Civil Remedy Notice of Insurer Violations
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Filing Number:     793837
Filing Accepted:  11/22/2024
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Complainant
Last/Business Name *  
FIELD   First Name   SUSANNA PEREZ-FIELD AND AARON
Street Address * 6915 NORTH DAKOTA AVE
City, State Zip * TAMPA, FL 33604
Email Address * N/A
Complainant Type: * Insured
Insured
Last/Business Name*   FIELD   First Name   SUSANNA PEREZ-FIELD AND AARON
Policy # * 1501-1302-2962 Claim #* FL 24-0103890-A322
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.

Unable to specify language in the policy that is relevant to the violation, as Universal Property & Casualty Insurance Company has refused to provide a certified copy of the policy, in violation of 627.421(1) (A paper copy of the policy shall be provided to the insured or to the person entitled to delivery at his or her request.)
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Susanna Perez-Field and Aaron Field (hereinafter the “Insureds”), paid for a policy of insurance with Universal Property & Casualty Insurance Company (hereinafter, “Insurer”) bearing policy number 1501-1302-2962 (the “Policy”). The Policy provides coverage for damage to the Insureds’ property located at 6915 North Dakota Avenue, Tampa, FL 33604 (the “Property”), including the significant damage that occurred as a result of Hurricane Ian on or about September 28, 2022 (the “loss”). Specifically, the Insureds’ Property sustained substantial damage to the roof, windows, stucco, gutters, fence, pantry ceiling and wall, hall carpet, bedroom ceiling, living room ceiling, living room wall, bathroom ceiling, garage door and garage ceiling. The Insureds subsequently contacted the Insurance Litigation Group, P.A. (hereafter, ILGPA), who reported the Insureds’ claim to the Insurer. On February 21, 2024, the Insurer sent a letter to the Insureds requesting records and documents, including a date and time to inspect the damaged property, a signed sworn proof of loss with detailed repair estimate, emergency mitigation services documents and invoices, and photos or videos taken by the insured because of the reported loss. ILGPA conducted a thorough inspection of the property and compiled an estimate of damages. ILGPA, on behalf of the Insureds, forwarded said estimate which fully detailed the Insureds’ damages and total $227,216.49. However, the Insurer refuses to resolve the Insureds’ claim and pay for all damages to the Property. 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. 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 Insureds’ behalf, in a timely manner. They are obligated to provide coverage for all damages to the Insureds’ 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. On October 1, 2024, ILGPA, on behalf of the Insureds, answered the Insurer’s requests for information with all the information that was available. However, the Insurer failed to inspect the interior of the Insureds’ home and has not yet made a coverage decision. Further, the Insurer has violated Florida Statute § 626.9541(1)(i)(3)(c) by failing to acknowledge and act promptly with the Insureds and its counsel. 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 Insureds, 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 Insureds. 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 Insureds under the Policy in the amount of $227,216.49 (less the deductible and any prior payments), plus all statutory interest; (3) act fairly and honestly towards its Insureds and with due regard for their interests in attempting to settle their Insureds’ claim; (4) hold the claim open in the event that its errors and delay does or may cause the Insureds to suffer either further loss and/or damage; and, (5) stipulate to the Insureds’ 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
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.: 793837 Filing Date: 11/22/2024 Complainants(s): Susanna Perez-Field and Aaron Field Insured(s): Susanna Perez-Field and Aaron Field Policy No.: 1501-1302-2962 Claim No.: FL24-0103890-A322 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 R Elimelech, on behalf of Complainants, Susanna Perez-Field and Aaron Field (also referenced as the “Insureds.”) 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; 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 Complainants 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 Complainants 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 Complainants must name the individual(s) involved with specificity as it relates to the purported violation 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 “N/A,” which significantly prejudices Universal, as Universal has not been properly notified by Complainants of the individuals 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. Accordingly, the 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. Instead, the Notice states, “[u]nable to specify language in the policy that is relevant to the violation, as Universal Property & Casualty Insurance Company has refused to provide a certified copy of the policy, in violation of 627.421(1) (A paper copy of the policy shall be provided to the insured or to the person entitled to delivery at his or her request.)” It is therefore unclear as to what, if any, policy language pertains to any purported allegation or how it relates to the allegations. The Complainants’ failure to reference relevant policy language does not satisfy the specificity required by Section 624.155(3)(b)(4), Florida Statute. 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 specify sufficient facts that would put Universal on notice it violated any policy provision or statute. The Notice asserts general allegations consisting largely of conclusory, inaccurate, and boilerplate statements rather than providing specific facts to support any allegation. For example, the Notice alleges Universal violation of Sections, 624.155(1)(b)(3), Florida Statutes, “failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear” and Section 626.9541(1)(i)(3)(c), Florida Statutes, “[f]ailing to acknowledge and act promptly upon communications with respect to claims.” However, the Complainants fail to specify specific facts or circumstances that give rise to the above referenced statutory 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 therefore evident that the statement of facts falls short of the specificity required by Section 624.155, Florida Statutes. As a result, the Complainants fail to comply with the requirements provided in Section 624.155(3)(b)(2), Florida Statutes. Finally, the Notice does not provide a proper means whereby Universal can “cure” the alleged defects, without paying additional 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 does not impose on an insurer the obligation to pay whatever amount its 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 insureds. See Talat, 753 So. 2d at 1281. The Complainants demand extra contractual damages, which are not owed under the policy. The Notice states that to cure the alleged defects, Universal must “stipulate to the Insureds’ entitlement to attorney’s fees and court costs…” Thus, the Notice is deficient as it does not provide Universal an opportunity to “cure” the alleged violations without making payment of extracontractual damages. Universal is only obligated to pay contractual amounts owed to cure a civil remedy notice. See id. at 1278. Accordingly, the Notice is deficient as a matter of law. 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, 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, and the failure to allege any specific conduct on the part of Universal that would violate any policy provision or statute. 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 February 14, 2024, Universal received untimely notice from the Insureds’ attorney representative, Insurance Litigation Group, the insured location had damage which occurred on September 28, 2022. Universal inspected the property and documented any visible damage. Thereafter, Universal advised the Insured of its coverage decision pursuant to the terms of the policy and outline applicable policy language. 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 filed by the Complainants. 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