Breach Of Contract
August 28, 2018
To Whom It May Concern:
Policy Number THO 122212676
Re: Claim Number: 013290891
Date of Loss: May 27, 2018
Name of Insured: Shavonda Lindsey and Andre Haynes
Address of Insured Property: 36 16th Ave Texas City, TX 77590
The intent and sole purpose of this letter is to file a formal complaint against AAA Texas aka Auto Club Indemnity Company Texas. AAA Texas has displayed acts that violate several Texas Insurance Codes. As well as a breach of contract, which I believe has implied acts of bad faith involving claim # 013290891. Throughout the entirety of this compliant, I will include the Texas Insurance code. In which, I believe has been violated along with documents that support my logics. First, I would like to give you a little background about my claim, before I address my concerns. I submitted a claim in response to a theft that occurred between 5/26/2018 and 5/27/2018. Due to the holiday weekend, I was unable to report my theft to AAA Texas until 5/29/2018. However, I did report my theft to Texas City Police Department, shortly after I was notified of the theft. I was out of town, when I received notification about the theft. The process of reporting my claim was at ease, no problems. Customer service representative was very, helpful and knowledgeable within her job. My claim was quickly handed over to Ginger Glander, whom I received very prompt response time from. My first notification was delivered May 29, 2018 at 12:32(email included). Ginger, shortly followed up with an email the same day containing the property loss worksheet and very short and simple instructions. Ginger explained to me the need of proof of loss. Also, to make sure everything listed on the worksheet was included on the police report. After receiving the email, I requested a call from Ginger. During our phone conversation, I asked Ginger if hotel fees were covered (Use of Loss) under my policy. Ginger stated, that my husband explained to her the broken window that occurred during the theft had been boarded up, so I was not entitled to the use of loss provision. I expressed my concerns for my children’s safety but was told AAA would not approve. I was surprised that AAA would not cover a hotel stay, not for even for a short period of time. Particularly, since the policy states, under
Section I- PERILS INSURED AGAINST- Extensions of Coverage #2
LOSS OF USE. If a loss caused by a Peril Insured Against under Section I makes the residence premises wholly or partially untenantable, we cover:
A. Additional living expense, meaning any necessary and reasonable increase in living and reasonable increase in living expense you incur so that your household can maintain its normal standard of living.
Fair rental value, meaning the fair rental value of that part of the residence premises usually rented to others by you, less any expenses that do not continue.
The total limit of liability for all loss of use is 20% of the Coverage B (Personal Property) limit of liability. This is additional insurance and does not reduce the Coverage B (personal property) limit of liability. The deductible clause does not apply to loss of use coverage.
Payment will be for the reasonable time required to repair or replace the damaged property (which is required under Duties after Loss). If you permanently relocate, payment will be for the reasonable time required for your household to become settled.
The periods of time for loss of use are not limited by expiration of this policy.
Sec. 541.051. MISREPRESENTATION REGARDING POLICY OR INSURER. It is an unfair method of competition or an unfair or deceptive act or practice in the business of insurance to:
(1) make, issue, or circulate or cause to be made, issued, or circulated an estimate, illustration, circular, or statement misrepresenting with respect to a policy issued or to be issued:
(A) the terms of the policy;
(B) the benefits or advantages promised by the policy;
Sec. 541.060. UNFAIR SETTLEMENT PRACTICES. (a) It is an unfair method of competition or an unfair or deceptive act or practice in the business of insurance to engage in the following unfair settlement practices with respect to a claim by an insured or beneficiary:
(1) misrepresenting to a claimant a material fact or policy provision relating to coverage at issue;
Sec. 541.061. MISREPRESENTATION OF INSURANCE POLICY. It is an unfair method of competition or an unfair or deceptive act or practice in the business of insurance to misrepresent an insurance policy by:
(1) making an untrue statement of material fact;
My second encounter by breach of contract and violation of Texas Insurance Codes Section 541.051, 541.060 and 541.061 evolved from email correspondence titled Repairs dated June 21, 2018. I sent Ginger an email questioning, if the cost of repairs for the window and door that was broken resulting from theft, was covered under my policy? Ginger’s verbatim reply stated, “we do not cover damage to the property we insured your contents not the dwelling.”
Section I- PERILS INSURED AGAINST- Extensions of Coverage #3
Reasonable Repairs. If a Peril Insured Against causes the loss, we will pay the reasonable cost you incur for necessary repairs made solely to protect covered property from further damage. This coverage does not increase the limit of liability that applies to the property being repaired.
Also, under Endorsement NO. HO-101 Effective October 2, 1993
a. We will pay you:
1. The replacement cost of your damaged property up to $1,500 and
2. The actual cash value of your remaining damaged property within 5 business days after we notify you that we will pay the claim.
If you repair or replace the damaged property, you may make claim for reimbursement on a replacement cost basis for the replacement cost of your property exceeding $1,500. You must repair, restore or replace the property with 365 days after the loss. Reimbursement will be made within 5 business days after we receive proof that the property has been repaired, restore or replaced.
b. In lieu(a.) above we may offer, and you may accept or reject our offer to provide a replacement item of like kind quality for you damaged property.
As a result, of failure to relay pertained information, making untrue statements and failing to state material fact. I failed to stay in compliance with the Duties After Loss. However, I did repaired the window and door but did not keep up with receipts. Since I was told damage wasn’t covered. Currently, I’m in the process of recovering those proof of purchase for repairs. An act of good faith would have been to correct the situation as soon as she was made aware. So that I could recover receipts in a timely manner. On July 30, 2018, I was requested by David Godell, to bring receipts for repairs to our meeting which occurred August 3, 2018. Due to the absence of my proof of receipts this may have caused assumptions to be made by David. For instance, I wasn’t cooperating or even worse that I didn’t repair the damage. However, I did repair the damages but during the shuffle of relocating and living out of a hotel for over a month. I have misplaced them. Now, that we are 90 days into the claim and no one has yet to correct that statement along with other deceptions. I have no choice but to believe AAA Texas is acting in bad faith. Continuing to allow me to believe something untrue on the basis that I have not mentioned it or in hopes that I’m not aware of my policy. Also, on June 21, 2018 I questioned the time frame of the case and was given a very vague response time. I was also quoted (email time stamped June 21, 2018at 0956) the investigation of the claim must be completed prior to being able to make any type of payment. Also stated, in addition, you will need to update the police report with all the item that you have listed on the property loss worksheet. Which was already completed (failure to investigate). Nevertheless, confusion struck upon deliverance of email (stamped June 22, 2018 at 0810). Not even 24 hours later. I received an email from Ginger, stating my policy limit of $500.00 for the jewelry portion was paid. Yet, my remaining items where still under review. At the time she only requested more proofs of purchase but didn’t recommend in specifics. I wasn’t concerned at that point, due to pictures and receipts were in process of delivery by mail. However, confirmation was never received. Because of the language of the previous email, it was safe to conclude the investigation was complete due to making some sort of payment.
Twenty-four business days went by before I realized I hadn’t received any updates or correspondence from AAA Texas. July 26,2018, I reached out to Ginger, but she was unavailable, so I called her manager Kent Neading requesting an update. He informed me my investigation was still in process and the investigator deadline was Monday July 30, 2018. July 30,2018, I received a voice mail from David Godell wanting to schedule a recorded meeting. Once I spoke with David, we scheduled a meeting for Friday August 3, 2018. Upon arrival, I learned David was with the Special Investigations Unit. Again, I was disappointed that I was not informed/ notified my case was being referred to a specials unit. It would have been in great faith to be notified, instead of taken by surprise. I didn’t see a policy in regards to a recorded statement and was never advised on my rights. Meeting him and providing a recorded statement was not the issue. My concern was not being notified in advance. That’s just common courtesy and good faith. Another display, of an act of failing to relay important information. During our meeting with David my tone for this investigation started to change. My understanding for the investigation was clearly understood and respected, but I didn’t appreciate some of the remarks and questions. In example, he asked if I turned over my ironing board after watching the video I provided on my phone. From the aftermath of the theft. He had no regards to my feelings or emotions this situation has caused. There was another way to rephrase that question to lessen the impoliteness he displayed. That question made me feel as if I was being disrespected and interrogated. Later, in the interview he questions the amount of money my husband keeps in his pocket on a daily. That question was unfit and unethical. Whether he keeps a dollar or two million dollars in his pocket does not provide a reason for us to be robbed and then victimized by our insurance company. My concerns grew stronger when David implied he has failed to properly and promptly investigate our case. David did not have the final police report from Texas City Police Department. David had not fully reviewed the pictures and receipts I had sent in to Ginger. David had not been in contact with Texas City Police or at least that what he has lead me to believe from his statements. Please request recording from David if there are any questions about our recorded interview. In addition, David requested that we sign an Authorization for use or disclosure of financial and other information form. Stating that the form would allow AAA to speak with the different companies to verify the receipts/ purchases. However, the form included in the email was blank and did not specify which department stores he would be in contact with. The form also required our social security number. I don’t understand why? I have no problem signing a specific form to release information, it will save me time and the headache in dealing with it. After reading the entire form, I felt it was entirely too vague. Also allow access to insignificant information related to this case. Not to mention a bold face lie, providing misleading leading information. Please refer to email AAA Claim 013290891 dated August 6, 2018 at 1713. Once again, I feel Texas Insurance Code 541.060 (1) has been violated in result of his actions and remarks.
My last and final complaint that I would like to bring to your attention stems from an email I received from Walters Balido and Crain Law Firm retained by AAA requesting an Examination Under Oath. Which I have no issue providing, but what I do have an issue with is once again I was never notified by anyone from AAA Texas. Please refer to email (Claim 013290891; EUO) which also included a reservation of rights. Respected, fair and understood. Yet, very distasteful in the nature of deliverance. Not to mention the email was not accompanied on a company letter head or signed by company management. So I didn’t know if it was a scam. Should I reply or shouldn’t I? I haven’t heard anything about this from Ginger, David or Kent. The first email didn’t provide the company name in which requested the EUO. I wasn’t provided with a claim #. Lastly, one of the documents requested is a request for my W2’s and federal tax return among other excessive information dated from January 1, 2015 to present. Wow. Which is a violation of:
Texas Insurance Code 541.060
(a) It is an unfair method of competition or an unfair or deceptive act or practice in the business of insurance to engage in the following unfair settlement practices with respect to a claim by an insured or beneficiary:
(9) requiring a claimant as a condition of settling a claim to produce the claimant's federal income tax returns for examination or investigation by the person unless:
(A) a court orders the claimant to produce those tax returns;
(B) the claim involves a fire loss; or
(C) the claim involves lost profits or income.
I have concluded, as of August 21, 2018 that AAA Texas is acting out of bad faith and trying to delay my claim for some unknown reason. Since no one seems to be straight forward. The last straw was receiving a letter from Ginger August 21, 2018, via mail, written August 8,2018, printed August 9, 2018, and postage dated August 14, 2018. Stating as of August 27, 2018, approximately 90 days since I submitted my claim to notify me that more time is needed, for review. Why not email me for faster delivery if it’s not meant as an intentional delay? Why request the extension after 3 months of telling me my claim is under review. Why not notify me sooner? Why not give me frequent and honest updates? If all this was standard procedures it would be no problem being forthright with information. Yet, the lies and deceitful acts display mere acts of bad faith. There must be some level of balance that AAA Texas employees are trained on. Clearly, the standards are changing within the company. TDI records show complaints reported 12 complaints in 2015, 2016-2017 maintained 18 complaints. Four months left in 2018 AAA Texas is already at 31 about to be 32 complaints. Funny, how three years can change anyone’s situation, even a suggested reputable company much like yours! For the last 3 months I have been left in the blind, during a very uneasy situation. I’m not asking for any special treatment, I’m just expecting the promises you committed to like equal treatment, fair treatment, use of loss, loss settlement, repair reimbursement and the right to protect my privacy. Just because one chooses to enforce their privacy rights doesn’t mean there is a reason of deceit behind it. Maybe it strictly means it’s no one else’s business. I voluntarily provided AAA Texas enough documents to justify the figures in the inventory. The items stolen from us didn’t come over night nor did they come in one, two or three years. It took sacrifice and hard work. Other sentiments that was selfishly stolen from me, no amount of money can ever replace the emptiness I have suffered. I was always taught never address a complaint without a solution. So, my suggestion is to require upfront documentation approval prior to providing coverage limit, before a policy is purchased. When an individual or family is going through a problem, the last thing they want is another problem. Insurance is meant for protection not stress and confusion. During a conversation with Sheri O’Neal she stated, a very powerful statement when she said, “not everyone lives the same!” I hope this complaint can be transformed into a learning tool to grow and train in a positive way within AAA. I have attached all correspondence I have related to this claim. After the Examination Under Oath my prayer is to come to a speedy agreement in resolving this case. Thank you so much for your time. I do hope that my concerns were clear and understood.