Filing Number: 810503
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| Filing Accepted: 3/11/2025 |
| Last/Business Name
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| Street Address
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1407 CALLEN STREET |
| City, State Zip
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TALLAHASSEE,
FL
32301
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| Email Address
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WITHELD |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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SENOR |
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First Name |
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PEGGY |
| Policy # * |
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030613576/90A |
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Claim #* |
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030613576-006 |
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Attorney is Applicable
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| Last Name* |
GUTIERREZ
First Name *
DANIEL
Initial
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| Street Address* |
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924 DELANEY AVENUE |
| City, State Zip* |
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ORLANDO
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FLORIDA
32806
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| Email Address * |
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SERVICE@DGPALAW.COM |
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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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USAA GENERAL INDEMNITY 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 18600 |
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| Name of individual responsible for violation (if any):*
DANIEL WILT, TROY MATTHEW HOLLINGSWORTH
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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 Delay
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Claim Denial
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Unfair Trade Practice
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Unsatisfactory Settlement Offer
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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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| 624.155(1)(b)(2) |
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Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
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| 624.155(1)(b)(3) |
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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.
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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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| 626.9541(1)(i)(3)(b) |
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Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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| 626.9541(1)(i)(3)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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| 626.9541(1)(i)(3)(f) |
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Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement.
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| 626.9541(1)(i)(3)(g) |
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Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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| 626.9541(1)(i)(3)(h) |
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Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
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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.
The coverage decision correspondence does not rely on any policy language for their underpayment. However, they have failed to properly adjust and pay the claim pursuant to the Section I – Conditions, Loss Settlement provision and the Section I – Conditions, Loss Payment provision.
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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.
On or about January 9, 2024, the home of Peggy Senor (hereinafter referred to the “Insured”) was damaged by a storm. Specifically, the roof and exterior were damaged and interior water damages ensued. The Insured reported these damages to her homeowners’ insurance company, USAA General Indemnity Company (hereinafter referred to as “Insurer”). The Insurer responded to the claim and inspected the damages.
Troy Hollingsworth prepared an estimate of damages totaling $15,638.17 RCV and $12,241.76 ACV for roof damages and interior water damages. The Insured’s roofer questioned the amount of loss and a revised estimate was prepared totaling $18,336.24 RCV. The insurer ultimately made payments totaling $16,336.24, which reflects application of the $2,000 deductible.
The Insured received an estimate from a contractor for storm damages to the interior and exterior that totaled $53,365.86 RCV. This estimate was provided to the Insurer on December 10, 2024 along with a photosheet. The Insurer responded requested additional photos of the laundry room damages reflected in the estimate. On January 10, 2025, a link was provided with a virtual tour of the property reflecting areas of damage taken by the contractor. On January 21, 2025, the Insurer advised that they were unable to click external links due to security of their system and again photos were requested. On February 21, 2025 an additional photograph of the laundry room was provided. If any additional information or documentation is needed for the Insurer to further consider the claim, then the Insurer failed to advise of what information is necessary for the processing of the claim and why it is necessary.
It is clear that the carrier is not treating the Insured with good faith claims conduct by failing to pay a claim clearly owed, not adjusting the claim and evaluating the loss properly, failing to promptly and fairly provide full and prompt indemnity to the Insured, failing to advise of any information necessary for further processing of the claim, failing to provide a reasonable explanation in writing of the basis in the insurance policy in relation to the facts for the denial of the claim, and failing to implement proper standards for the adjustment and investigation of claims by its adjusters. This Insurer is placing the company’s interests before the Insured’s interests when a reasonable carrier in a similar position would have provided full coverage. In particular, it is a business practice of the Insurer to severely lowball storm damage claims with their initial claim adjustment with the intent of effecting settlement of such claims on less favorable terms than those provided by the policy.
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 Insured’s 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 pursuant to the cost of roof replacement and the estimate of interior repairs provided (after application of the deductible and reduction for prior payment), and; 2)Pay the statutory interest on the amount of unpaid damages from the date the loss was reported to the date payment is finally made.
A copy of this form has been submitted to the FDFS and has been printed out and mailed to the following parties providing them notice of the filing of the Civil Remedy Notice:
USAA General Indemnity Company
9800 Fredericksburg Road
San Antonio, Texas 78288
Certified Return Receipt #9589 0710 5270 1009 7574 73
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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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