Civil Remedy Notice of Insurer Violations
Login

Filing Number:     800814
Filing Accepted:  1/14/2025
         Print Filing
Complainant
Last/Business Name *  
KNOWLES   First Name   CORAL AND CRICKETT
Street Address * 3300 MIDSHIP DRIVE
City, State Zip * NORTH FORT MYERS, FL 33903
Email Address * BESTHEART.CK@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   KNOWLES   First Name   CORAL AND CRICKETT
Policy # * 01669701893A Claim #* 016697018-04
Attorney
Attorney is Applicable
Last Name* KESSLER First Name * JOSEPH Initial
Street Address* 333 SE 2ND AVE, SUITE 2000
City, State Zip* MIAMI , FL 33131
Email Address * JKESSLER@DKLAWFL.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   UNITED SERVICES AUTOMOBILE ASSOCIATION
NAIC Company Code 25941
 
Name of individual responsible for violation (if any):* CLAIMS DEPARTMENT
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Claim Denial
* 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.
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

These actions from the carrier as set forth above violate the following Florida Statutes: 626.9541(1)(i)(3)(d), Denying claims without conducting reasonable investigations based upon available information; 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; 626.9541(1)(i)(3)(a), Failing to adopt and implement standards for the proper investigation of claims. The Carrier’s actions set forth above also violated the following policy provisions: 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.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

January 14th, 2025, Sent Via U.S. Mail & Email United Services Automobile Association (Attn: Claims department) 9800 Fredericksburg Rd. San Antonio, TX 78288 4mwm33d72d3m@claims.usaa.com RE: Insured(s) : Coral Knowles and Crickett Knowles (“insured(s)”) Policy # : 01669701893A Claim # : 016697018-04 Property Address : 3300 Midship Drive North Fort Myers FL 33903 Insured(s) Email : 0oohstewardess@gmail.com Dear United Services Automobile Association, (“carrier”): Please find enclosed the civil remedy notice filed for the above referenced claim. As discussed in greater detail in the notice, the carrier 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 its insureds and with due regard for their interests. The carrier is required to properly investigate and adjust claims and cannot place that burden upon the insureds. The carrier was put on notice of the insureds’ claim that occurred on 09/28/2022. After being put on such notice, the carrier initially sent a representative to inspect the property. It is believed the representative initially sent to the property was unqualified or lacked the necessary training to determine the cause of the damages observed during the inspection. It is also believed that the representative initially sent to the property was unqualified or lacked the necessary training to determine the amount of damages sustained as a result of the loss. It is upon information and belief that the carrier’s initial representative observed widespread wind and water damages from Hurricane Ian to the property. The initial representative was unable to rule out wind and water from Hurricane Ian as the cause of the damages observed during the inspection of the property. After the cursory inspection of the property, the carrier sent a coverage letter to the insured. The coverage letter provided by the carrier advised the insured there was no coverage for the loss. The policy exclusions/reasons for not extending coverage cited to by the carrier are not supported by the information known to the carrier or the representative that inspected the property at the time the coverage decision was made for the loss. The carrier and its representative lacked necessary information needed to support the incorrect conclusions regarding the cause of the damages to the property. The carrier and its representative relied on a boilerplate exclusion that were not supported by the facts of the loss tin order to deny the claim. It is clear by the language of the carrier’s denial letter that it did not determine what caused the damages observed at the property. The carrier just included various exclusions under the policy. The carrier inspected the property with a representative that was not qualified to determine what caused the damages to the property. After this cursory inspection, the carrier issued its denial letter. The carrier also did not value or evaluate the amount of damages observed to the property. This shows the carrier did not adjust the loss with the insured. The carrier engages in this practice of incorrectly denying claims with such regularity and frequency as to indicate that it is a general business practice of this carrier, in reckless disregard for the rights of the insured. The carrier routinely relies on unsupported conclusions to deny claims based on exclusions under the policy that do not apply to the facts of the loss at the time the carrier issued its coverage decision. The carrier denied the claim without conducting a reasonable investigation and failed to properly adjust the loss. The carrier’s actions have severely delayed the resolution of this claim. Rather than inspecting the property and evaluating the damage in a prudent manner or making any good-faith effort to investigate the claim, the carrier incorrectly denied the claim. This investigation by the carrier is in direct violation of the statutory requirement for carriers to promptly and properly investigate all claims. These actions from the carrier as set forth above violate the following Florida Statutes: 626.9541(1)(i)(3)(d), Denying claims without conducting reasonable investigations based upon available information; 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; 626.9541(1)(i)(3)(a), Failing to adopt and implement standards for the proper investigation of claims. The Carrier’s actions set forth above also violated the following policy provisions: 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. The carrier has mishandled the claim in a classic textbook bad-faith claims handling practice by stonewalling, stalling, and failing to adjust and properly cover the claim by retaining outcome-oriented agents that did not evaluate the loss, coverage, or information objectively. Had the carrier taken the time to properly investigate this claim, reviewed the readily available guidelines, or sent qualified unbiased people out to the property to investigate, the insured would not be in this situation. It is clear that the carrier is not treating the insured with good faith claims conduct; failing to pay a claim clearly owed and acknowledged in writing; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insured; failing to implement proper standards for the adjustment and investigation of claims; not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company’s interests before the insured’s interests; refusing to cover the claim and pay the full amount owed to the insured despite the fact that the damages are covered under the policy; looking for ways to delay full recovery or any recovery to the insured; and refusing to provide coverage for the insured’s loss in a timely manner. The carrier engages in this practice of attempting to delay and deny claims in order to maximize the carrier’s profit margins with such regularity and frequency as to indicate that it is a general business practice of this carrier, in reckless disregard for the rights of the insured. It is clear that the carrier is not treating the insured with good faith claims conduct. 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 $87,234.05; 2.) Pay the Insureds’ attorneys’ fees and costs as they have been forced to retain counsel; 3.) 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 printed out and mailed. Please do not hesitate to contact the undersigned if you have any questions or concerns. Sincerely, Joseph Kessler, Esq. Attorneys at Law Enclosed: Civil Remedy Filing
Comments
User Id Date Added Comment
tonya.nixon@usaa.com 01-22-2025 The independent adjuster inspection supports not storm related damages to the home. Full denial stands for wear, tear, deterioration, and maintenance. USAA denies the allegations contained in the Notice and finds them to be without merit. The Notice is also legally insufficient in that it fails to state with specificity, the facts giving rise to the alleged violations. USAA has promptly and thoroughly investigated this claim
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