Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 805917

Filing Accepted: 2/10/2025

Print Filing

Complainant

Last/Business Name *

LYONS

First Name

JOHN AND DONATILA

Street Address *

17206 CYPRESS PRESERVE PKWY

City, State Zip *

ORLANDO, FL 32820

Email Address *

SNOYLWJ56@GMAIL.COM

Complainant Type: *

Insured

Last/Business Name*		LYONS		First Name		JOHN AND DONATILA
Policy # *		020406928-90A		Claim #*		020406928

Attorney

Attorney is Applicable

Last Name*	DIAZ First Name * DIANA Initial
Street Address*		333 SE 2ND AVE, SUITE 2000
City, State Zip*		MIAMI , FL 33131
Email Address *		DDIAZ@DKLAWFL.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		USAA CASUALTY INSURANCE COMPANY
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 25968

Name of individual responsible for violation (if any):* CLAIMS DEPARTMENT
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Delay
	Unsatisfactory Settlement Offer
	Unfair Trade Practice

* 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.

* 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: 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.

December 24th, 2024 Sent Via U.S. Mail & Email USAA Casualty Insurance Company (Attn: USAA Claims Department and/or P.O. Box 33490 San Antonio, TX 78265 4zqjczw9q9l8@claims.usaa.com RE: Insured(s) : John and Donatila Lyons (insured(s)”) Policy # : 020406928-90A Claim # : 020406928 Property Address : 17206 CYPRESS PRESERVE PKWY, ORLANDO, FL 32820 Insured(s) Email : SNOYLWJ56@GMAIL.COM Dear USAA Casualty Insurance Company, (“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 10/09/2024. 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 hurricane damages to the property. The initial representative was unable to rule out hurricane as the cause of the damages observed during the inspection of the property. After the cursory inspection of the property, the carrier advised the insured there was coverage for the loss but the carrier drastically underestimated the amount/scope of damages sustained as a result of the loss. The carrier’s valuation of the damages is severely less than the damages actually sustained as a result of the loss. The carrier did not pay for all direct physical damages sustained as a result of the loss. The carrier failed to properly investigate the claim due to the fact it unvalued the amount/scope of damages sustained as a result of the loss. The carrier failed to provide the full amount of coverage for the physical damages sustained to the property as a result of the loss. The carrier engages in this practice of underpaying/undervaluing 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 insureds. The carrier consistently relies on under scoped and underpriced estimates to under pay or not pay for covered claims. The carrier’s value of the damages sustained and the amount needed to restore the property are well below the relevant market pricing. 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 undervalued the claim. The carrier’s actions have significantly delayed the resolution of this claim and the insured has been unable to restore the property to it’s pre-loss condition. The carrier has a pattern of drastically lowballing claims and then demanding appraisal when the insured disputes the coverage determination/valuation. These appraisal awards consistently come back drastically above the carrier’s evaluation and coverage of the loss. The insurance carrier undertakes this lowball scheme with such frequency as to be a regular business pattern. The scheme is undertaken as a textbook pattern and practice for underpaying paying claims in order to maximize the carrier’s profits. The carrier hopes the insureds do not have the funds/ability to pay the cost and participate in appraisal so that the carrier can drastically underpay claims. The carrier has failed to adjust the loss with the insured and has failed to pay for all sudden and accidental physical damage to the property. This investigation by the carrier was not done in good faith and 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: 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, low-ball, 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 $55,504.29 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, Diana Diaz, Esq. Attorneys at Law

Comments

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