Civil Remedy Notice of Insurer Violations
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Filing Number:     793195
Filing Accepted:  11/19/2024
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Complainant
Last/Business Name *  
LONG   First Name   VINCENT AND JULANN
Street Address * 3238 ENDICOTT DR.,
City, State Zip * TALLAHASSEE, FL 32311
Email Address * WITHHELD
Complainant Type: * Insured
Insured
Last/Business Name*   LONG   First Name   VINCENT AND JULANN
Policy # * 1501-2106-0095 Claim #* FL24-0108972-F724
Attorney
Attorney is Applicable
Last Name* GUTIERREZ First Name * DANIEL Initial
Street Address* 924 DELANEY AVENUE
City, State Zip* ORLANDO , FLORIDA 32806
Email Address * SERVICE@DGPALAW.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):* RON BRYSON
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Claim Denial
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)(2) Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
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)(3)(f) Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement.
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.

The Insurer has failed to properly adjust and pay the claim pursuant to the Section I – Conditions, Loss Settlement provision and the Section I – Conditions, Loss Payment provision.
 
* 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 January 9, 2024, the home of Vincent and Julann Long (hereinafter referred to as the “Insureds”) was damaged a storm. The Insureds reported the damages to their homeowners’ insurance company, Universal Property and Casualty Insurance Company (hereinafter referred to as the “Insurer”). The Insurer sent an adjuster to inspect the damages and although the Insurer acknowledged damage to the roof and jack and jill bathroom totaling $23,941.00. However, these damages were depreciated by adjuster Ron Bryson by almost $10,000 and only $14,104.31 of coverage was acknowledged (prior to application of the $1,000 deductible). As a result, the Insurer severely lowballed the covered amount of repairs necessary. The Insureds were concerned that the claim was underpaid, so they retained the assistance of an attorney. Also, a contractor was retained to prepare an estimate on the Insureds’ behalf of the necessary repairs required because of the storm damages. The contractor’s estimate totaled $91,406.64 RCV and $89,537.27 ACV, which reflects $1,869.37 of recoverable depreciation (much less than the Insurer’s estimate). It is clear that the carrier is not treating the Insureds with good faith claims conduct by failing to pay a claim clearly owed, not adjusting the claim and evaluating the loss properly, failing to promptly and fairly provide full and prompt indemnity to the Insureds, failing to advise of any information necessary for further processing of the claim, failing to provide a reasonable explanation in writing of the basis in the insurance policy in relation to the facts for the denial of the claim, and failing to implement proper standards for the adjustment and investigation of claims by its adjusters. This Insurer is placing the company’s interests before the Insureds’ interests when a reasonable carrier in a similar position would have provided full coverage. In particular, it is a business practice of the Insurer to severely lowball storm damage claims and overly apply “depreciation” with their initial claim adjustment with the intent of effecting settlement of such claims on less favorable terms than those provided by the policy. 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. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $89,537.27 ACV (after application of the deductible and reduction for prior payment); and 2.) Pay the statutory interest on the amount of unpaid damages from the date the loss was reported to the date payment is finally made. A copy of this form has been submitted to the FDFS and has been printed out and mailed to the following parties providing them notice of the filing of the Civil Remedy Notice: Universal Property & Casualty Insurance Company 1100 West Commercial Blvd Fort Lauderdale, Florida 33309 Certified Return Receipt # 9589 0710 5270 4213 30
Comments
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jr0405@universalproperty.com 01-08-2025 January 8, 2025 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.: 793195 Filing Date: 11/19/2024 Complainant(s): Vincent and Julann Long Insured(s): Vincent and Julann Long Policy No.: 1501-2106-0095 Claim No.: FL24-0108972-F724 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, Daniel Gutierrez, on behalf of Complainants, Vincent and Julann Long (also referenced as “Insureds”). As a preliminary matter, the Complainants prematurely filed the Notice, and it is therefore legally deficient. Pursuant to Sec. 627.70131(7)(a) Fla. Stat., an insurer has sixty (60) days from the date it receives notice of a supplemental claim to make a coverage determination unless there are factors beyond its control that prevents a coverage determination. On November 15, 2024, the Complainants notified Universal of a supplemental claim. The instant Notice was filed on November 19, 2024, and therefore well within the 60-day period allowed an insurer to pay or deny a claim pursuant to Florida law. Thus, the Notice is legally deficient as it was filed prematurely. 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 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; 1. the facts and circumstances giving rise to the violation; 2. the name of any individual involved in the violation; 3. reference to specific policy language that is relevant to the violation, if any...; 4. 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) 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 Civil Remedy Notice requires the Complainant(s) “pursuant to section 624.155, Florida Statutes, please indicate all statutory provisions alleged to have been violated.” The Notice filed by Complainants in this matter includes almost every statutory provision that could be claimed against an insurance company. The Notice, however, fails to specify any facts to support when or how or by whom any of these statutes were violated. Because the Notice fails to provide the requisite specificity, it does not comply with Section 624.155, Florida Statutes. The Notice fails to provide Universal with the necessary notice of what needs to be corrected, if anything at all. 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. To comply with Sec. 624.155, Fla. Stat., the Complainants must name the individual(s) involved with specificity related 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 “RON BRYSON.” Aside from identifying Mr. Bryson as the “adjuster,” the Complainants fail to sufficiently specify what, if anything, Mr. Bryson is knowledgeable about and/or what, if anything, Mr. Bryson did or failed to do as it relates to the claim at issue. Specific identification of a person or persons with the most knowledge within Universal is of particular importance because the Complainants allege Universal made “[a] material misrepresentation … to an insured or any other person having an interest in the proceeds” and “[m]isrepresent[ed] pertinent facts or insurance policy provisions relating to coverages at issue.” The Notice fails to specify whom made any misrepresentations, what was misrepresented, and when any of these misrepresentations occurred. Accordingly, Complainants’ Notice is insufficient as a matter of law. Third, the Notice fails to satisfy Sec. 624.155(3)(b)(4), Fla. Stat. because it fails to reference any specific policy language relevant to any alleged violation. Instead, the Notice states, “[t]he Insurer has failed to properly adjust and pay the claim pursuant to the Section I – Conditions, Loss Settlement provision and the Section I – Conditions, Loss Payment provision.” The Complainants failed to state any specific policy language relevant to any alleged violation, and instead broadly referenced the Loss Settlement and Loss Payment provisions. The Notice provides no guidance or explanation such that Universal is left to wonder what policy provisions Complainants believe were allegedly violated. General, vague, and overbroad references to policy provision titles do not satisfy the specificity required by Sec. 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). Fourth, 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 Complainants provide four (4) reasons for submitting the Notice: “Claim Denial”, “Claim Delay”, “Unsatisfactory Settlement Offer”, and “Unfair Trade Practice.” However, the Complainants’ allegations regarding these “Reasons for Notice” have no factual support anywhere in the Notice. The Notice also asserts general allegations consisting of boilerplate and conclusory statements rather than specifying facts to support any allegation. For example, the Notice alleges in part, “It is clear that the carrier is not treating the Insureds with good faith claims conduct by failing to pay a claim clearly owed, not adjusting the claim and evaluating the loss properly, failing to promptly and fairly provide full and prompt indemnity to the Insureds, failing to advise of any information necessary for further processing of the claim, failing to provide a reasonable explanation in writing of the basis in the insurance policy in relation to the facts for the denial of the claim, and failing to implement proper standards for the adjustment and investigation of claims by its adjusters. This Insurer is placing the company’s interests before the Insureds’ interests when a reasonable carrier in a similar position would have provided full coverage. In particular, it is a business practice of the Insurer to severely lowball storm damage claims and overly apply “depreciation” with their initial claim adjustment with the intent of effecting settlement of such claims on less favorable terms than those provided by the policy.” The Complainants fail to specify any facts to support these conclusory statements. The Notice also alleges “[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.” The Complainants fail to specify facts to support these conclusory and speculative allegations. The Complainants do not specify any facts about when, how or whom, violated the Insureds’ rights. The Complainants are required to specify the facts and circumstances giving rise to the alleged violation strictly related to the Complainants’ allegations, not conjecture or speculation of the carrier’s business practices. Furthermore, the Notice generally alleges that Universal violated Fla. Stat. 626.9541(1)(i)(2) by making “[a] material misrepresentation … to an insured or any other person having an interest in the proceeds…” and Fla. Stat. 626.9541(1)(i)(3)(b) by “[m]isrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.” However, the Notice does not specify any facts regarding any misrepresentations made by Universal, state what was allegedly misrepresented and does not identify the person or persons who made such misrepresentations. The Notice is replete with vague and generic boilerplate and/or conclusory assertions which are not supported with any facts and do not provide the requisite specificity as to how Universal allegedly violated any policy provision or statute. 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 failed to comply with the requirements provided in Sec. 624.155(3)(b)(2), Fla. Stat., thus the Notice is insufficient as a matter of law. 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. In this claim, specifically, as discussed above, Universal was provided with the Insureds’ supplemental claim four (4) days prior to the filing of this Notice, thus not allowing Universal the statutory time period to investigate the supplemental claim to determine if additional amounts were owed. Thus, the Complainants failed to provide Universal with an appropriate cure period. In summary, as outlined above, the Complainants fail 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 Universal’s response to the Notice. On April 18, 2024, Universal was untimely notified by Pro Styles Roofing that the insured location was damaged on January 9, 2024. Universal inspected the property and documented any visible damage. Universal, in accordance with the terms and conditions of the Policy, issued payment in the full amount of its estimate, less recoverable depreciation and applicable deductible. 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 Insureds submitted an estimate prepared by NeJame Claims Adjusting Inc., for the first time. Pursuant to Section 627.70131(7)(a) Florida Statute, an insurer has sixty (60) days from the date a supplemental claim is received to make a coverage determination unless there are factors beyond its control that prevent a coverage determination. The Notice was filed on November 19, 2024. As such, the Notice was filed prematurely and is therefore legally deficient. At no time has Universal breached any duty to its Insureds. An Insurer is not required to pay whatever amount its insureds demand, especially when Universal is not provided with sufficient time to investigate the dispute asserted in the supplemental claim. As outlined above, the alleged statutory violations set forth in the Notice lack factual support and are therefore 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 adjustment 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/ 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