Civil Remedy Notice of Insurer Violations
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Filing Number:     793805
Filing Accepted:  11/22/2024
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Complainant
Last/Business Name *  
DOMINGUE   First Name   CRISSY
Street Address * 5231 SW 7TH ST.
City, State Zip * MARGATE, FL 33068
Email Address * CLAIMS@WINDLAWGROUP.COM
Complainant Type: * Insured
Insured
Last/Business Name*   DOMINGUE   First Name   CRISSY
Policy # * 1501-1803-9761 Claim #* FL23-0128210
Attorney
Attorney is Applicable
Last Name* AVARELLO First Name * ALEXANDER Initial L
Street Address* 8724 SUNSET DR. #233
City, State Zip* MIAMI , FLORIDA 33173
Email Address * ALEX@WINDLAWGROUP.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):* THE ASSIGNED DESK ADJUSTER, FIELD ADJUSTER, SUPERVISOR(S) AND/OR MANAGER(S); AND ANY OTHER INDIVIDUAL THAT HAS REVIEWED THIS CLAIM OR MADE DETERMINATIONS WITH RESPECT TO THIS CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
Other : Unfair Settlement 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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY failed to adequately adjust and pay the claim covered under the subject insurance policy. Specifically, but not limited to, UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY failed to properly apply the Loss Settlement and Loss Payment provisions of the policy. In addition to the policy sections, all endorsements and changes to the subject policy are relevant to the insured’s claim for civil remedy. There may be additional policy language relevant to this violation that may be discovered
 
* 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 July 10, 2023, while the insurance policy (Policy Number: 1501-1803-9761) was in full force and effect, the subject property located at 5231 SW 7TH ST. MARGATE, FL 33068 sustained a covered loss as a result of water damage from kitchen plumbing system. The insured filed a claim (Claim Number: FL23-0128210) per the terms of the insurance policy with UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY (the “carrier”). UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY received timely notice of the claim but failed to perform a thorough and prompt investigation so the subject property could be restored to its pre-loss condition. The carrier’s adjuster did not properly adjust the loss to include obviously related damages resulting from the loss. After the carrier’s inspection, UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY opened coverage for the loss and offered a miniscule payment of $7,912.21 to repair all the damages. This amount is a gross under-valuation of the claim and is not close to what is needed to restore the subject property to its pre-loss condition, even when accounting for the deductible and depreciation. The insured retained a representative, who performed a comprehensive investigation of the subject property that identified the damage that the carrier knew existed but failed to address. The insured’s representative determined there were damages and repairs necessary to restore the property to its pre-loss condition and submitted claim-related documentation to UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY, including a detailed estimate for repairs for $76,328.56. After offering its initial payment, UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY made it clear that it had no intention of dealing fairly with the insured and properly addressing the gross discrepancy between its offer and the insured’s estimate. Once it became abundantly clear that UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY had no intention of acting in good faith, the insured was forced to retain counsel and initiate a lawsuit against the carrier, and file the instant Civil Remedy Notice. The adjusters assigned to this claim have a duty to adjust and treat all claims equally. Since the beginning of this claim the representatives on behalf of UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY have approached this investigation in a manner prejudicial to the insured. UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY is using either untrained or improperly trained adjusters in connection with this claim. UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY should have been fairly adjusting this claim, but instead, it was looking for ways not to pay the claim at all or not pay the claim in full. The above are all examples of UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY’S unfair trade practices, improper investigation and adjustment of the claim, and unfair claim settlement practices. These actions demonstrate the carrier is 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 the insured. The insured gives this notice to perfect the right to pursue the civil remedy authorized by Florida Statute § 624.155. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: (1) Pay the complete covered loss in the amount of $76,328.56, less any prior payments and less any applicable policy deductible; (2) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made; and (3) implement appropriate standards and procedures for claims investigations and resolution in regard to the outstanding amount of this claim.
Comments
User Id Date Added Comment
oc1102@universalproperty.com 01-10-2025 January 10, 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.: 793805 Filing Date: 11/22/2024 Complainant(s): Crissy Domingue Insured(s): Crissy Domingue Policy No.: 1501-1803-9761 Claim No.: FL23-0128210 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, Alexander L Avarello, on behalf of Complainant Crissy Domingue (also references as the “Insured.”) The Notice alleges violations of Sections 624.155 and 626.9541, Florida Statutes. Universal 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; 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 requirement 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 Complainant attempts a “catch-all” by stating, “THE ASSIGNED DESK ADJUSTER, FIELD ADJUSTER, SUPERVISOR(S) AND/OR MANAGER(S); AND ANY OTHER INDIVIDUAL THAT HAS REVIEWED THIS CLAIM OR MADE DETERMINATIONS WITH RESPECT TO THIS CLAIM.” The statement significantly prejudices Universal, as Universal has not been properly notified by Complainant of the individual(s) that purportedly committed statutory violations or the specific statutory violations any individual purportedly committed. The Complainant has effectively provided no one specifically with the most knowledge of the facts giving rise to any of the purported allegations in the Notice on behalf of Universal. Specific identification of a person or persons with the most knowledge within Universal is of particular importance because the Complainant alleges Universal has “[m]isrepresent[ed] pertinent facts or insurance policy provisions relating to coverages at issue.” The Notice fails to include sufficient specificity as to whom made any misrepresentations, what was misrepresented, and 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(s). The Notice does not reference any specific policy language allegedly violated, but instead states in pertinent part the following: “UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY failed to adequately adjust and pay the claim covered under the subject insurance policy. Specifically, but not limited to, UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY failed to properly apply the Loss Settlement and Loss Payment provisions of the policy. In addition to the policy sections, all endorsements and changes to the subject policy are relevant to the insured’s claim for civil remedy. There may be additional policy language relevant to this violation that may be discovered.” The Complainant failed to state any specific policy provisions and instead broadly makes references to various policy sections which provide no guidance or explanation, such that Universal is left to wonder what policy provisions Complainant believes were allegedly violated. General, vague, and overbroad references to possible or potential policy 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 Complainant provides four (4) reasons for submitting the Notice. The Complainant’s allegations have no specific factual support specified in the Notice. The Notice asserts general allegations consisting of conclusory and boilerplate allegations. As an example, the Notice alleges: UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY received timely notice of the claim but failed to perform a thorough and prompt investigation so the subject property could be restored to its pre-loss condition. The carrier’s adjuster did not properly adjust the loss to include obviously related damages resulting from the loss. … Since the beginning of this claim the representatives on behalf of UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY have approached this investigation in a manner prejudicial to the insured. UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY is using either untrained or improperly trained adjusters in connection with this claim. UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY should have been fairly adjusting this claim, but instead, it was looking for ways not to pay the claim at all or not pay the claim in full. The above are all examples of UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY’S unfair trade practices, improper investigation and adjustment of the claim, and unfair claim settlement practices. These actions demonstrate the carrier is 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 the insured. The Complainant fails to provide any specific facts or examples to support these conclusory statements. The Notice fails to adequately identify or explain how Universal violated the provisions of Florida law cited in the Notice or how the alleged violations relate to the facts of the Complainant’s claim. Moreover, the Complainant alleges that Universal violated Section 626.9541(1)(i)(3)(b), Florida Statutes, “[m]isrepresenting pertinent facts or insurance policy provisions relating to the coverages at issue.” However, the Notice does not set forth any facts regarding any misrepresentations made by Universal and does not identify the person or persons who made such misrepresentations. The Notice does not state any facts to support the Complainant’s misrepresentation allegations or any of the allegations contained therein. Therefore, 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 by the Insured initiating litigation before serving the Notice, prejudice 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. As such, the Notice is deficient. 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 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 July 25, 2023, Universal received notice from the Insured’s public adjuster, Five Star Claims Adjusting, the insured location had damage which occurred on July 10, 2023. Universal inspected the property and documented any visible damage. Universal issued an undisputed payment to the Insured in the full amount of its estimate less the applicable policy deductible and the recoverable depreciation, pursuant to the terms of the Policy. On February 22, 2024, the Insured initiated litigation against Universal in Circuit Court of Broward County under Case No. CACE-24-002507. 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 responds to the Notice file 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