Filing Number: 668837
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| Filing Accepted: 1/19/2023 |
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| Street Address
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2402 S. OREGON AVENUE |
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SANFORD,
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32771
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| Email Address
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ILIEVILIYA@GMAIL.COM |
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Insured |
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ILIEV |
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First Name |
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ILIYA |
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1501-1804-6892 |
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Claim #* |
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FL20-0117475 |
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Attorney is Applicable
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SCHULZ
First Name *
SEAN
Initial
P
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| Street Address* |
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947 LONGDALE AVENUE |
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LONGWOOD
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FL
32750
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DEMAND@KSLAWGROUP.NET |
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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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UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY
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NAIC Company Code 10861 |
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| Name of individual responsible for violation (if any):*
ALL ADJUSTERS WITH UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY WHO PARTICIPATED IN THE CLAIM INVESTIGATION INCLUDING ERIKA GARCIA AND RYAN RIGGS
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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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Claim Denial
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Claim Delay
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Unsatisfactory Settlement Offer
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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)(2) |
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Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
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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)(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)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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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)(3)(h) |
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Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
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| 626.9541(1)(o)(1) |
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Knowingly collecting any sum as a premium or charge for insurance, which is not then provided, or is not in due course to be provided, subject to acceptance of the risk by the insurer, by an insurance policy issued by an insurer as permitted by this code.
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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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| 626.9541(1)(i)(3)(i) |
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Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
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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 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;
(7) Any of the following:
(a) Wear and tear, “marring”,
deterioration;
(b) Mechanical breakdown, latent
defect, inherent vice or any
quality in property that causes it
to damage or destroy itself;
(c) Smog, rust “spalling”, decay or
other corrosion;
(d) Smoke from agricultural
smudging or industrial
operations;
(e) Discharge, dispersal, seepage,
migration, release or escape, of
pollutants unless the discharge,
dispersal, seepage, migration,
release or escape is itself caused
by a Peril Insured Against named
under Coverage C.
Pollutants means any solid,
liquid, gaseous or thermal irritant
or contaminant, including smoke,
vapor, soot, fumes, acids, alkalis,
chemicals and waste. Waste
includes materials to be recycled,
reconditioned or reclaimed;
(f) Settling, shrinking, bulging or
expansion, including resultant
cracking, of bulkheads,
pavements, patios, footings,
foundations, walls, floors, roofs
or ceilings;
(g) Birds, vermin, rodents or insects;
(h) Nesting or infestation, or
discharge or release of waste
products or secretions, by any
animals; or
(i) Animals owned or kept by an
"insured".
If (a) through (i) above result in
accidental discharge or overflow of
water or steam causing damage to
property covered under Coverage A
or B, not otherwise excluded or
limited in this policy, we will cover the
loss as described in Section I – Perils
Insured Against (6).
Section I – Exclusion A.3. Water, Paragraphs a.
and c. that apply to surface water and water
below the surface of the ground do not apply to
loss by water covered under c.(6) and (7) above.
Under 2.b. and c. above, any ensuing loss to
property described in Coverages A and B not
precluded by any other provision in this policy is
covered.
SECTION I – EXCLUSIONS
A. We do not insure for loss caused directly or
indirectly by any of the following. Such loss is
excluded regardless of any other cause or event
contributing concurrently or in any sequence to
the loss. These exclusions apply whether or not
the loss event results in widespread damage or
affects a substantial area.
B. We do not insure for loss to property described in
Coverages A and B caused by any of the
following. However, any ensuing loss to property
described in Coverages A and B not precluded
by any other provision in this policy is covered.
3. Faulty, inadequate or defective:
a. Planning, zoning, development,
surveying, siting;
b. Design, specifications, workmanship,
repair, construction, renovation,
remodeling, grading, compaction;
c. Materials used in repair, construction,
renovation or remodeling; or
d. Maintenance;
of part or all of any property whether on or off
the "residence premises".
SECTION I – 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
taken 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. a. Notify the police in case of loss by theft;
b. Notify the credit card or electronic fund
transfer card or access device company
in case of loss as provided for in F.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 Additional Coverage 2.
A reasonable emergency measure under
4.a. above may include a permanent
repair when necessary to protect the
covered property from 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;
c. Any and all “insureds” must submit to
recorded statements when requested by
us;
d. In the County where the “residence
premises” is located, you, your agents,
your representatives and any and all
“insureds” must submit to examination
under oath, while not in the presence of
another "insured", and sign the same
when requested by us;
At your or our request, the examinations
will be conducted separately and not in the presence of any other persons except
legal representation;
e. Permit us to take samples of damaged
and undamaged property for inspection,
testing and analysis; and
f. Any and all “insureds” must execute all
authorizations for the release of
information when requested by us.
8. You must give notice of a claim, a
supplemental claim, or a reopened claim for
loss or damage caused by the peril of
windstorm or hurricane, with us in
accordance with the terms of this policy and
within three years after the hurricane first
made landfall or the windstorm caused the
covered damage. For purposes of this
section, the term supplemental claim or
reopened claim means any additional claim
for recovery from us for losses from the same
hurricane or windstorm which we have
previously adjusted pursuant to the initial
claim. This section does not affect any
applicable limitations on civil actions for
claims, supplemental claims, or reopened
claims timely filed under this section.
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,
Forgery And Counterfeit Money under
Section I – Property Coverages, stating
the amount and cause of loss.
The duties above apply regardless of whether
you, an "insured" seeking coverage, or a
representative of either retains or is assisted by a
party who provides legal advice, insurance advice
or expert claim advice, regarding an insurance
claim under this policy.
D. Loss Settlement
In this Condition D., the terms cost to repair or
replace and replacement cost do not include the
increased costs incurred to comply with the
enforcement of any ordinance or law, except to
the extent that coverage for these increased
costs is provided in Additional Coverage
11. Ordinance Or Law under Section I – Property
Coverages. Additionally, the valuation of any
covered property losses does not include and we
will not pay any amount for “diminution in value”.
Covered property losses are settled as follows:
1. Property of the following types:
a. Personal property;
b. Awnings, carpeting, household
appliances, outdoor antennas and
outdoor equipment, whether or not
attached to buildings;
c. Structures, other than screened
enclosures, that are not buildings; and
d. Grave markers, including mausoleums;
at actual cash value at the time of loss but
not more than the amount required to repair
or replace.
2. Buildings and screened enclosures covered
under Coverage A or B at replacement cost
without deduction for depreciation, subject to
the following:
a. If, at the time of loss, the amount of
insurance in this policy on the damaged
building is 80% or more of the full
replacement cost of the building
immediately before the loss, we will pay
the cost to repair or replace, without
deduction for depreciation, but not more
than the least of the following amounts:
(1) The limit of liability under this policy
that applies to the building;
(2) The replacement cost of that part of
the building damaged with material of
like kind and quality and for like use;
or
(3) The necessary amount actually spent
to repair or replace the damaged
building.
If the building is rebuilt at a new
premises, the cost described in (2) above
is limited to the cost which would have
been incurred if the building had been
built at the original premises.
b. If, at the time of loss, the amount of
insurance in this policy on the damaged
building is less than 80% of the full
replacement cost of the building
immediately before the loss, we will pay
the greater of the following amounts, but
not more than the limit of liability under
this policy that applies to the building:
(1) The actual cash value of that part of
the building damaged; or
(2) That proportion of the cost to repair
or replace, without deduction for
depreciation, that part of the building
damaged, which the total amount of
insurance in this policy on the
damaged building bears to 80% of
the replacement cost of the building.
c. To determine the amount of insurance
required to equal 80% of the full
replacement cost of the building
immediately before the loss, do not
include the value of:
(1) Excavations, footings, foundations,
piers, or any other structures or
devices that support all or part of the
building, which are below the
undersurface of the lowest basement
floor;
(2) Those supports described in (1)
above which are below the surface of
the ground inside the foundation
walls, if there is no basement; and
(3) Underground flues, pipes, wiring and
drains.
d. We will initially pay at least the actual
cash value of the insured loss, less any
applicable deductible. We will then pay
any remaining amounts necessary to
perform such repairs as work is
performed and expenses are incurred,
subject to 2.a. and 2.b. above.
If a total loss of a building or structure
insured under this policy occurs, the
provisions of 2.d. above do not apply and
we will pay the replacement cost
coverage without reservation or holdback
of any depreciation in value, subject to
policy limits. This does not prohibit us
from exercising our right to repair the
damaged property in compliance with this
policy and pursuant to Florida Statutes.
However, if the cost to repair or replace
the damage is both:
(1) Less than 5% of the amount of
insurance in this policy on the
building; and
(2) Less than $2,500;
we will settle the loss as noted in 2.a. and
b. above whether or not actual repair or
replacement is complete.
e. If the dwelling where loss or damage
occurs has been “vacant” for more than
30 consecutive days before the loss or
damage, we will:
Not pay for any loss or damage caused
by any of the following perils, even if they
are Perils Insured Against:
(1) Vandalism;
(2) Sprinkler leakage, when caused by or
arising out of the freezing of a fire
protective sprinkler system, unless
you have protected the system
against freezing;
(3) Dwelling glass breakage;
(4) Water damage;
(5) Theft; or
(6) Attempted theft.
Dwellings under construction are not
considered “vacant”.
f. In the event of a “catastrophic ground
cover collapse”, any repairs must be
made in accordance with the
recommendations of our professional
engineer. If our professional engineer
selected or approved by us determines
that repairs cannot be completed within
the applicable limit of insurance, we will
at our option, either:
(1) Complete the professional engineer’s
recommended repairs; or
(2) Pay the policy limits without a
reduction for the repair expenses
incurred.
J. Loss Payment
We will adjust all losses with you. We will pay you
unless some other person is named in the policy
or is legally entitled to receive payment. Loss will
be payable upon the earliest of the following: 1. 20 days after we receive your proof of loss and
reach written agreement with you; or
2. 60 days after we receive your proof of loss
and:
a. There is an entry of a final judgment; or
b. There is a filing of an appraisal award or
a mediation settlement with us.
3. Under Florida Statutes we are required to pay
or deny an initial, reopened, or supplemental
property insurance claim or portion of a claim,
within 90 days of notice of such claim unless
there are reasonable circumstances which
prevent us from so doing.
Our failure to comply with this paragraph shall
not form the sole basis for an action against us
for breach of contract under this policy or for
benefits under this policy.
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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 May 21, 2020, Iliya Iliev and Dimitrina Ilieva, husband and wife (hereafter referred to as “the Insureds”) suffered a covered windstorm loss causing extensive wind and hail damages to the exterior of the property as well as subsequent interior rainwater damages (hereafter referred to as the “Loss”) at the insured property located 2402 S. Oregon Avenue, Sanford, Florida 32771 (hereafter referred to as the “Insured Property”). Both Insured lived in the Insured Property at the time of the Loss. The Loss caused extensive hail and wind damage to the exterior of the Insured Property allowing for interior water intrusion to the property which occurred later as Universal improperly denied the claim. Prior to the Loss, the Insureds purchased and obtained an insurance policy from Universal Property & Casualty Insurance Company (hereafter referred to as “Universal”), bearing policy number 1501-1804-6892, with effective dates of September 1, 2019 through September 1, 2020, which afforded homeowners insurance coverage for the Insured Property (hereafter referred as the “Policy”). The subject Policy was in full force and effect at the time of the Loss and provided for replacement cost coverage for direct physical loss to the Insured Property including damages caused by wind, hail and interior water intrusion from a windstorm event. Furthermore, this policy specifically provides coverage for Ordinance and Law coverage in the amount of 25% of the Coverage A in the amount of $54,634.
Following the covered Loss to the Property, the Insureds timely notified Universal of the covered Loss six (6) days after the loss on May 27, 2020. Universal assigned claim number FL20-0117475 to the subject Loss. On May 27, 2020, Mr. Iliev uploaded four photos of the roof with chalk marks showing the clear and obvious hail strikes to the roofing system through Universal’s online claim portal.
In light of the damage to the Property, the Insureds contacted Central Homes, LLC, a licensed roofing company to inspect the Insured Property. Central Homes, LLC inspected the property on or about June 12, 20202 and June 14, 2020 advising the Insureds of the extensive wind and hail damage to the roofing system requiring full replacement. At that time, the Insured executed an assignment of benefits to Central Homes, LLC which was subsequently reassigned to the named insureds. At all times, Central Homes, LLC and the Insureds complied with the subject policies duties after loss.
Upon the Insureds’ timely notification of the Loss to Universal, Universal assigned a field adjuster, Ryan Riggs, to inspect the Property. The Insureds complied with the subject policy and allowed for Universal’s unfettered inspection of the property. Mr. Riggs inspected the Insured Property on June 4, 2020 and took 86 photographs of exterior of the property. It is clearly evident in Mr. Riggs photographs there is wind and hail damages to the Insured Property’s roofing system. This was the one and only inspection requested and performed by Universal despite the extensive hail and wind damages to the Insured Property’s roofing system. At the time of this inspection of the Insured Property, a representative of Central Homes, LLC showed the wind and hail damage to Mr. Riggs. In light of the obvious disregard my Mr. Riggs of the wind and hail damage to the roofing system, Central Homes, LLC requested a re-inspection by Universal on June 30, 2020, and July 15, 2020, via email. These requests for a re-inspection of the property were completely ignored by Universal. At the time, Central Homes, LLC has the assignment of benefits. Universal did not acknowledge these correspondence either in writing or via telephone with Central Homes, LLC or the Insureds. Furthermore, Central Homes, LLC had performed a hail test square and circled the hail marks in chalk showing the obvious hail damage to the roofing system. At the time of the inspection, Mr. Riggs informed Mr. Iliev that there were no wind or hail damages to the property. Mr. Iliev informed Mr. Riggs that he was home during the windstorm and that he witnessed the hailstones on the ground around the property.
On June 15, 2020, and June 17, 2020, Central Homes, LLC provide Universal with an estimate of the damages including full replacement of the subject property’s roofing system. This correspondence was never responded to or acknowledged by Universal.
Furthermore, Central Homes, LLC emailed Universal on June 24, 2020, eight photos of the subject roofing system showing the obvious hail stone damage chalked marked on the roofing system. Central Homes, LLC also requested that someone from Universal contact them to discuss the status of the case. At no time to Universal contact Central Homes, LLC or the Insureds via regarding the submission of the photographs or aforementioned estimate.
On July 23, 2020, Erika Garcia with Universal, with only completing one inspection of the property and conducting no further investigation of the claim, provided its unbased and improper claim determination to the Insureds advising as follows: “We have completed our investigation of the above referenced claim. After careful consideration, we have concluded that coverage does not apply to the roof portion of your loss. Therefore, we must respectfully deny this aspect of your claim. Our field adjuster inspected your dwelling and found no evidence of covered wind or hail damage to the roof and that which was observed is attributed to long term wear and tear, deterioration of the water shedding material and deferred dwelling maintenance. Based on the above, we must deny coverage concerning the roof portion of your loss.” Universal also advised the Insureds that “If this document contains an excerpt from a Universal Property & Casualty Insurance policy ("the Policy") it is provided here for informational purposes only. This excerpt is not the official version of the Policy. The official version of the Policy is the policy issued to the insured on the policy effective date. In the event there is inconsistency between this document and the Policy, the Policy shall serve as the official version.” At the time of the effective date of the policy Universal did not provide the Insureds an official version of the policy. Furthermore, pursuant to Florida Statutes, Universal had an obligation to provide the Insureds with a statement setting forth the coverage and to provide a reasonable explanation in writing as to the basis in the insurance policy in relation to the facts or applicable law, for denial of their claim. Furthermore, Universal failed to promptly notify the Insureds of any additional information necessary for the processing of the claim. Universal continued in this July 23, 2020, claim denial letter to advise the Insureds that “This denial has occurred after a good faith evaluation of the total circumstances involved. If you know of any reason why our evaluation of the facts is not correct, please advise us in writing.” At no time prior to this denial of the claim did Universal contact the Insureds or Central Homes, LLC to discuss the loss, request any further inspection or respond to Central Homes, LLC’s multiple requests for a re-inspeciton, request a Sworn Proof of Loss, request a recorded statement or examination under oath of the Insureds or any representatives of Central Homes, LLC or any documentation from the Insureds or Central Homes, LLC. Furthermore, at no time prior to the claim determination did Universal contact the Insureds or Central Homes, LLC to discuss the estimate provided by Central Homes, LLC or the photographs provide by Mr. Iliev on May 27, 2020 or by Central Homes, LLC on June 24, 2020.
In light of the improper, completely unbased and will wanton disregard for the facts, the Insureds were forced to retain counsel, KS Law Group, PLLC (hereafter referred to as KS Law Group”) to represent them. On August 27, 2020, KS Law Group provided Universal with their letter of representation. On September 14, 2020, KS Law Group sent Universal correspondence advising Universal of the Insureds disagreement with the July 23, 2020, claim determination based upon the improper denial of coverage. With this September 14, 2020, correspondence KS Law Group provided Universal with a detailed three page estimate of the damages to the property (specifically for full roof replacement), a signed contract with Central Homes, LLC, five photos taken by Mr. Iliev on May 27, 2020 showing the hails stones in the yard of the property and in Mr. Iliev’s hand showing the evident size of the hail stones which correlate with the additional 97 photographs taken by Central Homes, LLC showing the obvious hail damage to the shingle roofing system, dents to the gutters and ridge vents as well as tears in windows screens of the Insured Property. Universal at no point in time acknowledge or responded to this September 14, 2020 correspondence and enclosures.
Universal purposefully disregarded the obvious evidence of the damages to the property as observed by Ryan Riggs and in complete disregard for the evidence provided by the Central Homes, LLC and Ks Law Group
In light of Universal denial of the claim and failure to provide coverage for Loss, on March 31, 2021 the Insureds were forced to file suit for breach of contract. In the litigation process, Universal has been provided ample documentation showing this was a covered loss including but not limited to an engineering report from Grant Crocket, P.E. finding that the wind and hail caused significant damages to the roofing system allowing for interior water damages requiring full roof replacement, a forensic meteorologist report from Rocco Calaci showing the subject property sustained 33-45 mph winds and 1.25 to 1.50 inch hail stone at the subject property on May 21, 2020, and a price and scope report showing the costs to restore the property to its pre-loss condition at $45,771.34.
As of the date of this civil remedy notice Universal has failed to provide a proper claim determination in light of the facts of this Loss. As of this writing, Universal has objectively failed to address the information that the Insureds and the Insureds representatives have provided to Universal and has further failed properly apply the policy to the loss, failed to provide coverage for damage, failed to acknowledge claims correspondence all in direct violation of Florida Statutes referenced below.
This is a pattern of Universal to specifically deny wind and hail damage claims as a pattern and practice to specifically target and adjust wind and hail claim differently. This is evident in the complete disregard for the facts of this loss provided to Universal both prior to suit being filed and after suit was filed. Universal failed to provide any reasonable explanation in writing as to the basis of its denial of the claim, failed to acknowledge and act promptly upon communications with report to the claim, misrepresented the facts of the claim and the applicable policy provisions, failed to perform a reasonable investigation of the claim, failed to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insureds and with due regard for his interests, failed to make a claim payment when it knows it should have, failed to adopt and implement standards for the proper investigation of the claim, and purposefully underpaid and denied the claim without conducting a reasonable investigation of the claim as seen by the above actions. Ultimately, Universal failed to act in favor of its Insureds despite clear photographic evidence of the sudden and accidental wind and hail loss at the Insureds’ Property.
In the present claim Universal intentionally denied the claim with the intent to willfully, wantonly and in a malicious way deprive the Insureds of their rightful benefits under the Policy and acted in reckless disregard for the rights of the Insureds. Universal does it as a pattern and practice in regards to wind and hail claim such as this. At no time during the investigation of the claim or after the Insureds retained counsel did Universal attempt in anyway to further adjust the claim or negotiate settlement.
These patterns and practices are part of a larger scheme of Universal to investigate wind and hails claim under a different set of standards as compared to other types of property insurance claims. Universal is on notice that its adjustment practices are inadequate and has failed or otherwise refuses to address the issue by enacting proper guidelines to ensure that claims are investigated, adjusted, and otherwise handled in good faith. Universal has engaged in this claims handling practice in regards to wind and hails claims for many years. Universal is on notice of these improper violations of Florida Statutes, putting it on notice of the pattern and practices that are resulting in completely improper denials of wind and hail claim to the detriment of consumers and insureds of the State of Florida.
As shown above, Universal has failed to adopt and implement standards for the proper investigations of claims, failed to acknowledge and act promptly upon communications with respect to claims, failed to promptly provide any reasonable explanation in writing to the Insureds of the basis in the insurance policy or in relation to the fact or applicable law, for the underpayment and denial of a claim. In addition, based on the facts, Universal has failed to adjust the claim properly and blatantly refused to acknowledge the facts and extent of the damages to the Insured Property. Universal has failed to promptly notify the Insureds of any additional information necessary for the processing of their claim. Further, Universal has failed to promptly settle the claim, when the obligation to settle the 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, and Universal has also misrepresented pertinent facts or policy provisions relating to coverage at issue in this claim. The aforementioned issues demonstrate a pattern and practice of unfair claim settlement practices by Universal.
The subject Policy of insurance is a Replacement Cost Value policy which is due and owing to the Insureds. Universal consistently and purposefully improperly denies claims in spite of the obvious covered damages in a purposefully effort to maximize profits. Furthermore, Universal consistently and purposefully denies claims despite being provided ample documentation. This happens with such frequency that it is a pattern and practice. Universal has either failed to train and supervise its employees and agents, or Universal simply denies claims and refuses to conduct claims investigations in good faith toward its insureds and refuses to conduct claims investigations in good faith toward its insureds as a routine business practice.
Universal has failed to adequately state in writing the basis for its denial of the Replacement Cost Value benefits owed, and failed to state with any specificity why it refused to cover and pay for covered damage in violation of Florida law, and in purposeful disregard for the Replacement Cost coverage afforded by the subject Policy. Furthermore, Universal has internal practices of not paying for wind and hail damages. This practice occurs with such frequency as to constitute not acting in good faith while adjusting claims and to constitute unfair claims settlement practices.
Universal is on notice that its adjustment practices are inadequate, and has failed or otherwise refused to address the issue by enacting sufficient guidelines to ensure that claims are investigated, adjuster, and otherwise handled in good faith.
Universal has failed to pay the Insureds for the full amount of the Loss, properly adjust the loss to bring the Property back to its pre-loss condition, including replacement cost of the covered damage, due to a lack of training, supervision, competence, and understanding of damages as a part of Universal’s general pattern and practice of purposefully denying claims, thus result in the Insured not being fully indemnified as required by the subject insurance policy and in violation of Florida Statute. If any other reasonable insurer was provided all of the above information, the insurer would have acted promptly to extend any pay the fully replacement cost value coverage afforded by the subject policy and Florida Statutes.
Universal has violated the following statutory provisions, including but not limited to:
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)(2): Making claim payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
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)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
626.9541(1)(i)(3)(i): Unfair claim settlement practices
626.9541(1)(i)(4) Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 90 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 an act of God, prevented by the impossibility of performance, or due to actions by the insured or claimant that constitute fraud, lack of cooperation, or intentional misrepresentation regarding the claim for which benefits are owed.
626.9541(1)(o)(1) Knowingly collecting any sum as a premium or charge for insurance, which is not then provided, or is not in due course to be provided, subject to acceptance of the risk by the insurer, by an insurance policy issued by an insurer as permitted by this code
Iliya Iliev hereby puts Universal on notice of the above actions. Notice is given in order to perfect the rights of the Iliya Iliev damaged to pursue civil remedies authorized by section 624.155 Iliya Iliev is to be contacted through counsel, Sean P. Schulz, Esq, with KS Law Group, PLLC at 947 Longdale Avenue, Longwood, FL 32750
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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
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DFS-10-363
Rev. 10/14/2008
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