost an additional 18 tree, including one that landed in our driveway again, and one in front of the garage door, while others fell on numerous fences and structures. Ultimately, I paid an additional $10,600 out of pocket to have those trees removed from structures throughout my property because USAA deliberately ignore my claim. My barn suffered significant damage. We immediately filed a second claim for Hurricane Helene, Claim 803.
7. USAA assigned the second claim to John Romero an in-house adjuster. Mr. Romero actually came to our premises with our public adjuster and spent most a full day assessing the damage. Like the first adjuster for Hurricane Debby, Romero took many pictures including pictures of the trees. USAA is in possession of this documentation yet Mr. Calhoun asked us for these again on 12/13/24. Why does Mr. Calhoun request data he already has access to? After Romero’s visit, claim 803 was closed by a form letter with no reasonable explanation thus constituting a Denial of the claim. This was done before our public adjuster could even submit a proof of loss for Helene. Like Hurricane Debby, we supplied extensive photos of the damage to our property. After the claim was closed, Romero arranged for Serve Pro to come to our house for water mitigation; they destroyed a portion of it, under the pretense of drying it out to avoid mold. Wooden floors were ripped apart, Cabinets in our kitchen were removed, drywall was removed, half of the tin roof was removed, and lights were left hanging. Then Serve Pro left and to this day our kitchen is a war zone. Serve Pro damaged and broke several pieces of crystal and slit the actual air conditioner ducts while they were ripping our ceiling apart.
8. On 11/12/24 we received a second low-ball estimate of damages for Hurricane Debby with no mention of Hurricane Helene. It has clearly been altered with annotation that the information came from Mr. Romero’s report; it is NOT the original report from Mr. Romero and it is UNSIGNED. Clearly that report was doctored and low balled by USAA management. We were never given a written explanation for the closure of the claim for Hurricane Helene. We phoned on 11/14 asking for Mr. Calhoun’s supervisor, Mr. Lawrence; the call was intercepted by another individual who stated that claim 803 was rolled into 801. We asked for that information to be sent in writing,
9. It has now been two months since we submitted the actual cost of roof repair that I made at my own expense. Our public adjuster’s attempt to communicate with Mr. Calhoun has been laborious at best. After leaving messages and repeatedly calling USAA’s Main Claims Center Mr. Bozeman “may” be able to obtain a one sentence response from Calhoun. Our communication with Mr. Calhoun continues to be ignored. We have requested in writing the original independent adjusters report from Mr. Hunter as well as from Mr. Romero. We have been ignored. Mr. Calhoun is supposedly handling this claim and his strategy is to delay and ignore. I am not sure why the policy holder must submit an email and then call Mr. Calhoun to tell him the email is there, and to ask him to do his job. Since when is that our burden?
10. We were unable to celebrate Thanksgiving with our extended family, and will be unable to celebrate Christmas due to the damage in our home. Just now on 12/13, Mr. Calhoun requested photos of the trees that we submitted long ago. It seems his new strategy is to request photos that have been provided in order to further delay this claim. He also requested photos of the roof repair that has already been made, 58 days after the paid receipt was sent to him. While it may be within policy guideline, to delay until 2 days shy of 60 days will not sit well with a jury. Mr. Calhoun was given the actual photos with eight holes long ago and the dimensions of the roof that was repaired. I have advanced approximately $50,000 of our money for the roof and the tree removal from structures. We are unable to make our house habitable, let alone to restore it so we are ‘made whole’, without being fairly compensated. We have faithfully paid significant premiums. We have honored our end of the contract.
Summary:
We intend to initiate litigation for our damages incurred for breach of contract against USAA for damages actually incurred for Hurricane Debby which are over $265,005.69 as per the Proof of Loss. We intend to seek damages for policy limits for denial of our claim for Hurricane Helene. We intend to depose each and every executive at USAA that doctored and reduced internal reports. We will reserve the right to sue for bad faith after discovery proves us right, as well as seek recovery for attorney’s fees for my time, which I am keeping as I am a licensed attorney in the State of Florida. USAA has, we believe, a normal business practice of low-balling valid claims; thus effectively denying the claim in the hope that the insured does not have the resources to validate their rights in court. My law license is fully active and I will not rest until we are fairly compensated. After USAA’s actions, my cardiologist office reached to me to advised me that my heart rate was accelerated at an abnormally high rate and I had to have my medication adjusted for my own protection.
USAA needs to be investigated by you as Insurance Commissioner. I would be happy to testify. However, I recognize that I have to wait 60 days to sue and I am willing to mediate as I have mediated hundreds of cases as a construction lawyer, many for legitimate insurance companies. So many people are not as fortunate as we are and we are mindful of that. Although the Legislature has made it difficult to sue for bad faith, it has not eliminated this method of recovery for egregious cases. The larger question is what are you doing to prevent companies like USAA from preying upon the less fortunate? Please serve this notice on USAA as is required by law. Thank you.
Alfred L. Frith, Sr. Esq and Diane D. Frith, insureds Dated 12/15/24
221 Kiley Dr, Monticello, Fl 32344. 850-408-1092
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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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