Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 806291

Filing Accepted: 2/11/2025

Print Filing

Complainant

Last/Business Name *

NAYLOR

First Name

SARA

Street Address *

12388 CLASSIC DRIVE

City, State Zip *

CORAL SPRINGS, FL 33071

Email Address *

SALLYPOET@YAHOO.COM

Complainant Type: *

Insured

Last/Business Name*		NAYLOR		First Name		SARA
Policy # *		CIC 00319 49 20 94A		Claim #*		003194920-529

Attorney

Attorney is Applicable

Last Name*	ELAZAR First Name * SAPIR Initial
Street Address*		800 E BROWARD BLVD., STE.510
City, State Zip*		FORT LAUDERDALE , FLORIDA 33301
Email Address *		SE@WEKLAW.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):* N/A
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.
	624.155(1)(b)(3)		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.
	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)(a)		Failing to adopt and implement standards for the proper investigation of claims.
	626.9541(1)(i)(3)(b)		Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
	626.9541(1)(i)(3)(c)		Failing to acknowledge and act promptly upon communications with respect to claims.
	626.9541(1)(i)(3)(g)		Failing to promptly notify the insured of any additional information necessary for the processing of a claim.

* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Loss Payment Provision. Loss Settlement Provision.

* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Sara Naylor (the "Insured") purchased an insurance policy ("Policy") from USAA Casualty Insurance Company ("USAA"), ensuring coverage for her home, located at 12388 Classic Drive, Coral Springs, FL 33071 (the "Property"). The Policy, under number CIC 00319 49 20 94A, was in full force and effect when the devastating Hurricane Ian affected the Property on or about September 28, 2022. The hurricane caused extensive damage, impacting the Property’s exterior, interior, and roofing system. The Insured reported the claim to USAA, which acknowledged receipt by generating claim number 003194920-529. As part of its contractual obligations, USAA conducted an inspection of the Property and subsequently issued a grossly inadequate estimate, valuing the damages at a mere $8,364.02 after the application of the deductible. This low-ball valuation blatantly disregarded the full extent of the damages, demonstrating USAA’s deliberate attempt to minimize its contractual obligation and low-ball its policyholder. Despite the Insured's full cooperation and submission of all necessary documentation to substantiate the claim, USAA refused to conduct a fair and thorough evaluation. Left with no choice, the Insured retained Five Star Claims Adjusting ("Five Star") to act as their public adjuster, advocate on their behalf and conduct a proper assessment of the damage. Five Star’s inspection revealed the true extent of the loss, generating an estimate of $194,422.49—an amount that reflected the necessary repairs to restore the Property to its pre-loss condition. This estimate was promptly submitted to USAA, yet USAA failed to issue any additional payment, further exacerbating the Insured’s financial and personal hardship. USAA’s refusal to fairly compensate the Insured is not only a breach of contract but a clear example of bad faith claims handling. Rather than fulfilling its duty to assist its policyholder in a time of need, USAA has obstructed the Insured’s ability to repair their home, forcing them into undue distress. The Insured and their family continue to endure unnecessary hardship due to USAA's failure to adjust the loss. Upon information and belief, USAA, as part of its general business practice, initially low-balls its policyholders. USAA does this in a calculated and systematic scheme that begins with manipulating the software system used in estimating its property damage claims. It appears that USAA issues its adjusters estimating software which contains construction pricing below the fair market value. It also appears that USAA trains its claim adjusters to overlook and/or turn a blind eye to a number of routine costs that USAA knows most policyholders generally would not know to request but are actually covered under the insured’s policy. Moreover, as part of this scheme, after making one initial low-ball payment – USAA stalls and intentionally delays the claim, all under the false pretense that it’s “investigating” the claim. USAA has violated Florida Statute § 624.155(1)(b)(1) by continuously not attempting in good faith to settle this claim when it should have done so if it had acted fairly and honestly towards its Insured. USAA has also violated Florida Statute § 624.155(1)(b)(3) by failing to promptly settle this obviously covered claim to influence settlement in its favor. Despite being presented all of the indisputable evidence of the amount of damage sustained by this Property, it is a disgrace that the Insured have been treated in this manner by their insurance company after sustaining an obviously covered loss, submitting to every demand of USAA, and making a good faith effort to resolve in an attempt to amicably come to a fair resolution. USAA violated Florida Statutes § 626.9541(1)(i)(2) and § 626.9541(1)(i)(3)(b) by making material misrepresentations to the Insured for the purpose and with the intent to settle the claim on less favorable terms than those provided and contemplated by the policy. USAA was informed multiple times of the discrepancies and inconsistencies of the low-ball payment issued to the Insured. While USAA was made aware of this information for the purpose of obtaining the money contractually owed to the Insured under its insurance policy to attempt to return their home to its pre-loss condition in a timely fashion, USAA accepted that information and has used it to play the delay game with the Insured, knowing all too well the additional damage and hardship that was being placed on the Insured by its actions. USAA violated § 626.9541(1)(i)(3)(a) when it failed to adopt and implement standards for the proper investigations of claims. Under no circumstances is there an excuse for the lack of a proper investigation in this case. USAA and their representatives are willfully blind and grossly underqualified to handle a loss such as the one sustained by the Insured. In addition, after being placed on notice as to the blatant underpayment of the Insured’ claim, USAA has yet to rectify their actions and do right by the Insured by paying the money they are contractually owed. USAA violated § 626.9541(1)(i)(3)(c) by failing to acknowledge and act promptly upon the communications with respect to the claim. There still has yet to be significant action taken by USAA to this date, despite USAA being presented with the flawed rationale behind their underpayment of the Insured’ claim. USAA violated § 626.9541(1)(i)(3)(g) by failing to promptly notify the Insured of any additional information necessary for processing the claim. The Insured have more than complied with each and every request and there has still been no action by USAA. In the event USAA is in need of additional information, they have failed to promptly notify the Insured in a timely manner. This pattern of behavior is perpetuated by USAA and their representatives undeterred by the Ethical Requirements that are imposed by law on all Adjusters. Fla. Admin. Code Ann. R. (3) explicitly states the adjustment of insurance claims engage the trust of the public, and therefore, an adjuster has a duty of fair and honest treatment of the Insured throughout the insurance claim process. Several duties and responsibilities to the Insured were violated in the handling of this claim, which are specifically listed responsibilities of an Adjuster in the Florida Administrative Code. These breached duties and responsibilities include adjusters from USAA approaching the investigation and settlement in a manner prejudicial to the Insured, failing to allow a fair settlement with the Insured, and acting with due diligence in achieving a proper disposition of the claim. In contrast to the legislative intent motivating the enumeration of an Adjuster’s responsibilities outlined in the Administrative Code, the Insured were not afforded the professional duties entrusted on USAA by the public. To date, USAA has failed to adequately compensate the Insured for the damage that occurred on September 28th, 2022. As a direct result of USAA’s delay, the Insured were forced to seek the help of legal counsel to assist them. Due to the amount of time that has passed since the date of loss, this acknowledgement is evidence that USAA knowingly and intentionally are delaying the claims process in order to further disadvantage the Insured. The financial detriment caused to the Insured and their family is a direct result of USAA’s reckless delay of the claim process. The Insured are dutiful customers who made it a priority to pay their insurance premiums to ensure that in such an event as this devastating incident, their home would be covered. The Insured timely filed their claim and fulfilled all of their post-loss obligations. All requested information and documentation has been turned over to USAA and their representatives promptly by the Insured. However, USAA failed at every step of the process to adequately establish or identify the basis of its gross mismanagement of the claim, failed to inform the Insured how they may remedy any deficiencies in their claim, and failed to provide them with qualified representatives to ensure the claim was initially adjusted, evaluated, and estimated properly. To deny the Insured the benefit of their bargain after they satisfied all of their obligations is morally and ethically reprehensible, and reeks of Unfair Trade Practice. Upon information and belief, the aforementioned actions complained of, among others, were made by USAA so often as to constitute a general business practice, evidencing a motive to enhance USAA’s profits, and designed to cause a detrimental effect to its policy holders. USAA was aware that the Insured’ damages were covered and took advantage of its Insured in an attempt to force them into an irreparably disadvantaged position, which they hope will force the Insured to settle for less coverage than they are contractually entitled to under the policy. This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should USAA fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, USAA must: (1) Immediately tender all insurance proceeds due and owing to the Insured that are fairly owed to the Insured under the insurance policy that would reasonably place the Insured back to a pre-loss condition; (2) Agree to reimburse the Insured’ reasonable attorneys’ fees and costs for having to become involved to resolve the claim; (3) Agree to reimburse the Insured for interest on the amount of benefits that was found to be due and owing to the Insured, relating back to the date of loss; (4) Although the Insured have made a demand herein and have previously provided USAA with all the necessary estimates, invoices, receipts, etc. in support thereof, the Insured are still willing to consider and to potentially accept any reasonable counter-offer made by USAA. Therefore, if USAA is not in agreement with the Insured’ reasonable demand for payment of their rightfully-owed insurance benefits being submitted at this time, the Insured hereby request that USAA now make a reasonable counter-offer before the expiration of the cure period.

Comments

User Id		Date Added		Comment
michelle.copeland@usaa.com		02-12-2025		The allegations set forth in this notice are currently the subject of pending litigation. All allegations are denied. USAA CIC denies any and all allegations noted in the CRN. This response does not waive any affirmative defenses. A detailed response has been sent to the attorney of record.

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