Civil Remedy Notice of Insurer Violations
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Filing Number:     800109
Filing Accepted:  1/8/2025
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Complainant
Last/Business Name *  
LUNDEN   First Name   MARIE T.
Street Address * 810 S. PALMWAY
City, State Zip * LAKE WORTH, FL 33460
Email Address * DAVID@ABOSCHLAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   LUNDEN   First Name   MARIE T.
Policy # * CIC 00226 34 06 90A Claim #* 002263406-011
Attorney
Attorney is Applicable
Last Name* ABOSCH First Name * DAVID Initial
Street Address* 601 HERITAGE DRIVE, SUITE 508
City, State Zip* JUPITER , FL 33458
Email Address * DAVID@ABOSCHLAW.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):* BRIAN NATION, LINDA MONTELONGO
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
* Statutory provision(s) which the insurer allegedly violated.
 
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)(d) Denying claims without conducting reasonable investigations based upon available information.
626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

AGREEMENT In return for payment of premium and subject to all terms of this policy, we will provide the insurance described. .... SECTION I PROPERTY WE COVER COVERAGE A - Dwelling Protection We cover: 1. The dwelling on the "residence premises" shown in the Declarations, including structures attached to the dwelling; ... COVERAGE C - Personal Property Protection We cover: Tangible personal property owned or used by any "insured" while it is anywhere in the world. ... COVERAGE D - Loss of Use Protection The amount of insurance for Loss of Use shown in the Declarations is the total limit for the coverages that follow: 1. Additional Living Expense. If a loss covered under Section I - LOSSES WE COVER makes that part of the "residence premises" where you reside uninhabitable, we cover the reasonable and necessary increase in living expenses incurred by you so that your household can maintain its normal standard of living. Payment will be for the shortest time required to repair or replace the damage or, if you permanently relocate, the shortest time required for your household to settle elsewhere, in either event, not to exceed 12 months. . . . SECTION I - LOSSES WE COVER COVERAGE A - DWELLING PROTECTION COVERAGE AND COVERAGE B - OTHER STRUCTURES PROTECTION COVERAGE We insure against sudden and accidental, direct physical loss to tangible property described in PROPERTY WE COVER - Coverages A and B unless excluded in Section I - LOSSES WE DO NOT COVER. COVERAGE C - PERSONAL PROPERTY PROTECTION We insure against sudden and accidental, direct physical loss to tangible property described in PROPERTY WE COVER - Coverage C caused by a peril listed below unless the loss is excluded in LOSSES WE DO NOT COVER UNDER DWELLING PROTECTION, OTHER STRUCTURES PROTECTION AND PERSONAL PROPERTY PROTECTION. . . . SECTION I - CONDITIONS . . 3. Loss Settlement. We will not pay more than the amount of insurance that applies to the damaged, destroyed or stolen property as state don the Declarations page unless such amount is increased due to ADDITIONAL COVERAGES or the Home Protector Coverage. ... 10. Loss Payment. We will adjust all losses with you. We will pay you unless some other person is named in the policy or is legally entitled to receive payment. ...
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Marie T Lunden (Insured) purchased a homeowners insurance policy from USAA Casualty Insurance Company, policy number, CIC 00226 34 6 90A, with effective dates of coverage from February 14, 2020 to February 14, 2021, insuring the property located at 810 S Palmway, Lake Worth, Florida 33460. The Policy afforded coverage subject to its terms, conditions, limitations, exclusions and deductible provisions. During the effective dates of the policy, on July 27, 2020 the insured risk sustained damage from a coverage loss. The Insured provided prompt notice of the claim and otherwise complied with all conditions precedent required under the insurance policy. USAA assigned claim number 002263406-011 to the loss presented by the Insured. Ultimately, USAA afforded coverage for the claim but required that the Insured select from a list of approved contractors to perform repairs. As a result, the Insured hired Florida Executive Builders ("FEB"), at USAAs instruction. Had USAA not recommended and required FEB, the Insured would not have hired FEB. FEB failed in its duties and responsibilities insofar as it (1) failed to use materials of like kind and quality in the repair process; (2) employed defective workmanship techniques which not only failed to repair the damage, but exacerbated the conditions within the residence; (3) generally performed its tasks haphazardly and without regard for the condition of the insured risk; and, (4) upon information and belief utilized unqualified workers leading to poor workmanship and additional damage. Additionally, FEB was tasked with removing and storing the Insured's personal belongings during the course of repairs. In doing so, FEB caused additional damage to the Insured's personal belongings and stored them in unacceptable conditions which caused additional, irreparable damage. All while the above was unfolding, the Insured property was uninhabitable, requiring that the Insured live elsewhere at an additional expense. As a result, the Insured incurred out of pocket expenses which exceeded what USAA contends is the insured limit under Coverage D of the insurance policy. The fact that the Insured incurred damages in excess of the alleged limit is solely and attributable to USAAs conduct, vis-a-vis FEB, and their violations as outlined here of Florida law and the applicable insurance policy. Additional delays resulting in extended time requiring the Insured to live elsewhere was the result of FEBs failure to complete the work, let alone in a timely fashion. While all of the above transpired, the Insured and her representatives continually advised USAA of these issues and deficiencies. These concerns were ignored and left unresolved by USAA, resulting in ongoing and worsening damages, and additional costs to the Insured. Ultimately, the Insured was forced to hire her own contractor to complete repairs, and in doing so incurred significant out of pocket expenses. This information was repeatedly conveyed to USAA in various methods, including by way of a formal notice submitted by the Insured's counsel, Abosch Law Group, LLC. Nevertheless, USAA continued with its efforts to "brush the matter under the rug", leaving the Insured at present with significant out of pocket expenses, damages in excess of alleged policy limits, and mounting legal bills. In fact, USAA simply failed to serve a response to one of the forms of notice provided by Abosch Law Group, LLC, which is a blatant violation of Florida law. In explaining USAAs failure to provide the statutorily required response, USAAs Linda Montelongo acknowledged she was too busy and overburdened at the time to timely respond. Upon information and belief, the Insured believes USAA commits such violations of Florida law and the policy such that it constitutes a general business practice. In order to cure these violations, USAA must tender to the Insured all monies due and owing under the Policy and Florida law for this covered loss, along with interest due and owing, and attorney's fees and costs. Additionally, USAA must create and implement standards to ensure for the proper investigation of claims as required under Florida law, and to ensure USAA and its agents acknowledge and act promptly upon communications with respect to claims.
Comments
User Id Date Added Comment
jsariol@kelleykronenberg.com 03-05-2025 This is USAA Casualty Insurance Company’s (“USAA”) formal response to the Civil Remedy Notice of Insurer Violations (“CRN”) filed on behalf of Marie Lunden by attorney David Abosch, Esq., as it relates to Claim number 002263406-011. The Department of Financial Services (“DFS”) accepted the CRN on January 8, 2025, and assigned it filing number 800109. The following reply has been uploaded to the Department of Financial Services. After reviewing the CRN, USAA denies all allegation contained in the Insured’s CRN. USAA conducted a thorough review of its handling of the Insured’s claim, Subject Claim No.: 002263406-011. USAA denies that it has violated any of the statutes as alleged in the CRN. At all times, USAA acted in good faith, fairly and honestly toward its Insured and with due regard for the Insureds’ interests. USAA also argues that the CRN fails to adequately describe the alleged violations and fails to provide sufficient information to allow USAA to correct the alleged violations. The CRN requires the Insureds to “indicate all statutory provisions alleged to have been violated," pursuant to section 624.155, F.S. The notice filed by David Abosch, Esq., in the above-referenced matter includes statutory provisions that could be claimed against an insurance company regardless of whether they are relevant or applicable to the alleged facts contained in the Notice. Because the CRN fails to identify the specific facts applicable to the listed statutes that were allegedly violated with respect to the subject claim, USAA is unable to properly respond and said CRN should be rejected and returned. Specifically, Insureds allege the following violations of Florida Statutes: • § 626.9541(1) (i) (3) (a): Failing to adopt and implement standards for the proper investigation of claims. USAA strictly denies any violation of Florida Statute §626.9541(1) (i) (3) (a). • § 626.9541(1) (i) (3) (b): Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. USAA strictly denies any violation of Florida Statute §626.9541(1) (i) (3) (b). • § 626.9541(1) (i) (3) (c): Failing to acknowledge and act promptly upon communications with respect to claims. USAA strictly denies any violation of Florida Statute §626.9541(1) (i) (3) (c). • § 626.9541(1) (i) (3) (d): Denying claims without conducting reasonable investigations based upon available information. USAA strictly denies any violation of Florida Statute §626.9541(1) (i) (3) (d). • § 626.9541(1) (i) (3) (g): Failing to promptly notify the insured of any additional information necessary for the processing of a claim. USAA strictly denies any violation of Florida Statute § 626.9541(1) (i) (3) (g). USAA specifically denies the Insureds’ allegations that USAA violated the above referenced statutes, any portion of the administrative code, or any Florida Statute reference in the instant CRN. Also, the CRN fails to set forth any specific policy language alleged to have been violated in accordance with Florida Statute §624.155(3) (b) (4), other than listing a vague recitation of what they believe is the applicable policy language to the alleged violation. The copy of the CRN simply provides a summary the various sections of the insurance policy that were allegedly violated, some of which are wholly irrelevant to the Subject Claim in question. It is this failure to identify the specific policy provision(s) that is(are) allegedly relevant to the alleged violation(s) that prevent(s) USAA from addressing any issues regarding the Subject Claim and Policy. Furthermore, contrary to the requirement to “describe the facts and circumstances giving rise to the insurer’s violation as you understand them at this time,” the purpose of which is “to enable the insurer to investigate and resolve [the] claim,” the CRN itself only provides unsupported, vague, ambiguous, and incorrect allegations with no basis in fact or circumstances. Aside from the fact that the allegations are devoid of any specific facts, the tenor and inferences of the allegations are wholly without merit and USAA denies each and every one. Finally, the Notice fails with respect to its requirement to specify how USAA may “cure” the alleged violations. The purpose of a Civil Remedy Notice is to provide a carrier with one last opportunity to “cure” the alleged violations. In this instance, there is no indication at all what action USAA needs to take to cure the alleged violations. Assuming arguendo, that the real “cure,” sought by the Insured, is payment of all insurance proceeds demanded by the Insured, notwithstanding USAA’s right to investigate and adjust the loss. The method for curing the violations alleged in a civil remedy notice are not determined by the Insured. Section 624.155 does not impose on an insurer the obligation to pay whatever the insured demands. Section 624.155(2)(d) would have no effect or purpose under such an interpretation. In Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So.2d 1278 (Fla. 2000), the Florida Supreme Court accepted and quoted the reasoning of the court below in its opinion which stated in relevant part, as follows: Section 624.155 does not impose on an insurer the obligation to pay whatever the insured demands. . . . Section 624.155(2)(d) would have no effect or purpose under such an interpretation. The law does not support such an expansive and illogical reading of Fla. Stat. Ann. §624.155(2)(d). . . . [t]o cure an alleged violation and to avoid a civil action, an insurer must pay the claim . . . before the sixty days expire. Talat, 753 So2d at 1282 citing Talat Enterprises Inc. v. Aetna Cas. & Sur. Co., 952 F.Supp. 773, 777-778 (M.D. Fla. 1996). The law does not support such an expansive and illogical reading of Fla. Stat. Ann. §624.155(2)(d). Talat, 753 So2d at 1282 citing Talat Enterprises Inc. v. Aetna Cas. & Sur. Co., 952 F.Supp. 773, 777-778 (M.D. Fla. 1996). For the aforementioned reasons, the Civil Remedy Notice is insufficient as a matter of law. USAA acted in good faith, fairly and honestly toward the Insured in the adjustment of the instant claim. USAA was contacted on August 27, 2020, and was informed of a loss due to water intrusion at the subject property that occurred on July 27, 2020. USAA promptly set up a date and time for an inspection by a field adjuster to determine the cause of loss, and if appropriate, cost to bring the property back to pre-loss condition. The property was inspected on December 11, 2020, and an estimate was completed. The estimate totaled $32,927.53. Minus the $2,000.00 deductible, and payment was issued to the Insured in the amount of $30,778.75. This check was mailed to the Insured on December 19, 2020. Following this payment the Insured selected to retain Florida Executive Builders to provide construction services to the property. USAA issued additional payments directly to Florida Executive Builders for repairs. To date USAA issued $159,630.20, in indemnity payments. The Insured is claiming that USAA owes additional funds do to them “requiring that the Insured” use an approved contractor to perform repairs. However, on March 22, 2021, USAA sent a letter to the Insured regrading their interest in their preferred contractor program and further specified that the Insured is not required to use them, and it is their choice what contractor they choose to make the repairs. The letter specifically states: You can use any contractor of your choice to complete the repairs to your home. You are not under any obligation to use a contractor from this network. If you plan to use a contractor of your own choice, please contact your adjuster for additional information. The contractor from the Property Direct Repair Program provides a three-year limited workmanship warranty for the repair of covered damage and is fully licensed, insured and/or bonded. Further the Insured is claiming that USAA owes additional mold payments; but, USAA issued the full mold limits of the Policy of $10,000.00 to the Insured on March 22, 2021. Additionally, the Insured makes claim that additional funds are owed for ALE payments. USAA to date has issued ALE payments of $$74,636.77 to the Insured to cover housing an dog boarding from January 2021. The ALE benefits have been exhausted since the Insured is limited to 12 months as the policy states: Additional Living Expense. If a loss covered under SECTION I - LOSSES WE COVER makes that part of the "residence premises" where you reside uninhabitable, we cover the necessary increase in living expenses incurred by you so that your household can maintain its normal standard of living. Payment will be for the shortest time required to repair or replace the damage or, if you permanently relocate, the shortest time required for your household to settle elsewhere, in either event, not to exceed 12 months. It is important to note, that while an insurance company is required to settle claims that should be settled, it is not required to settle claims that are legitimately contested. Florida law continually affirms the principle that an insurer has the right to investigate claims presented for payment. An insurance company is expressly afforded an opportunity to evaluate its rights and liabilities. Neither the subject policy nor does Florida law provide that a carrier must accept whatever demand for repairs it is provided by its Insureds as the amount necessary to repair a loss. In the instant case, the violations alleged by the Insured all revolve around the contention that that USAA did not accept and pay the Insured’s full demand for repair. In closing, USAA takes the position that the CRN should be rejected and returned by the Department of Financial Services due to its failure to comply with Florida Statute §624.155 and Florida Case law, and regardless of the rejection, USAA denies all allegations contained in the CRN and submits there are no violations to the insured. While this response is meant to be comprehensive, USAA’s response above is based upon the limited information provided in the CRN and the information USAA has to date. If the Insured, or David Abosch Esq., is in possession of information or facts that USAA is not in possession of, USAA requests all such information or facts be provided to it immediately. Please note that USAA’s response is not necessarily exhaustive and does not preclude it from asserting any other valid reason for seeking rejection and return of the CRN. Also, this letter or any act or failure to act on the part of USAA or any agent or representative of USAA should not be construed as a waiver of any rights or defenses available to it by contract or at law as all such rights and defenses are hereby specifically reserved. We trust that this response addresses the allegations of insurer violation alleged in the CRN of Insurer Violation. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Very truly yours, /s/ Jennifer D. Sariol Jennifer D. Sariol, For the Firm cc: David Abosch Esq. Counsel for Marie Lunden david@aboschlaw.com
michelle.copeland@usaa.com 02-07-2025 USAA CIC denies all allegation contained in the CRN. The allegations set forth in this notice are currently the subject of pending litigation. All allegations are denied. A detailed response has been (or will be) sent to counsel of record.
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