Civil Remedy Notice of Insurer Violations
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Filing Number:     794233
Filing Accepted:  11/26/2024
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Complainant
Last/Business Name *  
ROBERTS   First Name   KEVIN
Street Address * 2147 NATURES GATE CT S
City, State Zip * FERNANDINA BEACH, FL 32034
Email Address * FBGATORS@ATT.NET
Complainant Type: * Insured
Insured
Last/Business Name*   ROBERTS   First Name   KEVIN
Policy # * 1501-2202-2284 Claim #* FL23-0137781
Attorney
Attorney is Applicable
Last Name* PLATT First Name * HOPE Initial
Street Address* 800 EAST BROWARD BLVD SUITE 500
City, State Zip* FT. LAUDERDALE , FL 33301
Email Address * HBP@WEKLAW.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):* BRET BLANCHFIELD
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
* 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)(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)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

PERILS INSURED AGAINST A. Coverage A – Dwelling And Coverage B – Other Structures 1. We insure against direct physical loss to property described in Coverages A and B. However, loss does not include and we will not pay for any “diminution in value”. 2. We do not insure, however, for loss: a. Excluded under Section I – Exclusions; … c. Caused by: … ( 7) Any of the following: (a) Wear and tear, “marring”, deterioration; (b) Mechanical breakdown, latent defect, inherent vice or any quality in property that causes it to damage or destroy itself; …S ECTION I – EXCLUSIONS A. We do not insure for loss caused directly or indirectly by any of the following. Such loss is excluded regardless of any other cause or event contributing concurrently or in any sequence to the loss. These exclusions apply whether or not the loss event results in widespread damage or affects a substantial area. … 10. Assignee(s) Or Third Parties, meaning we will not be responsible for payment under Section I and II – Conditions, E. Assignment, to any assignee(s) or third parties, for payments on losses that are not covered under this policy. … 12. "Fungi", Wet Or Dry Rot, Or Bacteria, meaning the presence, growth, proliferation, spread or any activity of "fungi", wet or dry rot, or bacteria. This exclusion does not apply: a. When "fungi", wet or dry rot, or bacteria result from fire or lightning; or b. To the extent coverage is provided for in the "Fungi", Wet Or Dry Rot, Or Bacteria Additional Coverage under Section I – Property Coverages with respect to loss caused by a Peril Insured Against other than fire or lightning. Direct loss by a Peril Insured Against resulting from "fungi", wet or dry rot, or bacteria is covered. … SECTION I – CONDITIONS … C. Duties After Loss Any claim or reopened claim under an insurance policy that provides property insurance for loss or damage caused by any covered peril is barred unless notice of the claim or reopened claim is given to us in accordance with the terms of the policy and within two years after the date of loss. A supplemental claim is barred unless notice of the supplemental claim is given to us in accordance with the terms of the policy and within three years after the date of loss. For purposes of this section, the term reopened claim means a claim that we have previously closed, but that has been reopened upon an insured’s request for additional costs for loss or damage previously disclosed to us. Supplemental claim means a claim for additional loss or damage from the same peril which we previously adjusted or for which costs have been incurred while completing repairs or replacement pursuant to an open claim for which timely notice was previously provided to us. This section does not affect any applicable limitation on civil actions. Additionally, we have no duty to provide coverage under this policy to you or an “insured” seeking coverage, if the failure to comply with the following duties is prejudicial to us. These duties must be performed either by you, an "insured" seeking coverage, or a representative of either: 1. Give prompt notice to us or our agent; Except for Reasonable Emergency Measures taken under Additional Coverage 2. there is no coverage for repairs that begin before the earlier of: a. 72 hours after we are notified of the loss; b. The time of loss inspection by us; or c. The time of other approval by us. 2. a. To the degree reasonably possible, retain the damaged property; and b. Allow us to inspect, subject to 2.a. above, all damaged property prior to its removal from the “residence premises.” … 4. Protect the covered property from further damage. If emergency measures are required, the following must be performed: a. Take reasonable emergency measures that are necessary to protect the covered property from further damage, as provided under Additional Coverage 2. A reasonable emergency measure under 4.a. above may include a permanent repair when necessary to protect the covered property from further damage or to prevent unwanted entry to the property. To the degree reasonably possible, the damaged property must be retained for us to inspect; and b. Keep an accurate record of repair expenses; 5. Cooperate with us in the investigation of a claim; 6. Prepare an inventory of damaged personal property showing the quantity, description, actual cash value and amount of loss. Attach all bills, receipts and related documents that justify the figures in the inventory; 7. As often as we reasonably require: a. Show us the damaged property and the cause of loss, if reasonably possible, except as to any repairs performed under Section I – Additional Coverages, 2. Reasonable Emergency Measures; b. Provide us with records and documents we request and permit us to make copies; … The duties above apply regardless of whether you, an " insured" seeking coverage, or a representative of either retains or is assisted by a party who provides legal advice, insurance advice or expert claim advice, regarding an insurance claim under this policy.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Kevin and Nancy Roberts ("Insureds") purchased an insurance policy ("Policy") from Universal Property and Casualty Insurance Company ("Universal" or “Carrier”) with effective coverage on the date of loss, on or about October 13, 2023, and Policy number 1501-2202-2284 to insure their property located at 2147 Natures Gate Ct S, Fernandina Beach, FL 32034 (the "Property").??With effective dates from June 29, 2023, to June 29, 2024. On or about October 13, 2023, the Property suffered roof damage from a storm event which caused damage to the Property, including but not limited to the roof and exterior of the home which caused an opening in the structure to allow for interior water entry and damage to the interior of the home. ("Loss"). Universal sent a Field Adjuster, Bret Blanchfield to inspect the subject property. The Field Adjuster took pictures of the roof and noted his observations of the damage to the roof. There were obvious marks on the roof which showed that the roof was damaged from the storm. Additionally, the Insureds hired 5th Element Adjusting to assist them with the claim. 5th Element inspected the Insureds roof and determined that the roof was damaged from the October 13, 2023, storm. 5th Element has provided Universal with an estimate for the cost to replace the roof and repair the interior damage in the amount of $50,340. However, Universal has chosen to ignore this information and still refused to fully indemnify the Insureds. Universal, authored a letter on November 3, 2023, to the Insureds (“Coverage letter”) denying coverage for this claim. Specifically, the policy language that Universal incorporated into their denial letter is regarding diminution in value, which is not being alleged in this claim. They also contended that they do not provided coverage for wear, tear, and deterioration, as well as mechanical breakdown. None of these policy provisions are at issue in this case. Specifically, the Insured is claiming that their roof was damaged as a result of a storm that occurred on October 13, 2023. Universal has failed to specifically articulate a reason for the denial of the claim that makes logical sense. Nowhere in the letter does Universal state that they were unable to conduct or complete an investigation of the damages and necessary repairs to the Property. The Insureds have complied with post loss duties and the Carrier needs to fulfill its obligations. Specifically, Universal did not hire a roofer or engineer to inspect the home and to determine the cause of the damage, they merely relied on observations by an unlicensed Field Adjuster to form the basis of their denial. After being provided plenty of evidence (including photos, estimates, and access to the property, showing that the storm event caused damage at the property, Universal continues to refuse to provide additional money in order to begin these repairs. Universal is trying to avoid finding any further information that would increase the amount of coverage available on this claim despite being aware that additional costs would need to be incurred by the Insured to repair their home. The Insured has fully complied with all applicable Policy provisions requiring cooperation with the?investigation;?however, Universal has unequivocally failed to properly adjust this Claim, as further elaborated above. Rather than paying the actual damages and/or trying to settle with the Insured, Universal has continued its pre-suit failures to act in good faith into litigation by delaying the prompt resolution of the claim. Universal has not attempted, in good faith, to settle this claim when, under the circumstances, it could and should have done so had it acted fairly and honestly toward the policyholder and with due regard to the policyholder's interests.? Rather, Universal has acted with only its own profit and shareholders in mind. As a direct consequence of Universal’s failure to adjust this Loss in good faith and make any supplemental payment, the Insured continues to be without adequate compensation for the damages sustained at the Insured's Property more than a year ago and has been forced to continue to live in a damaged home. By stating the above detailed?facts,?it is clear that Universal has violated the following Florida statutes:? • 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 Insureds and with due regard for their interest. • 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)(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)(i) Unfair claim settlement practices To date, Universal has in bad faith failed to provide sufficient coverage under the Policy to the Insured. The Insured is without the funds to replace her damaged roof and bring it back to its pre-loss condition. As a direct result of Universal’s failure to pay the Claim and breach of the Florida Statutes, the Insured was forced to seek the?help of licensed professionals to assist her, including legal counsel.?Due to the amount of time that has passed since the date of loss and the information discussed above, there is irrefutable evidence that Universal knowingly and intentionally, and in bad faith delayed the settlement process in order to further disadvantage the Insured. The financial detriment caused to the Insured is a direct result of Universal’s reckless treatment of the claims process. The Insured submitted all documents requested in a timely fashion, made their property available for inspection immediately after the discovery of the loss, submitted an estimate, and satisfied all requests. However, Universal failed at every step of the process to adequately establish or identify the basis of its gross mismanagement of the claim.? Upon information and belief, the aforementioned actions complained of, among others, were made by Universal so often?as to constitute a general business practice, evidencing a motive to enhance Universal’s profits, and designed to cause a detrimental effect to its policyholders. The above clearly depicts that Universal adjusted this claim in bad faith, continue to act in bad faith towards its Insured, and that Universal is in direct violation of Unfair Claims Practices.?? This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should Universal fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, Universal must: (1) Immediately tender all proceeds due and owing to the Insured that are fairly owed to the Insured under the insurance policy that would reasonably compensate the Insured in order to put the loss property back to its pre-loss condition in the amount of $50,340; (2) Immediately afford coverage for the repairs to the subject property necessary to put the property back into its pre-loss condition (3) Agree to reimburse the Insured's reasonable attorneys’ fees and costs for having to become involved to resolve the claim; and (4) Agree to reimburse the Insured for interest on the amount of benefits that was found to be?due and owing to the Insured, relating back to the date of loss.
Comments
User Id Date Added Comment
jr0405@universalproperty.com 01-15-2025 January 15, 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.: 794233 Filing Date: 11/26/2024 Complainant(s): Kevin Roberts Insured(s): Kevin Roberts Policy No.: 1501-2202-2284 Claim No.: FL23-0137781 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, Hope Platt, on behalf of Complainant, Kevin Roberts (also referenced as “Insured”). 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 it violated these or any statutes, Florida law, or policy provisions regarding the adjudication of this matter. With that said, Universal asserts the Notice fails to comply with the specific notice and information requirements as set forth in Civil Remedy Notice of Insurer Violation document provisions, Sec. 624.155, Fla. Stat. and Florida law. The Notice is deficient as a matter of law as it fails to comply with Sec. 624.155, Fla. Stat. 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 Sec. 624.155(3)(b), Fla. Stat., 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...; and 5. a statement that the Notice is given to perfect the right to pursue the civil remedy authorized by this section. Moreover, the Florida Department of Financial Services (“DFS”) created form DFS-10-363, which sets out fifteen (15) requirements that the Complainant(s) must respond to with specificity. The Florida Supreme Court holds that Sec. 624.155, Fla. Stat. “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, regarding 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 Complainant provides three (3) reasons for submitting the Notice: “Claim Denial,” “Claim Delay,” and “Unsatisfactory Settlement Offer.” However, the Complainant’s allegations regarding these “Reasons for Notice” have no factual support anywhere in the Notice. The Notice contains boilerplate, conclusory and inaccurate statements without specifying facts to support the same. For example, the Notice states “Universal did not hire a roofer or engineer to inspect the home and to determine the cause of the damage, they merely relied on observations by an unlicensed Field Adjuster to form the basis of their denial.” The Complainant fail to provide any facts to support this conclusory allegation. As an additional example, the Notice states, “Universal has not attempted, in good faith, to settle this claim when, under the circumstances, it could and should have done so had it acted fairly and honestly toward the policyholder and with due regard to the policyholder's interests.? Rather, Universal has acted with only its own profit and shareholders in mind.” The Complainant fails to provide any facts to support these conclusory and speculative allegations. The Complainant also alleges “[u]pon information and belief, the aforementioned actions complained of, among others, were made by Universal so often?as to constitute a general business practice, evidencing a motive to enhance Universal’s profits, and designed to cause a detrimental effect to its policyholders.” The Notice once again does not specify any facts to support this speculative and conclusory statement. The Complainant is required to provide with specificity the facts and circumstances giving rise to the alleged violation strictly related to Complainant’s allegations, not conjecture or speculation of what may be the carrier’s business practices. It is evident that the statement of facts falls short of the specificity required by Sec. 624.155, Fla. Stat. As a result, the Complainant fails to comply with Sec. 624.155(3)(b)(2), Fla. Stat. 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 the requirements of Sec. 624.155, Fla. Stat., 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 necessary specificity as required by Sec. 624.155, Fla. Stat. Here, the Notice states “BRET BLANCHFIELD.” Aside from identifying Mr. Blanchfield as the field adjuster, the Complainant fails to specify what, if anything, Mr. Blanchfield is knowledgeable about and/or what, if anything, Mr. Blanchfield did or failed to do as it relates to the claim at issue. Therefore, the Notice does not have the requisite specificity as to what, if anything, this individual has knowledge of and/or how the individual relates to any allegation in the Notice. The failure to provide the requisite specificity precludes Universal from taking any corrective action and potentially curing any purported allegation. Accordingly, the Notice is insufficient as a matter of law. Third, the Notice fails to satisfy Fla. Statute § 624.155(3)(b)(4) in that it fails to reference any specific policy language relevant to any alleged violation. Instead, the Notice only references various policy provisions and policy section titles but fails to specify any facts regarding how those provisions or sections were violated. The Complainant provides no guidance or explanation such that it is unclear what policy language applies to any alleged violation and Universal is left to wonder what policy provisions Complainant believes were allegedly violated or breached and why. General, vague, or overbroad references to policy provisions and policy section titles do not satisfy the specificity required by Section 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). Lastly, 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). Section 624.155, Florida Statutes, however, 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 insured. See Talat, 753 So. 2d at 1281. The Notice demands among other things, that to cure the alleged defects, Universal must “[a]gree to reimburse the Insured’s reasonable attorneys’ fees and costs…” Thus, the Notice is deficient as it does not provide Universal 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. Notably, Universal asserts that by the Insured initiating litigation before serving the Notice prejudiced Universal’s ability to cure any purported allegation in the Notice as there is no actual cure period. In summation, the Complainant fails to respond to each of the fields set forth on the DFS Form with the requisite specificity as stated herein, including but not limited to, failing to list all named policyholders, failing to properly identify the person or persons representing the insurer who are most responsible for/knowledgeable of the facts giving rise to the allegations, failing to provide specific policy language relevant to any alleged violation, failing to sufficiently allege facts and circumstances giving rise to any violation, and failing to provide Universal with an opportunity to cure the Notice without paying extra-contractual benefits which are not required to cure a Civil Remedy Notice. Therefore, the Notice is legally deficient and fails to satisfy the condition precedent to filing a bad faith action. See Julien, 311 So. 3d 875 (Fla. 4th DCA 2021). Accordingly, the Notice is deficient as a matter of law. Nonetheless, and without waiving the above-referenced deficiencies, the following shall provide the facts and circumstances regarding this claim, which shall demonstrate that Universal did not violate any Policy terms or statutory provisions. On October 20, 2023, Universal was notified by the Insured, Kevin Roberts, that the insured location was damaged on October 13, 2023. Universal inspected the property and documented any visible damage. Pursuant to the terms of the Policy, Universal advised the named Insureds that there was no available coverage for the claim. Thereafter, on July 17, 2024, the named Insureds initiated litigation against Universal in the Circuit Court in and for Nassau County under Case No. 24CA000217. Thus, at the time the Notice was filed, the parties were and continue to litigate their dispute to determine what, if any, available coverage exists under the terms of the Policy. At no time has Universal breached any duty to its named Insureds. An Insurer is not required to pay whatever amount its 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 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 adjudication 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 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