Civil Remedy Notice of Insurer Violations
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Filing Number:     793292
Filing Accepted:  11/19/2024
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Complainant
Last/Business Name *  
HEALY   First Name   JENNIFER
Street Address * 29400 SOUTHWEST 180TH AVENUE
City, State Zip * HOMESTEAD, FL 33030
Email Address * HEALY1515@BELLSOUTH.NET
Complainant Type: * Insured
Insured
Last/Business Name*   HEALY   First Name   JENNIFER
Policy # * 1501-1703-4377 Claim #* FL24-0114643
Attorney
Attorney is Applicable
Last Name* KRAPF First Name * GRANT Initial W
Street Address* 2790 SUNSET POINT RD
City, State Zip* CLEARWATER , FL 33759
Email Address * GRANT@KRAPFLEGAL.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):* TIM TRAVNOR, DAVID SMART. AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY, WHO WAS INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unfair Trade Practice
Other : Misrepresenting the terms of the insurance policy
Other : Not treating the Insured with good faith claims conduct
Other : Looking for ways to deny full recovery to the Insured
Other : Looking for ways to delay full recovery to the Insured
Other : Failing to properly investigate the Insured's loss
Other : Failing to provide the Insured with the full benefits awarded under the contract of insurance in a t
Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made
Other : Not adjusting claims and evaluating loss properly
Other : Shifting the burden of insuring the loss to the Insured
Other : Failing to implement proper standards for the adjustment and investigation of claims
* 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)(c) Failing to acknowledge and act promptly upon communications with respect to 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.

Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language. "It is an accepted principle of law that when parties contract upon a matter which is the subject of statutory regulation, the parties are presumed to have entered into their agreement with reference to such statute, which becomes a part of the contract, unless the contract discloses a contrary intention." Westside EKG Assocs. v. Found. Health, 932 So. 2d 214, 216 (Fla. 4th DCA 2005), aff'd, 944 So. 2d 188 (Fla. 2006).
 
* 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 (the "Insurer") has committed the following in handling the Insured's claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the policyholder and the Insured; 3) looking for ways to deny benefit payments and otherwise "low ball" or "stone wall" claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; 8) failing to provide an estimate that complies with the Florida Building Codes; 9) shifting the burden of investigating the loss onto the Insured; 10) failing to acknowledge and act promptly upon communications with respect to claims; 11) artificially inflating the Insured's recoverable depreciation; and 12) misrepresenting the terms of the insurance policy. On or about May 29, 2024, while the subject policy was in full force and effect, the Insured's suffered a loss caused by wind. The areas impacted include but are not limited to the roofing system, exterior surfaces, foyer, dining room, and guest bedroom. The Insured timely submitted a claim to the Insurer for wind damage and the ensuing damage therefrom. Given the scope and nature of the damage, the Insured retained a public adjuster. After assessing the damage and the true scope of repairs, the public adjuster prepared an estimate identifying $172,944.23 in covered damage to the dwelling. The foregoing estimate and a letter of representation from the public adjuster were sent to the Insurer who thereafter, the Insurer assigned claim number FL24-0114643 to the loss and sent a field adjuster to inspect the property on July 8, 2024. Subsequently, in a coverage determination letter dated August 12, 2024, the Insurer notified the Insured that it was extending coverage for the loss. However, the Insurer wrongfully determined that it would only require $7,256.56 to restore the insured property to its pre-loss condition. After withholding $2,050.62 as recoverable depreciation, and subtracting the applicable deductible of $2,500.00, the Insurer only issued $2,705.94 to the Insured. The Insurer's lowball estimate is that of a classic under scope and under value of the claim. Upon receiving notice of the loss, the Insurer had the duty to provide the full benefits under the policy. This includes providing the Insured with a proper investigation and the funds necessary to return the home to its pre-loss condition. There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer's claim file and standards and procedures for the adjustment and investigation of claims. The Insurer unreasonably inflated the amount of recoverable depreciation in this case, thereby artificially lowering the Insured's recoverable value, to the detriment of the Insured. The Insurer withheld almost 30 percent of the net claim determined by the Insurer as recoverable depreciation. The Insurer has attempted to gain an unreasonable financial benefit by inflating the recoverable depreciation because it knows that it is unlikely, or at least less likely, that the Insured can actually complete the repairs which is a condition precedent to the recovery of the depreciation withheld under the claim. In other words, the Insurer pays an unreasonable amount less on the front end of a claim, which makes it more difficult for the Insured to restore the property to its pre-loss condition and recover the withheld depreciation from the Insurer. Only after Insured pays to restore the property out of pocket, if he can, will the Insurer fully pay its Insured under the policy. Withholding an inflated amount of depreciation is a creative, sneaky, and deceptive practice that is employed as to limit the amount the Insurer will ever have to pay out on a claim and essentially make the homeowner a self-insured. The Insurer is hoping that the Insured is unaware of her right to recover the recoverable depreciation so that it can pay Insured less than it is obligated. The Insurer is shifting the cost and the burden of investigating the loss onto the Insured. The Insurer has the duty to inspect the loss and provide the Insured with the full benefits under the policy. The Insurer has breached that duty by not providing the Insured with the full value of the loss and caused the Insured to take on the burden of investigating the loss. Moreover, upon information and belief, the Insurer wrongfully under-scoped for the Insured's roof because it knows or should have known that the Insured needs a new roof in order to comply with the Florida Building Code. Rather than paying for a roof replacement consistent with all laws and ordinances, the Insurer contends the roof is repairable, which is not true. All repairs to the roofing system must be done in accordance with applicable Florida Building Codes which require all repairs be done consistent with the manufacturer's specifications and warranties which this Insurer clearly did not account for. Additionally, Insurer shifted the burden and cost of investigating and insuring the loss onto the Insured. During their investigation, the insurer's adjuster did not use a moisture meter, despite the presence of interior water damage. A moisture meter can be purchased online from Amazon for around $40 before tax. The Insurer could purchase a moisture meter and assess thousands of properties with one meter. Instead, the Insurer would rather place its financial interests over those of the Insured by failing to provide the adjuster with the necessary tools to correctly inspect the loss. As a result of the inadequate investigation and surrounding circumstances it is apparent that the Insurer significantly underestimated the scope of the loss to the Insured's property. The Insurer and its adjuster have colluded to misrepresent the true scope of damages to the insured property and the true replacement costs of the damages. In short, the Insurer is not acting with due regard for the Insured's interests or safety. In Florida the work of adjusting insurance claims engages the public trust. The Insurer has breached this trust and its duty to the Insured. The Insurer and its agents conducted cursory and inadequate investigations and wrongfully determined that it would only require $7,256.56 to restore the insured property to its pre-loss condition. Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer's actions and inactions have continued to frustrate and delay the resolution of the Insured claim. The Insurer's actions amount to but are not limited to the following: 1. Claim delay 2. Not treating the Insured with good faith claims conduct 3. Looking for way to reduce recovery to the Insured 4. Looking for ways to deny recovery to the Insured 5. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured 6. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company's interests before the Insured's interests 7. Placing the financial interest of the Insurer over that of the health and safety of the Insured 8. Failing to provide an estimate that complies with the Florida Building Codes 9. Shifting the burden of investigating onto the Insured 10. Conducting inadequate investigations 11. Making material misrepresentations Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must: (1). Admit full coverage for the Insured's loss. (2). Tender full benefits owed to the Insured under the insurance contract. A copy of this form submitted to the FDFS has been sent via e-mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to badfaith@krapflegal.com. VIA CLAIMSPATH PORTAL Universal Property & Casualty Insurance Company 1110 W. Commercial Blvd. Fort Lauderdale, FL 33309
Comments
User Id Date Added Comment
grant@krapflegal.com 10-20-2025 The details herein have been amicably resolved between the parties; therefore, we withdraw this Civil Remedy Notice. This Civil Remedy Notice is hereby withdrawn.
jr0405@universalproperty.com 01-07-2025 January 7, 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.: 793292 Filing Date: 11/19/2024 Complainant(s): Jennifer Healy Insured(s): Jennifer Healy Policy No.: 1501-1703-4377 Claim No.: FL24-0114643 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, Grant W Krapf, on behalf of Complainant, Jennifer Healy (also referenced as “Insured.”) As a preliminary matter, attorney Grant Krapf filed a prior Civil Remedy Notice on the same claim referenced above on September 12, 2024, with the Florida Department of Financial Services (“DFS”) under File Number 782507 (“Prior Notice”). This instant Notice is identical to the Prior Notice except for the listed Complainant. On October 31, 2024, Universal properly responded to the Prior Notice outlining the legal deficiencies. None of the legal deficiencies noted in the Prior Notice have been rectified in the subject Notice. The Notice alleges violations of Sections 624.155 and 626.9541, Florida Statutes. 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 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). The Notice fails to meet the requirement of Section 624.155, Fla. Stat., 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, “TIM TRAVNOR, DAVID SMART.” The Notice fails 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, the named individuals did or failed to do as it relates to the claim at issue. Furthermore, the Complainant attempts a “catch-all” of “ANY OTHER INDIVIDUAL FROM, OR AGENT OF, UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY, WHO WAS INVOLVED IN THE CLAIM,” which significantly prejudices Universal because the Complainant is failing to notify Universal of the individual(s) that purportedly committed statutory violations or the specific statutory violations any individual purportedly committed. Further, the statement 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. Specific identification of a person or persons with the most knowledge within Universal is of particular importance because the Complainant alleges that Universal made “[a] material misrepresentation … to an insured or any other person having an interest…” and “misrepresent[ed] the terms of the insurance policy.” The Notice fails to include the requisite specificity as to whom made any misrepresentations, what was misrepresented, when any of these misrepresentations occurred nor to whom any alleged misrepresentation was made. 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., in that it fails to reference specific policy language relevant to the alleged violations. Instead, the Notice states in pertinent part “[r]eference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language.” Thus, the Complainant admits that Universal in fact did not violate any policy language but fails to provide any specificity as to whom, when, or how any statutes were violated. 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 Complainant provides twelve (12) reasons for filing the Notice, 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 boilerplate, conclusory and inaccurate statements rather than specific allegations of facts regarding any alleged misconduct or statutory violations. As an example, the Notice states in part: “Universal Property & Casualty Insurance Company (the "Insurer") has committed the following in handling the Insured's claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the policyholder and the Insured; 3) looking for ways to deny benefit payments and otherwise "low ball" or "stone wall" claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; 8) failing to provide an estimate that complies with the Florida Building Codes; 9) shifting the burden of investigating the loss onto the Insured; 10) failing to acknowledge and act promptly upon communications with respect to claims; 11) artificially inflating the Insured's recoverable depreciation; and 12) misrepresenting the terms of the insurance policy.” The Notice wholly fails to identify any specific facts or circumstances which support any of the above-listed conclusory and/or boilerplate allegations. Further, the Notice does not specify any facts regarding any misrepresentations made by Universal, does not identify the person or persons who made such misrepresentations, nor does it identify to whom any misrepresentations were made. Additionally, the Notice states, “the Insurer is not acting with due regard for the Insured’s interests or safety… Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer’s actions and inactions have continued to frustrate and delay the resolution of the Insured claim.” The Complainant fails to assert any specific facts to support these conclusory allegations. The Notice also alleges, “[t]here may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer’s claim file and standards and procedures for the adjustment and investigation of claims.” The Complainant is required to provide with specificity the facts and circumstances giving rise to the alleged violation strictly related to the allegations, not conjecture or speculation of purported “further wrongful conduct.” It is evident that the statement of facts in the Notice 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 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 named Insureds initiating litigation before the cure period expiring, prejudices Universal’s ability to cure any purported allegation in the Notice as there is no actual cure period. In summation, as outlined above, the Complainant failed to respond to each of the fields set forth on the DFS Form with the requisite specificity, including but not limited to, failing to identify all named policyholders, 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 reference specific policy language relevant to the alleged violation, failing to allege any specific conduct on the part of Universal that would violate any policy provision or statute, 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 27, 2024, Universal was untimely notified by the named Insureds’ public adjuster, Omega Public Adjusting, that the insured location was damaged on May 29, 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 for the interior dwelling damages observed, less recoverable depreciation and applicable deductible. Additionally, Universal advised the named Insureds that the roofing property damage was not covered under the terms of the Policy as the damage was precluded because the damage was caused by wear and tear and/or deterioration. 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 December 12, 2024, the named Insureds initiated litigation against Universal in the Circuit Court in and for Miami-Dade County under Case No. 2024-023586-CA-01. Thus, at this time, the parties continue to litigate their dispute to determine what, if any, additional available coverage exists under the terms of the Policy. At no time has Universal breached any duty to its named Insureds. An Insurer has no obligation 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 specific 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 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 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