Civil Remedy Notice of Insurer Violations
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Filing Number:     794923
Filing Accepted:  12/2/2024
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Complainant
Last/Business Name *  
SCHULTZ   First Name   JEFFEREY
Street Address * 900 NW SAVANNAH CIRCLE
City, State Zip * ORLANDO, FL 32055
Email Address * TW1726@AOL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   SCHULTZ   First Name   JEFFEREY
Policy # * 1501-2006-2770 Claim #* FL22-0112145
Attorney
Attorney is Applicable
Last Name* BRAZ First Name * TAMARA Initial
Street Address* 8865 COMMODITY CIR. STE. 12
City, State Zip* ORLANDO , FL 32819
Email Address * TBRAZ@THELAWGICALFIRM.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):* ? TAKARA JACKSON, CLAIMS EXAMINER ON BEHALF OF ALDER ADJUSTING A SUBSIDY OF UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY; ? DAVID HODGES, FIELD ADJUSTER ON BEHALF OF BAYSIDE ADJUSTERS, INC;
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Claim Denial
Unfair Trade Practice
Other : Improper Investigation
* Statutory provision(s) which the insurer allegedly violated.
 
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

FORM: UPCIC HO3 15 05 18 SECTION 1 - 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[;] *** 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[.] *** SECTION I – CONDITIONS *** C. Duties After Loss In case of a loss to covered property, we have no duty to provide coverage under this policy if the failure to comply with the following duties is prejudicial to us. These duties must be performed either by you, an "insured" seeking coverage, or a representative of either[:] *** 2. a. To the degree reasonably possible, retain the damaged property; and b. Allow us to inspect, subject to 2.a. above, all damaged property prior to its removal from the “residence premises[.]” *** 5. Cooperate with us in the investigation of a claim[;] *** 7. As often as we reasonably require: a. Show us the damaged property and the cause of loss…[.] ***
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

On or about February 15, 2021, Jefferey Schultz (Complainant(s)) suffered a loss to their Property, located at the address listed above due to hail. After discovering the damage, Complainant reported the loss to Universal Property & Casualty Insurance Company (“Insurer”) on or about April 14, 2022. Throughout Insurer’s investigation, Complainant has fully cooperated with Insurer and fully performed all duties and obligations under the policy by providing all information within Complainant’s custody, possession and control. Insurer, however, has failed to fulfill its duties under the Policy and Florida law by failing to conduct a proper and thorough investigation of the claim. Claim Facts On or about April 18, 2022, upon the First Notice of Loss, Insurer acknowledged the claim and sent a Reservation of Rights letter. On or about April 27, 2022, Insurer retained David Hodges, an Independent Field Adjuster (hereinafter “Field Adjuster”) on behalf of Bayside Adjusters to conduct an inspection of the property. Merely 8 days later, on or about May 5, 2022, Insurer issued a coverage denial letter solely basing the denial on the field inspection. This denial contained a vague and broad statement, asserting the following: “The field adjuster inspected your dwelling and found no evidence of covered wind or hail damage to the roof and that which was observed is attributed to normal wear and tear, and mechanical breakdown.” This explanation fails to define, describe, or provide any substantive details regarding the alleged wear, tear, or mechanical breakdown of the roof as required by Florida Law. Insurer was in clear violation of Fla. Stat. 626.9541(1)(i)(3)(f), which requires Insurer to provide a reasonable explanation for denying coverage. Here, Insurer issued a denial letter containing broad conclusory statements. Furthermore, Insurer relied on unqualified opinions as the sole basis for its denial. A Field Adjuster is strictly limited to observing conditions and collecting preliminary information; they are not qualified to determine causation. Properly assessing the cause of damages requires the expertise of a professional, such as an engineer or other specialist. Despite this, Insurer denied the claim less than a month after it was reported, relying solely on a single inspection without consulting or forwarding the matter to a qualified expert for evaluation. On or about June 1, 2022, Complainant retained Graystone Adjusting as their designated Public Adjuster (hereinafter “Public Adjuster”) to investigate the claim further. A Letter Of Representation was sent to Insurer shortly after. Insurer, however, never acknowledged such representation as required by Florida Law. Subsequently, the Public Adjuster conducted an inspection of the property, during which photographs were taken, and an estimate was generated. This estimate assessed the damages to the property at $33,307.30. This estimate, along with accompanying photographs, was sent to Insurer on or about June 3, 2023. The photographs taken from the Public Adjuster’s inspection show evidence of hail damage made to the roof. Specifically, Test Square 1 showed over 35 hits of hail damage, while Test Square 2 revealed more than 20 hits. These areas were circled in green marker, photographed, and documented. The Public Adjuster’s evidence clearly contradicted Insurer’s denial, yet Insurer failed to investigate further or even review the information at their possession. Under Fla. Stat. 626.9541(1)(i)(3)(c) Insurer is required to acknowledge and act promptly upon communications regarding claims. Here, Insurer has clearly violated Fla. Stat. 626.9541(1)(i)(3)(c) by failing to respond to all communications sent by the Public Adjuster. Insurer remained completely silent upon the Public Adjuster’s interference, including the letter of representation, new estimate, and photographs taken by the Public Adjuster. Acknowledging and reviewing supplemental evidence is crucial to the claim process and communications. Upon information and belief, Insurer intentionally ignored all supplemental evidence in order to limit the rightful remedies owed to Complainant and to unnecessarily delay the claim resolution. On or about August 5, 2022, the Complainant retained The Lawgical Firm for legal representation. To date, it is evident that Insurer has failed to adhere to the standards of proper investigations as required under Fla. Stat. § 626.9541(1)(i)(3)(a). Insurer continues to uphold its denial of coverage without conducting any further investigation into the claim. Instead, Insurer relies solely on the initial, inadequate investigation conducted by the Field Adjuster, upon which the coverage determination was made in less than a month. In fact, prior to litigation, despite being presented with two conflicting inspections, Insurer failed to retain any experts or third-party professionals to evaluate the findings or provide an additional perspective. An engineer's report or an expert’s opinion could have been utilized to confirm or refute these inspections, as required under Fla. Stat. § 626.9541(1)(i)(3)(d). Such an investigation would be expected to clarify the vague and generalized claim of “wear, tear, and mechanical breakdown” cited as the basis for the denial. Insurer has failed to uphold it’s duty of “fair and honest treatment of the claimant” as it seeks only to protect Insurer’s interests. Overall, it is clear that Insurer wholly failed to investigate causation, having sent adjusters who are only qualified to document the condition of the Property and assign repair values. Based on the events described above, it is clear that Insurer conducted an improper investigation using an unqualified field adjuster to intentionally minimize its liability, contrary to the policy and Florida law’s requirements. Moreover, Insurer has misrepresented pertinent facts and/or insurance policy provisions relating to coverages at issue, and delayed the resolution of the claim by engaging in conduct to deny or reduce recovery to the Insureds. These tactics are believed to be the general business practices of this Insurer. Insurer can cure its bad faith conduct by: 1) accepting the Insureds’ damage claim as compensable, and agreeing to pay the claim in accordance with the policy in the amount of $32,307.30, plus interest, prior to the expiration of the cure period, 2) reviewing and responding to all communications from the Insureds and their agents, including the request for a complete copy of the Policy. PLEASE GOVERN YOURSELF ACCORDINGLY.
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.: 794923 Filing Date: 12/2/2024 Complainant(s): Jefferey Schultz Insured(s): Jefferey Schultz Policy No.: 1501-2006-2770 Claim No.: FL22-0112145 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, Tamara Braz, on behalf of the Complainant, Jefferey Schultz (also referenced as “Insured.”) The Notice alleges violations of Florida Statutes, Section 626.9541. Universal specifically denies each allegation contained in the Notice. Additionally, Universal denies that it violated this or any statutes, Florida law, or policy provisions regarding the claim adjudication 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, Florida Statute §624.155 and Florida law. The Notice is deficient as a matter of law as it fails to comply with Fla. Stat. §624.155. 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 Fla. Stat. §624.155(3)(b), 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 in order 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 15 requirements that the Complainant(s) must respond to with specificity. The Florida Supreme Court holds that Fla. Stat. § 624.155 “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). To begin, the Notice fails to meet the requirements of Section 624.155, Florida Statutes, on several grounds. First, concerning the requirement to set forth, with specificity, the “facts and circumstances giving rise to the violation,” the Notice fails to specify any facts that would put Universal on notice that it violated any policy provision or statute. The Complainant provides four (4) reasons for submitting the Notice: “Claim Delay,” “Claim Denial,” “Unfair Trade Practice,” and “Improper Investigation.” However, the Complainant’s boilerplate allegations in the “Reasons for Notice” section have no factual support anywhere in the Notice. The Notice also asserts general allegations consisting of boilerplate and conclusory statements rather than specifying facts to support any allegation. For example, the Notice states “Insurer conducted an improper investigation using an unqualified field adjuster to intentionally minimize its liability, contrary to the policy and Florida law’s requirements.” The Complainant fails to specify any facts to support this conclusory statement. As an additional example, the Notice states “Insurer has misrepresented pertinent facts and/or insurance policy provisions relating to coverages at issue, and delayed the resolution of the claim by engaging in conduct to deny or reduce recovery to the Insureds [sic]. These tactics are believed to be the general business practices of this Insurer.” Again, the Complainant fails to specify any facts to support these allegations, let alone a single fact to support any allegation of delay. 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. Moreover, the Notice does not specify any facts regarding any misrepresentations made by Universal, does not identify the person or persons who made such misrepresentations, nor does it identify to whom any 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 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. In order to comply with the requirements of Section 624.155, Florida Statutes, the Complainant(s) 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 requisite specificity as required by Section 624.155, Florida Statutes. Here, the Notice states “? [sic] TAKARA JACKSON, CLAIMS EXAMINER ON BEHALF OF ALDER ADJUSTING A SUBSIDY OF UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY; ? [sic] DAVID HODGES, FIELD ADJUSTER ON BEHALF OF BAYSIDE ADJUSTERS, INC; [sic]” however, the Notice fails to include any specificity as to what facts any of the named individuals have knowledge of that would give rise to any purported allegation(s) or violation and/or what, if anything, they did or failed to do as it relates to the claim at issue. Further, the statement clearly defeats the requirement in the DFS form to provide specificity in order to put the carrier on notice and provide an opportunity to investigate any allegation with a specific individual. Specific identification of a person or persons with the most knowledge within Universal is of particular importance because, as noted, the Complainant alleges Universal “misrepresented pertinent facts and/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 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 references various policy provisions but fails to specify any facts regarding how those provisions 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 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 without paying benefits that are not due and owing to the Insured. A Civil Remedy Notice aims 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). However, Sec. 624.155, Fla. Stat., does not impose on an insurer the obligation to pay whatever amount its insureds demand. Talat, 753 So. 2d at 1282. On 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 insureds. See Talat, 753 So. 2d at 1281. Notably, Universal asserts that by initiating litigation before filing the Notice, the Complainant prejudiced Universal’s ability to cure any purported allegation in the Notice as there is no actual cure period wherein Universal could cure without potentially 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 failed 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 the person or persons representing the insurer who are most responsible for/knowledgeable of the facts giving rise to the allegations in the Notice, failing to reference specific policy language relevant to any alleged violation, failing to provide a proper cure without which Universal could potential cure without paying extra-contractual damages and failing to sufficiently allege facts and circumstances giving rise to any alleged violation. Therefore, the Notice is legally deficient and fails to satisfy the condition precedent to filing a bad faith action. See 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 April 14, 2022, Universal was untimely notified by the Insured, Jefferey Schultz, that the roof of the insured location was damaged by hail approximately 423 days prior, on February 15, 2021. Universal inspected the property and documented any visible damage. Pursuant to the terms of the Policy, Universal advised the Insured that there was no available coverage for the claim. Thereafter, on August 9, 2022, the Insured initiated litigation against Universal in Circuit Court in and for Columbia County under Case No. 2022-CA-000260. Thus, on the date the instant Notice was served, the parties were and continue to litigate their disputes to determine what, if any, available coverage exists under the Policy. Universal did not breach any duty to its Insured. An Insurer has no obligation 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. Accordingly, the alleged statutory violations and factual allegations of wrongdoing set forth in the Notice lack 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. Universal complied with all policy provisions and applicable Florida law regarding the adjudication of this claim. We trust that the foregoing is sufficient to advise you of Universal’s position regarding 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