Civil Remedy Notice of Insurer Violations
Login

Filing Number:     794858
Filing Accepted:  12/2/2024
         Print Filing
Complainant
Last/Business Name *  
JEANTILUS   First Name   JUNIA
Street Address * 2100 SW 119TH AVENUE
City, State Zip * MIRAMAR, FL 33025
Email Address * JUNIAJ43@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   JEANTILUS   First Name  
Policy # * 1501 1102 4070 Claim #* FL23-0112339
Attorney
Attorney is Applicable
Last Name* SANTANA First Name * ALEXANDER Initial J
Street Address* 5600 DAVIE ROAD
City, State Zip* DAVIE , FLORIDA 33314
Email Address * ASANTANA@MINEOLAW.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):* ALL ADJUSTERS, SUPERVISORS, MANAGERS, ATTORNEYS, AND INDIVIDUALS ASSOCIATED WITH AND/OR RETAINED BY UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY CONCERNING THE CLAIM AT ISSUE
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Other : Violation of Code of Ethics
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)(1) Attempting to settle claims on the basis of an application, when serving as a binder or intended to become a part of the policy, or any other material document which was altered without notice to, or knowledge or consent of, the insured.
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)(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.

In addition to the breach of the above statutory duties, see Coverage A and Loss Payment Provisions.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Universal Property and Casualty Insurance (hereinafter the “Insurance Company”) issued a homeowners’ insurance policy to its insured, Junia Jeantilus (the “Insured”), for the insured property located at 2100 SW 119th Avenue Miramar, FL 33025. The subject Policy afforded various types of coverages including coverage for damage to dwelling, other structures, personal property, and for loss of use. On or about March 01, 2023, while the subject Policy was in full force and effect, the Insured’s home was damaged as a result of plumbing which ensued water damage to the property. The Insured promptly notified the Insurance Company of the loss. Thereafter, the Insurance Company acknowledged the loss and assigned claim number FL23-0112339 to the loss. The Insured complied with all policy conditions and cooperating with the Insurance Company’s investigation efforts. The Insurance Company, failing to retain the experts necessary to adequately inspect the property to restore the property to its pre-loss condition and issued a “low-ball” payment to the Insured in the amount of $3,300.05. The Insured and Insureds’ representative provided the Insurance Company with all claim-related documents including an estimate to repair covered damages and other supporting documentation and/or information. The Insurance Company continues to completely ignore the Insured’s claim and request for supplemental payment. The Insurance Company has failed to issue proper payment for the claim and has failed to issue sufficient payment to include damages and repairs covered by the policy and Florida law. The Insured provided the Insurance Company with documentation evaluating the loss, and rather than issuing the proper payment or attempting to reach an agreement with its Insured, the Insurance Company is delaying and denying the claim. Upon information and belief, the Insurance Company performs the subject actions as a business practice, including delaying the claim and/or issuing "low ball" payments in an attempt to dissuade its insureds from pursuing the claim to the detriment of its insureds to increase financial profits. In order to remedy the above defects, the Insurance Company must do the following: 1. Pay the Insured the full value of the claim, (less applicable deductible and prior payment). 2. Pay statutory interest on the amount of unpaid damages from the date of loss. 3. Act fairly and honestly toward its Insured with due regard for its interests in attempting to resolve the claim. 4. Cease and desist all present and future bad faith actions with regard to this claim. 5. Implement standards for the property investigation of claims. 6. Stipulate to the Insured’s entitlement to attorney’s fees and court costs pursuant to section 627.428, Florida Statutes, and pay the amount of fees and costs incurred. The Insurance Company, failing to retain the experts necessary to adequately inspect the property to restore the property to its pre-loss condition and issued a “low-ball” payment to the Insured in the amount of $3,300.05. The Insured and Insureds’ representative provided the Insurance Company with all claim-related documents including an estimate to repair covered damages and other supporting documentation and/or information. The Insurance Company continues to completely ignore the Insured’s claim and request for supplemental payment. The Insurance Company has failed to issue proper payment for the claim and has failed to issue sufficient payment to include damages and repairs covered by the policy and Florida law. The Insured provided the Insurance Company with documentation evaluating the loss, and rather than issuing the proper payment or attempting to reach an agreement with its Insured, the Insurance Company is delaying and denying the claim. Upon information and belief, the Insurance Company performs the subject actions as a business practice, including delaying the claim and/or issuing "low ball" payments in an attempt to dissuade its insureds from pursuing the claim to the detriment of its insureds to increase financial profits. In order to remedy the above defects, the Insurance Company must do the following: 1. Pay the Insured the full value of the claim, (less applicable deductible and prior payment). 2. Pay statutory interest on the amount of unpaid damages from the date of loss. 3. Act fairly and honestly toward its Insured with due regard for its interests in attempting to resolve the claim. 4. Cease and desist all present and future bad faith actions with regard to this claim. 5. Implement standards for the property investigation of claims. 6. Stipulate to the Insured’s entitlement to attorney’s fees and court costs pursuant to section 627.428, Florida Statutes, and pay the amount of fees and costs incurred.
Comments
User Id Date Added Comment
sm1130@universalproperty.com 01-17-2025 January 17, 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.: 794858 Filing Date: 12/2/2024 Complainant: Junia Jeantilus Insured: Jeantilus Policy No.: 1501 1102 4070 Claim No.: FL23-0112339 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, Alexander J Santana, on behalf of Complainant, Junia Jeantilus (also referenced as “Insured.”) The Notice alleges violations of Sections 624.155 and 626.9541, Florida Statutes. Universal specifically denies the allegations in the Notice. Additionally, Universal denies that it violated these or any statutes, Florida law or policy provisions regarding the claim adjustment of this matter. With that said, Universal asserts that the Notice fails to comply with the specific notice and information requirements as set forth in Civil Remedy Notice of Insurer Violation document provisions, Section 624.155, Florida Statutes and Florida law. The Notice is deficient as a matter of law as it fails to comply with Section 624.155, Florida Statutes. See 316, Inc. v. Maryland Cas. Ins. Co., 625 F. Supp. 2d 1187 (N.D. Fla. 2008); Rousso v. Liberty Surplus Ins. Corp., 2010 WL 7367059, (S. D. Fla. 2010); Heritage Corp. of South Fla. v. Nat’l Union Fire Ins. Co. of Pittsburgh, P.A., 580 F. Supp. 2d 1294 (S.D. Fla. 2008); Talat Enterprises, Inc. v. Aetna Cas. & Surety Co., 753 So. 2d 1278 (Fla. 2000). Pursuant to Section 624.155(3)(b), Florida Statutes, the Notice “shall state with specificity” the following information: 1. The statutory provision, including the specific language, which the authorized insurer allegedly violated; 2. the facts and circumstances giving rise to the violation; 3. the name of any individual involved in the violation; 4. reference to specific policy language that is relevant to the violation, if any...; 5. a statement that the Notice is given in order to perfect the right to pursue the civil remedy authorized by this section. Moreover, the Department of Financial Services (“DFS”) created form DFS-10-363, which lays out 15 requirements that the Complainant(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 Notice fails to meet the requirements of Fla. Stat. § 624.155 on several grounds. First, the Civil Remedy Notice requires the Complainant(s) “pursuant to section 624.155, Florida Statutes, please indicate all statutory provisions alleged to have been violated.” The Notice filed by Complainant in this matter includes almost every statutory provision that could be claimed against an insurance company. The Notice, however, fails to specify any facts to support how any of these statutes were violated. In addition, when asked to indicate all statutory provisions alleged to have been violated, the Complainant asserts a violation of 626.9541(1)(i)(3)(i) for “[f]ailing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).” However, this is not applicable in a first party property claim. Because the Notice fails to specify when or how, if at all, or by whom any of these statutes were violated, it does not comply with Section 624.155, Florida Statutes. The Notice fails to provide Universal with the requisite specificity to put them on notice of what needs to be corrected, if anything at all. 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 Sec. 624.155, Fla. Stat., the Complainant(s) must name the individual(s) involved with specificity related to the purported violation(s) to allow Universal to investigate the allegations with the specified individual. The Notice lacks the requisite specificity required by Sec. 624.155, Fla. Stat., because the Complainant attempts a “catch-all” in the Notice by stating “ALL ADJUSTERS, SUPERVISORS, MANAGERS, ATTORNEYS, AND INDIVIDUALS ASSOCIATED WITH AND/OR RETAINED BY UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY CONCERNING THE CLAIM AT ISSUE” which significantly prejudices Universal because the Complainant is failing to notify Universal of the individuals that purportedly committed statutory violations or the specific statutory violations any individual purportedly committed. The failure to provide the requisite specificity precludes Universal from taking any corrective action and potentially curing any purported allegation. Specific identification of a person or persons with the most knowledge within Universal is of particular importance because, the Complainant alleges “[a] material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy” by Universal and that Universal “misrepresent[ed] pertinent facts or insurance policy provisions relating to coverages at issue” in the Notice. The Notice, however, fails to include the requisite specificity as to whom made any misrepresentations or when any of these misrepresentations occurred. Accordingly, the Notice is insufficient as a matter of law. Third, the Notice fails to satisfy Section 624.155(3)(b)(4), Florida Statutes, in that it fails to reference specific policy language relevant to any alleged violation. Instead, the Notice states, “[i]n addition to the breach of the above statutory duties, see Coverage A and Loss Payment Provisions.” The Notice is broad in scope and fails to identify any “specific policy language” relevant to any specific alleged violation. Further, the Notice provides no specificity or explanation as to how the entirety of “Coverage A” and the single referenced provision title relates to any allegation, such that Universal is left to wonder what policy language Complainant is alleging was violated. Therefore, it is unclear what, if any, policy language pertains to any allegation. General, vague and overbroad references to an entire category of coverage and/or a single potential or possible policy provision does not satisfy the specificity required by Section 624.155(3)(b)(4), Florida Statutes. As such, the Notice is deficient as a matter of law. See generally Julien v. United Property & Casualty Ins. Co., 311 So.3d 875 (Fla. 4th DCA 2021). Fourth, with respect to the requirement to set forth with specificity the “facts and circumstances giving rise to the violation,” the Notice fails to specify any facts or circumstances that would give rise to Universal having violated any policy provision or statute. The Complainant provides five (5) reasons for submitting the Notice: “Claim Delay,” “Claim Denial,” “Unsatisfactory Settlement Offer,” “Unfair Trade Practice,” and “Violation of Code of Ethics.” However, the Complainant’s boilerplate allegations in the “Reasons for Notice” section have no factual support anywhere in the Notice. The Notice also states general allegations consisting of boilerplate and conclusory statements rather than specifying facts to support its allegations. For example, the Notice alleges “the Insurance Company is delaying and denying the claim. Upon information and belief, the Insurance Company performs the subject actions as a business practice, including delaying the claim and/or issuing "low ball" payments in an attempt to dissuade its insureds from pursuing the claim to the detriment of its insureds to increase financial profits.” The Complainant fails to specify any facts to support these conclusory statements or allegations. Further, the Complainant is required to provide with specificity the facts and circumstances giving rise to the alleged violation strictly related to its allegations, not conjecture or speculation of the carrier’s business practices. The Notice is replete with vague and generic boilerplate and/or conclusory assertions which are unsupported by specific facts and do not provide the requisite specificity as to how Universal allegedly violated any policy provision or statute. Further, the Notice generally alleges that a violation of Sections 626.9541(1)(i)(2) for 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), Fla. Stat., by “[m]isrepresenting pertinent facts or insurance policy provisions relating to the coverages at issue.” However, the Notice fails to specify any facts regarding any misrepresentations made by Universal and does not identify any person or persons who made such misrepresentations nor to whom any alleged misrepresentations were made. 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 failed to comply with the requirements provided in Sec. 624.155(3)(b)(2), Fla. Stat. Thus, the Notice is legally deficient as a matter of law. 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 “[s]tipulate to the Insured’s entitlement to attorney’s fees and court 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 wherein Universal could cure without paying extra-contractual damages. In summary, as outlined above, the Complainant fails to respond to each of the fields set forth on the DFS Form 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 in which Universal could cure without potentially paying extra-contractual damages. Therefore, the Notice is legally deficient and fails to satisfy the condition precedent to filing a bad faith action. Pin-Pon Corp. v. Landmark American Ins. Co., 500 F. Supp. 3d 1336 (S.D. Fla. 2020); Julien v. United Property & Casualty Ins. Co., 311 So.3d 875 (Fla. 4th DCA 2021). For the aforementioned reasons, the Notice is deficient as a matter of law. Nonetheless, and without waiving the above-referenced deficiencies, the following shall provide you with Universal’s response to the Notice. On March 27, 2023, Universal was untimely notified by the Insured, Junia Jeantilus, that the insured location was damaged on March 1, 2023. Universal inspected the property and documented any visible damage. Universal, in accordance with the terms and conditions of the Policy, issued payment in the full amount of its estimate, less recoverable depreciation and applicable deductible. Under the terms of the Policy, Universal will initially pay at least the actual cash value of the insured loss, less any applicable deductible. It will then pay any remaining amounts necessary to perform such repairs as work is performed and expenses are incurred. Subsequently, the Insured submitted a competing estimate totaling $78,367.01 prepared by Baylis Claims Consultants on her behalf. In a good faith effort to amicably resolve any remaining dispute, Universal invoked the mediation provision under the terms of the Policy. The parties participated in mediation, however it resulted in an impasse. Thereafter, on November 28, 2023, the Insured initiated litigation against Universal in Circuit Court in and for Broward County under Case No. CACE23021665. Thus, at the time the Notice was served, the parties were and continue to litigate their disputes to determine what, if any, additional coverage exists under the terms of the Policy. At no time has Universal breached any duty to its Insured. An insurer is not required to pay whatever amount its insureds demand. While an insurance company 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 and factual allegations set forth in the Notice are devoid of factual support and are without merit. Thus, 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 with regard to this matter and fully responds to the Notice filed by the Complainant. Sincerely, /s/ Stephen Methe Stephen Methe
Acknowledgement
* The submitter hereby states that this notice is given in order to perfect the rights of the person(s) damaged to pursue civil remedies authorized by Section 624.155, Florida Statutes.

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




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