Civil Remedy Notice of Insurer Violations
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Filing Number:     790147
Filing Accepted:  11/4/2024
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Complainant
Last/Business Name *  
LAGANO   First Name   ALBERT JORDAN AND THERESA
Street Address * 7972 SOFT PINE CIRCLE
City, State Zip * ORLANDO, FL 32825
Email Address * LAGANO.JORDAN@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   LAGANO   First Name   ALBERT JORDAN AND THERESA
Policy # * 1501-1904-1426 Claim #* FL22-0103896
Attorney
Attorney is Applicable
Last Name* DIX First Name * ERIN Initial
Street Address* 350 NORTH LAKE DESTINY ROAD
City, State Zip* MAITLAND , FLORIDA 32751
Email Address * EDIX@ITSABOUTJUSTICE.LAW
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):* ANY ADJUSTER, MANAGER, OR INDIVIDUAL INVOLVED IN THE HANDLING OF THE SUBJECT CLAIM ON BEHALF OF THE INSURANCE CARRIER.
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.
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)(2) A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
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)(d) Denying claims without conducting reasonable investigations based upon available information.
626.9541(1)(i)(4) Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

A certified copy of the policy is not in the possession of the Insureds, but has been requested from the insurance carrier. Based on information and belief, the following policy provisions are relevant to this civil remedy notice. Section 1 – Coverage A – Perils Insured Against Section 1- Conditions – Loss Settlement Section 1 – Conditions - Loss Payment
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

On or about October 28, 2021, the Insureds, Albert Jordan Lagano and Theresa Lagano, suffered damage to their home located at 7972 Soft Pine Circle Orlando, FL 32825 as a result of a severe windstorm storm. Prior to the loss, Universal Property & Casualty Insurance Company (“Universal”), had issued a policy of insurance (Policy No.: 1501-1904-1426) for the Insureds’ property. Said policy was in full force and effect on date of loss and afforded coverage for wind damage. Universal was timely notified of the loss by the Insureds and assigned claim number FL22- 0103896. During the course of Universal’s investigation, the Insureds made their property available for inspection, provided facts and information surrounding the loss, and complied with Universal’s adjustment of the claim. Despite fully cooperating with Universal’s investigation, Universal capriciously denied coverage for the Insureds’ insurance claim even though there was clear evidence of storm damage to covered property. The denial came in Universal’s letter dated February 8, 2022, based on Universal’s field adjuster stating that the field adjuster “found no evidence of covered wind damage to the roof and that which was observed is attributed to long term wear and tear, deterioration, and mechanical breakdown.” However, the field adjuster, Ryan Wacker, testified in his deposition that he did not determine a cause of damage and that determining the cause of loss was not tasked to him by Universal. Further Mr. Wacker testified that Universal, as a whole, came up with the coverage decision. Universal came to its coverage determination by ignoring relevant facts and information provided by the Insureds and their contractors that established the damages to the roof and exterior of the residence were unquestionably the result of wind. Most concerning, Universal and its representatives either underplayed or misrepresented the findings from its own inspections in order to avoid having to tender payment on a claim that it knows should be covered pursuant to the terms of the policy. It is clear that Universal has not acted honestly or fairly towards its Insureds. Universal and its representatives have failed to conduct a proper investigation of the loss, misrepresented the scope and cause of damages at the residence, and misapplied exclusions in the policy in order to deny coverage for the Insureds’ claim. It has become a general business practice of Universal to not implement proper claims handling procedures, to hire consultants that routinely ignore or intentionally misidentify relevant evidence, and to not settle claims in good faith when under all circumstances it should have. As is the case here, it is a pattern and practice for Universal to arbitrarily deny claims without conducting reasonable investigations based upon information and evidence available to it. In order to cure this civil remedy notice, Universal must immediately acknowledge in writing that the roof, interior, and exterior damages claimed by the Insureds were caused by wind and immediately tender the full payment owed to the Insureds for damage to covered property in the amount of $68,044.82 less the applicable deductible. The written acknowledgement should be provided to the Insured’s counsel in writing at Erin Dix, Esq. at 350 N. Lake Destiny Road, Suite 300, Maitland, FL 32751.
Comments
User Id Date Added Comment
sm1130@universalproperty.com 12-20-2024 December 20, 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.: 790147 Filing Date: 11/4/2024 Complainant(s): Albert Jordan and Theresa Lagano Insured(s): Albert Jordan and Theresa Lagano Policy No.: 1501-1904-1426 Claim No.: FL22-0103896 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, Erin Dix, on behalf of the Complainants, Albert Jordan and Theresa Lagano (also referenced as “Insureds”). The Notice alleges violations of Florida Statutes, Sections 624.155 and 626.9541. Universal specifically denies each 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, Florida Statute §624.155 and Florida law. The Notice is deficient as a matter of law as it fails to comply with Fla. Stat. §624.155. 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 Fla. Stat. §624.155(3)(b), 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...; and 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 Florida Department of Financial Services (“DFS”) created form DFS-10-363, which sets out 15 requirements that the Complainant(s) must respond to with specificity. The Florida Supreme Court holds that Fla. Stat. § 624.155 “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 requirements of Section 624.155, Florida Statutes, on several grounds. First, concerning the requirement to set forth, with specificity, the “facts and circumstances giving rise to the violation,” the Notice fails to specify any facts that would put Universal on notice that it violated any policy provision or statute. The Notice asserts general allegations consisting of speculative, boilerplate, and conclusory statements rather than specific allegations of facts regarding any alleged misconduct or statutory violations. As an example, the Notice states, “[i]t is clear that Universal has not acted honestly or fairly towards its Insureds. Universal and its representatives have failed to conduct a proper investigation of the loss, misrepresented the scope and cause of damages at the residence, and misapplied exclusions in the policy in order to deny coverage for the Insureds’ claim. It has become a general business practice of Universal to not implement proper claims handling procedures, to hire consultants that routinely ignore or intentionally misidentify relevant evidence, and to not settle claims in good faith when under all circumstances it should have.” The Notice does not specify any facts to support these speculative and conclusory statements. 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. Further, the Notice generally alleges that “UPCIC and its representatives either underplayed or misrepresented the findings from its own inspections” and alleges violations of Sections 626.9541(1)(i)(2) for allegedly making “[a] material misrepresentation … to an insured or any other person having an interest in the proceeds payable under such contract or policy…” and 626.9541(1)(i)(3)(b), Fla. Stat., by “[m]isrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.” However, the Notice fails to specify any facts regarding any misrepresentations made by Universal and does not identify any person or persons who made such misrepresentations nor to whom any alleged misrepresentations were made to. 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 the requirements provided in Sec. 624.155(3)(b)(2), Fla. Stat. Second, 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 required by Sec. 624.155, Fla. Stat. because the Notice states “ANY ADJUSTER, MANAGER, OR INDIVIDUAL INVOLVED IN THE HANDLING OF THE SUBJECT CLAIM ON BEHALF OF THE INSURANCE CARRIER” which clearly defeats the requirement in the DFS Form to provide specificity to put the carrier on notice and provide an opportunity to investigate any allegation with a specific individual. The Notice does not have the requisite specificity as to whom the Complainants are asserting has knowledge as to any purported 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, as noted, the Complainants allege “[a] material misrepresentation made to an Insured…” by Universal and Universal “[m]isrepresent[ed] facts and policy provisions relating to coverages at issue.” The Notice fails to include any specificity as to whom made any misrepresentations, what was misrepresented, when any of these misrepresentations were made and/or to whom any alleged misrepresentation was made to. Accordingly, Complainants’ Notice is insufficient as a matter of law. Third, the Notice fails to satisfy Fla. Statute § 624.155(3)(b)(4) in that it fails to reference any specific policy language relevant to any alleged violation. Instead, the Notice states: “A certified copy of the policy is not in the possession of the Insureds, but has been requested from the insurance carrier. Based on information and belief, the following policy provisions are relevant to this civil remedy notice. Section 1 – Coverage A – Perils Insured Against Section 1- Conditions – Loss Settlement Section 1 – Conditions - Loss Payment[.]” The Notice fails to identify how the referenced sections and/or provision titles relate to any alleged violation or how, if at all, they are relevant to the subject claim. Further, a copy of the Policy can be obtained from the Insureds directly or from their agent. Therefore, it is unclear what if any policy language pertains to any allegation. General, vague, and overbroad references to policy section titles and/or provision titles do not satisfy the specificity required by Section 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). 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). Section 624.155, Florida Statute, however, does not impose on an insurer the obligation to pay whatever amount its insureds demand. Talat, 753 So. 2d at 1282. On 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 insureds. See Talat, 753 So. 2d at 1281. Notably, Universal asserts that by the Insureds 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. Universal is only obligated to pay contractual amounts owed to cure a civil remedy notice. See id. at 1278. In summation, the Complainants failed to respond to each of the fields set forth on the DFS Form with the requisite specificity as stated herein, including but not limited to, failing to identify the person or persons representing the insurer who are most responsible for/knowledgeable of the facts giving rise to the allegations in the Notice, failing to reference specific policy language relevant to any alleged violation, failing to provide a proper cure as proscribed by Florida law and failing to sufficiently allege facts and circumstances giving rise to any alleged violation. Therefore, the Notice is legally deficient and fails to satisfy the condition precedent to filing a bad faith action. See 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 February 4, 2022, Universal was untimely notified by the Insured, Albert Lagano, that the roof of the insured location was damaged approximately 99 days prior, on October 28, 2021. 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. Subsequently, the Insureds submitted an estimate for previously unreported interior damages totaling $16,260.93 prepared by CSL Construction on their behalf. Universal requested material documents and information to assist in its investigation of the supplemental interior dwelling damages, including but not limited to, a reinspection of the property. Prior to affording Universal an opportunity to reinspect the property or address the supplement submitted by the Insureds, on June 20, 2022, the Insureds initiated litigation against Universal in Circuit Court in and for Orange County under Case No. 2022-CA-005609-O. Thus, at the time the instant Notice was served, the parties were and continue to litigate their disputes to determine what, if any, available coverage exists under the Policy. Universal did not breach any duty to its Insureds. An Insurer has no obligation 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. The alleged statutory violations and factual allegations of wrongdoing 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 Statutes and 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