Civil Remedy Notice of Insurer Violations
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Filing Number:     786380
Filing Accepted:  10/10/2024
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Complainant
Last/Business Name *  
RIVERO   First Name   KEITH AND EILEEN
Street Address * 8110 CITRUS HILL COURT
City, State Zip * ORLANDO, FL 32818
Email Address * ERIVERO210@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   RIVERO   First Name   KEITH AND EILEEN
Policy # * 1501-1500-0792 Claim #* FL24-0101233-F724
Attorney
Attorney is Applicable
Last Name* GELBER First Name * MATTHEW Initial
Street Address* 2385 NW EXECUTIVE CENTER DRIVE, SUITE 100
City, State Zip* BOCA RATON , FL 33431
Email Address * MATT@GELBERLAWGROUP.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):* DEANTE FIELDS; WILLIAM CARVALHO
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.
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)(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.
* Specific policy language that is relevant to the violation.
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AGREEMENT We will provide the insurance described in this policy in return for the premium and compliance with all applicable provisions of this policy… SECTION I – PROPERTY COVERAGES A. Coverage A – Dwelling 1. We cover: a. The dwelling on the “residence premises” shown in the Declarations, including structures attached to the dwelling; and b. Materials and supplies located on or next to the “residence premises” used to construct, alter or repair the dwelling or other structures on the “residence premises”… F. Additional Coverages 1. Debris Removal a. We will pay your reasonable expense for the removal of: (1) Debris of covered property if a Peril Insured Against that applies to the damaged property causes the loss… SECTION I – PERILS INSURD 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”. SECTION I – CONDITIONS… D. Loss Settlement, Covered property losses are settled as follows:… 2. Buildings and screen enclosures covered under Coverage A or B at replacement cost without deduction for depreciation subject to the following: (a) lf, 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, after application of deductible and 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 for like construction and use on the same Premises; or (3) The necessary amount actually spent to repair or replace the damaged building… (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, after application of deductible and 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… J. Loss Payment We will adjust all losses with you…. 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; 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 doing so. FLORIDA STATUTES VIOLATED §627.70131(7)(a) - Within 60 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer. The insurer shall provide a reasonable explanation in writing to the policyholder of the basis in the insurance policy, in relation to the facts or applicable law, for the payment, denial, or partial denial of a claim. If the insurer’s claim payment is less than specified in any insurer’s detailed estimate of the amount of the loss, the insurer must provide a reasonable explanation in writing of the difference to the policyholder. Any payment of an initial or supplemental claim or portion of such claim made 60 days after the insurer receives notice of the claim, or made after the expiration of any additional timeframe provided to pay or deny a claim or a portion of a claim made pursuant to an order of the office finding factors beyond the control of the insurer, whichever is later, bears interest at the rate set forth in s. 55.03. Interest begins to accrue from the date the insurer receives notice of the claim. The provisions of this subsection may not be waived, voided, or nullified by the terms of the insurance policy. If there is a right to prejudgment interest, the insured must select whether to receive prejudgment interest or interest under this subsection. Interest is payable when the claim or portion of the claim is paid. Failure to comply with this subsection constitutes a violation of this code. However, failure to comply with this subsection does not form the sole basis for a private cause of action.
 
* Facts and circumstances giving rise to the violation.
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The Complainants and Insureds, EILEEN RIVERO AND KEITH RIVERO (referred to as “Insureds” or “Complainants”), file this Civil Remedy Notice (“Notice”) in order to perfect the right to pursue the civil remedy authorized by this section. The Complainants maintained a homeowner’s policy of insurance (“Policy”) with UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY (“INSURER”) to the insured property located at 8110 Citrus Hill Court, Orlando, FL 32818 (“Property”), which provided coverage for their sudden and accidental damages associated with the direct physical loss caused by wind, which resulted in ensuing damages and losses (“Loss”). The Loss caused substantial, direct, and consequential damages, and INSURER’s general business practice of willful, wanton, immoral, deceptive and bad faith claim handling policies, procedures, guidelines, protocol, adjusting, investigating, drawing valuations and issuing payment (or lack thereof) has caused the Insureds to suffer further harm and extra-contractual damages which have accrued, and will continue to accrue. The stated misconduct is collectively referred to as “Bad Faith”, and the specific factual and/or legal consideration in relation thereto are further outlined below for their consideration in accordance with Fla. Stat. Sec. 624.155 and the cited legal authorities associated therewith. Specifically, on or about January 9, 2024, the INSUREDS sustained roof and interior damage to their Property due to wind. On January 11, 2024, the INSUREDS retained a professional public adjuster who reported the loss to the INSURER on or about January 12, 2024. The INSURER assigned a claim number FL24-0101233-F724 and a field adjuster, DeAnte Fields, to inspect the Property. Mr. Fields inspected the property on behalf of the INSURER on or about January 24, 2024 and took photos and prepared a report. On February 6, 2024, the INSURER issued a denial letter. Specifically, the letter stated, “Universal has been investigating your property damage claim since it was reported on January 12, 2024. During our investigation, it was concluded that the claimed damage to the roofing system covering the dwelling and the interior ceiling conditions reported as related to the loss are due to wear, tear and deterioration, and/or inadequate maintenance. Pursuant to the applicable Policy, the claimed roof damage is not covered.” On or about February 6, 2024, the INSUREDS sent the INSURER a Sworn Proof of Loss in the amount of $59,937.72 after the application of the Policy’s $2,500.00 deductible which corresponds to the estimate that was prepared by their Public Adjuster. There was no response from the INSURER. On March 6, 2024, the INSUREDS, through their Public Adjuster, sent the INSURER correspondence invoking appraisal as prescribed by the provisions within the Policy. 21 days later, on March 27, 2024, the INSURER sent the INSUREDS correspondence rejecting the request for appraisal. On May 29, 2024, INSUREDS, through their Attorney, filed a Notice of Intent to Initiate Litigation. On May 1, 2024, in response to the Notice of Intent to Initiate Litigation, the INSURER made a pre-suit settlement offer of $5,000 globally. However, this amount was insufficient to fully repair the Property back to its pre-loss condition. As such, litigation ensued. In litigation, the INSURER has taken sanctionable positions that are not founded in fact nor in law. The INSURER alleges that it denied the INSUREDS claim because of “wear, tear and deterioration, and/or inadequate maintenance.” During the deposition of its Corporate Representative, William Carvalho, no valid testimony was extended to support these baseless positions. For example, the Corporate Representative testified that the claim was denied due to the damages being caused by an excluded peril; however, the support for that assertion was only that no documentation was received from the INSUREDS related to any tarping or water restoration of the interior of the property. Mr. Carvalho stated there was “Neglect” to the property, however; when asked if the INSURER has any evidence that the damage from the loss became worse due to the INSUREDS not tarping or hiring a water mitigation company, Mr. Carvalho testified that there were no documents provided, and that the claim was reported 3 days after the loss occurred, and therefore this is neglect. In fact, Mr. Carvalho testified that the Field Adjuster did not observe any active leaks or standing water during his inspection on January 24, 2024. There were 15 days between the date of loss (January 9, 2024), and the date of the field adjuster’s inspection (January 24, 2024), and Mr. Carvalho stated that there was ongoing damage due to neglect as an Affirmative Defense; however, he also testified that there was no evidence of neglect pertaining to prior to the date of loss and that only the lack of documents can substantiate this assertion. He testified that the INSURER received no documents related to water restoration or tarp installation to support the Affirmative Defense of failing to mitigate the damages; however, when asked if the Field Adjuster observed any active leaks or standing water during the inspection, Mr. Carvalho testified that the field adjuster did not. The INSURER did little to fully investigate the claim. They failed to send an engineer or contractor to the Property prior to making a coverage determination and denying the claim. Mr. Carvalho testified that the Field Adjuster was the only person sent to the Property on behalf of the INSURER to investigate the claim. However, Mr. Carvalho testified that the Field Adjuster did not make a coverage recommendation and did not determine causation, nor was he tasked with either by the INSURER. In fact, Mr. Carvalho testified that the INSURER had nothing to refute the damages claimed by the Public Adjuster for the INSUREDS’ claim. The INSURER’S refusal to properly investigate, adjust, and fully compensate the Complainant for its claim undoubtedly evidences the INSURER’S violation of section 626.9541(1)(i)(3)(a), Florida Statutes, which requires the INSURER to “adopt and implement standards for the proper investigation of claims.” All available information leads to one conclusion—the Insureds’ property was damaged by a covered cause of loss for which the Insured is entitled to full and complete compensation. The INSURER’S obligation to promptly settle the Insureds’ claim is undeniable, and therefore, the INSURER has also violated section 624.155(1)(b)(1), Florida Statutes. The Defendant also violated section 626.9541(1)(I)(3)(d) and (g) by failing to send experts or any other professionals to the property to assess the damages and confirm the cause of loss, or to advise why restoration or tarp documentation would be necessary and relevant to this claim. The actions taken by the INSURER in the handling and adjustment of the Insureds’ claim are willful, wanton, and in disregard for the rights of the Insured. The INSURER’S actions amount to, but are not limited to: A. “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 the insured and with due regard for her or his interests;” B. “Failing to adopt and implement standards for the proper investigation of claims;” C. “Denying claims without conducting reasonable investigations based upon available information;” D. “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;” E. Claim Delay; F. Claim Denial; and G. Unfair Trade Practices. To cure the defects outlined above, the INSURER must pay $40,500.00 within 60 days of receiving this Complaint.
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.: 786380 Filing Date: 10/10/2024 Complainant(s): Keith and Eileen Rivero Insured(s): Keith and Eileen Rivero Policy No.: 1501-1500-0792 Claim No.: FL24-0101233-F724 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, Matthew Gelber, on behalf of Complainants, Keith and Eileen Rivero (also referenced as “Insureds.”) The Notice alleges violations of Sections 624.155, 626.9541, and 627.70131, Florida Statutes. Universal specifically denies each and every allegation contained in the Notice. Additionally, Universal denies that it violated these or any statutes, Florida law or policy provisions regarding the claim adjudication 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 simply states “DEANTE FIELDS; WILLIAM CARVALHO,” without more. The Notice fails to include any specificity as to how the named individuals are knowledgeable of the facts giving rise to any purported allegation(s) and what the named individuals did or failed to do as it relates to the claim at issue. Specific identification of a person or persons with the most knowledge within Universal is of particular importance because, the Complainants allege Universal has “[m]isrepresent[ed] pertinent facts or insurance policy provisions relating to coverages at issue.” The Notice fails to include sufficient 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. Second, the Notice fails to satisfy Section 624.155(3)(b)(4), Florida Statutes, because it fails to reference any specific policy language relevant to any alleged violation(s). Instead, the Notice improperly cites to Section 627.70131, 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 or whom allegedly violated this statute. Additionally, the Notice cites to various sections and provisions of the Policy, without any explanation of how the language was violated. The Notice fails to identify how the referenced policy sections or provisions relate to any purported allegation. The broad references to provisions in the Policy provide no guidance or explanation, such that Universal is left to wonder what policy provisions Complainants believe were allegedly violated or breached and why. General, vague and overbroad references to policy provisions and/or sections do not satisfy the specificity required by Section 624.155(3)(b)(4), Florida Statutes. As such, the Notice is deficient as a matter of law. Julien v. United Property & Casualty Ins. Co., 311 So.3d 875 (Fla. 4th DCA 2021). Third, 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 Complainants provide four (4) separate reasons for submitting the Notice: claim denial, 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. Further the Notice asserts general allegations consisting largely of conclusory and inaccurate statements rather than specifying facts regarding any alleged misconduct or statutory violations. As an example, the Notice alleges “[t]he INSURER’S refusal to properly investigate, adjust, and fully compensate the Complainant [sic] for its [sic] claim undoubtedly evidences the INSURER’S violation of section 626.9541(1)(i)(3)(a), Florida Statutes…” The Complainants fail to provide any facts to support this conclusory statement. As an additional example, the Notice asserts purported factual allegations regarding the alleged bad faith claim handling that instead relate to Universal’s defense of the lawsuit filed against it by the Insureds. Litigation is not bad faith claim handling, and it is inappropriate to be included in a Civil Remedy Notice. The Parties’ litigation strategies, including affirmative defenses and deposition testimony, are not a proper subject for the Notice. The Civil Remedy Notice of Insurer Violation process is not the appropriate venue for the resolution of any such disputes and therefore is not relevant in this forum. The Notice also contains vague and generic conclusory assertions that fail to include the requisite specificity as to how Universal allegedly violated any policy provision or statute. For example, the Notice states “…INSURER’s general business practice of willful, wanton, immoral, deceptive and bad faith claim handling policies, procedures, guidelines, protocol, adjusting, investigating, drawing valuations and issuing payment (or lack thereof) has caused the Insureds to suffer further harm and extra-contractual damages which have accrued, and will continue to accrue.” The Notice does not specify any facts to support this speculative and conclusory statement. 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 generally alleges that Universal violated Section 626.9541(1)(i)(3)(b), Florida Statutes, by “[m]isrepresenting pertinent facts or insurance policy provisions relating to the coverages at issue.” However, 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. The Notice does not state any facts to support the Complainants’ misrepresentation allegations or any of the allegations contained therein. It is evident that the statement of facts falls short of the specificity required by Section 624.155, Florida Statutes. As a result, the Complainants fail to comply with the requirements provided in Section 624.155(3)(b)(2), Florida Statutes. Lastly, the Notice does not provide a proper means whereby Universal can “cure” the alleged defects. 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, Section 624.155, Florida Statute, does not impose on an insurer the obligation to pay whatever amount its insureds demand. Talat, 753 So. 2d at 1282. Notably, Universal asserts that by the Complainants initiating litigation before filing the Notice and/or the cure period expiring prejudices Universal’s ability to cure any purported allegation in the Notice as there is no actual cure period. In summation, the Complainants failed 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 specify an individual with the most knowledge as to the allegations, the failure to specify relevant policy language, the failure to specify facts and circumstances in support of any allegation, and the failure to provide a proper cure. Therefore, the Notice is legally deficient and fails to satisfy the condition precedent to filing a bad faith action. See 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 January 12, 2024, Universal received notice from the Insureds’ public adjuster, Horizon Public Adjusters, that the insured location was damaged on January 9, 2024. Universal inspected the property and documented any visible damage. Pursuant to the terms of the Policy, Universal advised the Insureds that there was no available coverage for the claim. Thereafter, on May 10, 2024, the Insureds initiated litigation against Universal in Circuit Court in and for Orange County under Case No. 2024-CA-004131-O. Thus, at the time the instant Notice was filed, the parties were and continue to litigate their dispute to determine what, if any, available coverage exists under the terms of the Policy. Universal did not breach any duty to its Insureds. An Insurer is not required to pay whatever amount its Insureds demand. While an insurance company 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 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 law regarding the adjudication 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 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