Civil Remedy Notice of Insurer Violations
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Filing Number:     811205
Filing Accepted:  3/14/2025
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Complainant
Last/Business Name *  
COAD   First Name   DUSTIN
Street Address * 1041 VIA MERANO COURT
City, State Zip * WINTER PARK, FL 32789
Email Address * CLAIMS@WINDLAWGROUP.COM
Complainant Type: * Insured
Insured
Last/Business Name*   COAD   First Name   DUSTIN
Policy # * 034574456-90A Claim #* 034574456–800
Attorney
Attorney is Applicable
Last Name* GALLAGHER First Name * ROBERT Initial
Street Address* 8570 STIRLING ROAD, SUITE 102-406
City, State Zip* HOLLYWOOD , FL 33024
Email Address * ROBERT@WINDLAWGROUP.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   USAA GENERAL INDEMNITY COMPANY
NAIC Company Code 18600
 
Name of individual responsible for violation (if any):* THE ASSIGNED DESK ADJUSTER, FIELD ADJUSTER, SUPERVISOR(S) AND/OR MANAGER(S); AND ANY OTHER THAT HAS REVIEWED THIS CLAIM OR MADE DETERMINATIONS WITH RESPECT TO THIS CLAIM
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
Other : Unfair Settlement 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.
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)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

USAA GENERAL INDEMNITY COMPANY failed to adequately adjust and pay the claim covered under the subject insurance policy. Specifically, but not limited to, USAA GENERAL INDEMNITY COMPANY failed to properly apply the Loss Settlement and Loss Payment provisions of the policy. In addition to the policy sections, all endorsements and changes to the subject policy are relevant to the insured’s claim for civil remedy. There may be additional policy language relevant to this violation that may be discovered.
 
* 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 October 9, 2024, while the insurance policy (Policy Number: 034574456-90A) was in full force and effect, the subject property located at 1041 VIA MERANO COURT WINTER PARK, FL 32789 sustained a covered loss as a result of wind and water damage from Hurricane Milton. This was a Category 5 hurricane, and when it struck Florida, it was a strong Category 3 hurricane that devastated the state. The insured filed a claim (Claim Number: 034574456–800) per the terms of the insurance policy with USAA GENERAL INDEMNITY COMPANY (the “carrier”). USAA GENERAL INDEMNITY COMPANY received timely notice of the claim but failed to perform a thorough and prompt investigation so the subject property could be restored to its pre-loss condition. The carrier’s adjuster did not properly adjust the loss to include obviously related damages resulting from Hurricane Milton. After the carrier’s inspection, USAA GENERAL INDEMNITY COMPANY opened coverage for the loss and offered a miniscule payment of $1,513.31 to repair all the damages. This amount is a gross under-valuation of the claim and is not close to what is needed to restore the subject property to its pre-loss condition, even when accounting for the deductible and depreciation. The insured retained a representative, who performed a comprehensive investigation of the subject property that identified the damage that the carrier knew existed but failed to address. The insured’s representative determined there were damages and repairs necessary to restore the property to its pre-loss condition and submitted claim-related documentation to USAA GENERAL INDEMNITY COMPANY, including a detailed estimate for repairs for $378,209.92. After offering its initial payment, USAA GENERAL INDEMNITY COMPANY made it clear that it had no intention of dealing fairly with the insured and properly addressing the gross discrepancy between its offer and the insured’s estimate. Once it became abundantly clear that USAA GENERAL INDEMNITY COMPANY had no intention of acting in good faith, the insured was forced to file the instant Civil Remedy Notice. The adjusters assigned to this claim have a duty to adjust and treat all claims equally. Since the beginning of this claim the representatives on behalf of USAA GENERAL INDEMNITY COMPANY have approached this investigation in a manner prejudicial to the insured. USAA GENERAL INDEMNITY COMPANY is using either untrained or improperly trained adjusters in connection with this claim. USAA GENERAL INDEMNITY COMPANY should have been fairly adjusting this claim, but instead, it was looking for ways not to pay the claim at all or not pay the claim in full. Moreover, despite the Insureds’ request for appraisal and Policy’s provision requiring same, USAA GENERAL INDEMNITY COMPANY has refused to engage in the appraisal process. The above are all examples of USAA GENERAL INDEMNITY COMPANY’s unfair trade practices, improper investigation and adjustment of the claim, and unfair claim settlement practices. These actions demonstrate the carrier is 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 the insured. The insured gives this notice to perfect the right to pursue the civil remedy authorized by Florida Statute § 624.155. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: (1) Pay the complete covered loss in the amount of $378,209.92, less any prior payments and less any applicable policy deductible; (2) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made; and (3) implement appropriate standards and procedures for claims investigations and resolution in regard to the outstanding amount of this claim.
Comments
User Id Date Added Comment
vincent.kelley@usaa.com 03-20-2025 USAA Casualty Insurance Co. denies any and all allegations noted in this CRN. USAA Casualty Insurance Co. has promptly and thoroughly investigated this claim, and has based its coverage decision on the investigation of the facts. This response does not waive any affirmative defenses.
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