Civil Remedy Notice of Insurer Violations
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Filing Number:     794865
Filing Accepted:  12/2/2024
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Complainant
Last/Business Name *  
VILLANUEVA   First Name   MORGAN
Street Address * 11278 SW 153RD PLACE
City, State Zip * MIAMI, FL 33196
Email Address * WITHHELD
Complainant Type: * Insured
Insured
Last/Business Name*   VILLANUEVA   First Name   MORGAN
Policy # * 592-459-224 Claim #* FL21-0124052-P420
Attorney
Attorney is Applicable
Last Name* PARDO First Name * ERIKA Initial
Street Address* 9700 SOUTH DIXIE HWY, SUITE 660
City, State Zip* MIAMI , FL 33156
Email Address * ERIKA@THEPARDOLAWFIRM.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):* RONALD SMITH
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)(3) Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
626.9541(1)(i)(3)(f) Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement.
626.9541(1)(i)(3)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Governed by the cited authorities, the subject policy provides coverage for sudden and accidental roofing system failures that allow ensuing water at the subject property as a result of Tropical Storm ETA’s heavy wind and rain. The loss payment provision and governing law provides that the insurer has a fiduciary duty to in good faith to promptly investigate, adjust, and issue payment of the undisputed amount of the loss and damages. Furthermore, the policy provides coverage for, inter alia, assessments in relation to remediation, as well as the amount necessary to perform remediation. The operative relevant Policy of Insurance at issue is an “all risk” Policy which provides as follows and ensuing damages for mold as follows: 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”. *** F. Additional Coverages 14. “Fungi” Wet or Dry Rot, Or Bacteria c. Each covered loss. $10,000.00 is the most we will pay for the total of all loss or costs payable under this Additional Coverages resulting from any one covered loss.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The Complainant and Insured, Morgan and Delia Villanueva (hereinafter referred to as “Complainant”), maintained a homeowner’s policy of insurance (hereinafter referred to as “Policy”) with UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY (hereinafter referred to as “Universal”), which provides coverage for sudden and accidental damages and losses arising from a sudden and accidental roofing system failure which allows ensuing water damages at the subject property which in part may be due to Tropical Storm ETA's heavy wind and rain which said damages first manifested on or about July 1, 2021 (“Loss”). The Loss caused substantial, direct and consequential damages, and Universal’s general business practice of willful, wanton, immoral, deceptive and bad faith claim handling policies, procedures, guidelines, protocol, adjusting, investigating, drawing valuations and issuing payment for the claim, has caused the Complainant to suffer further harm and extra-contractual damages which have accrued, and will continue to accrue. The stated misconduct outlined below is collectively referred to as “Bad Faith,” and the specific, straightforward factual and/or legal considerations in relation thereto are further outlined below for its consideration in accordance with Fla. Stat. Sec. 624.155 and the cited legal authorities associated therewith. On or about July 1, 2021, the Complainant suffered direct physical loss to the subject property by way of ensuing water damages that first manifested on or about said date. During the adjustment of the claim, the Complainant hired Full Pro Restoration (hereinafter referred to as “Full Pro”), to perform the necessary, industry wide practice of performing moisture meter assessments coupled with the corresponding thermal imaging, to detect latent conditions, which, if undetected, will serve to create toxic conditions at the subject property. During the adjustment of the claim, all relevant documents from Full Pro, were dutifully provided. To date, no adjuster and/or qualified expert has been retained by Universal to dispute findings of elevated latent levels of water moisture at the subject property via the moisture meter assessments coupled with the corresponding thermal imaging. Moreover, the Complainant through his agents hired A1 Max Pro to perform mold testing at the subject property. All relevant documents from A1 Max Pro were dutifully provided during the pre-suit adjustment of the claim. To date, no adjuster and/or qualified expert has been retained by Universal to dispute the positive findings of mold at the subject property. Pursuant to the positive findings of mold, the Complainant retained Full Pro to perform the necessary, industry-wide practice of mold remediation, given the positive findings of mold at the subject property. All relevant documentation in relation to the mold remediation performed by Paramount, were dutifully provided too Universal. To date, no adjuster and/or qualified expert has been retained by Universal to dispute the necessity and/or reasonable course of repairs by way of the mold remediation services provided. Universal inspected the subject property by way of a field adjuster by the name of Andres Marin (hereinafter referred to as “Mr. Marin”). It is important to note that Mr. Marin who is not a licensed roofer and all indications as of the date of this filing are that he is not duly qualified to take into consideration latent water damages and the necessary repairs in relation to same. In addition, all indications are that he is not a duly qualified expert that can attest as to the efficient proximate being due to any purported excluded causes of loss. In addition, as of the date of this filing, Mr. Marin has failed to dispute the latent water damages that were detected via the moisture meter assessments and/or corresponding thermal imaging, as well as the necessary water remediation services provided, coupled with the mold testing (which was found positive), and corresponding mold remediation to protect the inhabitants of the subject property from toxic conditions. Based on the insufficient adjustment of the claim as outlined herein, Universal issued a wholly unsatisfactory valuation of $4,896.13 replacement cost value for the loss. In opposition to same, prior to suit being filed, the Complainant through his retained counsel provided an estimate with a valuation of $188,920.53 replacement cost value that duly takes into consideration the full extent of the latent conditions, that serve to create a plethora of extra contractual damages that continue to accrue, given Universal’s general business practice of failing to adjust the full extent of the damages as outlined herein. In other words, the Complainant notified Universal of its unsatisfactory, lowball valuation of the underlying claim. On or about March 29, 2022, the Complainant (through his retained counsel) filed its original Civil Remedies Notice (hereinafter referred to as “CRN”) putting Universal on notice of the alleged bad faith conduct. On or about May 19, 2022, Universal filed its Response. Of importance, therein, Universal alleged that the original CRN failed to provide sufficient specificity as to how the carrier violated the purported 624.155 provisions. As to the purported lack of sufficient specificity, the facts outlined above clearly rebut any perceived prejudice in said regard. The sufficient specificity and/or particularity as to the facts and/or circumstances outlined by this bad faith conduct cannot be clearer. To cure the above stated immoral, deceptive, unlawful and collectively defined general business practice of bad faith claims handling practices that are knowingly, willfully, wantonly and/or with a reckless disregard for the insured’s interests being implemented, Universal must perform as follows within 60 days of receiving this CRN: I. Take corrective action in association with the Bad Faith claims handling practices by way of rectifying same, and thereafter duly adjusting, investigating and issuing payment for all benefits owed to the Complainant as per the industry wide accepted standards outlined herein. To hold otherwise, would allow Universal’s bad faith claims handling described above to leave the insureds, the insured’s counsel, the insurer’s counsel, and even the judiciary guessing as to when and how Universal will duly perform. These continuously vacillating positions and cherry-picking of the described bad faith conduct outlined herein, not only serves to maximize Universal’s prospective financial gains by being able to avoid paying benefits, it also serves to minimize Universal’s loss adjusting expenses as it sees fir to the invariable detriment of the insureds, the Complainants, and ultimately the tax paying citizens of this State that bear the expense of the judicial system, which needs to be unraveled due to the tangled web created by Universal.
Comments
User Id Date Added Comment
oc1102@universalproperty.com 01-21-2025 January 21, 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.: 794865 Filing Date: 12/2/2024 Complainant(s): Morgan Villanueva Insured(s): Morgan Villanueva Policy No.: 592-459-224 Claim No.: FL21-0124052-P420 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, Erika Pardo on behalf of Complainant Morgan Villanueva (also referenced as the “Insured.”) The Notice alleges violations of Sections 624.155, and 626.9541, Florida Statutes. 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. Here, the Notice fails to meet the requirements of Section 624.155, Florida Statutes on several grounds. First, the Notice fails to list all of the named Insureds listed under the subject Policy. 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. Third, the Notice fails to reference specific policy language relevant to the alleged violation. Fourth, with respect to the requirement to set forth with specificity the “facts and circumstances giving rise to the violation,” the Notice fails to allege specific conduct on the part of Universal that would violate any policy provision or statute. Lastly, the Notice fails to provide a proper means by which Universal can cure the alleged defects in the Notice. Therefore, the Notice is insufficient and fails to satisfy the condition precedent to filing a bad faith cause of action. See 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). Notwithstanding the above referenced deficiencies, the parties have reached an amicable resolution of the disputed claim. Throughout the handling of the Insureds’ claim, Universal has acted in good faith toward the interests of its Insureds. Universal has timely and fairly investigated the reported loss in accordance with Florida law, the policy provisions, and standard claims handling practices. Notwithstanding, any alleged dispute between the parties has been resolved via an amicable resolution of the disputed claim in exchange for a full Release of Claims. Universal is pending receipt of the original executed Release by the Insured. Thus, it is Universal’s best understanding that the subject claim has been fully adjusted and resolved. Accordingly, the alleged statutory violations and factual allegations of wrongdoing set forth in the Notice are without merit. As previously noted, although the carrier strongly believes it has not been in violation of the Policy or law, circumstances giving rise to any alleged violation(s) have been corrected. 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. If there are any questions, please contact the undersigned. 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