Civil Remedy Notice of Insurer Violations
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Filing Number:     650043
Filing Accepted:  10/4/2022
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Complainant
Last/Business Name *  
HINDS   First Name   JULIET
Street Address * 6251 NW 16TH COURT
City, State Zip * SUNRISE, FL 33313
Email Address * JAYHINN55@YAHOO.COM; MRPERSONALITY60@YAHOO.COM
Complainant Type: * Insured
Insured
Last/Business Name*   HINDS   First Name   JULIET
Policy # * 1501-1801-0481 Claim #* FL20-0116033
Attorney
Attorney is Applicable
Last Name* SAINTILUS First Name * WILLIAM Initial
Street Address* 7292 NW 1ST COURT
City, State Zip* MIAMI , FLORIDA 33150
Email Address * WILLIAM@BENMELEHLAW.COM ; JACK@LAWLP.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):* • FILED ADJUSTER RYAN KIMBROUGH, CLAIMS EXAMINER VANESSA COBAS AND ALL ADJUSTERS, SUPERVISORS, MANAGEMENT AND INDIVIDUALS ASSOCIATION WITH OR RETAINED BY THE INSURANCE COMPANY INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Unfair Trade Practice
Claim Delay
* 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.
624.155(1)(b)(3) 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.
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.
626.9541(1)(i)(3)(f) 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.
626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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.

STATUTES VIOLATED CONTINUED: 69B-220.201 Florida Ethical Requirements for All Adjusters and Public Adjuster Apprentices. 69B-220.201 (b) An adjuster shall treat all claimants equally; 1. An adjuster shall not provide favored treatment to any claimant; 2. An adjuster shall adjust all claims strictly in accordance with the insurance contract. 69B-220.201 (c) an adjuster shall never approach investigations, adjustments, and settlements in a manner prejudicial to the insured. 69B-220.201 (d) an adjuster shall make truthful and unbiased reports of the facts after making a complete investigation 69B-220.201 (e) an adjuster shall handle every adjustment and settlement with honesty, integrity, and allow fair adjustment or settlement to all parties without any remuneration to himself except to that which he is legally entitled. 69B-220.201 (f) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim. SPECIFIC POLICY LANGUAGE THAT IS RELEVANT TO THE VIOLATIONS INCLUDE BUT ARE NOT LIMITED TO THE FOLLOWING: All terms and conditions of Section 1 – CONDITIONS of the insurance policy. Universal Property & Casualty Insurance Company (hereinafter “Insurance Company” or “UPCIC”) failed to adequately adjust and pay the claim under the subject insurance policy. Specifically, but not limited to, Insurance Company failed to properly apply the Loss Settlement(D.) provisions of the policy. In addition to the policy sections specifically cited herein, any endorsements or changes to said sections are relevant to the Insured’s claim for civil remedy. There may be additional policy language relevant to this violation that may be discovered. SECTION I – PERILS INSURED AGAINST A. Coverage A – Dwelling And Coverage B – Other Structures 1. We insure against direct physical loss to property described in Coverages A and B. However, loss does not include and we will not pay for any “diminution in value”. 2. We do not insure, however, for loss: a. Excluded under Section I – Exclusions; b. Involving collapse, including any of the following conditions of property or any part of the property whether above or below the ground: (1) An abrupt falling down or caving in; (2) Loss of structural integrity, including separation of parts of the property or property in danger of falling down or caving in; or (3) Any “spalling”, crumbling, cracking, shifting, bulging, racking, sagging, bowing, bending, leaning, settling, shrinkage or expansion as such condition relates to (1) or (2) above; except as provided in F.8. Collapse under Section I – Property Coverages; or B. Coverage C – Personal Property We insure for direct physical loss to the property described in Coverage C caused by any of the following perils unless the loss is excluded in Section I – Exclusions. However, loss does not include and we will not pay for any “diminution in value”. SECTION I – PROPERTY COVERAGES A. Coverage A – Dwelling 1. We cover: a. The dwelling on the "residence premises" shown in the Declarations, including structures attached to the dwelling; and b. Materials and supplies located on or next to the "residence premises" used to construct, alter or repair the dwelling or other structures on the "residence premises". … B. Coverage B – Other Structures 1. We cover other structures on the "residence premises" set apart from the dwelling by clear space. This includes structures connected to the dwelling by only a fence, utility line, or similar connection. … D. Coverage C – Personal Property 1. Covered Property We cover personal property owned or used by an "insured" while it is anywhere in the world. After a loss and at your request, we will cover personal property owned by: a. Others while the property is on the part of the "residence premises" occupied by an "insured"; or b. A guest or a "residence employee", while the property is in any residence occupied by an "insured". … E. Coverage D – Loss Of Use The limit of liability for Coverage D is the total limit for the coverages in 1. Additional Living Expense, 2. Fair Rental Value and 3. Civil Authority Prohibits Use below. 1. Additional Living Expense If a loss covered under Section I makes that part of the "residence premises" where you reside not fit to live in, we cover the Additional Living Expense, meaning any necessary increase in living expenses incurred by you so that your household can maintain its normal standard of living. Payment will be for the shortest time required to repair or replace the damage or, if you permanently relocate, the shortest time required for your household to settle elsewhere. … 8. Collapse a. The coverage provided under this Additional Coverage – Collapse applies only to an abrupt collapse. d. We insure for direct physical loss to covered property involving abrupt collapse of a building or any part of a building if such collapse was caused by one or more of the following: (1) The Perils Insured Against named under Coverage C – Personal Property; (2) Decay, of a building or any part of a building, that is hidden from view, unless the presence of such decay is known to an "insured" prior to collapse; (5) Weight of rain which collects on a roof; or
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The Insurance Company’s: 1) Failure to pay full claim owed, 2) Failure to promptly investigate claim, 3) Failure to properly investigate claim, 4) Failure to adjust loss, 5) Failure to act in due diligence and good faith to resolve claim, 6) Placing financial interest of insurer before that of policy holders and claimants, 7) Failure to properly train, evaluate and manage adjusters, 8) Looking for ways to deny coverage, pay less, delay payment and otherwise “low ball” or “stone wall” claim. The reasons for this may be attributed to improper training, supervision, and/or motivation of adjusters and claims supervisors to investigate, adjust and pay full benefits available to all beneficiaries promptly and fairly. The insurer may have failed to adopt proper standards of investigation and adjustment of losses, or is otherwise not implementing those standards because full payment and prompt payment for the loss is not occurring. When an insurer receives a claim, it has an independent duty to evaluate the claim in advance of a determination of damages and take timely, independent action. Zaleski v. State Farm Fla. Ins. Co., 315 So. 3d 7, 12 (Fla. 4th DCA 2021). This duty includes determining coverage, liability, and the amounts due under the policy. Second, they have a statutory duty to act reasonably and in good faith in evaluating the claim. See § 624.155(1). Williams v. State Farm Fla. Ins. Co., 47 Fla. L. Weekly 633 (Fla 2d DCA 2022). In Florida, the work of adjusting insurance claims engages the public trust. The insurance company has breached this duty by its adjustment of the insured’s claim of loss. The insurance company has failed to create and implement adequate guidelines for proper investigation to evaluate claims handling and for training and supervision of employees resulting in statutory violations as set forth above in paragraph no. 5. The insurance company has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate insured’s insurance claim for damages. Notwithstanding the insured’s timely notification to the insurance company of its insurance claim, the insurance company has delayed in paying or tendering to the insured all insurance proceeds due and owing it under its insurance policy. Juliet Hinds And Lenford Hinds (the “Insureds”) own the insured property at 6251 NW 16th Court, Fort Lauderdale, FL 33313 (the “Property”). The Property was significantly damaged after heavy rains and the flat roof of the Property abruptly collapsed on May 18, 2020. The Property was insured through UPCIC under Policy No. 1501-1801-0481 at the time of the loss. The loss was reported on May 19, 2020. Following the Insureds reporting, on June 4, 2020, the Insurance Company’s Field Adjuster Ryan Kimbrough conducted an inspection of the property and observed the obvious carnage. The Property was not in a livable condition and was deemed unsafe by the City of Sunrise. It is unclear if Ryan Kimbrough prepared an estimate following his inspection for the obvious undisputed damages. On June 9, 2020, National Water Restoration provided the Insurance Company with documents related to the services they rendered at the Property such as Dry Logs, Estimate and photos of the Property. On August 12, 2020, the Insurance Company denied, the Insureds claim. The denial letter stated in part: “ Universal understands that due to the declared national emergency and state and local government restrictions to reduce the spread of the COVID-19 pandemic; special circumstances could have arisen that caused your inability to submit to the requested documentation. Due to these special circumstance Universal remains committed to investigating your claim. If you would like us to re-consider the denial of coverage for the reference claim, please submit the requested documentation...” On September 15, 2020, the Insurance Company conducted the recorded statement of the Insured, where the insurance company obtained more knowledge of the sudden loss. On September 18, 2020, the Insureds Public Adjuster requested that the Insurance Company reconsider its denial, responded to the Insurance Company’s inquires in its denial letter and provided the Insurance Company with: a Fully executed sworn proof of loss($264,431.45); Statement of loss; Estimate ($217,806.81); EMS Report and documents (already in the Insurance Company’s possession); Inventory of Personal Items, Loss Photos; Home Inspection Report by Polaris; 4-Point Inspection Report and Photos; Uniform Mitigation Verification Inspection Form; ALTA Combined Settlement Statement; and Residential Contract for Sale and Purchase. Upon receipt of the requested documents, the Insurance Company was fully aware that the roof at the Property was in good condition, prior to the Insureds purchasing the Property, yet the Insurance Company maintained its denial of the Insureds’ claim. The Insurance Company investigated the Property, received requested documents and to take responsibility for the obvious covered loss. The Insurance Company has failed and refused to provide full benefits to the Insured for the loss. As result of the Insurance Company’s failure to compensate the Insureds for their loss, the Insureds have been unable to restore the Property to its pre-loss condition. The Insureds suffered a covered loss under the Policy and has otherwise suffered damage that is not excluded under the Policy. All conditions precedent to obtaining coverage for the loss have been complied with, met, or waived. Moreover, the Insurance Company failed to comply with the policy's Loss Settlement provisions because it failed to properly adjust the loss, retain experts and persons necessary to identify the repairs necessary to restore the property to its pre-loss condition. In adjusting this claim: The Insurance Company has failed and/or refused to acknowledge and act promptly upon communication of its insured with respect of its insurance claim in violation of F.S. 626.9541(1)(i)(3)(c). The Insurance Company has failed to adopt and implement standards for the proper investigation of claims in violation of F.S. 626.9541(1)(i)(3)(a). The Insurance Company has denied this claim and presumably many others without conducting reasonable investigations based upon available information in violation of F.S. 626.9541(1)(i)(3)(d). The Insurance Company has failed to promptly settle the Insured’s insurance claim when the obligation to settle the insurance claim had become reasonably clear, under one portion of the insurance policy coverage to date in violation of F.S. 624.155(1)(b)(3). It is clear that the Insurance Company 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 its insured and with due regard for their interests in violation of F.S. 624.155(1)(b)(1). Notwithstanding the Insureds pleas, the Insurance Company has continued to refuse to acknowledge its obligation to tender all insurance proceed monies due and owing to the Insureds, or assist the Insureds in the mitigation of their damage. The concept of insurance is that insurance is the insurer’s granting timely and prompt indemnity or security against a contingent loss. Florida statute §624.02 defines “insurance” as a contract whereby one undertakes to indemnify another or pay or allow specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that the insured may mitigate its damages and to put it back into the position it was in prior to loss as quickly as possible. See also Allstate Indemnity Co. v. Ruiz, 899 So. 2d 1121 (Fla. 2005) (“The Legislature has clearly chosen to impose on the insurance companies a duty to use good faith and fair dealing in processing and litigating the claims of their insureds…”). The insurance company breached this duty. On information and belief, the Insurance Company has not acted in good faith to settle this claim as it could and should have done, with due regard to the interests of the Insureds. The Insurance Company has undervalued the loss, breached the policy by failing to provide full compensation for a covered loss, and generally misrepresented pertinent facts to the Insureds. The Insurance Company’s actions have resulted in the violations noted above and occur with such frequency as to constitute a general business practice. In order to cure the defects outlined in this civil remedy notice, the Insurance Company must issue payment for all contractual damages owed, more specifically the Insurance Company must : (1) Tender payment for the full amount needed to restore the Property to its pre-loss condition, consistent with the amount requested in the sworn proof of loss; (2) Tender interest for benefits due at the statutory rate dating back to the date of loss per Florida Statute § 627.70131; and (3) Compensate the Insured for the attorneys’ fees and costs accrued as a result of the Insurance Company’s bad faith conduct. Failure to cure all defects during the 60-day safe harbor period may result in additional extra-contractual damages. This notice is given in order to perfect the right to pursue the civil remedy authorized by F.S. 624.155.
Comments
User Id Date Added Comment
jhinz@hightowerlaw.net 11-30-2022 UPCIC believes that the Civil Remedy Notice you filed fails to comply with the specific notice and information requirements as set forth in Civil Remedy Notice of Insurer Violation document provisions as set forth in Florida Statute § 645.155 and Florida law. First, the Civil Remedy Notice requires the Complainant “pursuant to section 624.155, F.S. please indicate all statutory provisions alleged to have been violated.” The Notice you filed in this matter includes: • F.S. § 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. • F.S. § 624.155(1)(b)(3) 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. • F.S. § 626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims. • F.S. § 626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. • F.S. § 626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims. • F.S. § 626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information. • F.S. § 626.9541(1)(i)(3)(f) 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. • F.S. § 626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim. • F.S. § 626.9541(1)(i)(3)(i) Unfair claim settlement practices UNIVERSAL denies any and all allegations of violations of Florida law or policy provisions regarding the claim adjudication of this matter. The Notice filed by the Insured generally alleges that UNIVERSAL did not attempt to settle the claim in good faith without conducting a reasonable investigation. UNVIERSAL contends that the Notice filed by the Insured 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., F. Supp. 2d 1187 (N.D. Fla. 2008; Russo 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 § 624.155(3)(b), Fla. Stat., 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; and 5. A statement that the notice is given in order to perfect the right to pursue the civil remedy authorized by this section. In addition to the criteria above, the Florida legislature created “Form DFS-10-363,” which is a Civil Remedy Notice form that lays out an additional fifteen (15) requirements: 1. Complainant’s Name; 2. Complainant’s Address; 3. Complainant’s email address; 4. Complainant type (Insured or otherwise); 5. Insured’s Name; 6. Insurance Policy Number; 7. Insurance Claim Number; 8. Attorney’s Name; 9. Attorney’s Address; 10. Attorney’s email address 11. Type of Insurer (authorized or otherwise); 12. Name of Insurer; 13. Address of Insurer; 14. Type of Insurance (Commercial property & casualty or otherwise); and 15. Reason for Notice. Similar to the five (5) criteria listed in Fla. Stat. § 624.155. The fifteen (15) additional items required by the Department of Financial Services must be correctly stated with specificity in order to satisfy a condition precedent to bringing an action under Fla. Stat. § 624.155. See Pin-Pon Corp. v. Landmark Am. Ins. Co., 20-CV-14013, 2020 WL 3038576, at *3-4 (holding that the plaintiff’s Civil Remedy Notice was deficient as a matter of law because the email address listed for the Complainant was the attorney’s email); Mathurin v. State Farm Mut. Auto Ins., Co., 285 F. Sup. 3d 1311 (M.D. Fla. 2018) (holding that the correct policy number, one of the above listed requirements promulgated by the Florida Department of Financial Services, must be on a Civil Remedy Notice for it to be valid because Fla. Stat. § 624.155 requires a Civil Remedy Notice to have the information required by the Florida Department of Financial Services). To put it simply, a CRN is defective as a matter of law if any of the twenty (20) mandatory items cited above are missing or otherwise incorrect. With respect to the statutory requirement set forth with specificity the “facts and circumstances giving rise to the violation,” the Notice fails to allege any specific conduct on the part of UNIVERSAL that would violate any policy provision or statute. The Notice contains conjecture and supposition as opposed to any facts supporting the conclusory allegations. A written notice which is vague and “shotgun” in nature or is written in general terms fails to satisfy the specificity requirement of the statute. See Heritage Corp. of South Fla., 580 F. Supp. 2d at 1300; 316 Inc., 625 F. Supp. 2d at 1193; see also Russo, 2010 WL 7367059 at *3-6; Valenti v. Unum Life Ins. Co. of Am., 2006 WL 1627276 (M.D. Fla. 2006) Julien v. United Prop. & Cas. Ins. Co., 311 So.3d 875 (Fla. 4th DCA 2021) (holding that insured's notice failed to include specific information required to allege circumstances giving rise to bad-faith claim). Thus, the Notice is insufficient as a matter of law. Finally, the Notice fails with respect to its requirement to specify how UNIVERSAL may “cure” the alleged violations. The purpose of a Civil Remedy Notice is to provide a carrier with one last opportunity to “cure” the alleged violations. In this instance, the only real “cure” the Notice is seeking is full payment of a random sum unilaterally determined by the Insureds, notwithstanding UNIVERSAL’S right to investigate and adjust the loss. The purpose of a Civil Remedy Notice is to provide the insurer an opportunity to “cure” the alleged wrongdoing. Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So. 2d 1278 (Fla. 2000). The Notice does not survive this purpose. Specifically, the Notice does not provide a proper means whereby UNIVERSAL can “cure” the alleged defects, short of paying additional benefits which are not due and owing. This failure to provide a proper opportunity to cure renders the Notice improper. Longpoint Condominium Associations v. Allstate Insurance Co., 2005 WL 131580 (N.D. Fla. June 2, 2005). Moreover, the method determined by the Insureds. In Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So. 2d 1278 (Fla. 2000), the Florida Supreme Court accepted and quoted the reasoning of the court below in its opinion which stated in relevant part, as follows: Section 624.155 does not impose on an insurer the obligation to pay whatever the insured demands. Section 624.155(2)(d) would have no effect or purpose under such an interpretation. The law does not support such an expansive and illogical reading of Fla. Stat. Ann. § 624.155(2)(d). To cure an alleged violation and to avoid a civil action, an insurer must pay the claim . . . before the sixty days expire. Talat, 753 So2d at 1282 (citing Talat Enterprises Inc. v. Aetna Cas. & Sur. Co., 952 F. Supp. 773, 777-778 (M.D. Fla. 1996)). In addition, the Notice seeks remedies that are “extra-contractual.” A demand for a cure is properly limited to the four corners of the policy and thus the extra-contractual demands render the Notice insufficient on its face. In fact, the Florida Supreme Court has recognized that a Civil Remedy notice is invalid if the curative action demands more than the payment of contractual benefits under the insurer’s policy. See, Talat Enterprises, Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). Subsequent to Talat, Florida courts, and federal courts applying Florida law, reaffirmed the rule articulated in Talat. See, Do. v. Geico Gen. Ins. Co., 1:17-CV-23041-JLK, 2019 WL 331295, at *1 (S.D. Fla. Jan. 25, 2019) (finding that a plaintiff’s Civil Remedy Notice was invalid as a matter of law because the curative actions demanded did not concern payment of contractual benefits owed under the insurer’s policy). Here, UNIVERSAL properly adjusted the claim and paid for repairs completed by a company hired by the Insureds, despite the Insureds failure to respond to UNIVERSAL’s written requests for documents to investigate the claim. For the aforementioned reasons, the Notice is insufficient as a matter of law. Nonetheless, the following shall provide you with the accurate facts and circumstances regarding this matter, which shall demonstrate that UNIVERSAL has not violated any Policy or statutory provisions. Universal issued Policy Number 1501-1801-0481 for the period of March 15, 2020, through March 15, 2021, to the Insureds for the real property located at 6521 NW 16th Court, Sunrise, FL 33313 (the “Insured Property”). On May 19, 2020, the Insureds reported a claim for alleged damage due to a flat roof collapse that allegedly occurred on May 18, 2020. On June 4, 2020, UNIVERSAL’s Field Adjuster (“FA”), Ryan Kimbrough, inspected the subject property. The FA found that the water damage was caused by the flat roof holding water and collapsed after a few days of rain. Likewise, the FA noted: the Storage Room had stains on the wall sheathing and framing. Therefore, repairs would consist of repairing affected sheathing and framing. Although, the bottom of the frame looks rotted; the Florida Room, had stains on the carpet, and the door to the Dining Room was torn down. Repairs would require replacing the carpet, replacing the affected door/casing, and painting the wooden base/wainscoting/casing; the wooden base adjacent to the Florida room had been removed in the Kitchen, and the drywall behind the base was stained. Repairs would require repairing the affected drywall, replacing the affected base, and painting the base/walls; the wooden base adjacent to the Florida Room had been removed in the Dining Room, and the drywall behind the base was stained. Repairs would require repairing the affected drywall, replacing the affected base, and painting the base and walls; the wooden base adjacent to the front exterior wall was removed in the Living Room, and the Dining Room's base below the mirrored wall was drilled. Additionally, drills and stains were observed on the base wall and drywall adjacent to the Den. Repairs would require repairing the affected drywall, replacing the affected base, and painting the base/walls; the wooden base had been removed in the Hallway, and the drywall behind the base was stained. Repairs would require repairing the affected drywall, replacing the affected base, and painting the base/wall; in the Bathroom, the door casing was stained. Repairs would consist of replacing the casing and painting the casing and walls above the tile; the wooden base was removed in the Guest Room, and the drywall behind the base was stained. Repairs would require repairing the affected drywall, replacing the affected base, and painting the base/walls; the wooden base was removed in the Children’s Bedroom, and the drywall behind the base was stained. Repairs would require repairing the affected drywall, replacing the affected base, and painting the base/walls. Based on this, UNIVERSAL provided an estimate total amount of $15, 069.08 which was an estimate for the Flat Roof replacement, and repairs to the Florida Room, Storage Room, Kitchen, Dining Room, Living Room, Hallway, Bathroom, Guest Room, and Children’s Bedroom, and General Items. UNIVERSAL sent the insured’s its First Document Request Letter on May 30, 2020, which rendered no response by the Insured, so UNIVERSAL sent two more Document Request Letters on July 8, 2020, and July 23, 2020, respectively. The Insured’s failed to respond to any of the requests and consequentially UNIVERSAL denied the claim on August 12, 2020 for lack of cooperation, failure to comply with post-loss obligations, and failure to provide requested documents. At some point, the Insured had remediation services were performed on the subject property by National Water Restoration. Those repairs were covered by UNIVERSAL; National Water Restoration was paid in the amount of $27,800.00 on November 18, 2020. The aforementioned requests and determinations were made pursuant to the terms and conditions of the policy, which provide in pertinent part as follows: SECTION – CONDITIONS C. Duties After Loss In case of a loss to covered property, we have no duty to provide coverage under this policy if the failure to comply with the following duties is prejudicial to us. These duties must be performed either by you, an "insured" seeking coverage, or a representative of either: 1. Give prompt notice to us or our agent; Except for Reasonable Emergency Measures taking under Additional Coverage 2. there is no coverage for repairs that begin before the earlier of: a. 72 hours after we are notified of the loss; b. The time of loss inspection by us; or c. The time of other approval by us. 2. a. To the degree reasonably possible, retain the damaged property; and b. Allow us to inspect, subject to 2.a. above, all damaged property prior to its removal from the “residence premises.” 3. Notify the credit card or electronic fund transfer card or access device company in case of loss as provided for in E.6. Credit Card, Electronic Fund Transfer Card or Access Device, Forgery and Counterfeit Money under Section I – Property Coverages; 4. Protect the covered property from further damage. If emergency measures are required, the following must be performed: a. Take reasonable emergency measures that are necessary to protect the covered property from further damage, as provided under Addition Coverage 2. A reasonable emergency measure under 4.a. above may include a permanent repair when necessary to protect the covered property form further damage or to prevent unwanted entry to the property. To the degree reasonably possible, the damaged property must be retained for us to inspect; and b. Keep an accurate record of repair expenses; 5. Cooperate with us in the investigation of a claim; 6. Prepare an inventory of damaged personal property showing the quantity, description, actual cash value and amount of loss. Attach all bills, receipts and related documents that justify the figures in the inventory; 7. As often as we reasonably require: a. show us the damaged property and the cause of loss, if reasonably possible, except as to any repairs performed under Section I – Additional Coverages, 2. Reasonable Emergency Measures; b. Provide us with records and documents we request and permit us to make copies; . . . 9. Send to us, within 60 days after our request, your signed, sworn proof of loss which sets forth, to the best of your knowledge and belief: a. The time and cause of loss; b. The interests of all “insureds” and all others in the property involved and all liens on the property; c. Other insurance which may cover the loss; d. Changes in title or occupancy of the property during the term of the policy; e. Specifications of damaged buildings and detailed repair estimates f. The inventory of damaged personal property described in C.6. above; g. Receipts for additional living expenses incurred and records that support the fair rental value loss; and h. Evidence or affidavit that supports a claim under F.6. Credit Card, Electronic Fund Transfer Card or Access Device. As stated in the above excerpt from the subject policy, UNIVERSAL has no duty to provide coverage under the policy if the Insureds’ failures to comply with their duties after loss were prejudicial to it. UNIVERSAL was prejudiced in its investigation of the damages alleged to have occurred due to the Insureds’ failures to provide UNIVERSAL with records and documents requested as well as the delayed reporting of the subject claim. The CRN alleges that UNIVERSAL’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c), 626.9541(1)(i)(3)(d), 626.9541(1)(i)(3)(f), 626.9541(1)(i)(3)(g), and 626.9541(1)(i)(3)(i) but fails to provide any facts or evidence in support of any covered damages. UNIVERSAL has been diligent in responding to the Insureds’ requests and in its investigation of the claim. The subject policy of insurance, governing statutes, and case law only permit submission of a claim and payment for covered losses. 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 represented for payment. An insurance company is expressly afforded an opportunity to evaluate its rights and liabilities. UNIVERSAL stands behind its determination on the alleged claim and maintains the Insureds’ claim was properly investigated and adjusted in good faith. After reviewing the Civil Remedy Notice, UNIVERSAL conducted a thorough review of their handling of the Insureds’ claim. UNIVERSAL handled the claim correctly and denies that it violated any statutes, administrative code provisions, or either rules or obligations in connection with their investigation and handling of the Insureds’ claim. At the outset, the Civil Remedy Notice contains non-specific, boilerplate allegations that UNIVERSAL violated applicable statutes. None of the allegations contained in the Civil Remedy Notice have any basis in fact. UNIVERSAL unequivocally denies each and every allegation asserted in the Civil Remedy Notice. The Insureds are attempting to utilize the Civil Remedy Notice procedure to engage in an ad hominem attack on UNIVERSAL. The Insureds included hyperbole, exaggeration, and inaccuracies in the Civil Remedy Notice in an effort to prejudice the Department of Financial Services against UNIVERSAL, without basis or justification. Notwithstanding, UNIVERSAL remains committed to resolving this matter. As outlined above, the alleged statutory violations and factual allegations set forth in the Notice are devoid and without merit. UNIVERSAL has abided by the policy and the coverage determination was made in accordance with the terms agreed upon by the parties. We trust that this response addresses the allegations of insurer violation alleged in the Civil Remedy Notice of Insurer Violation. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned.
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