Civil Remedy Notice of Insurer Violations
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Filing Number:     786369
Filing Accepted:  10/10/2024
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Complainant
Last/Business Name *  
LOUIS J. PULIAFITO AND ANTOINETTE PULIAFITO   First Name  
Street Address * 27 ROYAL PALM WAY #104
City, State Zip * BOCA RATON, FL 33432
Email Address * LOU.PULIAFITO@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   LOUIS J. PULIAFITO AND ANTOINETTE PULIAFITO   First Name  
Policy # * 1503-1802-8004 Claim #* FL23-0126795
Attorney
Attorney is Applicable
Last Name* SCHLOSSER First Name * BRADEN Initial
Street Address* 925 FEDERAL HWY
City, State Zip* BOCA RATON , FL 33432
Email Address * BSCHLOSSER@KPATTORNEY.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):* BRANDAN SCHUTZE
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)(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)(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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Loss settlement provision
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The carrier was put on notice that the insureds’ property had been infected with mold/ gross bacterial growths in areas of the house in addition to the widespread damage detailed throughout the property. The carrier initially attempted to low-ball the claim. Subsequently, the insureds prepared a loss package in the amount of $148,746.80 needed to restore the property back to its pre-loss condition. Whereas, the carrier furnished a wrongful estimate and, having withheld the deductible, offered a deficient payment in the amount of $13,285.14 only, leaving a remainder in the amount of $135,461.66 to be paid in order to cure the breach, less any applicable policy deductible. Not only have the insureds have complied with all of the carrier’s requests to date but, the insureds have been forced to pay substantial sums out of pocket for work at their property as well as in additional living expenses because their home was uninhabitable. And the carrier has still failed to treat this claim with good faith. This intentional delay with the claim has led to direct prejudice of the insured. About four hundred thirty days have passed since the original date of loss. The carrier has still refused to pay the fully covered amount owed under the policy. The carrier is aware of damage sustained by the insureds’ property and has not taken any meaningful ensuing action. In Florida, the profession of adjusting insurance claims involves a special relationship of trust with the public. As such, insurance adjusters and insurance company claims representatives are imposed with a duty of good faith claims conduct. This duty of good faith transfers to claims for roof repair services or other construction, remediation, or mitigation services. Universal Proper & Casualty Insurance Company (“Insurer”) has breached this duty by its adjustment of the Plaintiffs’ claim in connection with the sudden and severe damages to their property. An insurance policy is obtained by homeowners to protect against unknown disasters, catastrophes and misfortunes, which may, or may not, ever occur. The policyholder, after paying premiums and expecting protection against a loss, is in an especially vulnerable economic and personal position when the unexpected loss occurs. The entire purpose of insurance is defeated if those involved with insurance adjustment can refuse or delay the prompt and full payment of monies due under the contract. Insurance contracts are not like other contracts because insurers have an advantage in bargaining power. Insurers and their representatives are therefore held to a higher standard of care. When an insurance company, such as Insurer, issues an insurance policy to an insured, it promises to provide financial security in the event of damage to the insured’s home. Claims representatives are the people responsible for fulfilling the insurance company’s promise. When a covered loss occurs, the insurance company’s obligation under its promise to pay is triggered. The policyholder is completely dependent on performance by the insurance company when the insured is at its most vulnerable position, after a loss, since the policyholder is an economically inferior party to the contract. Therefore, the claim representative’s chief task should be to seek and find coverage, not to seek and find coverage controversies or to delay, deny, dispute or underpay insurance benefits. If the insurance company fails to fulfill its obligations, such as Insurer has done with regard to this claim, the policyholder not only suffers contractual damages but also extra-contractual damages. When an insurance company fails to pay claims it owes or engages in wrongful practices, contractual damages alone are inadequate. It is hardly a penalty to require an insurer to pay an insured (or the assignee of an insured) what it owed all along. Accordingly, the Florida legislature addressed the need for a bad faith action against an insurer in §624.155, Fla. Stat., and the Complainant adopts and incorporates all provisions of that statute into this Civil Remedy Notice including all of the applicable provisions of §624.155(1)(i). It is far more profitable for an insurance company to take in an insured’s premium and not pay, rather than to promptly and fully pay what is owed. This financial incentive conflicts with the extreme public trust placed in the insurance industry which is the reason that the State of Florida also implemented codes of ethics and good faith duties articulated in the Florida Administrative Code. Insurers and their representatives must follow these ethical duties. Insurer violated ethical requirements in its adjustment of the Complainant’s claim for insurance benefits pursuant to Fla. Admin. Code R. 69B-220.201, specifically: (3) Code of Ethics. The work of adjusting insurance claims engages the public trust. An adjuster shall put the duty for fair and honest treatment of the claimant above the adjuster's own interests in every instance. The following are standards of conduct that define ethical behavior, and shall constitute a code of ethics that shall be binding on all adjusters: (b) An adjuster shall treat all claimants equally.1. An adjuster shall not provide favored treatment to any claimant.2. An adjuster shall adjust all claims strictly in accordance with the insurance contract. (c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured. (d) An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation. (e) An adjuster shall handle every adjustment and settlement with honesty and integrity, and allow a fair adjustment or settlement to all parties without any compensation or remuneration to himself or herself except that to which he or she is legally entitled. (f) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim In turn, the insureds have complied with all of the carrier’s requests to date and the carrier has still failed to treat this claim with good faith. This intentional delay with the claim has led to direct prejudice of the insureds. About one hundred eighty-five days have passed since the original date of loss. The carrier has still refused to pay the fully covered amount owed under the policy. The carrier is aware of the damage sustained by the insured’s property and has not taken any meaningful ensuing action. It is clear that the carrier is not treating the insureds with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insureds; failing to implement proper standards for the adjustment and investigation of claims by its adjusters and placing the company’s interests before the insureds’ interests; refusing to pay the full amount owed to the insureds despite the fact that the carrier has been on notice of the damages and looking for ways to delay full recovery or any recovery to the insureds, when a reasonable carrier in a similar position would have tendered a full payment in accordance with both the policy language and statutory requirements. The carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c) and 626.9541(1)(i)(3)(f), as well as Section I- Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss; and the loss payment provision under Section I- Conditions requiring payment of a claim within 90 days. All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless disregard for the insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $148,746.80, less any prior payments and less any applicable policy deductible; and 2.) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been sent to the carrier. Please do not hesitate to contact the undersigned or Rodneisha Smith at (561)-892-9928 if you have any questions or concerns. Sincerely, Braden Schlosser Attorney at Law Enclosed: Civil Remedy Filing
Comments
User Id Date Added Comment
sm1130@universalproperty.com 11-27-2024 November 27, 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.: 786369 Filing Date: 10/10/2024 Complainant: Louis J. Puliafito and Antoinette Puliafito Insured: Louis J. Puliafito and Antoinette Puliafito Policy No.: 1503-1802-8004 Claim No.: FL23-0126795 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, Braden Schlosser, on behalf of Complainants, Louis J. Puliafito and Antoinette Puliafito (also referenced as “Insureds.”) The Notice alleges violations of Sections 624.155 and 626.9541, Florida Statutes. Universal specifically 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(s) 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(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 requirement of Section 624.155, Florida Statutes, on several grounds. First, 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(s) 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 “Brandan Schutze,” without more. The Notice fails to include any specificity as to how or what facts giving rise to any purported allegation(s) Mr. Schutze has knowledge of and/or what, if anything, Mr. Schutze did or failed to do as it relates to the claim at issue. Therefore, the Notice does not have the requisite specificity as to what, if anything, this individual has knowledge of and/or how the individual relates to any allegation in the Notice. The failure to provide the requisite specificity precludes Universal from taking any corrective action and potentially curing any purported allegation. Specificity as to a person’s knowledge within Universal is of particular importance because the Complainants allege Universal “[m]isrepresent[ed] pertinent facts or insurance policy provisions relating to coverages at issue.” The Notice, however, fails to include the requisite specificity as to whom made any misrepresentations or when any of these misrepresentations occurred or what was misrepresented. Accordingly, the Complainants’ Notice is insufficient as a matter of law. Second, the Notice fails to satisfy Sec. 624.155(3)(b)(4), Fla. Stat., because it fails to reference any specific policy language relevant to any alleged violation. Instead, the Notice only states, “Loss settlement provision.” The Notice provides no guidance or explanation, such that Universal is left to wonder when, how or by whom this policy provision title was violated. Therefore, it is unclear what, if any, policy language pertains to any allegation. General, vague, or overbroad references to a policy provision title does not satisfy the specificity required by Sec. 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). Third, regarding the requirement to set forth with specificity the “facts and circumstances giving rise to the violation,” the Notice fails to specify sufficient facts that would put Universal on notice that it violated any policy provision or statute. The Complainants list three (3) reasons for filing the Notice: “Claim Delay,” “Unsatisfactory Settlement Offer,” and “Unfair Trade Practice.” However, the Complainants’ boilerplate allegations in the “Reasons for Notice” section have no factual support anywhere in the Notice. The Notice also asserts general allegations consisting of inaccurate, boilerplate and conclusory statements in lieu of specifying facts to support its allegations. For example, the Notice states in part “the insureds prepared a loss package in the amount of $148,746.80 needed to restore the property back to its pre-loss condition. Whereas, the carrier furnished a wrongful estimate and, having withheld the deductible, offered a deficient payment… This intentional delay with the claim has led to direct prejudice of the insured [sic]. The Complainants fail to assert any facts to support these conclusory statements. Further, there are no facts to support that the amount claimed by the Insureds is what is owed for the claim at issue, let alone a single fact to support that there has been any delay. The Complainants also allege “[t]he carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c) and 626.9541(1)(i)(3)(f), as well as Section I- Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss; and the loss payment provision under Section I- Conditions requiring payment of a claim within 90 days.” However, the Complainants fail to specify any facts or examples to support the above referenced boilerplate statutory violations and alleged violation of the Policy. Further, 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. As to the Complainants’ general reference to an alleged violation of the Policy “requiring payment of a claim within 90 days,” Universal asserts as phrased, this is misleading, and Universal relies on the actual Policy language itself. Further, there are no facts asserted to support this allegation. In addition, the Notice states “[a]ll the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless disregard for the insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida.” The Complainants fail to specify facts to support these conclusory and speculative allegations. The Complainants do not specify any facts of when, how or whom, violated the Insureds’ rights. The Complainants are required to specify the facts and circumstances giving rise to the alleged violation strictly related to the Complainants’ allegations, not conjecture or speculation of the carrier’s business practices. 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 fail to comply with Sec. 624.155(3)(b)(2), Fla. Stat. In summary, as outlined above, the Complainants fail to respond to each of the fields set forth on the DFS Form with the requisite specificity including, but not limited to, failing 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, failing to allege any specific conduct on the part of Universal that would violate any policy provision or statute, and failing to reference specific policy language relevant to any alleged violation. 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 Universal’s response to the Notice. On July 11, 2023, Universal was notified by the Insured, Antoinette Puliafito, that the insured location was damaged the same day. 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. Universal has also issued payment to the Insureds for the incurred additional living expenses submitted by the Insureds totaling $4,413.78. Subsequently, the Insureds submitted additional estimates for consideration. Universal timely issued a supplemental undisputed payment based on the estimates received. Thereafter, the Insureds submitted an estimate totaling $148,746.80 prepared by Catastrophic Investigations on their behalf. Universal advised the Insureds that based on the facts known to date, no additional amounts were owed. Additionally, Universal advised the Insureds of the Policy’s alternative dispute resolution methods. To date, Universal has not received any documentation showing the amount necessary to perform such repairs or that expenses have been incurred in excess of the payment issued by Universal to the Insureds. At no time has Universal breached any duty to its Insureds. An insurer is not required to pay whatever amount its insureds demand. As outlined above, the alleged statutory violations and factual allegations set forth in the Notice are devoid of factual support and are without merit. Thus, the Notice is legally deficient and fails to satisfy the condition precedent to filing a bad faith action. Universal has complied with all policy provisions and applicable Florida law regarding the adjustment of this claim. We trust that the foregoing is sufficient to advise you of Universal’s position with regard to this matter and fully responds to the Notice filed by the Complainants. Sincerely, /s/ Stephen Methe Stephen Methe
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