Civil Remedy Notice of Insurer Violations
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Filing Number:     794451
Filing Accepted:  11/27/2024
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Complainant
Last/Business Name *  
FIELDS   First Name   ALEXIS
Street Address * 9123 N.W 21ST COURT
City, State Zip * CORAL SPRINGS, FL 33071
Email Address * JDS@WEKLAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   FIELDS   First Name   ALEXIS
Policy # * 1501-1700-8040 Claim #* FL21-0143067
Attorney
Attorney is Applicable
Last Name* SPILLER First Name * JASON Initial
Street Address* 800 EAST BROWARD BLVD., SUITE 510
City, State Zip* FORT LAUDERDALE , FLORIDA 33301
Email Address * JDS@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):* JON SPRINGER
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
* Statutory provision(s) which the insurer allegedly violated.
 
624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
624.155(1)(b)(2) Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
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)(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)(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).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

SECTION I – PROPERTY COVERAGES A. Coverage A – Dwelling 1. We cover: a. The dwelling on the "residence premises" shown in the Declarations, including structures attached to the dwelling; and b. Materials and supplies located on or next to the "residence premises" used to construct, alter or repair the dwelling or other structures on the "residence premises". Coverage C – Personal Property 1. Covered Property We cover personal property owned or used by an "insured" while it is anywhere in the world. Coverage D – Loss Of Use The limit of liability for Coverage D is the total limit for the coverages in 1. Additional Living Expense, 2. Fair Rental Value and 3. Civil Authority Prohibits Use below. 1. Additional Living Expense If a loss covered under Section I makes that part of the "residence premises" where you reside not fit to live in, we cover the Additional Living Expense, meaning any necessary increase in living expenses incurred by you so that your household can maintain its normal standard of living. SECTION I – 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”. Coverage C – Personal Property We insure for direct physical loss to the property described in Coverage C caused by any of the following perils unless the loss is excluded in Section I – Exclusions. However, loss does not include and we will not pay for any “diminution in value”.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Alexis Fields (“Insured”) purchased an insurance policy ("Policy") from Universal Property & Casualty Insurance Company (“Carrier”) with effective coverage on the date of loss, on or about March 5, 2023, and Policy number 1501-1700-8040 to insure her property located at 9123 N.W. 21st Ct., Coral Springs, FL 33071 ("Property"). On or about March 5, 2023, plumbing leak originating from underneath the flooring and behind several walls caused extensive damage to the Property ("Loss"). At first, the Insured discovered what appeared to be a small puddle of water near the washing machine. On the same day, the Insured called a plumbing company, Art Plumbing Air Conditioning & Electric, to further investigate her concerns. The plumber arrived on March 7, 2023, performed leak detection services, and informed the Insured as to the severity of the issue. The Insured immediately began water mitigation through a company called Steam-A-Way, Inc. d/b/a Entrusted (“Entrusted”), which was completed on March 10, 2023. The Insured also hired a mold company, Enviro-Source, for mold testing. This was all completed in an effort to protect herself and her property from further damage, as required by her Policy. On March 24, 2023, the Insured received estimates from Entrusted, one for rebuild in the amount of $80,404.44 to perform rebuild repairs to her home following the Loss. Upon learning the significance and extent of the cost to effectuate the repairs, the following day, March 25, 2023, the Insured reported the claim to the Carrier and provided supporting documentation regarding the extent of the Loss. The Carrier acknowledged the claim and assigned claim number FL21-0143067 ("Claim") to the Loss. Thereafter, on April 4, 2023, the Carrier sent a field adjuster, Mr. Ardit Dullovi, to the Property to inspect and document his observations regarding any possible damages to the Property. Following said inspection, on April 12, 2023, the Carrier issued payment of $6,727.73 to the Insured, after deducting $2,382.44 in recoverable depreciation and applying her $2,500.00 Policy deductible. Disappointed with the Carrier’s decision, the Insured contacted the Carrier disputing the amount. On April 27, 2023, Chris Gonzalez, a representative of the Carrier, contacted the Insured and advised that the aforementioned payment did not represent final payment of the claim. About a month later, and no longer able to wait on the Carrier to decide on whether it is issuing further payment, on May 22, 2023, Entrusted begins mold remediation work. Further, as a result of the ongoing remediation and mitigation work, the Insured was forced to temporarily relocate her family to an AirBnB. A post-remediation mold inspection was completed on May 30, 2023. All supporting documentation was provided to the Carrier for its consideration. All of the aforementioned services have been paid out of the Insured’s own pocket. Of great concern, during this process, the Insured discovered that Entrusted had been directly communicating with the Carrier, seemingly acting as her representative without direct authorization to do so and submitted unauthorized rebuild estimate revisions to the Carrier regarding the extent of the repairs. On June 6, 2023, Mr. Gonzalez advised as to the specifics regarding Entrusted’s revisions (such as removing replacement of the damaged flooring) and, without consulting the Insured, remitted payment directly to Entrusted for same. Of even greater concern, on July 12, 2023, despite knowing that the Insured had paid thousands of dollars to Entrusted for the aforementioned water mitigation and mold remediation services, Mr. Gonzalez, for the first time, informed the Insured that the Carrier had paid Entrusted directly for said services as well. Mr. Gonzalez also advised that the “rebuild” was already addressed via the unauthorized estimate submitted by Entrusted. Alarmed by the unilateral, unauthorized communications held between Entrusted and the Carrier, and payments made to Entrusted, the Insured requested to be released by any and all contracts executed by and between her and Entrusted, and that she would be enlisting other companies to repair her flooring and kitchen areas This was relayed to a new Carrier representative, Leonardo Pimentel. Then, on July 17, 2023, the Insured and Mr. Pimentel discussed the above and, at the conclusion of the call, advised the Insured that the Carrier would be issuing payment to the Insured DIRECTLY for the full original rebuild estimate submitted by Entrusted. Although this likely meant that the Insured would be getting less than what she would be entitled to under the Policy, in an effort to compromise and get her matter resolved, she reluctantly agreed. After numerous follow-ups over the course of several months regarding said rebuild payment (or lack thereof), the Insured lost faith in the Carrier’s willingness to do the right thing and remit payment as agreed upon, as the Carrier ignored each and every follow-up from the Insured in this regard. Despite providing uncontroverted proof of the extent of her damages, and the Carrier seemingly at least agreeing to what was originally submitted by Entrusted for the rebuild, which exceeded $80,000.00, the Carrier failed to honor its agreement to pay the Insured directly for the amounts clearly owed. Growing increasingly frustrated with the Carrier’s unwarranted delays, in November of 2023, the Insured advised that she is now seeking the full amount that she is entitled to under her Policy. Since the Insured became aware of the damages to the Property, she has acted promptly in reporting the claim and mitigating further damage to the Property. She has cooperated in all ways possible with every request of the Carrier. The Insured has fully complied with all applicable Policy provisions requiring cooperation with the investigation; however, the Carrier 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, the Carrier has failed to act in good faith, delaying any prompt resolution of the claim. The Carrier 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 policyholders and with due regard to the policyholders' interests. As a result of this incident, the Insured has suffered damage to the building on the subject Property and loss of use of the Property and possessions therein. As a direct consequence of the Carrier’s failure to adjust this Loss in good faith and make proper payment, the Insured continues to be without adequate compensation for the damages sustained at the Insureds' Property. By stating the above detailed facts, it is clear that the Carrier 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)(2) Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made; • 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)(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)(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). To date, the Carrier has acted in bad faith, and failed to provide coverage under the Policy to the Insured. As a direct result of Carrier’s underpayment of the Claim and breach of the Florida Statutes, the Insured was forced to seek the help of licensed professionals to assist them, 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 Carrier 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 the Carrier’s reckless treatment of the claims process. The Insured submitted all documents requested in a timely fashion, made their property available for inspection, submitted estimates and requests. However, the Carrier failed at every step of the process to adequately establish or identify the basis of its gross mismanagement of the claim. To deny the Insured the benefit clearly due and owing under the Policy, for which she has time and time again been making premium payments for and after they have satisfied all of her obligations is morally and ethically reprehensible, and reeks of Unfair Claims Practice and Bad Faith. Upon information and belief, the aforementioned actions complained of, among others, were made by the Carrier so often as to constitute a general business practice, evidencing a motive to enhance the Carrier’s profits, and designed to cause a detrimental effect to its policyholders. The above clearly depicts that the Carrier adjusted this claim in bad faith, continue to act in bad faith towards its Insured, and that the Carrier 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 the Carrier 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, the Carrier must: (1) Immediately tender $147,065.99 in US dollars to the Insured which is fairly owed to the Insured under the insurance policy and would reasonably compensate the Insured in order to put the Property back to its pre-loss condition; (2) 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; and (3) Agree to reimburse the Insured’s reasonable attorneys’ fees and costs for having to become involved to resolve the claim.
Comments
User Id Date Added Comment
jr0405@universalproperty.com 01-14-2025 January 14, 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.: 794451 Filing Date: 11/27/2024 Complainant(s): Alexis Fields Insured(s): Alexis Fields Policy No.: 1501-1700-8040 Claim No.: FL21-0143067 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, Jason Spiller, on behalf of Complainant, Alexis Fields. 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 adjustment 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 Delay,” “Unsatisfactory Settlement Offer” and “Unfair Trade Practice.” However, the Complainant’s allegations regarding each of these “Reasons for Notice” lack sufficient factual support in the Notice. The Notice contains boilerplate, conclusory and inaccurate statements without specifying facts to support the same. For example, the Notice states, “the Carrier 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, the Carrier has failed to act in good faith, delaying any prompt resolution of the claim. The Carrier 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 policyholders and with due regard to the policyholders' interests.” 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 the Carrier so often as to constitute a general business practice, evidencing a motive to enhance the Carrier’s profits, and designed to cause a detrimental effect to its policyholders.” The Notice 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. Further, the Notice generally alleges Universal violated Sec. 626.9541(1)(i)(3)(b), Fla. Stat., by “[m]isrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.” However, the Notice does not set forth any facts regarding any misrepresentations made by Universal, state what was misrepresented and does not identify the person or persons who made such misrepresentations. It is evident that the statement of facts fall 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 “JON SPRINGER,” without more. The Complainant fails to specify what, if anything, the named individual is knowledgeable about and/or what, if anything, the named individual did or failed to do. 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. Specific identification of a person or persons with the most knowledge within Universal is of particular importance because, as noted, the Complainant alleges Universal has “misrepresent[ed] pertinent facts or insurance policy provisions relating to coverages at issue.” The Notice fails to include any specificity as to whom made any misrepresentations, what was misrepresented, and when any of these misrepresentations were made. 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. 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. 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 identify a claim number associated with the listed Insured or policy number, 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 a proper cure. 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 you with Universal’s response to the Notice. The Notice lists the claim number as FL21-0143067. However, this claim number does not correspond to the listed Insured, policy number, or property address. Based on this inconsistency, Universal asserts that it cannot discuss any specific facts of the referenced claim. As outlined above, the alleged statutory violations set forth in the Notice lack specific factual support and are without merit. Therefore, the Notice is legally deficient and fails to satisfy the condition precedent to filing a bad faith action. We trust that the foregoing is sufficient to advise you of Universal’s position regarding this matter and fully responds to the alleged violations in 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