Civil Remedy Notice of Insurer Violations
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Filing Number:     794065
Filing Accepted:  11/25/2024
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Complainant
Last/Business Name *  
BISHOP   First Name   MARK AND ANAMARIA
Street Address * 216 SEA COAST LANE
City, State Zip * PONTE VEDRA BEACH, FL 32082
Email Address * STEVEN@PLG.LAWYER
Complainant Type: * Insured
Insured
Last/Business Name*   BISHOP   First Name   MARK AND ANAMARIA
Policy # * 150120006854 Claim #* FL23-0133643
Attorney
Attorney is Applicable
Last Name* HOFFMAN First Name * STEVEN Initial
Street Address* 1790 HIGHWAY A1A, SUITE 209
City, State Zip* SATELLITE BEACH , FLORIDA 32937
Email Address * STEVEN@PLG.LAWYER
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):* UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY'S ADJUSTERS, EMPLOYEES, REPRESENTATIVES, AGENTS, VENDORS, AND/OR ENGINEERS AND CONTRACTORS WHO HANDLED THE CLAIM, SPECIFICALLY THE DESK ADJUSTER.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unsatisfactory Settlement Offer
Claim Delay
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.
* 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 Policy language relevant to the violations includes all applicable loss payment, duties after loss, and coverage provisions of Policy Number 150120006854, including the declarations page and all endorsements to the Policy.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Claim# FL23-0133643; DOL: 09/06/2023 Mark and Anamaria Bishop ("Insureds") are the owners of a property with a policy of insurance issued by Universal Property & Casualty Insurance Company ("Carrier"). The Insureds' residence is located at 216 Sea Coast Lane Ponte Vedra Beach, FL 32082 (the "Property"). On September 6, 2023, a water event caused extensive damage to the Property. The Insureds timely reported an insurance claim for this damage to the Carrier and fully cooperated with all requests for inspection and information. All of the requested documentation was provided. The insureds obtained kitchen, tile flooring and painting proposals for repair of dwelling. The Carrier grossly underpaid the claim, paying only $34,837.47. A Notice of Intent to Initiate Litigation (NOI) was filed by the undersigned counsel on August 16, 2024. The Carrier responded to the NOI on August 27, 2024, stating “A supplemental coverage determination, pursuant to §627.70131, by UPCIC has not yet been made as the statutory period for review has not expired. The supplemental documentation was not received until 08/16/2024.” The Carrier also sent a Request for Information (RFI) letter on September 26, 2024, which requested “records and documents.” The requested documents were already provided to the Carrier in September and should have been sufficient to answer the Carrier’s questions. To the extent they did not, the Carrier is making a request for documents that don't exist. The undersigned counsel filed a second NOI on October 15, 2024. The Carrier responded to the second NOI on October 23, 2024, once again stating, “a supplemental coverage determination, pursuant to §627.70131, by UPCIC has not yet been made as we are pending documentation previously requested. Please refer to correspondence's dated 9/26/2024.” To date, the Carrier has failed to make a timely coverage determination, and rather than doing so now, they are delaying. The Carrier has not investigated the claim properly. They have not called the contractors if they had specific questions about the proposals. They also have not responded to the undersigned counsel once they received a response to the RFI asking for more specifics. Section 624.02, Florida Statutes, defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit based on determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. The Carrier has breached this duty by refusing to properly and timely adjust the loss. The Carrier has more than enough information and is still refusing to accept full coverage for this claim. This continued and repeated reckless claim delay, unfair claim handling, failure to communicate, and failure to settle a claim in full that they should have, will result in a significant punitive damage award. The Carrier can avoid a lawsuit for bad faith by immediately accepting full coverage under the subject insurance policy and by paying the Insureds $78,520.00, which reflects the full amount of the proposals plus the estimated loss of use, minus the Carrier's prior payment and the Insureds’ $2,500.00 deductible. Further, the Carrier should pay incurred attorney fees and costs, as insureds were forced to hire the undersigned counsel due to the Carrier's bad faith actions, as well as pay the interest accrued from notice of the claim until the date that the Carrier pays $78,520.00, per Section 627.70131 Florida Statutes. Steven Hoffman Paraclete Law Group, PLLC Steven@PLG.Lawyer
Comments
User Id Date Added Comment
oc1102@universalproperty.com 01-14-2025 January 14, 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.: 794065 Filing Date: 11/25/2024 Complainant(s): Mark and Anamaria Bishop Insured(s): Mark and Anamaria Bishop Policy No.: 150120006854 Claim No.: FL23-0133643 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, Steven Hoffman, on behalf of Complainants, Mark and Anamaria Bishop (also referenced as the “Insureds.”) The Notice alleges violations of Sections 624.155, 624.02, 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 Complainants 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 “UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY'S ADJUSTERS, EMPLOYEES, REPRESENTATIVES, AGENTS, VENDORS, AND/OR ENGINEERS AND CONTRACTORS WHO HANDLED THE CLAIM, SPECIFICALLY THE DESK ADJUSTER.” Therefore, the Notice does not have the requisite specificity as to whom the Complainants are asserting has knowledge as to each specific allegation contained in the Notice. Accordingly, Complainants’ 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. The Notice states, “[t]he Policy language relevant to the violations includes all applicable loss payment, duties after loss, and coverage provisions of Policy Number 150120006854, including the declarations page and all endorsements to the Policy.” which is tantamount to the entire policy. It is therefore unclear what, if any, policy language pertains to any specific allegation. Further, the Notice fails to identify how the referenced provisions relate to any alleged violation or how and if the language is relevant to the subject claim. General, vague, missing, and overbroad references to policy sections, titles or 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 Complainants provide three (3) reasons for submitting the Notice. The Complainants’ allegations have no specific factual support specified in the Notice. The Notice asserts general allegations consisting of conclusory and inaccurate statements rather than specific allegations of fact regarding any alleged misconduct or statutory violations. As an example, the Notice alleges Universal violated Sections 624.155(1)(b)(1), “[n]ot 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” and Section 624.155(1)(b)(3), Florida Statutes, “[e]xcept 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.” The Notice fails to provide any specific facts to support any alleged statutory violations. Additionally, the Notice alleges Universal violated Section 624.02, Florida Statutes by, “refusing to properly and timely adjust the loss.” However, the Notice does not state any facts to support the Complainants’ allegations or any of the allegations contained therein. It is 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. 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 Insureds. 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. Complainants demand extra-contractual damages, including but not limited to requiring Universal to “pay incurred attorney fees and costs…” The Notice is deficient in that it does not provide Universal with 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. See id. at 1278. 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, 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 means whereby Universal can “cure” the alleged defects. 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 September 11, 2023, Universal received notice from the Insured, Mark Bishop, the insured location had damage which occurred on September 6, 2023. Universal inspected the property and documented any visible damage. Thereafter, Universal issued an undisputed payment to the Insureds in the full amount of its estimate less the applicable deductible and recoverable depreciation, pursuant to the terms of the policy. 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 August 16, 2024, Universal received the Insureds’ intent to litigate (“NOI”). Attached to the NOI, Universal received, for the first time, the Insureds’ rebuild documents. On September 26, 2024, Universal requested material documents and information from the Insureds. At the time the instant Notice was filed, the Insureds had yet to provide Universal with all requested material documents and information. As outlined above, the alleged statutory violations set forth in the Notice lack factual support and are without merit. We trust that the foregoing is sufficient to advise you of Universal’s position regarding this matter and fully respond to the alleged violations in 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.

Before submitting a Notice using this system, please verify that all text has been entered correctly and completely. Once the Notice has been submitted, the text cannot be changed or deleted.




DFS-10-363
Rev. 10/14/2008