Civil Remedy Notice of Insurer Violations
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Filing Number:     785119
Filing Accepted:  10/1/2024
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Complainant
Last/Business Name *  
ROSS   First Name   MARY
Street Address * 429 EAST GULF DRIVE, NO 15
City, State Zip * SANIBEL, FL 33957
Email Address * STEVEROSS45324@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   ROSS   First Name   MARY
Policy # * 1503-1703-9504 Claim #* FL22-0153589
Attorney
Attorney is Applicable
Last Name* KRAPF First Name * GRANT Initial W.
Street Address* 2790 SUNSET POINT ROAD
City, State Zip* CLEARWATER , FLORIDA 33579
Email Address * ASSIST@KRAPFLEGAL.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):* DANIEL WALE, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY, WHO WAS INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unfair Trade Practice
Claim Denial
Claim Delay
Other : Not treating the Insured with good faith claims conduct
Other : Looking for ways to deny full recovery to the Insured
Other : Looking for ways to delay full recovery to the Insured
Other : Failing to properly investigate the Insured’s loss
Other : Failing to provide the Insured with the full benefits awarded under the contract of insurance in a t
Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made,
Other : Not adjusting claims and evaluating loss properly
Other : Shifting the burden of insuring the loss to the Insured
Other : Failing to implement proper standards for the adjustment and investigation of claims ?
Other : Making material misrepresentations
* 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)(2) A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

626.9541(1)(i)(3)(i) Unfair claim settlement practices Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language.
 
* 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 (the “Insurer”) has committed the following in handling the Insured’s claim: 1) failing to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the Insured; 3) looking for ways to deny benefit payments and otherwise “low ball” or “stone wall” claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; 8) denying a claim which it knew or should have known the policy and Florida law provided coverage for; 9) shifting the burden of investigating the loss onto the Insureds; and 10) making material misrepresentations. On or about September 28, 2022, while the subject policy was in full force and effect, the insured property suffered a loss caused by Hurricane Ian. The areas impacted include but are not limited to the bedrooms, bathrooms, kitchen, pantry, and living room. The Insured timely submitted a claim on October 21, 2022, to the Insurer for damages caused by Hurricane Ian and the ensuing damage therefrom. Thereafter, the Insurer assigned claim number FL22-0153589 to the loss and inadequately investigated. Subsequently, in a coverage determination letter dated December 11, 2022, the Insurer notified the Insured that it was denying coverage for the loss. Despite being denied coverage, the Insured retained services to perform necessary repairs which were paid for out-of-pocket. Given the denial, the Insured’s disagreement with the coverage decision, and the scope and nature of the damage, the Insured retained a public adjuster. After assessing the damage and the true scope of repairs, the public adjuster prepared an estimate identifying $82,807.57 in covered damage to the dwelling. The foregoing estimate, photographs, and a letter of representation from the public adjuster were sent to the Insurer who subsequently informed the Insured that it was continuing to deny the claim. Upon receiving notice of the loss, the Insurer had the duty to provide the full benefits under the policy. This includes providing the Insured with a proper investigation and the funds necessary to return the home to its pre-loss condition. However, when the Insurer conducted its inspection of the insured property, the Insurer’s adjuster failed to conduct a thorough and adequate investigation, or the adjuster intentionally ignored the damage observed and failed to make truthful and unbiased reports of the facts after investigating. As a result, the Insurer breached the policy by failing to fully indemnify the Insured for the covered loss. The Insurer misrepresented the loss and issued a wrongful denial. The Insurer based this denial on its inadequate investigation, stating “…there is no direct physical loss to covered property, as required by the applicable Policy.” However, the Insurer never retained an engineer to ascertain the cause of damage to the Insureds dwelling. Although the Insurer and Insured are in dispute about how the roof was damaged, the Insurer knows or should know that when independent perils converge and no single cause can be considered the sole or proximate cause, it is appropriate to apply the concurring cause doctrine. Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016). The concurring cause doctrine states that coverage may exist where an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause. Id. at 698. A covered peril that meets with an uncovered peril may still provide for coverage under a policy when the covered peril triggered the events that eventually led to the loss. Id. at 697. Additionally, Insurer shifted the burden and cost of investigating and insuring the loss onto the Insured. During their investigation, the insurer’s adjuster did not use a moisture meter, despite the presence of interior water damage. A moisture meter can be purchased online from Amazon for around $40 before tax. The Insurer could purchase a moisture meter and assess thousands of properties with one meter. Instead, the Insurer would rather place its financial interests over those of the Insured by failing to provide the adjuster with the necessary tools to correctly inspect the loss. As a result of the inadequate investigation and surrounding circumstances it is apparent that the Insurer significantly underestimated the scope of the loss to the Insured’s property. The Insurer and its adjuster have colluded to misrepresent the true scope of damages to the insured property and the true replacement costs of the damages. The conduct outlined above is done within the Insurer’s routine course of the business. There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer’s claim file and standards and procedures for the adjustment and investigation of claims. In short, the Insurer is not acting with due regard for the Insured’s interests or safety. In Florida the work of adjusting insurance claims engages the public trust. The Insurer has breached this trust and its duty to the Insured. The Insurer and its agents conducted cursory and inadequate investigations and wrongfully denied coverage for a loss that should have been covered under the subject policy. Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer’s actions and inactions have continued to frustrate and delay the resolution of the Insured claim. The Insurer’s actions amount to but are not limited to the following: 1. Claim denial 2. Claim delay 3. Not treating the Insured with good faith claims conduct 4. Looking for way to reduce recovery to the Insured 5. Looking for ways to deny recovery to the Insured 6. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured 7. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company’s interests before the Insured's’ interests 8. Placing the financial interest of the Insurer over that of the health and safety of the Insured 9. Shifting the burden of investigating onto the Insured 10. Conducting inadequate investigations 11. Making material misrepresentations Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must: (1). Admit full coverage for the Insured’s loss. (2). Tender full benefits owed to the Insured under the insurance contract. A copy of this form submitted to the FDFS has been sent via e-mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to badfaith@krapflegal.com. VIA CLAIMSPATH PORTAL Universal Property & Casualty Insurance Company 1110 W. Commercial Blvd. Fort Lauderdale, FL 33309
Comments
User Id Date Added Comment
oc1102@universalproperty.com 11-20-2024 November 20, 2024 VIA ELECTRONIC FILING Florida Department of Financial Services Bureau of Consumer Assistance Civil Remedy Section 200 East Gaines Street Tallahassee, FL 32399-0322 Re: DFS File No.: 785119 Filing Date: 10/01/2024 Complainant(s): Mary Ross Insured(s): Mary Ross Policy No.: 1503-1703-9504 Claim No.: FL22-0153589 Dear Sir/Madam: Please allow this to serve as Universal Property & Casualty Insurance Company’s (“Universal”) formal response to the above-referenced Civil Remedy Notice (“Notice”) filed by Attorney, Grant W. Krapf on behalf of the Complainant Mary Ross (also referenced as the “Insured.”) As a preliminary matter, attorney Grant Krapf previously filed another Civil Remedy Notice for the same above referenced claim on July 31, 2024, under the name of Steven Ross Civil Remedy Notice No. 775718 (“Prior Notice”). This Prior Notice contains exactly the same information as the instant Notice, except for the changing of the Complainant/Insured name. On September 17, 2024, Universal properly responded outlining the legal deficiencies in the Prior Notice. None of the legal deficiencies noted in the Prior Notice have been rectified in the instant Notice. The Notice alleges violations of Sections 624.155 and 626.9541, Florida Statutes. Universal denies the allegations contained in the Notice. Additionally, Universal denies that it violated these or any statutes, Florida law, or policy provisions regarding the claim adjustment of this matter. With that said, Universal asserts that the Notice fails to comply with the specific notice and information requirements as set forth in Civil Remedy Notice of Insurer Violation document provisions, Section 624.155, Florida Statutes and Florida law. The Notice is deficient as a matter of law as it fails to comply with Section 624.155, Florida Statutes. See 316, Inc. v. Maryland Cas. Ins. Co., 625 F. Supp. 2d 1187 (N.D. Fla. 2008); Rousso v. Liberty Surplus Ins. Corp., 2010 WL 7367059, (S. D. Fla. 2010); Heritage Corp. of South Fla. v. Nat’l Union Fire Ins. Co. of Pittsburgh, P.A., 580 F. Supp. 2d 1294 (S.D. Fla. 2008); Talat Enterprises, Inc. v. Aetna Cas. & Surety Co., 753 So. 2d 1278 (Fla. 2000). Pursuant to Section 624.155(3)(b), Florida Statutes the Notice “shall state with specificity” the following information: 1. The statutory provision, including the specific language, which the authorized insurer allegedly violated; 2. the facts and circumstances giving rise to the violation; 3. the name of any individual involved in the violation; 4. reference to specific policy language that is relevant to the violation, if any...; 5. a statement that the Notice is given in order to perfect the right to pursue the civil remedy authorized by this section. Moreover, the Department of Financial Services (“DFS”), created form DFS-10-363, which lays out 15 requirements that the Complainant must respond to with specificity. The Florida Supreme Court holds that Section 624.155, Florida Statutes “must be strictly construed.” Talat Enterprises, Inc. v. Aetna Cas. and Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). Strict construction is appropriate as “this statute is in derogation of the common law.” Id. When interpreting a statute in derogation of the common law, “[a] court will presume that such a statute was not intended to alter the common law other than as clearly and plainly specified in the statute.” Time Ins. Co., Inc. v. Burger, 712 So. 2d 389, 393 (Fla. 1998). Such an interpretation would mean that statutory bad faith cases cannot proceed unless the Complainant has specifically complied with all statutory requirements. Pin-Pon Corp. v. Landmark American Ins. Co., 500 F. Supp. 3d 1336 (S.D. Fla. 2020); Julien v. United Property & Casualty Ins. Co., 311 So.3d 875 (Fla. 4th DCA 2021). To begin, the Notice fails to meet the requirement of Section 624.155, Florida Statutes, on several grounds. First, the Notice fails to list all the named Insureds under the subject Policy. This failure to properly respond to each field set forth on the DFS form with specificity is one of the reasons why the Notice is deficient and does not comply with Section 624.155, Florida Statutes. Second, the Notice fails to satisfy the requirement to identify the person or persons representing the insurer most responsible for or knowledgeable of the facts giving rise to the allegations. In order to comply with the requirements of Section 624.155, Florida Statutes, the Complainant must name the individual(s) involved with specificity as it relates to the purported violation(s) to allow Universal to properly investigate the allegations. The Notice lacks the requisite specificity as required by Section 624.155, Florida Statutes. Here, the Notice states, “DANIEL WALE …” without more. The Notice fails to include any specificity as to how the named individual is knowledge of the facts giving rise to any purported allegation(s) and/or what they did or failed to do. Furthermore, the Complainant attempts a “catch-all” of “ANY OTHER INDIVIDUAL FROM, OR AGENT OF, UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY, WHO WAS INVOLVED IN THE CLAIM,” which significantly prejudices Universal, as Universal has not been properly notified by Complainant of the individual(s) that purportedly committed statutory violations or the specific statutory violations any individual purportedly committed. The Complainant has effectively provided no one specifically with the most knowledge of the facts giving rise to any of the purported allegations in the Notice on behalf of Universal. Therefore, the Notice does not have the requisite specificity as to whom the Complainant is asserting has knowledge as to any allegation to put Universal on Notice of what needs to be cured. Accordingly, the Complainant’s Notice is insufficient as a matter of law. Third, the Notice fails to satisfy Section 624.155(3)(b)(4), Florida Statutes, in that it fails to reference specific policy language relevant to any alleged violation. Instead, the Notice improperly cites Section 626.9541, Florida Statutes. However, this section is not contained within the Policy and moreover, there are no facts specified to place Universal on notice of how it allegedly violated the statute. Moreover, the Notice states, “[r]eference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language.” Thus, the Complainant admits that Universal in fact did not violate any specific policy language but fails to provide any specificity as to how any statutes were violated. As such, the Notice is deficient as a matter of law. See generally Julien v. United Property & Casualty Ins. Co., 311 So.3d 875 (Fla. 4th DCA 2021). Lastly, with respect to the requirement to 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 asserts general allegations consisting largely of boilerplate, conclusory and inaccurate statements rather than specific allegations of facts regarding any alleged misconduct or statutory violations. As an example, the Notice states: “Universal Property & Casualty Insurance Company (the “Insurer”) has committed the following in handling the Insured’s claim: 1) failing to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the Insured; 3) looking for ways to deny benefit payments and otherwise “low ball” or “stone wall” claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; 8) denying a claim which it knew or should have known the policy and Florida law provided coverage for; 9) shifting the burden of investigating the loss onto the Insureds; and 10) making material misrepresentations. … The Insurer’s actions amount to but are not limited to the following: 1. Claim denial 2. Claim delay 3. Not treating the Insured with good faith claims conduct 4. Looking for way to reduce recovery to the Insured 5. Looking for ways to deny recovery to the Insured 6. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured 7. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company’s interests before the Insured's’ interests 8. Placing the financial interest of the Insurer over that of the health and safety of the Insured 9. Shifting the burden of investigating onto the Insured 10. Conducting inadequate investigations 11. Making material misrepresentations.” The Notice wholly fails to identify any specific facts or circumstances which support any of the above-listed conclusory and/or boilerplate allegations. Moreover, at no time has Universal placed the burden to investigate the claim on the Insureds. Furthermore, the Notice does not set forth any facts regarding any misrepresentations made by Universal and does not identify the person or persons who made such misrepresentations and/or when any such misrepresentations were made. Additionally, the Notice alleges, “[t]he conduct outlined above is done within the Insurer’s routine course of the business. There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer’s claim file and standards and procedures for the adjustment and investigation of claims.” The Complainant is required to provide with specificity the facts and circumstances giving rise to the alleged violation strictly related to his allegations, not conjecture or speculation of what may be a business practice by the carrier. It is evident that the statement of facts falls short of the specificity required by Section 624.155, Florida Statutes. As a result, Complainant failed to comply with the requirements provided in Section 624.155(3)(b)(2), Florida Statutes. In summary, as outlined above, the Complainant fails to respond to each of the fields set forth on the DFS Form with the requisite specificity, including but not limited to the failure to list all the named Insureds under the subject Policy, the failure to satisfy the requirement to identify the person or persons representing the insurer most responsible for or knowledgeable of the facts giving rise to the allegations, the failure to reference specific policy language relevant to the alleged violation, and the failure to allege any specific conduct on the part of Universal that would violate any policy provision or statute. Therefore, the Notice is legally deficient and fails to satisfy the condition precedent to filing a bad faith action. Pin-Pon Corp. v. Landmark American Ins. Co., 500 F. Supp. 3d 1336 (S.D. Fla. 2020); Julien v. United Property & Casualty Ins. Co., 311 So.3d 875 (Fla. 4th DCA 2021). For the aforementioned reasons, the Notice is deficient as a matter of law. Nonetheless, and without waiving the above-referenced deficiencies, the following shall provide you with the facts and circumstances regarding this claim, which shall demonstrate that Universal has not violated any Policy terms or statutory provisions. On October 21, 2022, Universal received notice from the Insured, Steven Ross, the insured location had damage which occurred on September 28, 2022. Universal inspected the property and documented any visible damage. Thereafter, Universal advised the Insureds there was no coverage available for the loss and outlined the basis for the claim denial citing relevant policy language pursuant to the terms of the policy. Universal denies the allegations asserted in the Notice. An insurer is not required to pay whatever amount an insured demands. As outlined above, the alleged statutory violations set forth in the Notice are devoid of factual support and are without merit. We trust that the foregoing is sufficient to advise you of Universal’s position with regard to this matter and fully respond to the Notice filed by the Complainant. Sincerely, /s/ Ozzy Cudila Ozzy Cudila, Esq. Associate General Counsel
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.

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 or deleted.




DFS-10-363
Rev. 10/14/2008