Filing Number: 794842
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| Filing Accepted: 12/2/2024 |
| Last/Business Name
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| Street Address
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1879 OAKCHIME DR |
| City, State Zip
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ORANGE PARK,
FL
32065
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| Email Address
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MABBASS@TALKTOMYATTORNEYS.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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RILEY |
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First Name |
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KEVIN |
| Policy # * |
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1501-2201-3308 |
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Claim #* |
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FL24-0120810 |
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Attorney is Applicable
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| Last Name* |
ABBASS
First Name *
MOHAD
Initial
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| Street Address* |
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8725 NW 18TH TERRACE, STE 313 |
| City, State Zip* |
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DORAL
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FLORIDA
33172
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| Email Address * |
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MABBASS@TALKTOMYATTORNEYS.COM |
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| Insurer Type
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 Authorized Insurer
 Unauthorized Insurer
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| Insurer Name |
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| Insurer Name* |
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UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY
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| Insurer Name* |
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| Street Address* |
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| City, State Zip* |
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,
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NAIC Company Code 10861 |
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| Name of individual responsible for violation (if any):*
JANET MORENO
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| Type of Insurance
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Residential Property & Casualty
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| Reason for Notice
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Claim Denial
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Claim Delay
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Unfair Trade Practice
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Unsatisfactory Settlement Offer
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Other
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Intentional Misrepresentation of the Date of Loss and Improper Deductible Application
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Statutory provision(s) which the insurer allegedly violated.
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| 624.155(1)(b)(1) |
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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.
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| 626.9541(1)(i)(3)(a) |
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Failing to adopt and implement standards for the proper investigation of claims.
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| 626.9541(1)(i)(3)(b) |
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Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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| 626.9541(1)(i)(3)(i) |
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Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Coverage A - Dwelling. All Optional Coverage provisions. All Additional Coverage provisions. All Coverage(s) provided by Endorsement or Rider. The Declarations Page. Loss Payment and Settlement provisions. Duties in Event of Loss Policy provision. The insurance policy's definition section. The insurance policy's exclusion of coverage provisions. All insurance policy provisions that provide coverage to the Insured’s property. All policy provisions.
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Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
I. INTRODUCTION
This Civil Remedy Notice (CRN) is filed on behalf of the insured, Kevin Riley, against Universal Property & Casualty Insurance Company ("Universal"), for its deliberate actions and statutory violations concerning a property damage claim filed under policy number 1501-2201-3308.
Kevin Riley sustained damages to his property caused by a covered peril on June 28, 2024. Upon filing a claim, Universal's adjuster intentionally manipulated the date of loss and misapplied the deductible, causing significant financial harm to the insured. These acts were performed with the intent to reduce Universal’s liability and minimize its financial obligation to Kevin Riley, contrary to the terms of the insurance policy and Florida law.
II. STATEMENT OF FACTS
1. The Covered Loss
On June 28, 2024, Kevin Riley’s property sustained significant damages caused by a covered peril under the terms of his policy with Universal. Riley promptly reported the loss to Universal and cooperated fully with the claims process.
2. The Adjuster’s Misconduct
Upon inspection, Universal’s assigned adjuster correctly documented the loss as occurring on June 28, 2024, as reflected in the insurance company’s internal estimates. However, the adjuster deliberately altered the reported date of loss to August 5, 2024. This manipulation was intentional, as the adjusted date triggered a higher hurricane deductible of $9,448.72, rather than the applicable all-other-peril deductible of $2,500.00.
By altering the date of loss, the adjuster’s actions served to increase the out-of-pocket costs borne by Kevin Riley while reducing Universal’s financial liability for the claim. This deliberate misrepresentation constitutes bad faith and unfair claims handling in violation of Florida law.
3. The Financial Impact
Due to the wrongful application of the hurricane deductible, Kevin Riley was deprived of $6,948.72 that he was rightfully entitled to under the terms of his policy. Despite multiple attempts to resolve this matter amicably and ample evidence that the actual date of loss was June 28, 2024, Universal has refused to rectify this issue or pay the outstanding balance owed to Kevin Riley.
4. Universal’s Failure to Correct Its Error
Universal has demonstrated an unwillingness to act in good faith by refusing to acknowledge the improper deductible application and continuing to withhold funds owed to the insured. This refusal has caused Kevin Riley to experience unnecessary financial hardship, as well as additional damages in the form of accrued interest on the wrongfully withheld payment.
III. VIOLATIONS OF FLORIDA STATUTES
Universal’s actions, including the adjuster’s intentional manipulation of the date of loss and the improper application of the deductible, violate the following sections of Florida Statutes:
1. Florida Statute 624.155(1)(b)(1):
Failing to settle claims in good faith where it could and should have done so had it acted fairly and honestly toward the insured and with due regard for his interests.
2. Florida Statute 626.9541(1)(i)(3)(a):
Engaging in unfair claims settlement practices by misrepresenting pertinent facts or policy provisions related to coverages. Universal’s adjuster intentionally altered the date of loss to increase the deductible unfairly.
3. Florida Statute 626.9541(1)(i)(3)(b):
Failing to acknowledge and act promptly upon communications with respect to claims. Universal ignored multiple communications from Kevin Riley attempting to resolve the discrepancy in the deductible and date of loss.
4. Florida Statute 626.9541(1)(i)(3)(i):
Conducting unfair claims settlement practices by altering the date of loss to create a financial advantage for the insurer at the insured’s expense.
IV. REMEDY SOUGHT
Kevin Riley respectfully demands that Universal Property & Casualty Insurance Company immediately:
1. Correct the Date of Loss:
Acknowledge that the date of loss for the claim is June 28, 2024, and amend all records to reflect this accurate date.
2. Apply the Proper Deductible:
Adjust the deductible to the all-other-peril deductible of $2,500.00, as required by the policy terms for the loss sustained on June 28, 2024.
3. Pay the Outstanding Balance:
Issue payment for the withheld amount of $6,948.72, along with applicable interest accrued due to the delay in payment.
4. Provide Written Assurance:
Provide a written acknowledgment of the insurer's errors and confirmation that the claim has been adjusted appropriately and in compliance with Florida law.
5. Reimburse Additional Damages:
Compensate Kevin Riley for any additional damages, including interest and costs incurred due to Universal’s bad faith actions.
V. NOTICE TO INSURER
This Civil Remedy Notice is filed pursuant to Florida Statutes and must be responded to within 60 days of filing. Failure to address the violations outlined herein, including failure to settle the claim fairly and promptly, will result in further legal action against Universal Property & Casualty Insurance Company, including but not limited to a lawsuit for bad faith damages under Florida law.
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The submitter hereby states that this notice is given in order to perfect the rights of the
person(s) damaged to pursue civil remedies authorized by Section 624.155, Florida Statutes.
Before submitting a Notice using this system, please verify that all text has been entered
correctly and completely. Once the Notice has been submitted, the text cannot be changed
or deleted.
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DFS-10-363
Rev. 10/14/2008
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