Civil Remedy Notice of Insurer Violations
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Filing Number:     805370
Filing Accepted:  2/5/2025
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Complainant
Last/Business Name *  
HOOD   First Name   RICHARD
Street Address * 1604 AUGUSTA DRIVE
City, State Zip * TALLAHASSEE, FL 32303
Email Address * MIKE@FLALAWFIRM.COM
Complainant Type: * Insured
Insured
Last/Business Name*   HOOD   First Name   RICHARD
Policy # * 000807723 Claim #* 000807723-802
Attorney
Attorney is Applicable
Last Name* RAYBOUN First Name * MICHAEL Initial C.
Street Address* 1410 PIEDMONT DRIVE E, SUITE 2
City, State Zip* TALLAHASSEE, FLORIDA , FL 32308
Email Address * MIKE@FLALAWFIRM.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):* SARAH GILPIN
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Constant or repeated seepage or leakage of water or steam over a period of 14 days or more from within a plumbing, heating, air conditioning or automatic fire protective sprinkler system or from within a household appliance, unless such seepage or leakage of water or steam and the resulting damage is unknown to all "insureds" and is hidden within walls or beneath the floor or above the ceilings of a structure;
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

1. The Insurer included only the first clause of the subject term in the claim denial letter, implying to the elderly insureds that ANY constant or repeated seepage that exists for 14 days is excluded, but failed to include the entire sentence and its remaining clause that states "unless such seepage or leakage of water or steam and the resulting damage is unknown to all "insureds" and is hidden within walls or beneath the floor or above the ceilings of a structure." 2. The claim is based on a cracked shower pan, which exists below the floor's surface and is impossible to see until there is damage. As such, the problem was hidden beneath the floors until it was discovered, and the insured then promptly reported the claim. 3. The insurer's effort to conceal the exclusion's exception for hidden damage is a patent lack of good faith and honesty and now refuses to change its position of claim denial, which is patently unfair.
Comments
User Id Date Added Comment
tonya.nixon@usaa.com 03-07-2025 No new information has been provided to over turn the full denial of this claim. The denial based on contract language for constant repeated seepage from within a plumbing system. 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