Filing Number: 801891
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| Filing Accepted: 1/17/2025 |
| Last/Business Name
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DOUGHERTY
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First Name |
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KENNETH AND AVA |
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| Street Address
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4973 SAPPHIRE SOUND DRIVE |
| City, State Zip
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WIMAUMA,
FL
33598
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| Email Address
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MCKENZIE@GREENLAWGRP.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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DOUGHERTY |
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First Name |
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KENNETH AND AVA |
| Policy # * |
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GIC02856240391A |
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Claim #* |
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028562403-804 |
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Attorney is Applicable
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| Last Name* |
GREEN
First Name *
PAUL
Initial
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| Street Address* |
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8833 PERIMETER PARK BLVD SUITE 104 |
| City, State Zip* |
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JACKSONVILLE
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FL
32216
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| Email Address * |
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PAUL@GREENLAWGRP.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):*
EUGENE MCQUIRTER AND ALL OTHER SUPERVISORS
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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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Unfair Trade Practice
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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)(c) |
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Failing to acknowledge and act promptly upon communications with respect to claims.
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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)(e) |
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Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
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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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
See Below
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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.
On or about October 9th, 2024, Kenneth and Ava Dougherty (hereinafter “INSURED”), suffered damage to her property located at 4973 Sapphire Sound Drive, Wimauma, FL 33598. The property suffered extensive damage to the roof and interior. Garrison Property and Casualty Insurance Company (hereinafter “USAA”) issued an insurance policy for the Insured’s property, Policy Number GIC02856240391A, which was in full force and effect on the date of the loss. The loss was the result of a significant windstorm. Shortly following the loss, the Insured retained the Green Law Group (hereinafter “FIRM”) to help expedite the claim, to restore the property to its pre-loss condition. FIRM timely notified USAA of the damage sustained to the property and contemporaneously provided an estimate of the damages that are sought to be recovered. Despite demand of payment, USAA has failed or refused to pay full value to protect and return property to pre-loss conditions. USAA's refusal to adequately and otherwise make INSURED whole, constitutes a breach of contract. As a result of USAA’s aforementioned breach of contract, it has become necessary for INSURED to retain the services of FIRM. USAA has engaged in customary business practice and a deliberate course of conduct to hinder resolution of its claims until they enter litigation. USAA regularly and consistently denies justified claims outright, omits or denies specific line items required to properly repair/replace a homeowner’s roof/damages, and uses deceptive tactics, some, aforementioned, to prolong the process, in a hope that the homeowner will cancel his retainer with the FIRM and work directly with USAA. It has become a pattern of practice for USAA to not settle claims when it has the ability to do so, and these dilatory tactics serve no purpose other than to increase profits. USAA has violated the following statutory provisions: §642.155(1)(b)(1) - Not attempting in good faith to settle claims when, under all circumstances, it could and should have done so, had it acted fairly and honestly towards its insured and with due regards 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 reasonable clear, under one portion of the insurance policy coverage in order to influence settlement under other provisions 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) – Committing or performing with such frequency as to indicate a general business practice any of the following: (a) Failing to adopt and implement standards for the proper investigation of claims; (b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue; (c) Failing to acknowledge and act promptly upon communications with respect to claims; (d) Denying claims without conducting reasonable investigations based upon available information; (e) Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured with 30 days after proof-of-loss statements have been completed; (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; (g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim; (h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. To remedy this Civil Remedy Notice and to cure the conduct giving rise to the violations described herein, USAA must immediately: (i) tender the full remaining payment to FIRM, on behalf of INSURED; (ii) make payment of any pre-judgment interest owed under Florida law, including §627.70131(5)(a), which is accruing daily; (iii) make payment for the additional expense incurred by the insured in hiring an attorney; and (iv) implement appropriate standards and procedures for claims investigations and resolution in regard to the outstanding amount of this Claim. The aforementioned payments should be tendered to the INSURED’s attorneys at Green Law Group, 8833 Perimeter Park Blvd., Suite 104, Jacksonville, Florida 32216.
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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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