Civil Remedy Notice of Insurer Violations
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Filing Number:     789643
Filing Accepted:  10/31/2024
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Complainant
Last/Business Name *  
HIS AND HERS ROOFING LLC   First Name  
Street Address * 515 18TH STREET
City, State Zip * ORLANDO, FL 32805
Email Address * JBAER@HHROOFS.COM
Complainant Type: * Third Party
Insured
Last/Business Name*   REYNOLDS   First Name   BRENDA
Policy # * 1504-2001-0309 Claim #* FL24-0105462
Attorney
Attorney is Applicable
Last Name* TORRES First Name * ALEXIS Initial
Street Address* 515 18TH STREET
City, State Zip* ORLANDO , FLORIDA 32805
Email Address * ALEXIS@HHROOFS.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):* UNKNOWN
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unfair Trade Practice
* Statutory provision(s) which the insurer allegedly violated.
 
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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

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

October 31, 2024 Sent Via Email: cg0601@universalproperty.com Universal Property & Casualty Insurance Company ATTN.: Christopher Gonzalez 1110 West Commercial Blvd., Fort Lauderdale, FL 33309 RE: Complainant : His and Hers Roofing, LLC Insured : Brenda Reynolds Policy Number : 1504-2001-0309 Claim Number : FL24-0105462 Property Address : 3007 Joyann Street, Orlando, FL 32810 Dear Universal Property & Casualty Insurance Company: As discussed in greater detail in the notice, Carrier has not attempted to settle the claim 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 their interests. Carrier is required to properly investigate and adjust claims and cannot place that burden upon the insured or complainant. This was made clear by the appellate court and the Florida Supreme Court in Allstate Indemnity Co. v. Ruiz, 899 So. 2d 1121 (Fla. 2005)(“The Legislature has clearly chosen to impose on the insurance companies a duty to use good faith and fair dealing in processing and litigating the claims of their insureds…”). Carrier’s actions are in violation of Florida Statute §§ 626.9541(1)(i)(3)(a) and 626.9541(1)(i)(3)(b). Carrier received insured’s wind and hail storm claim upon receipt of a valid assignment of benefits in complainant’s favor. Complainant’s representative sent carrier a letter of representation. Following an inspection of the home, Carrier agreed with Complainant’s review of the damage that it required a replacement, leading to the issuance of $10,962.86 in ACV funds. Complainant then replaced the roof and provided proof of such to the carrier on August 27, 2024, requesting the withheld funds be release pursuant to the AOB previously submitted. After several weeks and the submission of a 10 day demand, Carrier’s response was that the AOB was invalid. Specifically, carrier references a change to the controlling statute but purposely misapplies and misinterprets the statute. Carrier’s invalidation of the assignment of benefits executed in this claim is based on an incorrect interpretation of Florida Statute 627.7152(2)(a)(1) and 627.7152(13). The language change in the statute states: that an assignment agreement must be executed under a residential property insurance policy or under a commercial property insurance policy as that term is defined in s. 627.0625(1), issued on or after July 1, 2019, and before January 1, 2023. It further goes on to add that, except as provided in subsection (11), a policyholder may not assign, in whole or in part, any post-loss insurance benefit under any residential property insurance policy or under any commercial property insurance policy as that term is defined in s. 627.0625(1), issued on or after January 1, 2023. An attempt to assign post-loss property insurance benefits under such a policy is void, invalid, and unenforceable. A plain reading of the above provisions clearly shows that if the insurance policy was issued on or after January 1, 2023, for which the claim date of loss then fell within this newly issued policy, then the assignment of benefits agreement executed in relation to said policy would be invalid. Here, the insurance policy in question was issued prior to January 1, 2023, as evidenced by the date of loss. Carrier knew this to be the language of the statute because it’s a public record and clear as day. Instead, they’ve continued to try to invalidate the assignment based on carrier’s own lack of legal expertise and lack of ability to read a Florida statute. Requests to rescind the incorrect position letter but this has not occurred. As a direct result, Carrier is not acting in good faith by failing to promptly acknowledge communications in relation to this claim in an effort to avoid communications with a roofing contractor and purposely misrepresenting controlling claim language. 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 regard for claimant’s 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.) rescind the October 31, 2024 email from Mr. Gonzalez stating the AOB is invalid. A copy of this letter and filed form submitted to the FDFS has been emailed as indicated above. Should you have any questions upon receipt of this filing, please do not hesitate to contact me at (407) 214-9305. We appreciate your attention to this matter. Sincerely, Alexis Torres, Esq. General Counsel for His and Hers Roofing, LLC Enclosed: Civil Remedy Notice Filing
Comments
User Id Date Added Comment
oc1102@universalproperty.com 12-17-2024 December 17, 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.: 789643 Filing Date: 10/31/2024 Complainant(s): His and Hers Roofing LLC Insured(s): Brenda Reynolds Policy No.: 1504-2001-0309 Claim No.: FL24-0105462 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, Alexis Torres, on behalf of Complainant, His and Hers Roofing LLC. The Notice alleges violations of Section 626.9541, Florida Statutes. Universal denies the allegations contained in the Notice. Additionally, Universal denies that it violated this 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) 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 requirements 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 must name the individual(s) involved with specificity as it relates to the purported violation to allow Universal to properly investigate the allegations. The Notice lacks the requisite specificity as required by Section 624.155, Florida Statutes. Here, the Complainant simply states, “UNKNOWN.” 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 of bad faith claims handling to put Universal on notice of what needs to be cured. Accordingly, the Complainant’s Notice is insufficient as a matter of law. Second, the Notice fails to satisfy Section 624.155(3)(b)(4), Florida Statutes, in that it fails to reference any specific policy language relevant to any alleged violation. Instead of identifying specific policy language the Complainant believes is relevant to any alleged violation, the Complainant states, “Duty after Loss,” which is a provision in the Policy referring to the Insured’s obligations under the Policy, and therefore not applicable to the carrier. As such Universal is left to wonder what policy provisions the Complainant believes were allegedly violated or breached and why. The Complainant’s failure to reference relevant policy language does not satisfy the specificity required by Section 624.155(3)(b)(4), Florida Statute. 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, 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 Complainant lists “unfair Trade Practice,” as “reasons for submitting the Notice.” The Complainant’s allegations have no factual support specified in the Notice. Additionally, the Notice asserts general allegations consisting largely upon conclusory and boilerplate statements rather than providing specific facts to support its conclusory allegations regarding any alleged misconduct or statutory violations. For example, the Notice states, “Carrier has not attempted to settle the claim 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 their interests. Carrier is required to properly investigate and adjust claims and cannot place that burden upon the insured or complainant.” However, the Complainant fails to specify any facts to support these conclusory statements. Furthermore, at no time has Universal place the burden of investigating and adjusting the claim upon the Insured or Complainant. Furthermore, the Notice states, “Carrier’s actions are in violation of Florida Statute §§ 626.9541(1)(i)(3)(a) and 626.9541(1)(i)(3)(b).” However, the Notice sets forth no specific facts to support this recitation of the statute. Additionally, 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 regard for claimant’s rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida.” However, the Complainant fails to specify any facts to support this conclusory statement. The Notice does not state any facts to support any of the allegations contained therein. Therefore, the statement of facts falls short of the specificity required by Section 624.155, Florida Statutes. As a result, the Complainant failed 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. The purpose of a Civil Remedy Notice is 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 Statutes, does not impose on an insurer the obligation to pay whatever an insured demands. Talat, 753 So. 2d at 1282. Here, Complainant demands, in part, a vague and amorphous cure unrelated to payment of contractual amounts due. As such, the Notice is deficient as it does not provide Universal an opportunity to “cure” the alleged violations without imposing obligations on Universal not contemplated by the Policy. Universal is only obligated to pay contractual amounts owed to cure a civil remedy notice. See id. at 1278. Notably, Universal asserts that when the Complainant initiated litigation before the expiration of the cure period for the Notice, it prejudiced Universal's ability to cure any purported allegation in the Notice wherein Universal could cure without paying extra-contractual damages. 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 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 any specific policy language relevant to any alleged violation, the failure to allege any specific conduct on the part of Universal that would violate any policy provision or statutes, 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. 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 March 5, 2024, Universal received notice from the Complainant that the insured location had damage which occurred that same day. On March 6, 2024, Universal received a document entitled “Assignment Agreement”, (“Assignment”) purportedly assigning benefits in favor of His and Hers Roofing, LLC., purportedly signed by the Insured, Brenda Reynolds, on March 5, 2024. It is unclear whether the purported Assignment is valid under Section 627.7152, Florida Statute. On March 8, 2024, Universal inspected the property and documented any visible damage. On March 10, 2024, Universal issued an undisputed payment to the Insured in the full amount of its estimate less the applicable policy deductible and recoverable depreciation pursuant to the terms of the Policy. 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 November 15, 2024, the Complainant initiated litigation against Universal in County Court of Orange County under Case No. 2024-CC-022781-O. Thus, at this time, Universal and the Complainant continue to litigate their dispute to determine what, if any, additional coverage exists under 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 responds to the Notice file 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