Civil Remedy Notice of Insurer Violations
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Filing Number:     696656
Filing Accepted:  5/25/2023
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Complainant
Last/Business Name *  
CALKINS   First Name   FATIMA
Street Address * 1708 MELANIE DR
City, State Zip * ORLANDO, FL 32825
Email Address * JD@PREMPROPLAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   CALKINS   First Name   FATIMA
Policy # * 1504-1100-3718 Claim #* FL22-0104350-V622
Attorney
Attorney is Applicable
Last Name* DUROCHER First Name * JOSHUA Initial
Street Address* 1314 EAST LAS OLAS BLVD, SUITE 1004
City, State Zip* FORT LAUDERDALE , FLORIDA 33301
Email Address * TEAM@PREMPROPLAW.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):* ANY AND ALL ADJUSTERS, SUPERVISORS, MANAGEMENT, ATTORNEYS AND INDIVIDUALS ASSOCIATED WITH THE CLAIM. THESE INDIVIDUALS INCLUDE BUT ARE NOT LIMITED TO MARIA FLEITAS AND RON HUTCHINSON.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
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.
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)(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)(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.

Section I Property Coverages of the appliable policy provides coverage for the reported claim. The Insured has complied with all policy conditions, and there are no exclusions that apply. The Insureds believe the Policy language relevant to the violations includes all applicable policy coverages, loss payment provisions, loss settlement provisions, valuation provisions and other terms and conditions of the subject policy. In particular, the Insured refers to the following policy language: Coverage A – Dwelling, Coverage B - Other Structures, Coverage C - Personal Property, Coverage D - Loss of Use, Additional Coverages, Law and Ordinance Coverage, and/or Additional Endorsements and Forms. Universal Property & Casualty Insurance Company has failed to issue insurance benefits to its Insured pursuant to the Loss Settlement, Loss Payment, and other Provisions in the applicable policy.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Universal Property & Casualty Insurance Company (“Carrier”) has committed blatant and inexcusable bad faith against their insured Fatima Calkins. This statement is not made lightly and is fully justified when analyzing the facts of the claim. On or about 1/16/2022, while the policy was in full force and effect, Mrs. Calkins property located at 1708 Melanie Drive, Orlando, FL 32825, was damaged by wind. Specifically, the roof was damaged with ensuing water damage. The Insureds timely reported the claim to Universal on February 9, 2022, and Carrier assigned it claim FL22-0104350-V622. The insured’s representative provided Carrier with all pertinent claim-related documentation, including a repair estimate to return the property to its pre-loss condition and a sworn proof of loss. After the carrier completed their investigation, a coverage determination letter was sent on or about March 16, 2022. Universal noted that the claim was denied because their conclusion found no coverage for the loss. More specifically, that the investigation found no wind or hail damage to the roof, nor was there a storm caused opening to allow for coverage to the ensuing water loss. Mrs. Calkins later filed a breach of action suit. In a recent deposition, the Corporate Representative of Universal was asked about the affirmative defenses being raised. They include concealment of fraud, the basis of which is that some of the claimed damages for the January 16, 2022 loss, overlapped with damages from Hurricane Irma. The corporate representative confirmed however, that it had never asked the insured about the prior damages or if they were repaired. In other words, Universal is accusing their insured of fraud, despite never even asking the insured during their effortless investigation. Had they inquired, they would have learned that the damages were taken care of after Hurricane Irma, and that the damages related to the January 16, 2022 loss were not only new, but also were for areas of the property never before damaged. Universal also doubled down, asserting that there is no damage to the roof. All facts seem to indicate otherwise, however. Specifically, the field adjuster – despite not being assigned to prepare an estimate – prepared an estimate that called for a full roof replacement. The field adjuster also identified that there was a soft spot in the roof but did not provide an opinion of cause since this was not part of his assignment. Without inquiring further into the soft spot, the claim was denied despite no post loss duties being violated, no document requests going unanswered, and no prejudice resulting from late notice. The insured pursued litigation given Universal refused to acknowledge any damage. As of November 9, 2022, Universal’s position remained the same as to the lack of damage to the roof, as well as the interior damages not being covered. Following Hurricane Nicole, the Insured reported a claim for possible wind damage. On December 20, 2022, a coverage determination was issued for Claim No. FL22-0161217-A522. In said correspondence, Universal stated “During our investigation, it was concluded that the claimed damage to the roofing system covering the dwelling and ensuing interior damages were addressed under a prior claim number FL22-0104350-V622 that was reported on February 9, 2022, with a January 16, 2022, date of loss. The settlement for the prior claim allowed for the replacement of the roofing system and repair of the ensuing interior damages. Evidently, the covered repairs allowed for in the prior claim were not completed. Pursuant to the applicable Policy, the claimed damage to the roofing system and ensuing interior damages is not covered. Based on the above, we must deny coverage concerning the roof and interior portion of the claim.” From this, it is clear that the damage to the roof and interior from the January 16, 2022 loss was evident, yet Universal made a deliberate decision to deny the claim regardless of the apparent facts and without even getting an opinion contrary to the field adjuster’s recommendations. The undersigned believes bad faith discovery will support that the January 16, 2022 claim had clear recommendations for full payment without any opposition, so much so that the Hurricane Nicole claims adjuster believed payment was issued thus forming the basis for that denial. Universal’s actions have not been without consequence. Mrs. Calkins, despite all efforts to mitigate her damages, has seen her health deteriorate due to the ongoing mold issues that have formed as a result of Universal’s inaction. This Notice is given in order to perfect the right to pursue the civil remedy authorized by Fla. Stat. Sec. 624.155, including any and all bad faith/extra contractual damages, should Carrier fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. The Insured also intends to seek punitive damages against Carrier as it appears that Carrier’s violations occur with such frequency as to evidence a general business practice in order to increase financial profits and the violations were willful, wanton, and malicious and were in reckless disregard for the rights of the Insured. While no specific “cure amount” is required for this Civil Remedy Notice to be valid, Carrier can cure the violations contained herein by: (i) issuing a payment for all contractual damages owed under the policy for the claim based on the public adjuster’s estimate, less the applicable deductible; (ii) make payment of interest owed under Florida law; and (iii) implement appropriate standards and procedures for claims investigations and resolution in regard to the outstanding amount of this Claim.
Comments
User Id Date Added Comment
bbellamy@gspalaw.com 06-16-2023 FILED ELECTRONICALLY Florida Department of Financial Services Division of Customer Service Consumer Assistance 200 E. Gaines Street Tallahassee, Florida 32399 Insured: Fatima Calkins Claim No.: FL22-0104350-V622 Policy No.: 1504-1100-3718 Date of Loss: January 15, 2022 Our File No.: UPC.45363-BO DFS Filing No: 696656 DFS Filing Date: May 25, 2023 Insurer: UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY To Whom It May Concern: Please be advised that the undersigned has been retained to represent the interests Universal Property & Casualty Insurance Company (“Universal”) in the above-referenced matter. We have received a copy of a Civil Remedy Notice of Insurer Violation (“CRN”), prepared by Joshua Durocher on behalf of Fatima Calkins (“the Complainant”). The Florida Department of Financial Services assigned this CRN an acceptance date of May 25, 2023, DFS File No. 696656. Universal does not consider there to have been any manner of violation, and questions the validity of the CRN. We note, at the outset, that the section of the CRN requiring the Complainant to describe the facts and circumstances giving rise to the insurer’s violation contains conclusory allegations with no supporting facts. Section 624.155, Florida Statutes, requires specificity in civil remedy notices. In Valenti v. Unum Life Ins. Co. of Am., 2006 U.S. Dist. LEXIS 36880, the Court stated: Pursuant to Florida Statute Section 624.155(3)(b), a civil remedy notice "shall state with specificity . . . [t]he facts and circumstances giving rise to the violation." Fla. Stat. § 624.155(3)(b) (2005). Defendant argues that while Plaintiff's April civil remedy notice states Defendant conducted an inadequate investigation, Plaintiff failed to identify specifically what Defendant failed to which made the investigation inadequate. This lack of specificity, according to Defendant, is insufficient as the notice does not adequately identify what conduct of Defendant's must be cured. This Court agrees. The Valenti Court found that a CRN which states “you denied my claim” is not sufficient to place the insurer on notice of what was needed to be cured, and concluded that Plaintiff’s allegation that Defendant failed to conduct an adequate investigation is insufficient to provide Defendant an opportunity to cure. Id. at 8. As it stands now, the CRN is insufficient for the purpose of allowing Universal to fully respond and/or remedy the alleged violations, if any. These allegations are inaccurate and are wholly without merit. The Complainant fails to provide any evidence to support these allegations and Universal denies these allegations. Simply because the Complainant disagrees with Universal’s denial of the claim does not establish that Universal acted in bad faith. The “facts and circumstances” set forth by the Complainant in the CRN do not establish any violation of any statute. Specifically, Complainant asserts no specific facts related to the handling of this claim that would constitute a violation of any statute. There are only general, conclusory allegations that the insurer failed to pay the full amount of Complainant’s public adjuster’s estimate. Complainant’s allegations in the CRN are unfounded and groundless as Complainant lacks reference to any pertinent evidence to support its accusation that Universal claims handling violated any statutory section. The mere fact that Universal denied the claim does not give rise to a violation of any statute or any act of bad faith. In sum, Universal denies each and every assertion of bad faith in the CRN. Universal promptly acknowledged the claim and sent a field adjuster to inspect and estimate the damage. Universal handled the subject claim in accordance with the insurance contract and all statutory and regulatory requirements. Universal has not failed to attempt to settle this claim in good faith; Universal considered all available information prior to making a claim decision, and upon making such decision, Universal promptly advised the insured of the same. Universal has and again denies each and every allegation contained and/or implied by the CRN. Universal also denies violating any Florida Statute or code, specifically those cited and asserted in the CRN. Complainant alleges that Universal violated §§624.155 and 626.9541. All of these allegations are baseless and unfounded. The Complainant fails to provide ultimate facts supporting these allegations. As indicated above, the allegations of alleged bad faith referenced in the CRN are denied. The very nature of the CRN does not allow for a more specific response to the alleged violations. Universal will provide a further response if and when any additional information is provided relative to any alleged violation. Universal has acted in good faith and will continue to act in good faith. Universal continues to reserve all of its rights under the policy, at law and in equity. Universal reserves the right to amend and supplement this response, as appropriate. If the Department has any question concerning this matter, please contact Universal or the undersigned, for a further response. Thank you. Very truly yours, GROELLE & SALMON, P.A Billie L. Bellamy, Esq. For the Firm BLB/at Cc: Universal Property & Casualty Insurance Company Josh Durocher, Esq.
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