Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 789393

Filing Accepted: 10/30/2024

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Complainant

Last/Business Name *

SOCORRO

First Name

RODOLFO

Street Address *

7905 LAKE MABEL LOOP ROAD

City, State Zip *

LAKE WALES, FL 33898

Email Address *

VR1209@AOL.COM

Complainant Type: *

Insured

Last/Business Name*		SOCORRO		First Name		RODOLFO
Policy # *		PFLH0000033013		Claim #*		00000011279

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
Insurer Name*		UNIVERSAL FIRE & CASUALTY INSURANCE COMPANY
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 32867

Name of individual responsible for violation (if any):* CRISTINA COLON, CHRIS BOGEN, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, UNIVERSAL INSURANCE COMPANY OF NORTH AMERICA WHO WAS INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Unfair Trade Practice
	Claim Delay
	Other : Misrepresenting the terms of the insurance policy
	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 : Intentionally misstating the terms, conditions, and benefits of the insurance policy to the insured

* 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)(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.
Enter all words or phrases (one at a time) that should be used to filter.

Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language. “It is an accepted principle of law that when parties contract upon a matter which is the subject of statutory regulation, the parties are presumed to have entered into their agreement with reference to such statute, which becomes a part of the contract, unless the contract discloses a contrary intention.” Westside EKG Assocs. v. Found. Health, 932 So. 2d 214, 216 (Fla. 4th DCA 2005), aff’d, 944 So. 2d 188 (Fla. 2006).

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

Universal Insurance Company of North America (the “Insurer”) has committed the following in handling the Insured’s claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the policyholder and 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) failing to provide an estimate that complies with the Florida Building Codes; 9) shifting the burden of investigating the loss onto the Insured; and 10) failing to clearly explain the nature of the requested information and the reasons why such information is necessary On or about July 27, 2024, while the subject policy was in full force and effect, the Insured’s property was severely damaged by water. The areas impacted include but are not limited to the living room, foyer, dining room, playroom, master bedroom, walk-in closets, master bathroom, kitchen, family room, cabana bathroom, hallways, bedrooms, laundry room. The Insured additionally incurred costs for alternative living expenses and contents. The Insured timely submitted a claim to the Insurer for water damage and the ensuing damage therefrom. Thereafter, the Insurer assigned claim number 00000011279 to the loss and sent a field adjuster to inspect the property. Then the Insurer notified the Insured that it was extending coverage for the loss. However, the Insurer wrongfully determined that it would only require approximately $59,000 to restore the insured property to its pre-loss condition. The Insurer’s lowball estimate is that of a classic under scope and under value of the claim. Given the vastly underestimated cost of repairs, the Insured’s disagreement with the coverage decision, and the scope and nature of the damage resulting from water, the Insured retained a public adjuster. After assessing the damage and the true scope of repairs, the public adjuster produced an estimate identifying $170,202.31 in covered damage to the dwelling. The foregoing estimate, photographs, and a letter of representation from the public adjuster were sent to the Insurer. In response, the Insurer retained a loss consultant to provide a comparative estimate. This consultant calculated the replacement cost value of the loss at $92,558.45, which continued to undervalue the claim. Moreover, the consultant attempted to force the Insured to sign a document under the guise that it was for verifying his visit, but upon closer review, served as a work authorization. The consultant misrepresented this documentation and advised if the Insured signed it he would supplement his estimate to include repairs for the tile floors and the bathroom. Despite this unethical behavior, the Insurer continued to rely upon his evaluation of the scope of the damage. 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. Additionally, although there was interior water damage the adjuster did not use a moisture meter. 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 Insurer significantly underestimated the scope of the loss to the Insured’s property. 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. This is an underhanded attempt to place the financial interest of Insurer over those of the Insured, to delay the Insured’s claim, and to delay the Insured in restoring his property to its pre-loss condition. Moreover, the Insured submitted a request for payment for alternative living expenses. The Insured had to relocate to his rental property until repairs could be completed at his home as well as stay at a hotel for a few nights. He had to incur additional costs for wifi, electric, furniture, mileage, and new mattresses. The Insured provided receipts for all requested items but lacked a formal prior lease agreement to demonstrate the monthly rental income amount. Instead, the Insurer provided evidence from Zillow of the fair rental price. The Insurer rejected the evidence from Zillow and required a formal prior lease agreement. The Insured’s public adjuster explained the previous tenant occupied the rental property for over 5 years and an agreement could not be found but he offered to provide bank statements for 1, 2, or even 3 years to demonstrate the rental income. The Insurer violated Fla. Stat. 626.9541(1)(i)(3)(h) by failing to clearly explain why it would only accept a lease agreement as evidence of rental income, especially in light of the Insurer’s September 24, 2024, email requesting, “a prior lease agreement and/or rental property information to assess rental costs.” To date, the Insurer has failed to make any payments for the Insured’s alternative living expenses. 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 determined that it would only require $92,558.45to restore the insured property to its pre-loss condition. 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 delay 2. Not treating the Insured with good faith claims conduct 3. Looking for way to reduce recovery to the Insured 4. Looking for ways to deny recovery to the Insured 5. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured 6. 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 7. Placing the financial interest of the Insurer over that of the health and safety of the Insured 8. Failing to provide an estimate that complies with the Florida Building Codes 9. Shifting the burden of investigating onto the Insured 10. Conducting inadequate investigations 11. Failing to clearly explain the nature of the requested information and the reasons why such information is necessary 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 Electronic Mail Universal Insurance Company of North America 101 Paramount Drive, Suite 220, Sarasota, FL 34232 claims@uihna.com

Comments

User Id		Date Added		Comment
grant@krapflegal.com		11-04-2024		This Civil Remedy Notice is hereby withdrawn.
compliance@ufcic.com		11-04-2024		In regard to FL Civil Remedy Notice – 789393 for UNIVERSAL FIRE & CASUALTY INSURANCE COMPANY, we have found no insured, policy, or claim under the insured name or numbers provided in the notice. UNIVERSAL FIRE & CASUALTY INSURANCE COMPANY (UFCIC) is a commercial P&C insurance carrier based in Michigan and domiciled in Indiana. UFCIC does not sell personal homeowners/residential insurance products in Florida. Also, the complaint clearly outlines UNIVERSAL INSURANCE COMPANY OF NORTH AMERICA as the insurance carrier. Therefore, this notice was incorrectly filed against Universal Fire & Casualty Insurance Company. It is recommended that the complaint be withdrawn and refiled with the correct insurance carrier.

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