Civil Remedy Notice of Insurer Violations
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Filing Number:     792740
Filing Accepted:  11/15/2024
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Complainant
Last/Business Name *  
FENELUS   First Name   RONY R.
Street Address * 1565 SW 30 TERRACE
City, State Zip * FORT LAUDERDALE, FL 33312
Email Address * N/A
Complainant Type: * Insured
Insured
Last/Business Name*   FENELUS   First Name   RONY R.
Policy # * 1501-1700-2597 Claim #* FL22-0120132
Attorney
Attorney is Applicable
Last Name* ELIMELECH First Name * REBECCA Initial R
Street Address* 1500 N.E. 162ND ST.
City, State Zip* MIAMI , FLORIDA 33162
Email Address * RELIMELECH@ILGPA.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):* N/A
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
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)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(e) Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

SECTION I – PROPERTY COVERAGES A. Coverage A – Dwelling 1. We cover: a. The dwelling on the "residence premises" shown in the Declarations, including structures attached to the dwelling; and b. Materials and supplies located on or next to the "residence premises" used to construct, alter or repair the dwelling or other structures on the "residence premises". SECTION I – PERILS INSURED AGAINST A. Coverage A – Dwelling and Coverage B – Other Structures 1. We insure against direct physical loss to property described in Coverages A and B. However, loss does not include and we will not pay for any “diminution in value”.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Rony R. Fenelus (hereinafter the “Insured”), paid for a policy of insurance with Universal Property & Casualty Insurance Company (hereinafter, “Insurer”) bearing policy number 1501-1700-2597 (the “Policy”). The Policy provides coverage for damage to the Insured’s property located at 1565 SW 30 Terrace, Fort Lauderdale, Florida 33312 (the “Property”), including the significant damage that occurred as a result of a sudden and accidental water leak from a broken pipe on or about March 15, 2022 (the “loss”). Specifically, the Insured’s Property sustained substantial water damage to the bathroom, kitchen, hall and adjacent bedroom to bathroom due to a pipe break between the bathroom and kitchen. The tiles in the bathroom caved in, the vanity tile in the hall cracked and the kitchen cabinets were destroyed. The Insured subsequently contacted the Insurance Litigation Group, P.A. (hereafter, ILGPA), who promptly reported the Insured’s claim to the Insurer. On June 27, 2022, the Insurer sent a letter to the Insured requesting records and documents. ILGPA conducted a thorough inspection of the property and compiled an estimate of damages, per the Insurer’s request for information. ILGPA, on behalf of the Insured, forwarded said estimate which fully detailed the Insured’s damages and total $67,200.41. However, the Insurer refuses to resolve the Insured’s claim and pay for all damages to the Property. On July 28, 2022, the Insurer issued a letter informing the Insured that they are proceeding under a reservation of rights. On August 9, 2022, the Insurer again sent a letter advising the Insured that they are proceeding with the investigation of their claim pursuant to a reservation of rights. In this letter, the Insurer states that they will close the Insured’s file if the requested documents and information is not provided within ten (10) days. On September 8, 2022, the Insurer issued a letter informing the Insured that they are closing the Insured’s file. The Insurer’s conduct is in bad faith and violates Florida’s statutes concerning the adjustment of insurance claims. First, Florida Statute § 624.155(1)(B)(1) requires good faith in the settlement of claims. The Insurer is in violation of this Statute for failing to make a coverage determination, despite receiving the requested information from the Insured. On November 2, 2023, the Insured provided the requested records and documents to the Insurer. However, the Insurer has yet to make a coverage determination. What is more, the Insurer violated Florida Statute § 624.155(1)(b)(3) by failing to promptly settle the claim, when the obligation to settle the claim became reasonably clear. Again, the Insurer failed to make a good faith offer to settle this claim and failed to account for the full scope of the damages. They failed to respond to the estimate provided by ILGPA, on the Insured’s behalf, in a timely manner. They are obligated to provide coverage for all damages to the Insured’s Property, and not attempt to resolve this claim with lowball offers. Additionally, the Insurer’s conduct violates Florida Statute § 626.9541, which prohibits unfair settlement practices. More specifically, the Insurer has violated Florida Statute § 626.9541(1)(i)(3)(a) by failing to adopt and implement standards for the proper investigation of claims. Further, the Insurer has violated Florida Statute § 626.9541(1)(i)(3)(c) by failing to acknowledge and act promptly with the Insured and its counsel. On November 2, 2023, the Insured responded to the Insurer’s requests for information and attached their detailed repair estimate, W-9 forms from 2022 and 2023, plumbing invoice and estimate from G&R Plumbing, Inc., photos of the damaged property prior to any repairs, photos taken by the Insured (or anyone else) at the time of loss, and water usage records from March 1st, 2021 through April 1st, 2022. On March 11, 2024, the Insured provided the Insurer with the signed Sworn Statement in Proof of Loss. Notwithstanding the Insured’s compliance with the Insurer’s requests for records, documents and information, as of this date, the Insurer has failed to make a coverage determination on the Insured’s claim. As mentioned above, the Insurer failed to account for the full scope of the damages and has additionally failed to respond to the estimate provided by ILGPA, on behalf of the Insured, in a timely manner, delaying the resolution of this claim. Had the Insurer done so, it would have immediately settled this claim on a fair and reasonable basis and provided full coverage to its Insured. Therefore, to cure the defects outlined in this Civil Remedy Notice, the Insurer must: (1) create and implement adequate guidelines for the proper investigation and evaluation of claims and for the training and supervision of employees, which will avoid future statutory violations and avoid this from occurring in the future; (2) immediately tender all insurance proceeds due and owing its Insured under the Policy in the amount of $67,200.41 (less the deductible and any prior payments), plus all statutory interest; (3) act fairly and honestly towards its Insured and with due regard for their interests in attempting to settle their Insured’s claim; (4) hold the claim open in the event that its errors and delay does or may cause the Insured to suffer either further loss and/or damage; and, (5) stipulate to the Insured’s entitlement to attorney’s fees and court costs pursuant to Florida Statutes §§ 627.428 and 626.9373. Acknowledgment This notice is given in order to perfect the right to pursue the civil remedy authorized by Florida Statutes section 624.155, should Universal Property & Casualty Insurance Company fail to cure the violations set forth in this Civil Remedy Notice within the given cure period.
Comments
User Id Date Added Comment
jr0405@universalproperty.com 12-23-2024 December 23, 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.: 792740 Filing Date: 11/15/2024 Complainant(s): Rony R. Fenelus Insured(s): Rony R. Fenelus Policy No.: 1501-1700-2597 Claim No.: FL22-0120132 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, Rebecca Elimelech, on behalf of Complainant, Rony R. Fenelus (also referenced as “Insured”). The Notice alleges violations of Sections 624.155 and 626.9541, Florida Statutes. Universal specifically denies the allegations 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, 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). The Notice fails to meet the requirements of Fla. Stat. § 624.155 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. To comply with Sec. 624.155, Fla. Stat., the Complainant(s) must name the individual(s) involved with specificity as to the purported violation(s) to allow Universal to investigate the allegations. The Notice lacks the requisite specificity required by Sec. 624.155, Fla. Stat., because the Notice states “N/A.” This clearly defeats the requirement in the DFS Form to provide specificity in order to put the carrier on Notice and provide an opportunity to investigate any allegation with a specific individual. The Notice does not specify whom the Complainant is asserting has knowledge as to any allegation in the Notice. Therefore, the Notice does not have the requisite specificity as to whom the Complainant is asserting has knowledge as to any specific allegations contained in the Notice. Accordingly, Complainant’s Notice is insufficient as a matter of law. Second, the Notice fails to satisfy Sec. 624.155(3)(b)(4), Fla. Stat., because it fails to reference specific policy language relevant to any alleged violation. The Notice references several section titles and provisions, but fails to specify how the referenced sections and/or provisions relate to any alleged violation or how, if at all, they are relevant to the subject claim. Therefore, it is unclear what, if anything, the insurer did to violate these sections or provisions. General, vague, and overbroad references to policy section titles and/or provisions 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). Third, regarding the requirement to set forth with specificity the “facts and circumstances giving rise to the violation,” the Notice fails to specify sufficient facts that would put Universal on notice it violated any policy provision or statute. The Complainant provides three (3) separate reasons for submitting the Notice including “Claim Delay,” “Unsatisfactory Settlement Offer” and “Unfair Trade Practice.” However, the Complainant’s allegations regarding these “Reasons for Notice” have no factual support anywhere in the Notice. The Notice asserts general allegations consisting largely of inaccurate and conclusory statements in lieu of specific facts to support any of the alleged misconduct or statutory violations. As an example, the Notice alleges “[t]he Insurer’s conduct is in bad faith and violates Florida’s statutes concerning the adjustment of insurance claims.” The Complainant fails to specify any actual facts to support this conclusory allegation. The Notice also alleges “the Insurer’s conduct violates Florida Statute § 626.9541, which prohibits unfair settlement practices. More specifically, the Insurer has violated Florida Statute § 626.9541(1)(i)(3)(a) by failing to adopt and implement standards for the proper investigation of claims. Further, the Insurer has violated Florida Statute § 626.9541(1)(i)(3)(c) by failing to acknowledge and act promptly with the Insured and its counsel.” The Complainant once again fails to assert specific facts in support of the conclusory allegations. The failure to provide specific facts to support the conclusory allegations of misconduct hinders Universal’s ability to appropriately investigate the allegations in the Notice. 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 failed to comply with the requirements provided in Section 624.155(3)(b)(2), Florida Statutes. Fourth, the Notice does not provide a proper means whereby Universal can "cure" the alleged defects without paying benefits that are not due and owing to the Insured. 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). However, Sec. 624.155, Fla. Stat., 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. The Complainant demands extra-contractual damages not owed under the policy in the Notice. The Notice demands, among other things, that to cure the alleged defects, Universal must “stipulate to the Insured’s entitlement to attorney’s fees and court costs…” The Notice is deficient as it does not provide Universal an opportunity to "cure" the alleged violations without paying extra-contractual damages. Universal is only obligated to pay contractual amounts owed to cure a civil remedy notice. See Id. at 1278. Notably, Universal asserts that by the Insured initiating litigation before serving the Notice, 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, failing 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, failing to allege any specific conduct on the part of Universal that would violate any policy provision or statute, failing to reference specific policy language relevant to any alleged violation, and failing 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 June 24, 2022, Universal was untimely notified by the Insured’s attorney(s), Insurance Litigation Group, that the insured location was damaged on March 15, 2022. Universal advised the Insured that it was reserving its rights under the policy due to the late reporting of the claim and requested the Insured provide material documents and information. Universal inspected the property and documented any visible damage. Universal sent follow-up requests for the material documents and information from the Insured. Based upon the Insured’s lack of compliance with the required Policy conditions, including the failure to provide Universal with all material documents and/or information necessary to make a coverage determination, Universal was forced to close the claim. On August 14, 2024, the Complainant initiated litigation against Universal in Circuit Court in Broward County under Case No. CACE-24-011590. Thus, at the time of the instant Notice, the parties were and continue to litigate their disputes to determine what, if any, available coverage exists under the Policy. At no time has Universal breached any duty to its Insured. An Insurer is not required to pay whatever amount an insured demands. While an insurance carrier is required to settle claims that should be settled, it is not required to settle claims that are legitimately contested. As outlined above, the alleged statutory violations 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 has complied with all policy provisions and applicable Florida 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 alleged violations in the Notice filed by the Complainant. Sincerely, /s/ Jonathan Rodriguez Jonathan Rodriguez, 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