Filing Number: 811377
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| Filing Accepted: 3/17/2025 |
| Last/Business Name
*
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EVERSOLE
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First Name |
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MICHAEL AND SHELLEY |
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| Street Address
*
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7799 133RD STREET |
| City, State Zip
*
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SEMINOLE,
FL
33776
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| Email Address
*
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ARES94M@GMAIL.COM |
| Complainant Type:
*
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Insured |
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| Last/Business Name* |
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EVERSOLE |
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First Name |
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MICHAEL AND SHELLEY |
| Policy # * |
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00886 35 49 91A |
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Claim #* |
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886-3549-019 |
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Attorney is Applicable
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| Last Name* |
WOOD
First Name *
ANGELA
Initial
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| Street Address* |
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350 N. LAKE DESTINY ROAD |
| City, State Zip* |
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MAITLAND
,
FLORIDA
32751
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| Email Address * |
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AWOOD@ITSABOUTJUSTICE.LAW |
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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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UNITED AUTOMOBILE INSURANCE 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 35319 |
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| Name of individual responsible for violation (if any):*
NA
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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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Unfair Trade Practice
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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)(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)(2) |
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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.
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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)(c) |
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Failing to acknowledge and act promptly upon communications with respect to claims.
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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)(4) |
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Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
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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.
Section 1 - Property Coverages – Coverage A – Dwelling
Section 1 – Perils Insured Against – Coverage A-Dwelling and Coverage B-Other Structures
Section 1- Conditions –Loss Settlement
Section 1 – Conditions –Loss Payment
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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 May 24, 2023 the Insureds, Michael and Shelley Eversole, suffered damage to their home located at 7799 133rd Street, Seminole, FL 33776 33709 as a result of a wind event.
Prior to the loss, United Services Automobile Association (“USAA”), had issued a policy of insurance (Policy No.: 00886 35 49 91A) for the Insureds’ property. Said policy, which was issued prior to the loss, was in full force and effect and afforded coverage for damage caused by the wind.
USAA was timely notified of the loss by the Insureds and assigned claim number 886-3549-019. During the course of USAA’s investigation, the Insureds made their property available for inspection, provided facts and information surrounding the loss, and complied with USAA’s adjustment of the claim.
Although USAA acknowledged the Insured’s property was damaged by the wind, USAA inexplicably underpaid a majority of the damages claimed, specifically with respect to the roof. USAA came to its coverage determination by ignoring relevant facts and information provided by the Insureds and their contractors that established the damages to the roof were substantial and required a full replacement. Most concerning, USAA and its representatives intentionally downplayed and misrepresented the scope of the damages. USAA failed to conduct a thorough evaluation as to the age and repairability of the roof that caused it to substantially undervalue the loss as a whole. USAA also omitted key facts from its coverage decision and misapplied exclusions to minimize its financial exposure in the claim.
On July 31, 2023, USAA issued its’ coverage decision and advised the Insureds that if the roof was replaced and documentation shown the depreciated value of $8,348.48 would be paid. Prior to filing the Notice of Intent to Litigate, the Insureds provided USAA with an invoice and proof that the roof had in fact been replaced. Despite this, USAA has failed to provide the depreciated value its’ own adjusters calculated.
It is clear that USAA has not acted honestly or fairly towards its Insureds. USAA and its representatives have failed to conduct a proper investigation of the loss, misrepresented the cause and scope of damages at the residence, and misapplied exclusions in the policy in order to wrongfully underpay the Insureds’ claim. It has become a general business practice of USAA to not implement proper claims handling procedures, to hire consultants that routinely ignore or intentionally misidentify relevant evidence, and to not settle claims in good faith when under all circumstances it should have. As is the case here, it is a pattern and practice for USAA to arbitrarily undervalue claims without conducting reasonable investigations based upon information and evidence available to it. It is also a pattern and practice of USAA to fail to disburse payments it agrees it owes.
In order to cure this civil remedy notice, USAA must immediately acknowledge in writing that the Insureds’ property was damaged by a wind event and that replacement of the roof is covered by the policy. USAA must also tender the undisputed benefits owed to replace the roof pursuant to the terms of the policy. The written acknowledgement and payment should be issued to the Insureds’ counsel, Angela A. Wood, Esq., at 350 N. Lake Destiny Road, Suite 300, Maitland, FL 32751.
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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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