Civil Remedy Notice of Insurer Violations
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Filing Number:     649973
Filing Accepted:  10/4/2022
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Complainant
Last/Business Name *  
SCAVONE   First Name   FRANK AND YAYLA
Street Address * 2710 AZALEA COURT
City, State Zip * DELRAY BEACH, FL 33445
Email Address * FRANKSCAVONEBASS@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   SCAVONE   First Name   FRANK AND YAYLA
Policy # * 1501-1805-3442 Claim #* FL22-0101260-P420
Attorney
Attorney is Applicable
Last Name* MARKER First Name * SHAUN Initial J.
Street Address* 222 LAKEVIEW AVENUE, SUITE 1250
City, State Zip* WEST PALM BEACH , FL 33401
Email Address * SMARKER@MERLINLAWGROUP.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY
NAIC Company Code 10861
 
Name of individual responsible for violation (if any):* OFFICERS, SUPERVISORS, AND OR MANAGEMENT OF UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY; CARLISS BRYANT
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Claim Denial
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.
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)(d) Denying claims without conducting reasonable investigations based upon available information.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Building coverage provisions; additional coverages; duties in event of loss policy provisions; all terms and conditions of Section I of the insurance policy; the insurance policy's definition section; the insurance policy's exclusion of coverage provisions; loss payment policy provision; loss settlement provision; the declarations page; we will adjust all losses with you.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

In Florida, the work of adjusting insurance claims engages the public trust. Universal Property & Casualty Insurance Company, (“UPCIC”), has breached this duty by its handling of the Insureds, Frank and Yayla Scavone’s Claim of Loss (Claim Number FL22-0101260-P420; D.O.L. 11/10/2020). UPCIC has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insureds’ insurance claim for damages. This claim arises from covered damages sustained by the Insureds from a Hurricane Eta loss and ensuing damages claim occurring on or about November 10, 2020. To date, notwithstanding the Insureds’ pleas otherwise, UPCIC has continued to refuse to acknowledge its obligation to tender all insurance proceed monies due and owing the Insureds or assist the Insureds in mitigation of the damages. UPCIC further states the date of loss is January 13, 2022, when all paperwork submitted indicates it to be a Hurricane Eta date of loss which occurred November 10, 2020. UPCIC was, and has been, provided significant documentation of the damages of the loss event that would give rise to coverage under the insurance policy. UPCIC refused to accept or contemplate such information, thus violating the above referenced statutes: 624.155(1)(b)(1); 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b); 626.9541(1)(i)(3)(c); 626.9541(1)(i)(3)(d). UPCIC has not properly addressed, evaluated and/or paid the covered damages that were caused by this loss. UPCIC procured outcome-oriented inspectors for the purposes of creating support for a pre-determined denial of the claim. It is clear that UPCIC is failing to properly adjust this loss. UPCIC issued a letter dated February 15, 2022. In that letter, UPCIC utilizes tortuous, buzzword-oriented language in an attempt to state that they are not obligated under the policy for the claim. UPCIC came to the determination that the claim should be denied because “Although your claimed damages covered by your policy of insurance, repair costs must exceed the applicable deductible.” Further, the letter states: "As investigated and evaluated by our claim representative, the estimated cost of repair for claimed damage related to the above-refenced wind loss amounts to $1,861.97, which does not exceed your applicable policy deductible of $4,750.00.." UPCIC failed to fully evaluate the claimed damages, or even more egregiously willfully turned a blind eye to the readily apparent damages and decided to leave its Insureds in a precarious situation to generate policy defenses against coverage rather than assisting their Insureds in this unfortunate loss. UPCIC’s approach to coverage is in clear violation of the above referenced statutes. Despite these improper conclusions, UPCIC then attempts to use a smoke-and-mirrors approach to the applicable exclusionary provisions by including unsubstantiated policy language. UPCIC’s approach to coverage is in clear violation of the above referenced statutes: 624.155(1)(b)(1); 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b); 626.9541(1)(i)(3)(c); 626.9541(1)(i)(3)(d). The insurer has failed and refused to acknowledge full coverage and restore the Insured to their pre-loss condition. UPCIC has sufficient information upon which to evaluate the Insureds’ claim for damages, and certainly has been provided with an independent means by which to determine the amount of loss. The Insureds have otherwise fully complied with the insurer's requests for post-loss compliance. UPCIC has not properly paid all of the covered damages. These actions by UPCIC occur with such frequency to indicate a general business practice of the company. The Insureds have complied with the policy of insurance and Florida law, and UPCIC continues to wrongfully refuse to tender the insurance proceeds that are due and owing the Insureds. The concept of insurance is the granting of timely and prompt indemnity or security against a contingent loss. Florida statute section 624.02 defines "insurance" as a contract whereby one undertakes to indemnify another or pay a specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that the Insureds may be put back into the position they were in prior to the loss as quickly as possible. UPCIC breached this duty. The Insureds were and still are forced to expend out of pocket monies to submit the insurance claim to force UPCIC to honor its obligations under the insurance policy to pay all the insurance proceeds due and owing them. UPCIC has clearly displayed bad faith in its handling, processing, and wrongful delay of this claim. The Insured merely requests that UPCIC "adjust the loss" with them in accordance with the policy of insurance for which UPCIC has accepted a premium, and in accordance with Florida law. UPCIC’s conduct has been reckless and unfair to its Insureds and has caused and continues to cause additional damages. These actions by UPCIC occur with such frequency to indicate a general business practice. Therefore, to cure the defects outlined in this Civil Remedy Notice, UPCIC must: (1) pay the claim pursuant to the estimates previously submitted; (2) immediately agree to pay interest, at the statutory rate, for all amounts paid in response to this notice (such amount is in flux as UPCIC’s refusal to pay continues); and (3) immediately agree to pay attorney’s fees and costs incurred by the Insured against UPCIC in this claim (such amount is in flux as UPCIC’s refusal to pay continues).
Comments
User Id Date Added Comment
swhetstone@gspalaw.com 10-20-2022 October 20, 2022 VIA ELECTRONIC FILING Florida Department of Financial Services Bureau of Consumer Assistance Civil Remedy Section 200 East Gaines Street Tallahassee, FL 32399-0322 Re: DFS File No.: 649973 Filing Date: 10/04/2022 Complainants: Frank Scavone and Yayla Scavone Insureds: Frank Scavone and Yayla Scavone Policy No.: FL22-0101260-P420 Claim No.: 1501-1805-3442 Dear Sir/Madam: Please allow this to serve as Universal Property & Casualty Insurance Company’s (“Universal”) formal response to the above-referenced Civil Remedy Notice (“Notice”) filed by Attorney Shaun J. Marker, on behalf of Complainants, Frank Scavone and Yayla Scavone. The Notice alleges violations of Florida Statute Section 624.155 and 626.9541. Universal specifically denies each and every allegation contained in the Notice. Additionally, Universal denies that it violated these or any statutes, Florida law or policy provisions regarding the claim adjudication of this matter. With that said, Universal asserts that the Notice fails to comply with the specific Notice and information requirements as set forth in Civil Remedy Notice of Insurer Violation document provisions, Florida Statute §624.155 and Florida law. The Notice is deficient as a matter of law as it fails to comply with Fla. Stat. §624.155. See 316, Inc. v. Maryland Cas. Ins. Co., 526 F. Supp. 2d 1187 (N.D. Fla. 2008); Rousso v. Liberty Surplus Ins. Corp., 2010 WL 7367059, (S. D. Fla. 2010); Heritage Corp. of South Fla. v. Nat’l Union Fire Ins. Co. of Pittsburgh, P.A., 580 F. Supp. 2d 1294 (S.D. Fla. 2008); Talat Enterprises, Inc. v. Aetna Cas. & Surety Co., 753 So. 2d 1278 (Fla. 2000). Pursuant to Fla. Stat. §624.155(3)(b), the Notice “shall state with specificity” the following information: 1. The statutory provision, including the specific language, which the authorized insurer allegedly violated; 2. the facts and circumstances giving rise to the violation; 3. the name of any individual involved in the violation; 4. reference to specific policy language that is relevant to the violation, if any...; 5. a statement that the Notice is given in order to perfect the right to pursue the civil remedy authorized by this section. Moreover, the Department created form DFS-10-363, which lays out 15 requirements that the Complainant(s) must respond to with specificity. The Florida Supreme Court holds that Fla. Stat. § 624.155 “must be strictly construed.” Talat Enterprises, Inc. v. Aetna Cas. and Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). Strict construction is appropriate as “this statute is in derogation of the common law.” Id. When interpreting a statute in derogation of the common law, “[a] court will presume that such a statute was not intended to alter the common law other than as clearly and plainly specified in the statute.” Time Ins. Co., Inc. v. Burger, 712 So. 2d 389, 393 (Fla. 1998). Such an interpretation would mean that statutory bad faith cases cannot proceed unless the Complainant(s) has specifically complied with all statutory requirements. Pin-Pon Corp. v. Landmark American Ins. Co., 2020 WL 6588379 (S.D. 2020); Julien v. United Property & Casualty Ins. Co., 2021 WL 824438. The Notice fails to meet the requirements of Fla. Stat. § 624.155 on several grounds. First, with respect to the requirement to set forth with specificity the “facts and circumstances giving rise to the violation,” the Notice generally alleges that Universal violated Fla. Stat. 626.9541(1)(i)(3)(b) by “Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.” However, the Notice does not set forth any facts regarding any misrepresentations made by Universal and does not identify the person or persons who made such misrepresentations. The Notice does not state any facts to support the Complainant’s misrepresentation allegations or any of the allegations contained therein. It is evident that the statement of facts falls short of the specificity required by Fla. Stat. §624.155. As a result, the Complainant failed to comply with the requirements provided in Section 624.155(3)(b)(2), Fla. Stat. Second, the Notice fails to satisfy Fla. Stat. § 624.155(3)(b)(4) in that it fails to reference specific policy language relevant to the alleged violation with any degree of specificity. In particular, the Notice cites to certain vast portions of the policy at issue without specifically delineating what specific subsection was violated. As such, the Notice is insufficient as a matter of law to satisfy the specificity requirement of Fla. Stat. § 624.155(3)(b)(4). Finally, the Complainant failed to respond to each of the fields set forth on the DFS Form with the requisite specificity, including failing to include the Insurer’s address. Therefore, the Notice is legally deficient and fails to satisfy the condition precedent to filing a bad faith action. See Pin Pon, 2020 WL 6588379; Julien v. United Property & Casualty Ins. Co., 2021 WL 824438. While an insurance company is required to settle claims that should be settled, it is not required to settle claims that are legitimately contested. Florida law continually affirms the principle that an insurer has the right to investigate claims presented for payment. An insurance company is expressly afforded an opportunity to evaluate its rights and liabilities. After reviewing the Civil Remedy Notice, Universal conducted a thorough review of its handling of the Insured’s claim. Universal denies that it violated any statutes, administrative code provisions, or ethical rules or obligations in connection with its investigation and handling of the Insured’s claim. Universal unequivocally denies each and every allegation asserted in the Civil Remedy Notice. Universal asserts it has complied with all policy provisions and applicable Florida law regarding the adjudication of this claim to date. We trust that the foregoing is sufficient to advise you of Universal’s position with regard to this matter and fully responds to the alleged violations in the Notice filed by the Complainant. Very truly yours, GROELLE & SALMON, P.A. /s/ Susan M. Whetstone, Esq. Susan M. Whetstone, Esq. For the Firm cc: Via email only Shaun J. Marker, Esq. smarker@merlinlawgroup.com
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