Civil Remedy Notice of Insurer Violations
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Filing Number:     790014
Filing Accepted:  11/2/2024
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Complainant
Last/Business Name *  
DEPAOLA JR.   First Name   ALFRED
Street Address * 900 CAMELLIA DR.
City, State Zip * ROYAL PALM BEACH, FL 33411
Email Address * AD.ADMINSOLUTIONS@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   DEPAOLA JR.   First Name   ALFRED
Policy # * 1504-1700-0706 Claim #* FL22-0117315-V622
Attorney
Attorney is Applicable
Last Name* KESSLER First Name * JOSEPH Initial
Street Address* 333 SE 2ND AVE, SUITE 2000
City, State Zip* MIAMI , FLORIDA 33131
Email Address * JKESSLER@DKLAWFL.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):* CHRISTOPHER O’BRIEN AND ROSEMARY RIVAS
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unsatisfactory Settlement Offer
Claim Delay
* 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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The carrier’s actions violated the following policy provisions: “SECTION I – PERILS INSURED AGAINST - We insure for direct physical loss to the property described in Coverages A, B and C caused by any of the following perils unless the loss is excluded in Section I – Exclusions.” “SECTION I – CONDITIONS - D. Loss Settlement - Covered property losses are settled at actual cash value at the time of loss but shall not be settled at more than the amount required to repair or replace.” “SECTION I – CONDITIONS - J. Loss Payment - We will adjust all losses with you.”
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Universal Property & Casualty Insurance Company Attn.: Rosemary Rivas and/or Christopher O’Brien 1110 W. Commercial Blvd., Fort Lauderdale, FL 33309 co0824@universalproperty.com rr0812@universalproperty.com RE: Insured : Alfred Depaola Jr. (“insured”) Policy # : 1504-1700-0706 Claim # : FL22-0117315-V622 Property Address : 900 Camellia Dr., Royal Palm Beach, FL 33411 Insured Email : ad.adminsolutions@gmail.com Dear Universal Property & Casualty Insurance Company, (“carrier”): Please find enclosed the civil remedy notice filed for the above referenced claim. As discussed in greater detail in the notice, the carrier has not attempted in good faith to settle the insureds’ claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insureds and with due regard for their interests. The carrier is required to properly investigate and adjust claims and cannot place that burden upon the insureds. The carrier was put on notice of the insureds’ wind damage claim that occurred on 01/16/2022. The carrier initially sent a representative to inspect the property. It is believed the initial representative sent by the carrier lacked the credentials/training to determine what caused the damages sustained as a result of the subject loss. It is also believed that the representative initially sent to the property was unqualified or lacked the necessary training to determine the amount of damages sustained as a result of the loss. The representative that inspected the property, Christopher O’Brien, observed wind damage to the shingle roof of the property. Mr. O’Brien also observed interior water damages to the property as a result of a roof leak. Mr. O’Brien provided his observations to the carrier and drafted an estimate of the damages observed during the inspection. The carrier removed line items from Mr. O’Brien’s initial estimate for the interior water damages. After reducing the estimate, the carrier represented to the insured the covered damages only totaled $1,080.57. The estimate lists “single axle dump truck – per load – including dump fees for $231.22 and “roofing repair – minimum charge – labor and material for $849.35.” The estimate fails to account for the amount of damaged shingles being removed, the amount of the new shingles being replaced, and fails to include the correct quantity of materials needed. The estimate also fails to include depreciation, which is required to determine the actual cash value of the damages owed under the policy. The carrier never actually determined the actual cash value of the covered damages at the time of loss, as required by the policy. The carrier failed to compensate the insured for the direct physical damage caused by wind to property. The carrier relied on an under-priced, under-scoped, and unclear damage estimate for its valuation of the loss. The incorrect estimate relied upon by Defendant resulted in a drastic undervaluing of the covered damages. It is clear that the Defendant feigned adjustment of the loss, but did not actually adjust the loss with the insured as required under the policy. These actions from the carrier as set forth above violate the following Florida Statutes: 626.9541(1)(i)(3)(a), Failing to adopt and implement standards for the proper investigation of claims; 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. The carrier’s actions set forth above also violated the following policy provisions: “SECTION I – PERILS INSURED AGAINST - We insure for direct physical loss to the property described in Coverages A, B and C caused by any of the following perils unless the loss is excluded in Section I – Exclusions.” “SECTION I – CONDITIONS - D. Loss Settlement - Covered property losses are settled at actual cash value at the time of loss but shall not be settled at more than the amount required to repair or replace.” “SECTION I – CONDITIONS - J. Loss Payment - We will adjust all losses with you.” The carrier’s relied on an estimate that failed to restore the property to it’s pre-loss condition. Due to its reliance on the incorrect and under-scoped estimate, the carrier advised the insured the covered damages did not exceed the applicable deductible and no payment would be made to the insured. The amount determined by the carrier was nowhere near enough to restore the covered property to it’s pre-loss condition. Rather than inspecting the property and evaluating the damages in a timely and prudent manner or making a good-faith effort to investigate the claim to come to a coverage decision, the carrier relied on a deficient damage estimate that is not supported by the information known to the carrier at the time of the coverage decision. It is clear the carrier did not adjust the loss with the insured. Instead of extending the proper amount of coverage and paying the insured the full amount that was what owed for the covered damages, the carrier decided to incorrectly underpay a covered claim. The carrier engages in this practice of underpaying claims based on incorrect estimates with such regularity and frequency as to indicate that it is a general business practice of this carrier, in reckless disregard for the rights of its insureds. The carrier initially had the intention to undervalue the claim and was imitating genuine good faith investigation of the claim only to prolong the claim delay and set additional bars to the recovery of the insurance proceeds legitimately owed to the insured. The carrier engages in this with such regularity and frequency as to indicate that it is a general business practice of this carrier, in reckless disregard for the rights of its insureds. This investigation by the carrier is in direct violation of the statutory requirement for carriers to promptly and properly investigate all claims. These actions from the carrier as set forth above violate the following Florida Statutes: 626.9541(1)(i)(3)(a), Failing to adopt and implement standards for the proper investigation of claims; 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. The carrier’s actions set forth above also violated the following policy provisions: “SECTION I – PERILS INSURED AGAINST - We insure for direct physical loss to the property described in Coverages A, B and C caused by any of the following perils unless the loss is excluded in Section I – Exclusions.” “SECTION I – CONDITIONS - D. Loss Settlement - Covered property losses are settled at actual cash value at the time of loss but shall not be settled at more than the amount required to repair or replace.” “SECTION I – CONDITIONS - J. Loss Payment - We will adjust all losses with you.” 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 insured’s rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. This notice is provided to perfect a right to pursue the civil remedy authorized by Florida Statute §624.155. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1) tender all actual cash value indemnity benefits due and owing on this claim in the amount of $68,698.96; and (2) pay all outstanding statutory interest on the past due amount because more than 90 days have elapsed since the claim was made. The cure stated herein is not to be considered an offer to settle the underlying litigation involving this claim. Rather, the stated cure is to cure the statutory violations identified herein only. This information is filed within a form submitted to the DFS.
Comments
User Id Date Added Comment
oc1102@universalproperty.com 12-20-2024 December 16, 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.: 790014 Filing Date: 11/2/2023 Complainant(s): Alfred Depaola JR. Insured(s): Alfred Depaola JR. Policy No.: 1504-1700-0706 Claim No.: FL22-0117315-V622 Re: DFS File No.: 790015 Filing Date: 11/2/2023 Complainant(s): Alfred Depaola JR. Insured(s): Alfred Depaola JR. Policy No.: 1504-1700-0706 Claim No.: FL22-0117315-V622 Dear Sir/Madam: Please allow this to serve as Universal Property & Casualty Insurance Company’s (“Universal”) formal response to the above-referenced Civil Remedy Notices (“Notices”) filed by attorney, Joseph Kessler, on behalf of Complainant, Alfred Depaola JR. (also referenced as the “Insured.”) The Notices allege violations of Sections 624.155 and 626.9541, Florida Statutes. Universal specifically denies each and every allegation contained in the Notices. 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 Notices fail 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 Notices are deficient as a matter of law as they fail 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 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 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 Notices fail to meet the requirement of Section 624.155, Florida Statutes, on several grounds. First, the Notices fail 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 Notices lack the requisite specificity as required by Section 624.155, Florida Statutes. Here, the Notices state “CHRISTOPHER O’BRIEN AND ROSEMARY RIVAS.” The Notices fail to include any specificity as to how the named individuals have knowledge of the facts giving rise to any purported allegation(s) and/or what, if anything, they did or failed to do as it relates to the claims at issue. The Complainant has effectively provided no one with the most knowledge of the facts giving rise to any of the purported allegations in the Notices on behalf of Universal. Therefore, the Notices do not have the requisite specificity as to whom the Complainant is asserting has knowledge as to any allegation to put Universal on notice of what needs to be cured. Accordingly, the Complainant’s Notices are insufficient as a matter of law. Second, the Notices fail to satisfy Section 624.155(3)(b)(4), Florida Statutes, in that they fail to reference specific policy language relevant to any alleged violation. Instead, the Notices state, “[t]he carrier’s actions violated the following policy provisions: “SECTION I – PERILS INSURED AGAINST - We insure for direct physical loss to the property described in Coverages A, B and C caused by any of the following perils unless the loss is excluded in Section I – Exclusions.” “SECTION I – CONDITIONS - D. Loss Settlement - Covered property losses are settled at actual cash value at the time of loss but shall not be settled at more than the amount required to repair or replace.” “SECTION I – CONDITIONS - J. Loss Payment - We will adjust all losses with you.” The Notices are broad in scope and fail to identify “specific policy language” relevant to any specific alleged violation. Therefore, it is unclear what, if any, policy language pertains to any allegation. General, vague and overbroad references to policy provisions and/or categories of coverage does not satisfy the specificity required by Section 624.155(3)(b)(4), Florida Statutes. As such, the Notices are 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 Notices fail to allege any specific conduct on the part of Universal that would violate any policy provision or statute. The Complainant generally lists “claim denial, claim delay, and unsatisfactory settlement offer,” as reasons for filing the Notices. However, the Complainant’s allegations regarding these “Reasons for Notice” are unsupported by actual facts and therefore are unfounded and insufficient to meet the threshold notice requirement of the Florida Civil Remedy Statute under Section 624.155, Florida Statutes. Additionally, the Notices assert 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 Notices state, “the carrier has not attempted in good faith to settle the insureds’ claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insureds and with due regard for their interests. The carrier is required to properly investigate and adjust claims and cannot place that burden upon the insureds.” However, the Complainant fails to specify any facts to support these conclusory statements. Moreover, at no time has Universal place the burden of investigating and adjusting the claim upon the Insured. Additionally, the Notices allege generic allegations without providing any specific facts to support those allegations. For example, the Notices allege: “The carrier engages in this with such regularity and frequency as to indicate that it is a general business practice of this carrier, in reckless disregard for the rights of its insureds. This investigation by the carrier is in direct violation of the statutory requirement for carriers to promptly and properly investigate all claims. These actions from the carrier as set forth above violate the following Florida Statutes: 626.9541(1)(i)(3)(a), Failing to adopt and implement standards for the proper investigation of claims; 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. The carrier’s actions set forth above also violated the following policy provisions: “SECTION I – PERILS INSURED AGAINST - We insure for direct physical loss to the property described in Coverages A, B and C caused by any of the following perils unless the loss is excluded in Section I – Exclusions.” “SECTION I – CONDITIONS - D. Loss Settlement - Covered property losses are settled at actual cash value at the time of loss but shall not be settled at more than the amount required to repair or replace.” “SECTION I – CONDITIONS - J. Loss Payment - We will adjust all losses with you.” The Complainant fails to specify any facts or circumstances that give rise to the above referenced conclusions which could enable Universal to investigate and resolve the Complainant’s allegations. The Notices do not state any facts to support the Complainant’s allegations contained therein. The Notices wholly fail to identify any specific facts or circumstances which support any allegations set forth above which is improper and contrary to the obligations imposed on the Complainant under Section 624.155, Florida Statutes. The Complainant is required to provide with specificity the facts and circumstances giving rise to the alleged violation strictly related to her allegations, not conjecture or speculation of what may be a business practice by the carrier. Moreover, the Notices 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 insured’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 nor provides any specific examples of how Universal violated the Insured’s rights. The Notices do not state any facts to support any of the allegations contained therein to demonstrate Universal violated any policy provision or statute. 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 Notices do not provide a proper means whereby Universal can “cure” the alleged defects, without paying benefits which are not due and owing to the Insureds. 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. To 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 insured. See Talat, 753 So. 2d at 1281. Notably, Universal asserts that when the Insured initiated litigation before filing the Notices, it prejudiced Universal's ability to cure any purported allegation in the Notices as there is no actual cure period 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 specific policy language relevant to the alleged violation, the failure to allege any specific conduct on the part of Universal that would violate any policy provision or statute, and the failure to provide a proper means whereby Universal can “cure” the alleged defects. Therefore, the Notices are 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 Notices are 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 June 2, 2022, Universal received untimely notice from the Insured’s public adjuster, Storm One Claims, the insured location had damage which occurred on January 16, 2022. Universal advised the Insured it would be reserving its rights under the policy for the late reporting of the claim. Universal requested material documents and information from the Insured on several different occasions. The Insured failed to provide Universal with all requested material documents and information. Universal inspected the property and documented any visible damage. Thereafter, Universal advised the Insured it accepted coverage for certain portion of the claim however the estimated cost for repairs fell below the applicable policy deductible and coverage for certain portion of the claim is denied pursuant to the terms of the Policy. On February 23, 2023, the Insured initiated litigation against Universal in Circuit Court of Palm Beach County under case No. 502023CA001679XXXXMB. Thus, at this time, the parties continue to litigate their despite to determine, what if any, additional coverage exists under the terms of the Policy. An Insurer is not required to pay whatever the Insured demands. As outlined above, the alleged statutory violations and factual allegations set forth in the Notices lack 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 alleged violations in the Notices filed 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.

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