Civil Remedy Notice of Insurer Violations
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Filing Number:     794244
Filing Accepted:  11/26/2024
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Complainant
Last/Business Name *  
MARCIANO   First Name   KEN
Street Address * 2703 HILL STREET
City, State Zip * NEW SMYRNA BEACH, FL 32169
Email Address * PLEADINGS@HGWLEGAL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   MARCIANO   First Name   KEN
Policy # * 1504-2000-5306 Claim #* FL22-0144107-A322
Attorney
Attorney is Applicable
Last Name* WOODWARD First Name * HEW Initial
Street Address* PO BOX 140312
City, State Zip* ORLANDO , FL 32814
Email Address * HEW@HGWLEGAL.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):* RYAN WACKER
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
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)(2) Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
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)(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.
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.
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)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
626.9541(1)(i)(4) Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
626.9541(1)(i)(3)(j) Altering or amending an insurance adjuster’s report without: (I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and (II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or (III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change;
* 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 SUBJECT INSURANCE POLICY PROVIDES COVERAGE FOR DIRECT PHYSICAL LOSS TO KEN MARCIANO’S PROPERTY. MR. MARCIANO SUBMITTED A CLAIM FOR WINDSTORM AND ASSOCIATED WATER DAMAGE TO THE INSURED PROPERTY THAT OCCURRED DURING THE EFFECTIVE POLICY PERIOD. THE LOSS IS NOT EXCLUDED UNDER THE TERMS AND CONDITIONS OF THE POLICY. THE INSURER HAS FAILED TO ISSUE PAYMENT PURSUANT TO THE LOSS SETTLEMENT PROVISIONS OF THE POLICY. COVERED CAUSE OF LOSS: SPECIAL INCLUDING THEFT WINDSTORM OR HAIL: COVERED DEDUCTIBLE HURRICANE DEDUCTIBLE: 3% PER CALENDAR YEAR COVERAGE A - DWELLING $504,925 DWELLING STRUCTURE COVERAGE REPLACEMENT COST COVERAGE B - OTHER STRUCTURE $117,993 OTHER STRUCTURES COVERAGE REPLACEMENT COST COVERAGE C - PERSONAL PROPERTY $252,463 PERSONAL PROPERTY COVERAGE REPLACEMENT COST COVERAGE D - LOSS OF USE $50,493 ADDITIONAL LIVING EXPENSE $50,493 FAIR RENTAL VALUE $100,985 DWELLING REPLACEMENT COST Y PERSONAL PROPERTY REPLACEMENT COST Y HOMEOWNERS 8 MODIFIED COVERAGE FORM REPLACEMENT COST LOSS SETTLEMENT ENDORSEMENT PERSONAL PROPERTY REPLACEMENT COST VALUATION - BUILDING REPLACEMENT COST VALUE VALUATION - ROOFS REPLACEMENT COST VALUE ORDINANCE OR LAW INCLUDED CONDOMINIUM ASSOCIATION COVERAGE FORM A. COVERAGE WE WILL PAY FOR DIRECT PHYSICAL LOSS OR DAMAGE TO COVERED PROPERTY AT THE PREMISES DESCRIBED IN THE DECLARATIONS CAUSED BY OR RESULTING FROM ANY COVERED CAUSE OF LOSS. 3. COVERED CAUSES OF LOSS SEE APPLICABLE CAUSES OF LOSS FORM AS SHOWN IN THE DECLARATIONS. CAUSES OF LOSS – SPECIAL FORM A.COVERED CAUSES OF LOSS WHEN SPECIAL IS SHOWN IN THE DECLARATIONS, COVERED CAUSES OF LOSS MEANS RISKS OF DIRECT PHYSICAL LOSS UNLESS THE LOSS IS: 1.EXCLUDED IN SECTION B., EXCLUSIONS; OR 2.LIMITED IN SECTION C., LIMITATIONS; THAT FOLLOW. ORDINANCE OR LAW COVERAGE D. COVERAGE 1.COVERAGE A – COVERAGE FOR LOSS TO THE UNDAMAGED PORTION OF THE BUILDING 2.COVERAGE B – DEMOLITION COST COVERAGE 3.COVERAGE C – INCREASED COST OF CONSTRUCTION COVERAGE ORDINANCE OR LAW COVERAGE SCHEDULE PROPERTY ENHANCEMENT ENDORSEMENT DEBRIS REMOVAL…$50,000 WIND DRIVEN PRECIPITATION…$250,000 FUNGUS, WET ROT, DRY ROT AND BACTERIA…$50,000 G. OPTIONAL COVERAGES 1. AGREED VALUE 2. INFLATION GUARD 3. REPLACEMENT COST A. REPLACEMENT COST (WITHOUT DEDUCTION FOR DEPRECIATION) REPLACES ACTUAL CASH VALUE IN THE LOSS CONDITION, VALUATION, OF THIS COVERAGE FORM. A. LOSS BY WINDSTORM DURING A HURRICANE WITH RESPECT TO PARAGRAPHS B. AND C. BELOW, COVERAGE FOR LOSS CAUSED BY THE PERIL OF WINDSTORM DURING A HURRICANE WHICH OCCURS ANYWHERE IN THE STATE OF FLORIDA INCLUDES LOSS TO: 1. THE INSIDE OF A BUILDING; OR 2. THE PROPERTY CONTAINED IN A BUILDING CAUSED BY: A. RAIN; B. SNOW; C. SLEET; D. HAIL; E. SAND; OR F. DUST; IF THE DIRECT FORCE OF THE WINDSTORM DAMAGES THE BUILDING, CAUSING AN OPENING IN A ROOF OR WALL AND THE RAIN, SNOW, SLEET, HAIL, SAND OR DUST ENTERS THROUGH THIS OPENING. LIBERALIZATION CLAUSE…IF WE ADOPT ANY REVISION THAT WOULD BROADEN THE COVERAGE UNDER THIS COVERAGE PART WITHOUT ADDITIONAL PREMIUM WITHIN 45 DAYS PRIOR TO OR DURING THE POLICY PERIOD, THE BROADENED COVERAGE WILL IMMEDIATELY APPLY TO THIS COVERAGE PART. LOSS PAYMENT…WE WILL PAY FOR COVERED LOSS OR DAMAGE UPON THE EARLIEST OF THE FOLLOWING: (1) WITHIN 20 DAYS AFTER WE RECEIVE THE SWORN PROOF OF LOSS AND REACH WRITTEN AGREEMENT WITH YOU; (2) WITHIN 30 DAYS AFTER WE RECEIVE THE SWORN PROOF OF LOSS AND: - (A) THERE IS AN ENTRY OF A FINAL JUDGMENT; OR - (B) THERE IS A FILING OF AN APPRAISAL AWARD WITH US; OR (3) WITHIN 90 DAYS OF RECEIVING NOTICE OF AN INITIAL, "REOPENED," OR "SUPPLEMENTAL CLAIM," UNLESS WE DENY THE CLAIM DURING THAT TIME OR FACTORS BEYOND OUR CONTROL REASONABLY PREVENT SUCH PAYMENT. IF A PORTION OF THE CLAIM IS DENIED, THEN THE 90-DAY TIME PERIOD FOR PAYMENT OF CLAIM RELATES TO THE PORTION OF THE CLAIM THAT IS NOT DENIED. ALL OF THE PROVISIONS IN THE SUBJECT INSURANCE POLICY ARE DICTATED BY THE FOLLOWING FLORIDA STATUTES: § 627.4025 (“RESIDENTIAL COVERAGE AND HURRICANE COVERAGE DEFINED”); § 627.404 (“INSURABLE INTEREST, PERSONAL INSURANCE”); § 627.405 (“INSURABLE INTEREST”); § 627.4091 (“SPECIFIC REASONS FOR DENIAL, CANCELLATION, OR NONRENEWAL”); § 627.40951 (“STANDARD PERSONAL LINES RESIDENTIAL INSURANCE POLICY”); § 627.410 (“FILING, APPROVAL OF FORMS”); § 627.412 (“STANDARD PROVISIONS, IN GENERAL”); § 627.413 (“CONTENTS OF POLICIES, IN GENERAL”); § IDENTIFICATION”); § 627.4131 (“TELEPHONE NUMBER REQUIRED”); § 627.4133 (“NOTICE OF CANCELLATION, NONRENEWAL, OR RENEWAL PREMIUM”); § 627.4135 (“CASUALTY INSURANCE CONTRACTS SUBJECT TO GENERAL PROVISIONS FOR INSURANCE CONTRACTS”); § 627.4143 (“OUTLINE OF COVERAGE”); § 627.4145 (“READABLE LANGUAGE IN INSURANCE POLICIES”); § 627.418 (“VALIDITY OF NONCOMPLYING CONTRACTS”); § 627.419 (“CONSTRUCTION OF POLICIES”); § 627.420 (“BINDERS”); § 627.421 (“DELIVERY OF POLICY”); § 627.425 (“FORMS FOR PROOF OF LOSS TO BE FURNISHED”); § 627.426 (“CLAIMS ADMINISTRATION”); § 627.4265 (“PAYMENT OF SETTLEMENT”); § 627.428 (“ATTORNEY'S FEE”); § 627.442 (“INSURANCE CONTRACTS”); § 627.7011 (“HOMEOWNERS' POLICIES, OFFER OF REPLACEMENT COST COVERAGE AND LAW AND ORDINANCE COVERAGE”); § 627.7015 (“ALTERNATIVE PROCEDURE FOR RESOLUTION OF DISPUTED PROPERTY INSURANCE CLAIMS”); § 627.7016 (“INSURER CONTRACTS WITH BUILDING CONTRACTORS”); § 627.7019 (“STANDARDIZATION OF REQUIREMENTS APPLICABLE TO INSURERS AFTER NATURAL DISASTERS”); § 627.702 (“VALUED POLICY LAW”); § 627.7061 (“COVERAGE INQUIRIES”); § 627.707 (“STANDARDS FOR INVESTIGATION OF SINKHOLE CLAIMS BY INSURERS. NONRENEWALS”); § 627.7072 (“TESTING STANDARDS FOR SINKHOLES”); § 627.7073 (“SINKHOLE REPORTS”); § 627.712 (“RESIDENTIAL WINDSTORM COVERAGE REQUIRED, AVAILABILITY OF EXCLUSIONS FOR WINDSTORM OR CONTENTS”).
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

UNIVERSAL INSURANCE COMPANY (“UNIVERSAL” OR “INSURER”) BREACHED ITS STATUTORY AND CONTRACTUAL DUTIES DURING ITS ADJUSTMENT OF THE INSURANCE CLAIM REPORTED BY KEN MARCIANO (THE “INSURED” OR “INSUREDS”) IN CONNECTION WITH SEVERE DAMAGE TO THE SCHEDULED LOCATIONS IDENTIFIED ABOVE ("PROPERTIES" OR “INSURED PROPERTY”) CAUSED BY WINDSTORM AND WATER INTRUSION OCCURING ON OR ABOUT SEPTEMBER 28, 2022 (“LOSS”). THE SUBJECT INSURANCE POLICY PROVIDES COVERAGE FOR THIS LOSS. REGENCY GARDENS SUBMITTED A VALID CLAIM FOR WINDSTORM AND WATER DAMAGE TO THE PROPERTIES THAT OCCURRED DURING THE EFFECTIVE POLICY PERIOD. THE LOSS IS NOT EXCLUDED UNDER THE TERMS AND CONDITIONS OF THE POLICY. UNIVERSAL HAS FAILED TO ISSUE PAYMENT PURSUANT TO THE LOSS SETTLEMENT PROVISIONS OF THE POLICY. AS SET FORTH IN GREATER DETAIL BELOW, UNIVERSAL ALSO VIOLATED THE MINIMUM STATUTORY AND CONTRACTUAL DUTIES THAT IT OWED TO THE INSURED, INCLUDING BUT NOT LIMITED TO THE FOLLOWING WAYS: FAILING TO INVESTIGATE THE CLAIMED DAMAGES TO THE INSURED PROPERTY WITH OBJECTIVE AND QUALIFIED EXPERTS AND ADJUSTERS; FAILING TO ADJUST THE CLAIMED DAMAGES AND EXPENSES IN AN OBJECTIVE AND REASONABLE MANNER; REFUSING TO ACKNOWLEDGE AND MEANINGFULLY RESPOND TO COMMUNICATIONS; REFUSING TO COMMUNICATE REASONABLE REQUESTS FOR DOCUMENTS AND INFORMATION; REFUSING TO PAY ALL UNDISPUTED AMOUNTS OWED; REFUSING TO PROVIDE REPORTS AND INFORMATION THAT WOULD ENABLE THE INSURED TO MEANINGFULLY EVALUATE THE NATURE AND SCOPE OF DAMAGE; REFUSING TO PAY INSURANCE BENEFITS TO REPAIR ALL OF THE DAMAGED PROPERTY COVERED BY THE INSURANCE POLICY, WHEN THE OBLIGATION TO ISSUE SUCH PAYMENT WAS APPARENT. UNIVERSAL ISSUED AN INSURANCE POLICY PROVIDING COVERAGE AGAINST WINDSTORM AND HURRICANE, WATERR DAMAGE AND MOLD DAMAGE TO THE INSURED. ACCORDINGLY, THE INSURANCE POLICY MUST BE READ TO PROVIDE COVERAGE FOR ANY AND ALL DAMAGE TO THE INSURED PROPERTY THAT IS NOT CLEARLY AND UNAMBIGUOUSLY EXCLUDED UNDER THE INSURANCE POLICY. MOREOVER, THE PROVISIONS OF THE POLICY PROVIDING COVERAGE ARE TO BE CONSTRUED BROADLY, WHILE THE EXCLUSIONARY LANGUAGE OF THE INSURANCE POLICY ARE TO BE READ NARROWLY AND STRICTLY. UNIVERSAL REFUSES TO ACKNOWLEDGE OR ADMIT THE BASIC TENETS OF THE POLICY THAT IS SOLD TO THE INSURED. IN FACT, IT WAS UNIVERSAL'S OBLIGATION TO AFFIRMATIVELY POINT OUT POLICY BENEFITS AVAILABLE TO ITS INSUREDS, DESPITE THE FACT THAT THE INSURED OR THE INSURED’S REPRESENTATIVE MAY NOT HAVE BEEN AWARE OF SUCH BENEFITS. THE INSURING AGREEMENT IS INTENDED TO PROVIDE THE INSURED WITH PEACE OF MIND AND THE INSURANCE COMPANY IS EXPECTED TO FACILITATE THAT INTENTION. UNIVERSAL HAS REFUSED TO PAY BENEFITS FOR DAMAGE TO THE INSURED PROPERTY CAUSED BY THE LOSS (AMONG OTHERS). UNIVERSAL HAS NOT PAID FULL REPLACEMENT COST BENEFITS AND HAS ABUSED THE CLAIM INVESTIGATION PROCESS TO EVADE PAYING ALL UNDISPUTED AMOUNTS OWED ON THE INSUREDS’ CLAIM. UNIVERSAL HAS NOT PROVIDED A COMPREHENSIVE REPORT SETTING FORTH THE CAUSE AND ORIGIN OF THE DAMAGES. RATHER, UNIVERSAL HAS PROVIDED ESTIMATES OF THE REPAIR COSTS, BUT HAS REFUSED TO PAY BENEFITS EQUIVALENT TO ITS ESTIMATES. IN FACT, UNIVERSAL REFUSES TO ACKNOWLEDGE OR ADMIT THE BASIC TENANTS OF THE REPLACEMENT COST COVERAGE THAT IS SOLD TO THE INSUREDS. UNDER THESE CIRCUMSTANCES, THE INSURED IS UNABLE TO COMMENCE PERMANENT REPAIRS. AS SET FORTH BELOW, UNIVERSAL’S CONDUCT BEFORE, DURING AND AFTER RECEIVING NOTICE OF THE CLAIM SHOWS THAT IT MADE A PRECONCEIVED DETERMINATION TO STALL, DELAY, UNDERPAY OR DENY ALL OR PART OF THE CLAIM BASED ON SPECULATION AND CONJECTURE, AS OPPOSED TO ADJUSTING THIS CLAIM IN GOOD FAITH AND PAYING THE INSURANCE BENEFITS IT OWES. UNIVERSAL HAS NOT PROVIDED A VALUE TO THE INSURED FOR REPAIRS TO THE PROPERTIES (INCLUDING UPGRADES REQUIRED BY THE BUILDING CODES). UNIVERSAL HAS NOT PAID OR HAS GROSSLY UNDERPAID THE CLAIM FOR DAMAGES SUSTAINED. UNIVERSAL HAS NOT RESPONDED TO THE INSUREDS REQUESTS FOR INFORMATION ABOUT THE CLAIM AND HAS MISLED THE INSURED AS TO REPAIRS. ON OR ABOUT OCTOBER 5, 6, 7 AND 11 2022, THE INSURED (OR HIS REPRESENTATIVES) COMMUNICATED WITH UNIVERSAL (OR HIS REPRESENTATIVES) SUBMITTED A CLAIM INCLUDING PHOTOGRAPHS, AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. THE INSURED REQUESTED A CERTIFIED COPY OF THE POLICY, THE CLAIMS HISTORY, CORRESPONDENCE, ESTIMATES, STATEMENTS OF LOSS, ITEL REPORTS, ENGINEERING REPORTS, CLAIM PAYMENTS, AND INSPECTION REPORTS FROM THE UNDERWRITING FILE, AND A STATEMENT OF ALL COVERAGE LIMITATIONS OR EXCLUSIONS THAT APPLY TO THE LOSS. UNIVERSAL FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT OCTOBER 27, 2022, THE INSURED (OR HIS REPRESENTATIVES) COMMUNICATED WITH UNIVERSAL (OR HIS REPRESENTATIVES) SUBMITTED ADDITIONAL DOCUMENTS AND PHOTOGRAPHS, INCLUDING AN INDOOR AIR QUALITY REPORT SHOWING THAT HAZARDOUS STORM WATER HAD INFILTRATED THE CEILINGS AND MOST OF THE EXTERIOR WALLS OF THE HOME, AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. UNIVERSAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THESE CLAIM SUBMISSIONS, FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT OCTOBER 26, 2022, AND NOVEMBRER 1, 2022, THE INSURED (OR HIS REPRESENTATIVES) AND UNIVERSAL (OR HIS REPRESENTATIVES) INSPECTED THE DAMAGED PROPERTY. DURING THE INSPECTION, THE INSURED REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. DURING THE INSPECTION UNIVERSAL ACKNOWLEDGED SEVERE DAMAGE TO ALL OF THE BUILDINGS. AT THAT TIME, UNIVERSAL DEVELOPED PRE-CONCIEVED CONTENTIONS AND CONCLUSIONS. HOWEVER, UNIVERSAL HAD NOT RETAINED ANY EXPERTS TO DETERMINE THE CAUSE AND ORIGIN OF THE DAMAGE, AND IT FAILED OR REFUSED TO ADEQUATELY RESPOND TO THE INSURED’S REQUESTS FOR DOCUMENTS AND INFORMATION, REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT NOVEMBER 8, 11, 14, 15, AND 22, 2022, THE INSURED (OR HIS REPRESENTATIVES) COMMUNICATED WITH UNIVERSAL (OR HIS REPRESENTATIVES) AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. UNIVERSAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THESE CLAIM SUBMISSIONS, FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT DECEMBER 5, 2022, JANUARY 11, 18, FEBRUARY 23, AND MARCH 13, 2023, THE INSURED (OR HIS REPRESENTATIVES) COMMUNICATED WITH UNIVERSAL (OR HIS REPRESENTATIVES) AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. UNIVERSAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THESE CLAIM SUBMISSIONS, FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT APRIL 20, 28, MAY 9, 25 AND 26, 2023, THE INSURED (OR HIS REPRESENTATIVES) COMMUNICATED WITH UNIVERSAL (OR HIS REPRESENTATIVES) AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. UNIVERSAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THESE CLAIM SUBMISSIONS, FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT JUNE 9, 20, AND 23, 2023, THE INSURED (OR HIS REPRESENTATIVES) COMMUNICATED WITH UNIVERSAL (OR HIS REPRESENTATIVES) AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. UNIVERSAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THESE CLAIM SUBMISSIONS, FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT JUNE 9, 20 AND 23, 2023, THE INSURED (OR HIS REPRESENTATIVES) COMMUNICATED WITH UNIVERSAL (OR HIS REPRESENTATIVES) AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. ON OR ABOUT JUNE 27, 2023, THE INSURED (OR HIS REPRESENTATIVE) SUBMITTED A SWORN STATEMENT IN PROOF LOSS CLAIMING AT LEAST $925,786 WITH SUPPORTING DOCUMENTATION. HOWEVER, UNIVERSAL REFUSED TO TIMELY ACKNOWLEDGE THE CLAIM SUBMISSIONS, AND FAILED TO ISSUE PAYMENT FOR THE AMOUNT OF THE PROOF OF LOSS. NEITHER FLORIDA LAW NOR THE SUBJECT INSURANCE POLICY PERMITS UNIVERSAL TO DISPOSE OF A CLAIM IN SUCH A MANNER. MOREOVER, UNIVERSAL ADVISED THAT CERTAIN DAMAGES WERE EXCLUDED, BUT PROVIDED NO EVIDENCE IN SUPPORT OF ITS PRE-CONCIEVED CONTENTIONS AND CONCLUSIONS. HOWEVER, UNIVERSAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THE INSURED’S REQUESTS FOR DOCUMENTS AND INFORMATION, REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT JULY 11, 2023, THE INSURED (OR HIS REPRESENTATIVES) COMMUNICATED WITH UNIVERSAL (OR HIS REPRESENTATIVES) AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. UNIVERSAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THESE CLAIM SUBMISSIONS, FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT JULY 18, 2023, THE INSURED (OR HIS REPRESENTATIVES) AND UNIVERSAL (OR HIS REPRESENTATIVES) INSPECTED THE DAMAGED PROPERTY. DURING THE INSPECTION, THE INSURED REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. DURING THE INSPECTION UNIVERSAL ACKNOWLEDGED SEVERE DAMAGE TO BOTH OF THE BUILDINGS. AT THAT TIME, UNIVERSAL DEVELOPED PRE-CONCIEVED CONTENTIONS AND CONCLUSIONS. HOWEVER, UNIVERSAL HAD NOT RETAINED ANY EXPERTS TO DETERMINE THE CAUSE AND ORIGIN OF THE DAMAGE, AND IT FAILED OR REFUSED TO ADEQUATELY RESPOND TO THE INSURED’S REQUESTS FOR DOCUMENTS AND INFORMATION, REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. AT THE CONCLUSION OF THE INSPECTION, UNIVERSAL REQUESTED THAT THE INSURED PROVIDE WORK PRODUCT PRESUMABLY TO ASSIST IN THEIR ADJUSTMENT OF THE CLAIM. ON OR ABOUT AUGUST 9, 2023, AND SEPTEMBER 12, 2023, THE INSURED (OR HIS REPRESENTATIVES) COMMUNICATED WITH UNIVERSAL (OR HIS REPRESENTATIVES) AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. UNIVERSAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THESE CLAIM SUBMISSIONS, FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT OCTOBER 2, 13 AND 25, 2023, THE INSURED (OR HIS REPRESENTATIVES) COMMUNICATED WITH UNIVERSAL (OR HIS REPRESENTATIVES), SUBMITTED ADDITIONAL ESTIMATES, INVOICES AND REPORTS, AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. UNIVERSAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THESE CLAIM SUBMISSIONS, FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT NOVEMBER 9, 13, AND 20, 2023, THE INSURED (OR HIS REPRESENTATIVES) COMMUNICATED WITH UNIVERSAL (OR HIS REPRESENTATIVES) AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. UNIVERSAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THESE CLAIM SUBMISSIONS, FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. ON OR ABOUT NOVEMBER 7, 2023, THE INSURED (OR HIS REPRESENTATIVES) COMMUNICATED WITH UNIVERSAL (OR HIS REPRESENTATIVES) AND REQUESTED BENEFITS, INCLUDING BUT NOT LIMITED TO THE PAYMENT OF ALL UNDISPUTED AMOUNTS, REIMBURSEMENT FOR TEMPORARY REPAIRS, AND FURTHER SOUGHT CLARIFICATION AND INFORMATION TO EFFECTUATE PAYMENT OF BENEFITS. UNIVERSAL FAILED OR REFUSED TO ADEQUATELY RESPOND TO THESE CLAIM SUBMISSIONS, FAILED OR REFUSED TO PAY ALL UNDISPUTED AMOUNTS OWED, FAILED OR REFUSED TO REIMBURSE THE COSTS OF TEMPORARY REPAIRS, AND FAILED OR REFUSED TO PROVIDE ADDITIONAL INFORMATION OR INSTRUCTION TO ENSURE THE TIMELY PAYMENT OF BENEFITS. IN LIGHT OF UNIVERSAL’S FAIULRE OR REFUSAL TO ADJUST THE CLAIM IN GOOD FAITH, THE INSURED ENGAGED LEGAL COUNSEL AND FILED A NOTICE OF INTENT TO INITIATE LITIGATION (“NOITL”) REQUESTING PAYMENT IN THE AMOUNT OF AT LEAST $905,000 ON OR ABOUT DECEMBER 12, 2024 (APPROXIMATELY 430-DAYS AFTER FIRST NOTICE OF LOSS). THE INSURED FURTHER REQUESTED IMMEDIATE PAYMENT OF ALL UNDISPUTED AMOUNTS OWED ON THE CLAIM, AS WELL AS A CERTIFIED COPY OF THE SUBJECT AND THE “LOSS RUN STATEMENT” PURSUANT TO FLORIDA STATUTE § 627.444. DESPITE HAVING IN ITS POSSESSION SUFFICIENT INFORMATION, UNIVERSAL DID NOT MAKE AN OFFER IN RESPONSE TO THE AMOUNT DEMANDED BY THE INSURED IN THE NOITL. AFTER RECEIVING THE NOITL, UNIVERSAL DID NOT REINSPECT THE LOSS, DID NOT MAKE ANY SETTLEMENT OFFERS AND REFUSED TO PRODUCE THE REQUESTED DOCUMENTATION. UNIVERSAL KNEW OR SHOULD HAVE KNOWN THAT ITS DELAYS AND REFUSAL TO ISSUE PAYMENT WOULD CAUSE UNDUE FINANCIAL DISTRESS. THESE TACTICS WERE PREMEDITATED WITH THE INTENT TO COERCE AN UNFAIR SETTLEMENT WITH THE INSURED. RATHER THAN ADJUSTING THE CLAIM IN GOOD FAITH, UNIVERSAL STALLED AND DELAYED, IMPROPERLY UNDERVALUED THE CLAIM, MISREPRESENTED AND MISLED REGENCY GARDENS, AND MADE LOW-BALL PAYMENTS ON THE CLAIM. DESPITE CLEAR EVIDENCE THAT THE CLAIMED DAMAGES WERE COVERED BY THE SUBJECT INSURANCE POLICY, AND ITS OWN CONSULTANT’S ESTIMATES SHOWING THAT APPROXIMATELY $700,000 MORE WAS OWED ON THE CLAIM, UNIVERSAL UNDERTOOK AN EXTENDED ADJUSTMENT PROCESS IN BAD FAITH, AND ULTIMATELY PAID A SMALL FRACTION OF THE BENEFITS OWED TO THE INSURED. THE INSURER’S FAILURE TO PROPERLY PAY ALL AMOUNTS DUE AND OWING UNDER THE APPROPRIATE COVERAGES HAS LED TO NON-PAYMENT OF REGENCY GARDENS’ CLAIM, IN ADDITION TO SUBSTANTIAL DELAYS. IT IS BELIEVED THAT THE INSURER’S ACTIONS DESCRIBED HEREIN ARE A GENERAL BUSINESS PRACTICE OF THE COMPANY. TO CURE THE DEFECTS OUTLINED IN THE CIVIL REMEDY NOTICE, THE INSURER MUST PROVIDE COVERAGE FOR THE COSTS TO COMPLETELY REPAIR THE PROPERTIES AND BRING THE PROPERTIES UP TO THE CURRENT BUILDING CODE (ORDINANCE AND LAW), AND TENDER PAYMENT FOR ALL CONTRACTUAL DAMAGES OWED. THE UNDERLYING CONCEPT OF INSURANCE IS THAT THE INSURER’S GRANTING OF TIMELY AND PROMPT INDEMNIFICATION OR SECURITY AGAINST A CONTINGENT LOSS PLACES THE INSURED BACK TO A PRE-LOSS CONDITION IN A TIMELY MANNER. HOWEVER, UNIVERSAL'S CLAIMS REPRESENTATIVES AND ADJUSTER(S) DID NOT PERFORM AN ADEQUATE OR REASONABLE INVESTIGATION OF THE DAMAGES, AND UNIVERSAL HAS PROVIDED NO REASONABLE EXPLANATION AS TO WHY PAYMENT FOR ALL OF THE DAMAGED PROPERTY WAS NOT ISSUED IN A TIMELY MANNER. UNIVERSAL HAS VIOLATED THE FUNDAMENTAL RULE REQUIRING IT TO IMMEDIATELY PAY BENEFITS OWED ON A CLAIM, AND PROHIBITING IT FROM WITHHOLDING UNDISPUTED AMOUNTS OWED IN ORDER TO EFFECTUATE A BETTER SETTLEMENT OF THE REMAINDER OF THE CLAIM. UNIVERSAL DENIED INSURANCE BENEFITS BASED UPON INSUFFICIENT INFORMATION, SPECULATION AND BIASED INFORMATION. THE FAILURE TO FAIRLY AND REASONABLY INVESTIGATE A CLAIM DOES NOT PERMIT UNIVERSAL TO DENY THE CLAIM, OR REFUSE BENEFITS, DUE TO LACK OF INFORMATION OR ONE-SIDED INFORMATION. IT CANNOT JUST FOCUS ON FACTS THAT WOULD SUPPORT DENYING A CLAIM. UNIVERSAL IGNORED EVIDENCE WHICH ESTABLISHES INSURANCE COVERAGE AND TRIGGERS THE PAYMENT OF INSURANCE BENEFITS. UNIVERSAL WAS REQUIRED TO ACKNOWLEDGE THE INSURED’S CLAIM SUBMISSIONS AND, AT A MINIMUM, ADVISE THE INSURED THAT IT DISAGREED WITH THEIR CLAIM SUBMISSIONS BY IDENTIFYING THE AREAS OF DISAGREEMENT AND CONDUCTING AN ADDITIONAL INVESTIGATION OF THE CLAIM. IN FACT, UNIVERSAL CANNOT IGNORE AN INSURED’S CLAIM SUBMISSIONS IN SUCH A MANNER. BY IGNORING THE INSURED’S CLAIM SUBMISSIONS, IT IS CLEAR THAT UNIVERSAL MADE A PRECONCEIVED DETERMINATION TO UNDERPAY OR DENY ALL OR PART OF THE CLAIM BASED ON SPECULATION AND CONJECTURE, AND USED PREDICTABLE OR BIASED EXPERTS AND/OR ADJUSTERS TO DEVELOP DEFENSES TO THE CLAIM, AS OPPOSED TO ADJUSTING THIS CLAIM IN GOOD FAITH AND PAYING THE INSURED INSURANCE THE BENEFITS IT OWES. UNIVERSAL’S BAD FAITH CONDUCT HAS EXACERBATED THE INSURED’S DAMAGES. DESPITE THE REQUESTS AND SUBMISSIONS MADE BY OR ON BEHALF OF THE INSURED, UNIVERSAL FAILED AND REFUSED TO PROVIDE ANY MEANINGFUL RESPONSE TO THEIR CLAIM SUBMISSIONS. RATHER THAN REVIEWING THE REPORTS, ESTIMATES AND/OR INVOICES PROVIDED, AND PAYING THE REQUESTED INSURANCE BENEFITS, UNIVERSAL EITHER COMPLETELY IGNORED OR TOTALLY DISMISSED THESE CLAIM SUBMISSIONS. PURSUANT TO THE TERMS, CONDITIONS AND COVERAGES OF THE SUBJECT INSURANCE POLICY, UNIVERSAL WAS OBLIGATED TO INVESTIGATE AND INDEMNIFY THE INSURED IN FULL. YET, AFTER RECEIVING DETAILED INVOICES AND/OR ESTIMATES SUBSTANTIATING THE DAMAGES, UNIVERSAL HAS MADE NO REASONABLE PAYMENTS AND HAS STALLED AND DELAYED PAYMENT ON THE CLAIM. UNIVERSAL WAS OBLIGATED TO CONTINUE ITS ADJUSTMENT OF THE CLAIM AND ISSUE PAYMENTS TO REPAIR THE DAMAGE TO THE PROPERTIES THAT UNIVERSAL BELIEVED TO BE CAUSED BY A COVERED LOSS. AT A MINIMUM, UNIVERSAL SHOULD HAVE PREPARED AND PROVIDED ANOTHER ESTIMATE OF THE COST TO REPAIR ALL OF THE OTHER CLAIMED AREAS OF DAMAGE FALLING OUTSIDE OF THE SCOPE OF COVERED DAMAGE, IF ANY. UNIVERSAL VIOLATED THE MINIMUM STATUTORY REQUIREMENTS OF ALL INSURERS TO PROVIDE PAYMENT OF ALL UNDISPUTED AMOUNTS DUE AND OWING UNDER THE SUBJECT INSURANCE POLICY IN A TIMELY MANNER. UNIVERSAL KNEW AND/OR SHOULD HAVE KNOWN THAT INSURANCE MONIES WERE DUE AND OWING, HOWEVER, UNIVERSAL HAS NOT MADE ANY PAYMENTS TO THE INSURED. UNIVERSAL MADE NO GOOD FAITH ATTEMPT TO ADJUST THE CLAIM PURSUANT TO THE REPLACEMENT COST VALUE COVERAGES OF THE SUBJECT INSURANCE POLICY. UNIVERSAL REFUSED TO ADJUST THE CLAIM BASED UPON THE SAME HIGH QUALITY MATERIALS AND LABOR THAT WAS USED TO BUILD THE PROPERTIES, WITH ALL OF THE ACCOUTERMENTS EXISTING AT THE TIME THE LOSS. UNIVERSAL ALSO FAILED AND REFUSED TO ADJUST THE INSURED'S CLAIM IN A MANNER THAT WOULD ENABLE THEM TO RESTORE THE PROPERTIES TO A PRE-LOSS CONDITION ON A REPLACEMENT COST BASIS, WITH NEW MATERIALS OF LIKE KIND AND QUALITY. IT DID NOT CALCULATE THE COST TO REPAIR OR REPLACE ADJOINING AREAS OF THE PROPERTIES SO THAT BOTH THE REPLACED AREAS AND ADJOINING AREAS OF THE PROPERTIES REASONABLY MATCH IN QUALITY, COLOR AND SIZE. IT DID NOT ESTIMATE THE COST TO REPAIR OR REPLACE ALL PORTIONS OF THE PROPERTIES THAT WOULD BE DAMAGED DURING THE COURSE OF REPAIRS. UNIVERSAL HAS LARGELY IGNORED THE INSURED'S CLAIM SUBMISSIONS. UNIVERSAL HAS ACTED IMPROPERLY AND IN BAD FAITH BY IGNORING OR SUMMARILY DISMISSING THE INSUREDS, AND THEIR CLAIM SUBMISSIONS, WITHOUT CONDUCTING A FAIR AND REASONABLE INVESTIGATION. IN SUM, UNIVERSAL DID NOT INVESTIGATE AND FAIRLY OR REASONABLY INTERPRET THE FACTS SURROUNDING THIS CLAIM. UNIVERSAL HAS FAILED TO ISSUE PAYMENT OF THE UNDISPUTED PORTION OF THE INSURED'S PROPERTY DAMAGE CLAIM WITHIN 90-DAYS, DESPITE THE FACT THAT IT HAD ALL INFORMATION NECESSARY TO CALCULATE THE PAYMENT FOR THE UNDISPUTED PORTION OF THE CLAIM. UNIVERSAL FAILED TO PROMPTLY PAY THE FULL BENEFITS OWED TO THE POLICYHOLDER. THE REASONS FOR THIS MAY BE ATTRIBUTED TO INADEQUATE STAFFING, IMPROPER TRAINING, SUPERVISION, AND/OR FAILURE OF ADJUSTERS AND CLAIMS SUPERVISORS TO PROMPTLY AND FAIRLY INVESTIGATE, ADJUST AND PAY FULL BENEFITS AVAILABLE TO ALL BENEFICIARIES. THE INSURER FAILED TO ADOPT PROPER STANDARDS OF INVESTIGATION AND ADJUSTMENT OF LOSSES, OR IS OTHERWISE NOT IMPLEMENTING THOSE STANDARDS BECAUSE FULL PAYMENT AND PROMPT PAYMENT FOR THE LOSS IS NOT OCCURRING. UNIVERSAL HAS FAILED TO CREATE AND IMPLEMENT ADEQUATE GUIDELINES FOR PROPER INVESTIGATION TO EVALUATE CLAIMS HANDLING AND FOR TRAINING AND SUPERVISION OF EMPLOYEES, RESULTING IN STATUTORY VIOLATIONS AS SET FORTH ABOVE. UNIVERSAL HAS FAILED AND/OR REFUSED TO THOROUGHLY, ACCURATELY, AND COMPLETELY INVESTIGATE, EVALUATE AND ISSUE PAYMENT ON THE INSURED'S INSURANCE CLAIM AND DAMAGES. UNIVERSAL HAS FAILED AND/OR REFUSED TO ACKNOWLEDGE AND ACT PROMPTLY UPON COMMUNICATION FROM ITS INSURED (OR THEIR REPRESENTATIVES) WITH RESPECT TO THE INSURANCE CLAIMS. UNIVERSAL HAS FAILED TO PROMPTLY SETTLE THE INSURED'S INSURANCE CLAIMS WHEN THE OBLIGATION TO SETTLE THESE CLAIMS HAD BECOME REASONABLY CLEAR, UNDER AT LEAST ONE PORTION OF THE INSURANCE POLICY’S COVERAGES, IN ORDER TO INFLUENCE THE SETTLEMENTS UNDER OTHER PORTIONS OF THE INSURANCE POLICY COVERAGE. TO DATE, NOTWITHSTANDING THE INSURED'S PLEAS OTHERWISE, UNIVERSAL HAS CONTINUED TO REFUSE TO ACKNOWLEDGE ITS OBLIGATION TO TENDER ALL INSURANCE MONIES DUE AND OWING THE INSURED, OR ASSIST THE INSURED IN THE MITIGATION OF THEIR DAMAGES. THE INSURED WAS THEN, AND IS STILL, FORCED TO EXPEND MONIES TO SUBMIT THE INSURANCE CLAIM, PAY FEES AND COSTS, RETAIN EXPERTS TO INVESTIGATE THE FULL EXTENT AND NATURE OF THE LOSS, AND TO FORCE UNIVERSAL TO HONOR ITS OBLIGATIONS UNDER THE INSURANCE POLICY AND PAY ALL THE INSURANCE PROCEEDS DUE AND OWING THE INSURED. THE INSURED HAS DEMANDED THAT UNIVERSAL ACKNOWLEDGE THE CLAIM SUBMISSIONS, AND ISSUE PAYMENT IN FULL. UNIVERSAL REFUSED AND/OR FAILED TO ACKNOWLEDGE THESE CLAIM SUBMISSIONS, TENDER ALL INSURANCE PROCEEDS OWED TO THE INSURED UPON DEMAND, AND UNREASONABLY WITHHELD PAYMENT TO THE INSURED. UNIVERSAL'S REFUSAL AND/OR FAILURE TO SETTLE THE INSURANCE CLAIM WHEN UNDER ALL CIRCUMSTANCES IT COULD HAVE AND SHOULD HAVE DONE SO HAD IT ACTED FAIRLY AND HONESTLY TOWARDS THE INSURED IS UNREASONABLE, WRONGFUL AND ILLEGAL CONDUCT. IN FACT, UNIVERSAL'S REPRESENTATIVES HAVE MADE MATERIAL MISREPRESENTATIONS TO THE INSURED CONCERNING THE STATUS OF ITS INVESTIGATION AND ADJUSTMENT OF THE CLAIM. UNIVERSAL HAS DONE LITTLE MORE THAN MANUFACTURE REASONS FOR DELAY, COVERAGE DEFENSES AND PURSUE EVIDENTIARY SUPPORT FOR PRE-CONCEIVED AND ILL-CONCEIVED COVERAGE DEFENSES, ALL IN BAD FAITH ON THE PART OF UNIVERSAL. IT IS BELIEVED THAT FUTURE BAD FAITH DISCOVERY MAY REVEAL AN EXTENSIVE HISTORY OF DENIALS (OR UNDERPAYMENTS) OF CLAIMS SIMILAR TO THAT OF THE INSURED(S) AND OTHER INSUREDS ACROSS THE STATE OF FLORIDA, AS THIS CONDUCT APPEARS TO BE A BUSINESS PRACTICE OF THIS INSURER. IN FLORIDA THE WORK OF ADJUSTING INSURANCE CLAIMS ENGAGES THE PUBLIC TRUST. UNIVERSAL BREACHED ITS STATUTORY AND CONTRACTUAL DUTIES AS WELL AS THIS TRUST. TO CURE THE DEFECTS OUTLINED IN THIS CIVIL REMEDY NOTICE, UNIVERSAL MUST: (1) CREATE AND IMPLEMENT ADEQUATE GUIDELINES FOR PROPER INVESTIGATION AND EVALUATION AS TO CLAIMS HANDLING AND FOR THE TRAINING AND SUPERVISION OF EMPLOYEES, AGENTS AND REPRESENTATIVES WHICH WILL AVOID FUTURE STATUTORY VIOLATIONS AS SET FORTH ABOVE TO AVOID THIS FROM OCCURRING IN THE FUTURE. (2) CREATE AND IMPLEMENT ADEQUATE GUIDELINES FOR THE PROPER INVESTIGATION AND EVALUATION OF WINDSTORM AND ASSOCIATED WATER DAMAGE CLAIMS, AND FOR THE TRAINING AND SUPERVISION OF EMPLOYEES, AGENTS AND REPRESENTATIVES WITH REGARD TO THESE CLAIMS TO ENSURE THAT UNIVERSAL'S CLAIMS HANDLING PROCEDURES WITH REGARD TO THESE TYPES OF LOSSES ARE ADEQUATE TO STOP UNFAIR AND WRONGFUL TREATMENT OF INSUREDS. (3) ASSIST THE INSUREDS IN MITIGATING DAMAGES. (4) PROMPTLY AND TIMELY RESPOND TO REQUESTS FOR INFORMATION BY INSURED. (5) ACT FAIRLY AND HONESTLY TOWARDS THE INSUREDS AND WITH DUE REGARD FOR THEIR INTERESTS IN ATTEMPTING TO SETTLE THE INSURED'S CLAIM. (6) IMMEDIATELY TENDER ALL INSURANCE MONIES DUE AND OWING THE INSURED PURSUANT TO THE MOST RECENT ESTIMATES AND PROPERTY INVENTORIES. (7) ACKNOWLEDGE IN WRITING TO THE INSURED THAT UNIVERSAL'S HANDLING OF THIS CLAIM IS AND WAS INSUFFICIENT TO PLACE THE INSURED BACK INTO A PRE-LOSS CONDITION. (8) TAKE ANY OTHER REASONABLE AND NECESSARY MEASURES TO PLACE THE INSURED BACK INTO A PRE-LOSS CONDITION. (9) ACKNOWLEDGE, IN WRITING, ITS SINCERE APOLOGY TO THE INSURED FOR ITS WRONGFUL CLAIMS HANDLING PRACTICES IN THE ADJUSTMENT OF THIS CLAIM. (10) IMMEDIATELY PAY ALL UNDISPUTED AMOUNTS CLAIMED PLUS ADDITIONAL LIVING EXPENSES AND INTEREST (BUT SUBTRACT PRIOR PAYMENTS AND DEDUCTIBLE) WHICH AMOUNT(S) IS/ARE EXCLUSIVE ANY CLAIMS FOR FEES, COSTS, BAD FAITH OR EXTRA-CONTRACTUAL DAMAGES.
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oc1102@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.: 794252 Filing Date: 11/26/2024 Complainant: Ken Marciano Insureds: Ken Marciano Policy No.: 1504-2000-5306 Claim No.: FL22¬¬0161534¬¬A522 Re: DFS File No.: 794250 Filing Date: 11/26/2024 Complainant: Ken Marciano Insureds: Ken Marciano Policy No.: 1504-2000-5306 Claim No.: FL22¬¬0161534¬¬A522 Re: DFS File No.: 794244 Filing Date: 11/26/2024 Complainant: Ken Marciano Insureds: Ken Marciano Policy No.: 1504-2000-5306 Claim No.: FL22-0144107-A322 Re: DFS File No.: 794242 Filing Date: 11/26/2024 Complainant: Ken Marciano Insureds: Ken Marciano Policy No.: 1504-2000-5306 Claim No.: FL22-0144107-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 Notices (“Notices”) filed by attorney, Hew Woodward, on behalf of Complainant, Ken Marciano (also referenced as “Insured.”) As a preliminary matter, attorney Hew Woodward, filed two Notices per claim with the Department of Financial Services. Notices 794252 and 794250, filed for claim FL22¬¬0161534¬-A522 are identical and Notices 794244 and 794242, filed for claim FL22-0144107-A322 are identical. However, filing 2 different Notices, per claim, for the same policyholder, policy or claim is not in accordance with Section 624.155, Florida Statutes or what is required under Department of Financial Services 10-363. Thus, the Notices are non-compliant. The Notices allege violations of Sections 624.155 and 626.9541, Florida Statutes. Universal specifically denies the allegations contained in the Notices. Additionally, Universal denies that it violated these or any statutes, Florida law or policy provisions regarding the claim adjustment of these matters. With that said, Universal asserts that the Notices fail 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 Notices are deficient as a matter of law as they fail 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 Notices “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(s) 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(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 Notices fail to meet the requirements of Section 624.155, Florida Statutes on several grounds. First, the Civil Remedy Notice statute requires the Complainant(s) “pursuant to section 624.155, Florida Statutes, please indicate all statutory provisions alleged to have been violated.” The Notices filed by Complainant in this matter include almost every statutory provision that could be claimed against an insurance company. The Notices, however, fail to specify any facts to support how any of these statutes were violated. Because the Notices fail to specify how, if at all, any of these statutes were violated, none of the Notices comply with Section 624.155, Florida Statutes. The Notices fail to provide Universal with the necessary notice of what needs to be corrected, if anything at all. Second, the Notices fail 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 Section 624.155, Florida Statutes, the Complainant must name the individual(s) involved with specificity related to the purported violation(s) to allow Universal to investigate the allegations. The Notices lack the requisite specificity required by Section 624.155, Florida Statutes because they each state “Ryan Wacker,” without more. The Notices, however, fail to include any specificity as to what facts the named individual has knowledge of that gave rise to any purported allegation(s) and/or what, if anything, they did or failed to do as it relates to the claim at issue. Further, the name in the Notices without more clearly defeat the requirement in the DFS forms to provide specificity in order to put the carrier on notice and provide an opportunity to investigate any allegation. Specificity as to a person’s knowledge within Universal is of particular importance because the Complainant alleges “[a] material misrepresentation made to an Insured…” by Universal and/or Universal “[m]isrepresent[ed] facts and policy provisions relating to coverages at issue.” The Notices, however, fail to include the requisite specificity as to whom made any misrepresentations or when any of these misrepresentations occurred or what was misrepresented. Accordingly, the Complainant’s Notices are insufficient as a matter of law. Third, the Notices fail to satisfy Section 624.155(3)(b)(4), Florida Statutes, in that they fail to reference specific policy language relevant to any alleged violation. The Notices are broad in scope and fail to identify any “specific policy language” relevant to any specific alleged violation. Instead, it recites the potential policy limits under the Policy. Further, the Notices provide no guidance or explanation as to how the referenced Policy sections or categories of coverage relate to any allegation, such that Universal is left to wonder what policy language, if any, Complainant is alleging was violated. Therefore, in the Notices, it is unclear what, if any, policy language pertains to any allegation. General, vague and overbroad references to potential or possible policy sections, titles and/or categories of coverage do not satisfy the specificity required by Section 624.155(3)(b)(4), Florida Statutes. As such, the Notices are deficient as a matter of law. See generally Julien v. United Property & Casualty Ins. Co., 311 So.3d 875 (Fla. 4th DCA 2021). Fourth, with respect to the requirement to set forth with specificity the “facts and circumstances giving rise to the violation,” the Notices fail to specify any facts or circumstances that would give rise to Universal having violated any policy provision or statute. The Notices assert a laundry list of general allegations consisting largely of inaccuracies, conclusory statements, speculation and/or conjecture. A written notice which is vague and “shotgun” in nature or is written in general terms fails to satisfy the specificity requirement of the statute. See Heritage Corp. of South Fla., 580 F. Supp. 2d at 1300; 316, Inc., 625 F. Supp. 2d at 1193; see also Rousso, 2010 WL 7367059 at *3-6; Valenti v. Unum Life Ins. Co. of America, 2006 WL 1627276 (M.D. Fla. 2006). The Notices consist of inferences and supposition rather than specific facts to support any of the alleged misconduct or statutory violations to support their conclusory statements. Further, the Notices state “IT IS BELIEVED THAT THE INSURER’S ACTIONS DESCRIBED HEREIN ARE A GENERAL BUSINESS PRACTICE OF THE COMPANY.” The Complainant fails to specify any facts to support this blanket conclusory statement or allegation in any of the Notices. Further, the Complainant is required to provide with specificity the facts and circumstances giving rise to the alleged violation strictly related to its allegations for the claim, not conjecture or speculation of the carrier’s business practices. Moreover, the Notices generally allege Universal violated Sections 626.9541(1)(i)(2), Florida Statutes by allegedly making “[a] material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy…” and 626.9541(1)(i)(3)(b), Florida Statutes, by “[m]isrepresenting pertinent facts or insurance policy provisions relating to the coverages at issue.” However, none of the Notices specify any facts regarding any misrepresentations made by Universal, do not identify the person or persons who made such misrepresentations, nor do they identify to whom any misrepresentations were made. The Notices are replete with vague and generic boilerplate and/or conclusory assertions which are not supported with specific facts and do not provide the requisite specificity as to when, what or how Universal allegedly violated any policy provision or statute. It is evident that the statements of facts fall short of the specificity required by Section 624.155, Florida Statutes. As a result, the Complainant failed to comply in any of the Notices, with the requirements provided in Section 624.155(3)(b)(2), Florida Statutes. Thus, the Notices are legally deficient as a matter of law. Lastly, the Notices do not provide a proper means whereby Universal can “cure” the alleged defects. 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). 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. As will be discussed further below, the Complainant initiated litigation before filing the Notices, thus there is no cure period available without Universal paying extra-contractual damages. Universal is only obligated to pay contractual amounts owed to cure a civil remedy notice. See id. at 1278. As such, the Notices are legally deficient as they do not provide Universal an opportunity to “cure” any alleged violation without imposing obligations on Universal not contemplated by the Policy. In summary, as outlined above, the Complainant, in the Notices, fails to respond to each of the fields set forth on the DFS Forms with the requisite specificity including, but not limited to, 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 allege any specific conduct on the part of Universal that would violate any policy provision or statute, failing to reference specific policy language relevant to any alleged violation and failing to provide a cure as proscribed by Florida law. Therefore, the Notices are legally deficient and fail 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 Notices are deficient as a matter of law. Nonetheless, and without waiving the above-referenced deficiencies, the following shall provide you with Universal’s response to each of the Notices. On October 5, 2022, Universal received notice from the Insured the insured location had damage which occurred on September 29, 2022, to which Universal assigned claim No. FL22-0144107-A322. Universal inspected the property and documented any visible damage. Thereafter, Universal issued an undisputed payment to the Insured in the full amount of its estimate less the applicable Policy deductible, recoverable depreciation and nonrecoverable depreciation. Pursuant to the terms of the policy, Universal initially pays at least the actual cash value of the insured loss, less any applicable deductible. Then, it will pay any remaining amounts necessary to perform such repairs as work is performed and expenses are incurred. On November 23, 2022, Universal received notice from the Insured the insured location had damage which occurred on November 10, 2022, to which Universal assigned claim No. FL22-0161534-A522. Universal inspected the property and documented any visible damage. Thereafter, Universal advised the Insured there was no coverage available for the loss and outlined the basis for the claim denial citing relevant policy language pursuant to the terms of the policy. On March 1, 2024, the Insured initiated litigation against Universal in Circuit Court of Volusia County under Case No. 2024-10741-CIDL, for claim No. FL22-0144107-A322, and under Case No. 2024-10743-CIDL, for claim No. FL22-0161534-A522. Thus, at the time the Notices were filed, the parties were and continue to litigate their disputes to determine what, if any, additional coverage exists under the terms of the Policy. As outlined above, the alleged statutory violations and factual allegations set forth in the Notices 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 these matters and fully responds to the Notices filed 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