Civil Remedy Notice of Insurer Violations
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Filing Number:     795650
Filing Accepted:  12/6/2024
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Complainant
Last/Business Name *  
KARKLINS   First Name   MICHAEL
Street Address * 21766 LITTLE BEAR CT
City, State Zip * BOCA RATON, FL 33428
Email Address * MARK75@ATT.NET
Complainant Type: * Insured
Insured
Last/Business Name*   KARKLINS   First Name   MICHAEL
Policy # * 1501-1803-4991 Claim #* FL24-0104987
Attorney
Attorney is Applicable
Last Name* FANTETTI First Name * KELLY Initial A
Street Address* 109 S. EDISON AVENUE
City, State Zip* TAMPA , FLORIDA 33606
Email Address * KFANTETTI@STOCKHAMLAWGROUP.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):* DIANNE WILMOT
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unsatisfactory Settlement Offer
Claim Delay
Unfair Trade Practice
Other : Insufficient Investigation
* 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.
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)(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)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Loss Payment Provision We will adjust all losses with you. We will pay you unless some other person is named in the policy or is legally entitled to receive payment. Loss Settlement Provision d. We will initially pay at least the actual cash value of the insured loss, less any applicable deductible.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

In Florida, the work of adjusting insurance claims engages the public trust. Universal Property & Casualty Insurance Company (“UNIVERSAL”) has breached the public’s trust by its adjustment of Michael Karklins’ (“INSURED”) claim of loss. Universal Property & Casualty Insurance Company’s address is 1110 W. Commercial Blvd., Fort Lauderdale, Florida 33309. UNIVERSAL has failed to create and implement adequate guidelines for the proper investigation and evaluation of claims, claims handling, and for training and supervision of employees resulting in statutory violations as set forth above. UNIVERSAL has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the INSURED’S insurance claim for damages. UNIVERSAL has failed to promptly settle the INSURED’S insurance claim when the obligation to settle the insurance claim had become reasonably clear. To date, notwithstanding the INSURED’S pleas otherwise, UNIVERSAL has continued to refuse to acknowledge its obligation to conduct a proper investigation, and to tender the full amount of insurance monies due and owing its INSURED under the policy. This claim involves the INSURED’S property located at 21766 Little Bear Ct., Boca Raton, Florida 33428, which sustained damage from a water loss on February 20, 2024, primarily affecting the kitchen flooring and cabinets. UNIVERSAL conducted a cursory investigation and accepted coverage for the loss, but woefully underpaid the claim. While UNIVERSAL included the wood flooring damage in its estimate, the amount estimated for these repairs was well below market prices. More importantly, UNIVERSAL wholly failed to include the damaged kitchen cabinets or to address the mold damages. The INSURED, through his public adjuster, has submitted a mold report, a mold estimate, and a competing rebuild estimate, by UNIVERSAL has ignored these submissions and has failed to respond to inquiries from the public adjuster about further adjusting the claim. It has not been more than 60 days since the INSURED submitted a signed proof of loss, and UNIVERSAL has failed to respond to the POL, conduct any further investigation or to make any attempt to settle the claim. The concept of insurance is that UNIVERSAL will investigate and grant timely and prompt indemnity or security against a contingent loss. Florida Statute §624.02 defines “insurance” as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit upon determinable contingencies. Inherent in that definition is the fact that payment must be made timely and promptly so that the INSURED may mitigate his damages and be put back into the position he was in prior to the loss as quickly as possible. UNIVERSAL has breached this duty. The INSURED was, and still is, forced to expend out of pocket monies to submit his insurance claim, e.g., retaining an attorney and other experts to force UNIVERSAL to honor its obligations under the insurance policy and to pay all the insurance proceeds due and owing to him. UNIVERSAL has refused and/or failed to tender all the insurance proceeds due and owing to the INSURED. UNIVERSAL’s refusal and/or failure to settle the insurance claim when under all circumstances it could have and should have done so had it acted fairly and honestly towards the INSURED is wrongful conduct. Furthermore, the INSURED contends that UNIVERSAL’s adjusters and/or representatives financially benefit from such wrongful conduct. To cure the defects outlined above, the UNIVERSAL must (1) promptly tender all insurance proceeds due and owing to the Insureds that would reasonably place the Insureds back into the pre-loss condition, including the tender of accrued interest due and owing to the Insureds; (2) promptly and timely communicate with the Insureds’ representative(s) to complete the adjustment of the Insureds’ loss by participating in good faith negotiations to reach an agreement relating to the parties’ dispute over coverage, scope and amount. This notice is given in order to perfect the right to pursue the civil remedy authorized by Fla. Stat. §624.155.
Comments
User Id Date Added Comment
oc1102@universalproperty.com 01-23-2025 January 23, 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.: 795650 Filing Date: 12/6/2024 Complainant(s): Michael Karklins Insured(s): Michael Karklins Policy No.: 1501-1803-4991 Claim No.: FL24-0104987 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, Kelly A Fanfetti, on behalf of Complainant, Michael Karklins (also referenced as the “Insured”.) The Notice alleges violations of Sections 624.155, 624.02, and 626.9541, Florida Statutes. Universal denies the allegations contained 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 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 has 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). First, 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 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 “DIANNE WILMOT,” without more. The Notice does not state what the named individual did or failed to do as it relates to the claim at issue. Therefore, the Notice does not have the requisite specificity as to whom the Complainant is asserting has knowledge as to each specific allegation contained in the Notice and this failure precludes Universal from investigating the alleged violations and potentially cure them. Accordingly, Complainant’s Notice is insufficient as a matter of law. Second, the Notice fails to satisfy Section 624.155(3)(b)(4), Florida Statutes, in that it fails to reference any specific policy language relevant to any alleged violation(s). The Complainant failed to state any specific policy provisions and instead broadly makes references to a policy section and provisions which provide no guidance or explanation, such that Universal is left to wonder what policy provisions Complainant believes were allegedly violated. General, vague, and overbroad references to a policy section and provisions 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). Lastly, with respect to the requirement to set forth with specificity the “facts and circumstances giving rise to the violation,” the Notice fails to allege any specific conduct on the part of Universal that would violate any policy provision or statute. The Complainant provides four (4) reasons for submitting the Notice, however, the Complainant’s allegations have no specific factual support specified in the Notice. The Notice asserts general allegations consisting of conclusory and inaccurate statements rather than specific allegations of fact regarding any alleged misconduct or statutory violations. For example, the Notice alleges in part: “UNIVERSAL has failed to create and implement adequate guidelines for the proper investigation and evaluation of claims, claims handling, and for training and supervision of employees resulting in statutory violations as set forth above. UNIVERSAL has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the INSURED’S insurance claim for damages. UNIVERSAL has failed to promptly settle the INSURED’S insurance claim when the obligation to settle the insurance claim had become reasonably clear…” “UNIVERSAL has refused and/or failed to tender all the insurance proceeds due and owing to the INSURED. UNIVERSAL’s refusal and/or failure to settle the insurance claim when under all circumstances it could have and should have done so had it acted fairly and honestly towards the INSURED is wrongful conduct. Furthermore, the INSURED contends that UNIVERSAL’s adjusters and/or representatives financially benefit from such wrongful conduct.” The Complainant fails to provide any specific facts to support the above referenced boilerplate and conclusory statements. Not only are there no facts in the Notice to support these or any of the conclusory allegations set forth therein, as will be explained in further detail below, Universal investigated the Insured’s claim and timely indemnified the Insured for the claim, in accordance with the terms and conditions of the Policy. Moreover, the Notice also alleges that Universal breached Section 624.02, Florida Statutes, but fails to provide facts to specify how this statute was breached. The Complainant fails to provide the requisite specificity as to how Universal allegedly violated any policy provision or statute. The failure to provide specific facts to support the conclusory allegations of misconduct hinders Universal’s ability to appropriately investigate the allegations in the Notice. It is evident that the statement of facts falls short of the specificity required by Section 624.155, Florida Statutes. As a result, Complainant failed to comply with the requirements provided in Section 624.155(3)(b)(2), Florida Statutes. 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, the failure 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, the failure to reference specific policy language relevant to the alleged violation, and the failure to allege any specific conduct on the part of Universal that would violate any policy provision or statute. 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 the facts and circumstances regarding this claim, which shall demonstrate that Universal has not violated any Policy terms or statutory provisions. On February 28, 2024, Universal received notice from the Insured the insured location had damage which occurred on February 20, 2024. Universal inspected the property and documented any visible damage. Universal indemnified the Insured in the full amount of its estimate, less the applicable deductible and the recoverable depreciation, pursuant to the terms of the Policy. Under the terms of the Policy, Universal will initially pay at least the actual cash value of the insured loss, less any applicable deductible. Universal will then pay any remaining amounts necessary to perform such repairs as work is performed and expenses are incurred. To date, Universal has not received any documentation from the Insured showing the amount necessary to perform such repairs or that expenses have been incurred in excess of the payment issued by Universal to the Insured. Universal denies the allegations asserted in the Notice. An insurer is not required to pay whatever amount an insured demands. As outlined above, the alleged statutory violations set forth in the Notice are devoid of factual support and are without merit. We trust that the foregoing is sufficient to advise you of Universal’s position with regard to this matter and fully respond to the Notice filed by the Complainant. 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