Civil Remedy Notice of Insurer Violations
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Filing Number:     791001
Filing Accepted:  11/8/2024
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Complainant
Last/Business Name *  
KANTANAS   First Name   ADAMANDIA
Street Address * 8275 IBIS CLUB DR., APT. 701
City, State Zip * NAPLES, FL 34104
Email Address * ERIK@DIENERFIRM.COM
Complainant Type: * Insured
Insured
Last/Business Name*   KANTANAS   First Name   ADAMANDIA
Policy # * 1503-1401-9972 Claim #* FL23-0135437
Attorney
Attorney is Applicable
Last Name* DIENER First Name * ERIK Initial D
Street Address* 5599 S. UNIVERSITY DR. #305
City, State Zip* DAVIE , FL 33328
Email Address * ERIK@DIENERFIRM.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 *
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.
Enter all words or phrases (one at a time) that should be used to filter.

2. Fair Rental Value If a loss covered under Section I makes that part of the "residence premises" rented to others or held for rental by you not fit to live in, we cover the fair rental value of such premises less any expenses that do not continue while it is not fit to live in. However, we do not cover any fair rental value arising out of or in connection with “homesharing host activities”. Payment will be for the shortest time required to repair or replace such premises. . . . SECTION I – PERILS INSURED AGAINST We insure for direct physical loss to the property described in Coverages A and C caused by any of the following perils unless the loss is excluded in Section I - Exclusions. However, loss does not include and we will not pay for any “diminution in value”. . . . 12. Accidental Discharge Or Overflow Of Water Or Steam a. This peril means accidental discharge or overflow of water or steam from within a plumbing, heating, air conditioning or automatic fire protective sprinkler system or from within a household appliance. b. We also pay for the cost of tear out and repair to only that part of a building or only that part of an other structure owned solely by you which is covered under Coverage A and at the location of the "residence premises", but only when necessary to access and repair the system or appliance from which the water or steam escaped. The cost that we will pay for tear out and repair above is only that cost necessary to access and repair only that part of the system or appliance, that caused the covered loss, whether the system or appliance, or any part or portion of the system or appliance, is repairable or not. Such tear out and repair coverage only applies to other structures owned solely by you if the water or steam causes actual damage to a building owned solely by you at the location of the "residence premises". In the event that additional tear out and repair are required beyond that necessary to access and repair only that part of the system or appliance that caused the covered loss, we will still only cover the cost as described above. c. This peril does not include loss: (1) To or within the "residence premises", if the "residence premises" or the building containing the “residence premises” has been “vacant” for more than 30 consecutive days immediately before the loss. A building being constructed is not considered “vacant”; (2) To the system or appliance from which the water or steam escaped; (3) Caused by or resulting from freezing except as provided in Peril Insured Against 14. Freezing; (4) To or within the "residence premises" caused by accidental discharge or overflow of water or steam which occurs away from the building where the "residence premises" is located; or (5) To a building caused by constant or repeated seepage or leakage of water or steam or the presence or condensation of humidity, moisture or vapor, over a period of weeks, months or years, unless such seepage or leakage of water or steam or the presence or condensation of humidity, moisture or vapor, and the resulting damage is unknown to all “insureds” and is hidden within the walls or ceilings or beneath the floors or above the ceilings of a structure; or (6) To a plumbing system, whether above or below the ground, caused by: (a) Age, collapse, obsolescence, wear, tear; (b) Fading, oxidization, weathering; (c) Deterioration, decay, marring, delamination, crumbling, settling, cracking; (d) Shifting, bulging, racking, sagging, bowing, bending, leaning; (e) Shrinkage, expansion, contraction, bellying, corrosion; (f) The unavailability or discontinuation of a part or component of the system; or (g) Any other age or maintenance related issue; (7) To a plumbing system, whether above or below the ground, caused by the impairment, state or condition of the system, which prohibits repair or replacement including access, necessary to connect the adjoining parts of appliances, pipes or system; or (8) Otherwise excluded or limited elsewhere in the policy. d. In this peril, a plumbing system or household appliance does not include a sump, sump pump, irrigation system or related equipment, or roof drain, gutter, downspout or similar fixtures or equipment. e. Section I – Exclusion 3. Water, Paragraphs a. and c. that apply to surface water and water below the surface of the ground do not apply to loss by water covered under this peril.
 
* Facts and circumstances giving rise to the violation.
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The insured property was damaged when a sprinkler in the condominium unit located above the insured condominium leaked water into the insured condominium unit causing extensive damage. The insurer underpaid the insured's property damage claim and asked the insured to submit estimates if she wanted to claim additional benefits. The insured submitted estimates from three companies, all of which were above or around the Coverage A policy limit. The insured also submitted a mold remediation estimate to the insurer. The insured's tenant moved out of the condominium due to mold, and the insured advised the insurer and requested loss of rent benefits. The insurer did not respond to the insured's requests for benefits to address the mold or lost rental income. The insurer refused to pay additional benefits under Coverage A alleging that the condominium association was responsible for the majority of the insured's damages. The insured provided the insurer the condominium documents showing that the dwelling damages the insurer alleged were the condominium association's responsibility are the insured's responsibility. The insurer failed to adopt and implement standards for the proper investigation of condominium claims to properly determine the scope of the insured's repair obligations versus the condominium association's repair obligations; failed to attempt in good faith to settle the subject 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 her or his interests; misrepresented pertinent facts relating to the condominium's repair obligations in order to deny liability for coverages at issue; failed to acknowledge and act promptly upon communications with respect to the subject claim related to mold, lost rent, and dwelling damages; and partially denied the subject claim without conducting reasonable investigations based upon available information regarding the condominium association's repair responsibilities versus the insured's repair responsibilities. The insurer also made multiple requests for documents that the insurer was told were previously provided or did not exist and failed to promptly notify the insured of any additional information necessary for the processing of the subject claim and failed to clearly explain the nature of the requested information and the reasons why such information is necessary. The insurer can correct the foregoing violations by paying the actual cash value of the dwelling damages after applying depreciation to one of the three repair estimates the insured provided, paying the policy's mold limit, and paying the policy's Coverage "D" limit before this notice expires. Alternatively, the insurer can pay the lump sum of $59,168.00 before this notice expires.
Comments
User Id Date Added Comment
oc1102@universalproperty.com 12-18-2024 December 18, 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.: 791001 Filing Date: 11/8/2024 Complainant(s): Adamandia Kantanas Insured(s): Adamandia Kantanas Policy No.: 1503-1401-9972 Claim No.: FL23-0135437 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, Erik D Diener, on behalf of Complainant, Adamandia Kantanas (also referenced as the “Insured.”) The Notice alleges violations of Sections 624.155 and 626.9541, Florida Statutes. Universal denies the allegation contained in the Notice. 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 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 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 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(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 states “UNKNOWN.” The Notice does not have the requisite specificity as to whom the Complainant is asserting has knowledge as to each specific allegation contained in the Notice. Specific identification of a person or persons with the most knowledge within Universal is of particular importance because the Complainant alleged that Universal “[m]isrepresent[ed] pertinent facts or insurance policy provisions relating to coverages at issue.” The Notice fails to include any specificity as to whom made any misrepresentations, what was misrepresented, or when any of these misrepresentations were made. Accordingly, 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. The Notice broadly cites to various sections and provisions of the Policy without identifying how the referenced provisions relate to any alleged violation. As such, Universal is left to wonder what policy provisions Complainant believes were allegedly violated or breached and why. General, vague, missing, and overbroad references to policy section titles or provisions 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. 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 Notice asserts general allegations consisting largely of boilerplate, conclusory and inaccurate statements rather than specific allegations of facts regarding any alleged misconduct or statutory violations. The Notice is replete with vague and generic conclusory assertions unsupported by specific facts and does not provide a sufficient explanation as to how Universal allegedly violated any policy provision or statute. As an example, the Notice alleges, The insurer failed to adopt and implement standards for the proper investigation of condominium claims to properly determine the scope of the insured's repair obligations versus the condominium association's repair obligations; failed to attempt in good faith to settle the subject 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 her or his interests; misrepresented pertinent facts relating to the condominium's repair obligations in order to deny liability for coverages at issue; failed to acknowledge and act promptly upon communications with respect to the subject claim related to mold, lost rent, and dwelling damages; and partially denied the subject claim without conducting reasonable investigations based upon available information regarding the condominium association's repair responsibilities versus the insured's repair responsibilities. The Notice does not state any facts to support the Complainant’s allegations contained therein. Additionally, Notice does not state any facts to support the Complainant’s 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 Complainant fails 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, without paying benefits which are not due and owing to the Insured. 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 Notice, it prejudiced Universal's ability to cure any purported allegation in the Notice 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 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 September 26, 2023, Universal received notice from a representative of the Insured, Linda Blackmon, the insured location had damage which occurred on September 23, 2023. Universal inspected the property and documented any visible damage. Thereafter, Universal issued an undisputed payment to the Insured in the full amount of its estimate less the applicable policy deductible, pursuant to the terms of the Policy. On May 16, 2024, the Insured initiated litigation against Universal in Collier County Circuit Court under case No. 11-2024-CA-001041-0001-XX. Thus, at the time the instant Notice was filed, the parties were and 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 respond to the Notice 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