Civil Remedy Notice of Insurer Violations
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Filing Number:     804477
Filing Accepted:  1/30/2025
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Complainant
Last/Business Name *  
COUFAL   First Name   JOHN AND MOLLY
Street Address * 6017 ROLLING VISTA LOOP
City, State Zip * DOVER, FL 33527
Email Address * MOLLY.COUFAL@YAHOO.COM
Complainant Type: * Insured
Insured
Last/Business Name*   COUFAL   First Name   JOHN AND MOLLY
Policy # * 9530294 91A Claim #* 009530294–016
Attorney
Attorney is Applicable
Last Name* CAREY First Name * CHRISTOPHER Initial
Street Address* 350 NORTH LAKE DESTINY ROAD
City, State Zip* MAITLAND , FLORIDA 32751
Email Address * CCAREY@ITSABOUTJUSTICE.LAW
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):* UNITED SERVICES AUTOMOBILE ASSOCIATION
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unsatisfactory Settlement Offer
* 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)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(4) Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

In order to cure this Civil Remedy Notice, USAA must immediately acknowledge in writing that Insureds’ estimate is reasonable in scope and tender all undisputed benefits owed. The written acknowledgment should be tendered to the Insureds’ attorney, Christopher S. Carey, Esq. at 350 N. Lake Destiny Road, Suite 300, Maitland, FL 32751. Policy A certified copy of the policy is not currently in the possession of the Insureds, but has been requested through discovery. Based on information and belief, the following policy provisions apply to this Civil Remedy Notice: Section 1 – Perils Insureds Against – Coverage A- Dwelling and Coverage B – Other Structures Section 1 – Property Coverages – Coverage A - Dwelling and Coverage B – Other Structures Section 1 – Conditions - Loss Payment Section 1 – Conditions - Loss Settlement 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 Insureds and with due regard for her or his interests; 624.155(1)(b)(3): 626.9541(1)(i)(3)(a) - Failing to adopt and implement standards for the proper investigation of claims; 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)(4): Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 90 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by an act of God, prevented by the impossibility of performance, or due to actions by the Insureds or claimant that constitute fraud, lack of cooperation, or intentional misrepresentation regarding the claim for which benefits are owed.
 
* 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 04/11/2024, John and Molly Coufal (“Insureds”) suffered significant damage to their home located at 6017 Rolling Vista Loop, Dover, FL 33527 caused by a windstorm. Prior to the loss, United Services Automobile Association (“USAA”) issued a homeowner’s insurance policy (policy no. 9530294 91A) for the Insureds’ home. The policy was in full force and effect on the date of loss and affords coverage for Hurricane damage. After providing prompt notice of the loss, the Insureds fully cooperated with USAA’s adjustment of the claim, including making their home available for inspection and providing all documents requested. Despite USAA acknowledging a significant amount of covered damage, USAA refused to tender sufficient payment to actually complete the necessary repairs, and, as is a pattern and practice of USAA, found that the Insureds’ damages were minor. Then, on October 10, 2024, the Insureds’ residence was struck again. This time by Hurricane Milton. This hurricane caused additional damage and more leaks. The Insureds filed another claim and while USAA opened coverage, severely undervalued the claim. The Insureds hired an attorney to represent their interest and rights under the policy and a Notice of Intent to Initiate Litigation was filed for both claims. In response, USAA asserted their right to reinspect the property. That is when USAA’s bad action really showed. USAA scheduled two inspections with the Insureds after the NOI was filed. One on December 18, 2024, one on January 24, 2025. USAA completely failed to appear for the December 18, 2024 inspection, further delaying the claim and risking further damage to the Insureds home. The adjuster also never called or warned the Insureds of her impending absence at the scheduled inspection. Then on January 24, 2025, instead of appearing on time at 1:30 PM as scheduled, the adjuster arrived two hours early and with a second representative from Hancock claims that refused to give the Insureds his card. The Insureds had scheduled their contractor to be present to point out damages to the interior and roof, but having arrived a full two hours before the scheduled time, that was not possible. The USAA adjuster then proceeded to wait in her car while the second representative did a cursory look of the roof, spending in total less than 10 minutes inspecting. What is worse is after the Insureds mentioned the interior damages from the leaks and the m0ld, both the adjuster and the Hancock claims inspector refused to even go in the property to check those damages. It is clear that USAA has not acted honestly or fairly towards its Insureds. USAA and its adjusters have misrepresented the scope and cause of damages to the residence and misapplied exclusions in the policy in order to deny coverage for the majority of the Insureds’ claim in order to ensure its valuation of the claim would be under Insureds’ deductible. As is the case here, it has become a general business practice of USAA to not implement proper claims handling procedures, to hire consultants that routinely ignore or intentionally misidentify relevant evidence, and to not settle claims in good faith when under all circumstances it should have. USAA regularly undervalues claims in order to avoid issuing payment on losses that it knows are covered under the policy. USAA also routinely refuses to pay claims in full when it has the ability to do so, waits to see if its Insureds contest her coverage determination, as was necessary here, and, only then, will it capriciously invoke appraisal. USAA knows that by opening up a small amount of coverage, it can maintain its ability to demand appraisal later on and deprive its Insureds access to the courts. Its Insureds is then forced to pay the cost of her own appraiser, which can total several thousands of dollars, before it is ever willing to perform repairs or issue benefits that were already owed under the policy. USAA has developed this deliberate strategy in order to deter its Insureds from challenging its coverage determinations and hinder her ability to seek additional payment for monies owed under the policy. USAA’s practice of not adjusting losses in good faith in accordance with section 627.70131, Florida Statues, unnecessarily delays resolution of its claims and leaves claimants like Insureds with no choice but to incur further time and expense just to be fully indemnified pursuant to the terms of her contract with USAA. USAA has completely abdicated its duty to adjust and has put the onus on its Insureds to spend thousands of dollars in appraisal before USAA is willing to issue benefits or make repairs that it knows are owed pursuant to the policy. USAA’s pattern and practice of underrepresenting the actual cost and cause of damages, then demanding appraisal if challenged, is evidence that it does not act fairly or honestly towards its Insureds during its adjustment process and that it has failed to implement proper standards for the investigation and handling of its claims.
Comments
User Id Date Added Comment
shane.strawn@usaa.com 03-28-2025 This is UNITED SERVICES AUTOMOBILE ASSOCIATION’S (“USAA”) reply to the Civil Remedy Notice filed on your client’s behalf, bearing filing number 804477. USAA denies any allegations of non-compliance with the code referenced by the Complainants herein and asserts the “Civil Remedy Notice” is legally insufficient and is without merit.
randy.denker@usaa.com 02-17-2025 USAA denies the allegations contained in the plaintiff's Civil Remedy Notice, and finds them to be without merit -USAA has in good faith made all undisputed claim payments associated with the claim. The claim was filed on October 10, 2024. First contact was made with the Insured on October 11, 2024. An inspection was performed onsite by an independent adjuster, with the insured on October 15, 2024. The undisputed dwelling repair payment was issued on October 25, 2024. -Proper inspection methods were used during the investigation. An onsite inspection to evaluate the damages was performed by an Independent Adjuster on October 15, 2024. -All communications with the Insured were responded to promptly and accurately, including a settlement letter and copy of the approved estimate which was provided to the member on October 25, 2024. -A a partial denial letter was sent for the flood damages to the shed and personal property December 30, 2024. -All undisputed payments have been issued to the insured. Payment was promptly issued for food spoilage on October 10, 2024. The dwelling repair payment was issued October 25, 2024. Payment was also issued for the water mitigation services rendered on November 6, 2024. - We subsequently received a letter of representation on or about December 23, 2024 from Cohen Law Group. -A copy of the certified policy, USAA estimate, mitigation estimate, and settlement letter were sent to the Attorney on January 2, 2025. -A notice of intent to litigate was filed by Cohen Law Group January 2, 2025. USAA was notified of additional damages being claimed at that time, which had not previously been presented under this claim. As such, USAA requested a reinspection of the property, per the conditions of the policy. - The additional damages presented include the office, entry, living room, and dining room areas. The damage to the office was previously claimed under Loss Record 16. To date Cohen Law Group has not presented proof that prior repairs were completed as a result of the damages from Loss Record 16. Cohen Law Group also has not supplied any documentation in support of there having been any secondary damages to the office area, that were not present in Loss Record 16. - USAA continues to investigate and negotiate this claim in good faith.
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