Filing Number: 803516
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| Filing Accepted: 1/27/2025 |
| Last/Business Name
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MARTINEZ
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First Name |
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RAYMOND |
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| Street Address
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780 HIGH GROVE PARK CT |
| City, State Zip
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OVIEDO,
FL
32765
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| Email Address
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RAY.MARTINEZ@OUTLOOK.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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MARTINEZ |
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First Name |
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RAYMOND |
| Policy # * |
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461915291A |
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Claim #* |
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004619152–800 |
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Attorney is Applicable
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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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US COASTAL PROPERTY & 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 15900 |
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| Name of individual responsible for violation (if any):*
ESENE TEEANESHIA AND ALL OTHER USAA EMPLOYEES, REPRESENTATIVES, AGENTS, AND VENDORS WHO HANDLED THIS CLAIM
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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 Denial
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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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| 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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Title: Section I - Losses we cover
Sub- Title: We insure against "sudden and accidental",
direct, physical loss to tangible property
described in PROPERTY WE COVER -
Coverages A and B
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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.
Raymond Martinez (“the insured”) is a homeowner insured under a homeowner’s policy issued by USAA (“the insurer”). The insured property is located at 780 High Grove Park Ct, Oviedo, FL 32765. On February 4, 2024, a hailstorm caused significant damage to the insured property, including impacts to the roof, garage, gutters, and window screens. The insured promptly reported the loss to USAA and complied with all post-loss obligations required by the policy. Despite this, USAA failed to adequately fulfill its statutory obligations under Florida law and mishandled the claim.
USAA conducted an initial inspection that failed to identify or acknowledge significant storm-related damage. After concerns were raised about the thoroughness and accuracy of the inspection, USAA sent the same adjuster for the re-inspection, creating a conflict of interest and allowing predetermined biases to influence the reassessment of the property. This resulted in a faulty and improper claim assessment. Additionally, during the claims process, a USAA desk adjuster admitted to the presence of damage to the gutters and window screens, stating in correspondence, “Can you please forward me photos of the drip edge nailed into the drip edge to show proof so I can see about adding that to my estimate. I will also accommodate the window screen.” Despite this acknowledgment, USAA failed to issue any revised estimate or supplemental payment for the documented damages.
Florida Statute § 624.02 requires insurers to act in good faith and fair dealing when adjusting and settling claims to indemnify policyholders promptly for covered losses. Furthermore, USAA's conduct—including its failure to issue an updated estimate for damages it acknowledged and reliance on a biased adjuster—constitutes violations of these statutory requirements and further demonstrates the insurer’s failure to act in good faith.
The insured submitted a comprehensive estimate for repairs totaling $59,230.57, reflecting the necessary costs to restore the property. Despite the overwhelming evidence of storm-related damage and acknowledgment of partial liability, USAA has refused to provide full and fair indemnification. These actions violate the insurer's contractual and statutory obligations, leaving the insured unable to fully mitigate damages and make necessary repairs.
To cure this civil remedy notice and avoid further legal action, USAA must immediately acknowledge full coverage for the insured's loss, issue payment based on the submitted estimate, $59,230.57. Failure to act accordingly will result in further damages, including potential punitive awards, and may necessitate legal action for bad faith.
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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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