Civil Remedy Notice of Insurer Violations
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Filing Number:     785173
Filing Accepted:  10/1/2024
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Complainant
Last/Business Name *  
WALLACK   First Name   WILLIAM & MARYANN
Street Address * 23429 SHINING STAR DRIVE
City, State Zip * LAND O LAKES, FL 34639
Email Address * WWALLACK2@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   WALLACK   First Name   WILLIAM & MARYANN
Policy # * 150116027850 Claim #* FL23­0122975
Attorney
Attorney is Applicable
Last Name* SMITH First Name * RYAN Initial
Street Address* 350 N LAKE DESTINY RD
City, State Zip* MAITLAND , FL 32751
Email Address * RSMITH@ITSABOUTJUSTICE.LAW
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):* N/A
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
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)(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)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
626.9541(1)(i)(4) 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).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Policy Provisions: The following policy provisions are relevant to this civil remedy notice. Section 1 - Property Coverages – Coverage A – Dwelling Section 1 – Perils Insured Against – Coverage A-Dwelling and Coverage B-Other Structures Section 1- Conditions – Loss Settlement Section 1 – Conditions –Loss Payment
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

On or about June 4, 2024, William and MaryAnn Wallack suffered damage to their home located at 23429 Shining Star Drive, Land O Lakes, Florida as a result of a storm event which caused damage to the roof and interior of the property. Prior to the loss, Universal Property & Casualty Insurance Company (hereinafter "Universal"), had issued a policy of insurance (Policy No.: (150116027850)) for the Insureds’ property. Said policy, which was issued prior to the loss, was in full force and effect and afforded coverage for damage caused by the loss. Universal was timely notified of the loss by the Insureds and assigned claim number FL23­0122975. During the course of Universal's investigation, the Insureds made their property available for inspection, provided facts and information surrounding the loss, and complied with the Insurer’s adjustment of the claim. Despite fully cooperating with Universal's investigation, Universal inexplicably failed to extend coverage for the entirety of the Insureds’ insurance claim even though there was clear evidence of additional covered damage to property. Universal came to its coverage determination by ignoring relevant facts and information proving that additional repairs were necessary to fix damaged property. Most concerning, Universal and its representatives purposely downplayed and misrepresented evidence at the property to avoid tendering full payment on a claim it knew was covered pursuant to the terms of the policy. In particular, Universal grossly undervalued the true replacement cost of water-damaged items within the home as well as the value of the roof which Universal agreed was in need of replacement as a result of the loss. Universal's actions have also gone so far as to not allow for the needed electrical work and replacement of electrical components within the home which are an ongoing fire hazard following the above-described water damage caused by the instant roof leak. Universal has also merely allowed for painting over water damaged and saturated portions of construction materials, despite their having been water logged and likely mold ridden. Not only has Universal intentionally omitted key facts from its coverage decision to avoid issuing further payment for repairs needed to return the property to its pre-loss condition, but now, Universal's counsel is engaged in bad-faith litigation tactics by unnecessarily delaying the end outcome of this claim. On its own volition, the insurance company has on a multitude of occasions inquired for settlement demands from the insured. Despite the insureds' prompt responses to those settlement demand inquiries, Universal has not acknowledged receipt of them nor responded to them with some justifiable counter offer. There is no doubt that all of Universal's coverage defenses in this action have been waived and the only items remaining for a Court's determination are the amount of the insureds' damages (which have been meticulously documented and provided to Universal). In addition to Universal's bad-faith litigation tactics, it has further become obvious to the insureds that Universal is purposefully perpetuating a delay of the proceedings, in an apparent effort of leverage to force the insureds to accept less than their claim is worth. This is wrote bad-faith claims handling, for there is no discernible reason for the insurance company to (1) delay discovery, (2) baselessly cancel the Plaintiffs deposition without notice or reason, and (3) to inquire for settlement demands from the insureds without any intention to acknowledge, respond, or enter into settlement negotiations. It remains clear that Universal has not acted honestly or fairly towards its Insureds. Universal and its representatives have failed to conduct a proper investigation of the loss, misrepresented the scope of damages and repairs, and misapplied policy provisions to wrongfully reduce payment for the Insureds’ claim. It has become a general business practice of Universal to not implement proper claims handling procedures, to hire consultants that routinely ignore or intentionally misidentify relevant evidence, and to not settle claims in good faith when under all circumstances it should have. As is the case here, it is a pattern and practice for Universal to arbitrarily deny appropriate payments on claims without conducting reasonable investigations based upon information and evidence available to it. Universal's actions are part of a broader scheme to delay claims and avoid issuing payment, and that purposeful delay is corroborated by the facts alleged above. Universal's actions are widespread sufficient to constitute a general business practice. In order to cure this civil remedy notice, Universal must acknowledge that the Insureds’ property was damaged by the wind and hail storm event and that replacement of the roof is covered by the policy. Universal must further tender the full contractual amount owed to replace the roof and make necessary interior repairs pursuant to the terms of the policy. Payment should be issued to the “Cohen Law Group Trust Account f/b/o (William and Mary Ann Wallack).” The written explanation of benefits and payment should be sent to the Insureds’ counsel’s office at 350 N. Lake Destiny Road, Suite 300, Maitland, FL 32751.
Comments
User Id Date Added Comment
jr0405@universalproperty.com 11-19-2024 November 19, 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.: 785173 Filing Date: 10/1/2024 Complainant(s): William & Maryann Wallack Insured(s): William & Maryann Wallack Policy No.: 150116027850 Claim No.: FL23-0122975 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, Ryan Smith, on behalf of the Complainants, William & Maryann Wallack (also referenced as “Insureds”). The Notice alleges violations of Florida Statutes, Sections 624.155 and 626.9541. Universal specifically denies each allegation 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, Florida Statute §624.155 and Florida law. The Notice is deficient as a matter of law as it fails to comply with Fla. Stat. §624.155. See 316, Inc. v. Maryland Cas. Ins. Co., 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 Fla. Stat. §624.155(3)(b), the Notice “shall state with specificity” the following information: 1. The statutory provision, including the specific language, which the authorized insurer allegedly violated; 2. the facts and circumstances giving rise to the violation; 3. the name of any individual involved in the violation; 4. reference to specific policy language that is relevant to the violation, if any...; and 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 Florida Department of Financial Services (“DFS”) created form DFS-10-363, which sets out 15 requirements that the Complainant(s) must respond to with specificity. The Florida Supreme Court holds that Fla. Stat. § 624.155 “must be strictly construed.” Talat Enterprises, Inc. v. Aetna Cas. and Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). Strict construction is appropriate as “this statute is in derogation of the common law.” Id. When interpreting a statute in derogation of the common law, “[a] court will presume that such a statute was not intended to alter the common law other than as clearly and plainly specified in the statute.” Time Ins. Co., Inc. v. Burger, 712 So. 2d 389, 393 (Fla. 1998). Such an interpretation would mean that statutory bad faith cases cannot proceed unless the Complainant(s) 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 requirements of Section 624.155, Florida Statutes, on several grounds. First, concerning the requirement to set forth, with specificity, the “facts and circumstances giving rise to the violation,” the Notice fails to specify any facts that would put Universal on notice that it violated any policy provision or statute. The Complainants provide three (3) reasons for submitting the Notice: “Claim Delay,” “Unsatisfactory Settlement Offer” and “Unfair Trade Practice.” However, the Complainants’ allegations regarding these “Reasons for Notice” have no factual support anywhere in the Notice. The Notice asserts general allegations consisting of inaccuracies and conclusory statements rather than specific allegations of facts regarding any alleged misconduct or statutory violations. As an example, the Notice states: “It remains clear that Universal has not acted honestly or fairly towards its Insureds. Universal and its representatives have failed to conduct a proper investigation of the loss, misrepresented the scope of damages and repairs, and misapplied policy provisions to wrongfully reduce payment for the Insureds’ claim. It has become a general business practice of Universal to not implement proper claims handling procedures, to hire consultants that routinely ignore or intentionally misidentify relevant evidence, and to not settle claims in good faith when under all circumstances it should have.” The Complainants’ boilerplate assertions, as outlined above, include no facts and do not provide any specificity as to how Universal allegedly violated any policy provision or statute. The Complainants are required to provide with specificity the facts and circumstances giving rise to the alleged violation strictly related to Complainants’ allegations, not conjecture or speculation of what may be the carrier’s business practices. Moreover, the Notice does not specify any facts regarding any misrepresentations made by Universal, does not identify the person or persons who made such misrepresentations, nor does it identify to whom any misrepresentations were made. The Notice also makes allegations relating to the pending litigation between Universal and the Complainants. Litigation is not bad faith claims handling, nor is it an appropriate subject for a Civil Remedy Notice under Fla. Stat. § 624.155. General references to unrelated litigation are in no way relevant to the handling of the instant claim or the alleged violations raised in the subject Notice. The Notice is replete with vague and generic boilerplate and/or conclusory assertions which are not supported with any facts and do not provide the requisite specificity as to how Universal allegedly violated any policy provision or statute. It is evident that the statement of facts falls short of the specificity required by Sec. 624.155, Fla. Stat. As a result, the Complainants failed to comply with the requirements provided in Sec. 624.155(3)(b)(2), Fla. Stat., thus the Notice is insufficient as a matter of law. 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. To comply with Sec. 624.155, Fla. Stat., the Complainant(s) must name the individual(s) involved with specificity related to the purported violation(s) to allow Universal to investigate the allegations properly. The Notice lacks the requisite specificity required by Sec. 624.155, Fla. Stat., because the Notice states “N/A” which clearly defeats the requirement in the DFS Form to provide specificity to put the carrier on notice and provide an opportunity to investigate any allegation with a specific individual. The Notice does not have the requisite specificity as to whom the Complainants are asserting has knowledge as to any purported allegation in the Notice. The failure to provide the requisite specificity precludes Universal from taking any corrective action and potentially curing any purported allegation. Specific identification of a person or persons with the most knowledge within Universal is of particular importance because the Complainants allege Universal made “[a] material misrepresentation … to an insured or any other person having an interest in the proceeds payable under such contract or policy,” and “[m]isrepresent[ed] pertinent facts or insurance policy provisions relating to coverages at issue.” The Notice fails to include any specificity as to whom made any misrepresentations, what was misrepresented, and when any of these misrepresentations were made. Accordingly, Complainants’ Notice is insufficient as a matter of law. Third, the Notice fails to satisfy Fla. Statute § 624.155(3)(b)(4) in that it fails to reference any specific policy language relevant to any alleged violation. Instead, the Notice states: “Section 1 - Property Coverages – Coverage A – Dwelling Section 1 – Perils Insured Against – Coverage A-Dwelling and Coverage B-Other Structures Section 1- Conditions – Loss Settlement Section 1 – Conditions –Loss Payment” The Notice fails to identify how the referenced sections and/or provision titles relate to any alleged violation or how, if at all, they are relevant to the subject claim. Therefore, it is unclear what, if any, policy language pertains to any allegation. General, vague, and overbroad references to policy section titles and/or provision titles do not satisfy the specificity required by Section 624.155(3)(b)(4), Fla. Stat. 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, the Notice does not provide a proper means whereby Universal can “cure” the alleged defects without paying benefits that are not due and owing to the Insured. A Civil Remedy Notice aims 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). However, Sec. 624.155, Fla. Stat., does not impose on an insurer the obligation to pay whatever amount its insureds demand. Talat, 753 So. 2d at 1282. On the contrary, the Florida Supreme Court holds that the scope of what can be “cured” in responding to a Civil Remedy Notice, is limited to contractual amounts due to the insureds. See Talat, 753 So. 2d at 1281. Notably, Universal asserts that by the Complainants initiating litigation before filing the Notice prejudices Universal’s ability to cure any purported allegation in the Notice as there is no actual cure period wherein Universal could cure without paying extra-contractual damages. Universal is only obligated to pay contractual amounts owed to cure a civil remedy notice. See id. at 1278. In summation, the Complainants failed to respond to each of the fields set forth on the DFS Form with the requisite specificity as stated herein including, but not limited to, failing to reference specific policy language relevant to any alleged violation, failing to identify the person or persons representing the insurer who are most responsible for/knowledgeable of the facts giving rise to the allegations in the Notice, failing to provide sufficient facts and circumstances giving rise to the alleged violations, and failing to allow Universal to cure the Notice without imposing an obligation to pay extra-contractual damages. Therefore, the Notice is legally deficient and fails to satisfy the condition precedent to filing a bad faith action. See 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 Universal’s response to the Notice. On June 7, 2023, Universal was notified by Insured, William Wallack, that the insured location was damaged on June 4, 2023. Universal inspected the property and documented any visible damage. Universal, in accordance with the terms and conditions of the Policy, issued payment in the full amount of its estimate, less recoverable depreciation and applicable deductible. Under the terms of the Policy, Universal will initially pay at least the actual cash value of the insured loss, less any applicable deductible. It will then pay any remaining amounts necessary to perform such repairs as work is performed and expenses are incurred. On April 10, 2024, the Complainants initiated litigation against Universal in Circuit Court in Pasco County under Case No. 2024CA000985. Thus, at the time of the instant Notice, the parties were and continue to litigate their disputes to determine what, if any, additional available coverage exists under the Policy. Universal did not breach any duty to its Insureds. An Insurer has no obligation to pay whatever amount its insureds demand. While an insurance carrier is required to settle claims that should be settled, it is not required to settle claims that are legitimately contested. As outlined above, the alleged statutory violations and factual allegations of wrongdoing set forth in the Notice lack factual support and are without merit. Therefore, the Notice is legally deficient and fails to satisfy the condition precedent to filing a bad faith action. Universal complied with all policy provisions and applicable Florida Statutes and law regarding the adjustment of this claim. We trust that the foregoing is sufficient to advise you of Universal’s position regarding this matter and fully responds to the alleged violations in the Notice filed by the Complainants. Sincerely, /s/ Jonathan Rodriguez Jonathan Rodriguez, 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.

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