Civil Remedy Notice of Insurer Violations
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Filing Number:     799011
Filing Accepted:  1/3/2025
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Complainant
Last/Business Name *  
DAVID M. BEK AND EVE A. BARTON   First Name  
Street Address * 4157 RIVER BANK WAY
City, State Zip * PORT CHARLOTTE, FL 33980
Email Address * FIVEBEKS@HOTMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   DAVID M. BEK AND EVE A. BARTON   First Name  
Policy # * 009567427/91A Claim #* 009567427-022
Attorney
Attorney is Applicable
Last Name* MONTAZER First Name * ARDALAN Initial
Street Address* 925 FEDERAL HWY
City, State Zip* BOCA RATON , FL 33432
Email Address * AMONTAZER@KPATTORNEY.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   USAA CASUALTY INSURANCE COMPANY
NAIC Company Code 25968
 
Name of individual responsible for violation (if any):* CLAIMS DEPARTMENT
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unfair Trade Practice
Claim Delay
* 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)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

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

The carrier was put on notice of the insured’s Hurricane Ian claim. The carrier initially attempted to low-ball the claim. Subsequently, the insured prepared a loss package in the amount of $44,575.61 needed to restore the property back to its pre-loss condition. Whereas, the carrier wrongfully represented the damages to the insured’s property to be below the policy deductible. Additionally, the carrier did not appropriately address the need for the replacement of the insured’s roof due to the tiles being discontinued, allegedly relying on the wrongful findings of a representative who it is believed was instructed to look for any signs of damage that could be attributed to any causes of loss excluded under the policy and to disregard any evidence of wind damage to the roof for the purpose of wrongfully low-balling the claim as a whole. The insured has complied with all of the carrier’s requests to date and the carrier has still failed to treat this claim with good faith. This intentional delay with the claim has led to direct prejudice of the insured. About eight hundred and thirty-five days have passed since the original date of loss. The carrier has still refused to pay the fully covered amount owed under the policy. The carrier is aware of damage sustained by the insured’s property and has not taken any meaningful ensuing action. It is clear that the carrier is not treating the insureds with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insureds; failing to implement proper standards for the adjustment and investigation of claims by its adjusters and placing the company’s interests before the insureds’ interests; refusing to pay the full amount owed to the insureds despite the fact that the carrier has been on notice of the damages and looking for ways to delay full recovery or any recovery to the insureds, when a reasonable carrier in a similar position would have tendered a full payment in accordance with both the policy language and statutory requirements. The carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c) and 626.9541(1)(i)(3)(f), as well as Section I- Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss; and the loss payment provision under Section I- Conditions requiring payment of a claim within 90 days. All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless disregard for the insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $44,575.61, less any prior payments and less any applicable policy deductible; and 2.) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been sent to the carrier. Please do not hesitate to contact the undersigned or Devin Wagner at (561)-892-9640 if you have any questions or concerns. Sincerely, Ardalan Montazer Attorney at Law
Comments
User Id Date Added Comment
yvonne.daniels@usaa.com 01-23-2025 USAA rejects all allegations contained within this civil remedy notice. USAA rejects the complainant's demand of $44,575.61 . USAA rejects the allegation of bad faith and unfair trade practice; along with the contention of improper investigation, misrepresentation, and failing to act promptly upon receipt of the claim. Additionally, USAA rejects the allegation of not promptly notifying our member of expectations or failing to provide a reasonable explanation of the claim disposition. This claim for wind damage as a result of Hurricane Ian was reported to USAA on Oct 01, 2022. The date that this storm hit Lee County, Florida was Sept 27, 2022. USAA inspected the property on Oct 4, 2022. The inspection revealed wind damages to the roof as well as the fenc to the property. The findings of our inspection along coverage was communicated to our policyholder on Oct 5, 2022 both verbally and in writing that the damages were under insured's deductible. Oct 9, 2022 insured provided us photos and an estimate to support additional damages. After which time USAA requested another reinspection. Reinspection took place on Oct 14, 2022, USAA received the reinspection report on Oct 17, 2022 and Oct 18, 2022 USAA communicated to the insured both verbally and in writting that the damages were under insured's deductible of $10,200.00. Insured sent a revised email estimate Oct 26, 2022, USAA called insured Oct 26, 2022 to obtain confirmation it would be ok to discuss the revised estimate with the roofer. Insured provided approval and USAA called roofer to confirm that they will need a supplement for code requirements total revision was approved and Actual cash value was paid that day. Verbal and written communication was sent out October 26, 2022. November 8, 2022 insured sent in a supplement for tarping of the roof for $300 payment was issued that day written communication was provided. November 12, 2022 insured sent in supplement request for a cieling fan and settlement was issued that day along with written communication sent to insured. January 6, 2023 insured sent communication that she received an estimate for her fence and that it would fully need to be replaced for $6,617.75; adjuster responded that day that she would need to provide photos along with the contractor providing additional information of the repairs. Insured responded January 6, 2023 with an Xactimate estimate for the fence and no photos. January 9, 2023 insured called into the office as well as sent a communication center post stating she was having trouble uploading photos. January 9, 2023 adjuster responded with an email address that insured could forward the additional photos if the system would not allow her to send through the communication center post. January 9, insured submitted the invoice for tree removal and adjuster issued payment for the tree removal the same date along with the supplement fence payment of $2,139.27. January 11, 2023 insured provided photos to support additional damage to the chain link fence and a supplement was issued the same date. March 28, 2023 insured sent a communication center post to inquire on payment for release of depreciation and the adjuster responded the same date that insured would need to provide the final invoice indicating was was completed. Insured inquired as to how much was paid for the roof and adjuster emailed a copy of the estimate for the claim on the same date March 28, 2023. December 11, 2023 insured sent in an invoice from the roofer $33,425.00 confirming amount was less than the RCV approved; therefore, no depreciation was applicable email communication sent to insured. September 27, 2024 email supplement request sent with no photos Attorney submitted letter of Attorney Representation September 30, 2024. October 4, 2024 Adjuster replied to insured and insured submitted a new revised estimate of $44,575.61. January 3, 2025 and January 17, 2025 USAA notified the complainant in writing on the above information as we responded to an intent to litigate notice. We also informed the complainant we would need supports of the additional new damages to the window that the claimant was intending on additing that were not noted at the two inspections performed.
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.

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