Civil Remedy Notice of Insurer Violations
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Filing Number:     796785
Filing Accepted:  12/13/2024
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Complainant
Last/Business Name *  
ROMMEL M. LOPEZ   First Name  
Street Address * 6117 WHALTON STREET
City, State Zip * WEST PALM BEACH, FL 33411
Email Address * ROMMEL_33@HOTMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   ROMMEL M. LOPEZ   First Name  
Policy # * 1501-2002-3563 Claim #* FL22-0118249
Attorney
Attorney is Applicable
Last Name* DAVIS First Name * JARED Initial
Street Address* 925 S. FEDERAL HWY
City, State Zip* BOCA RATON , FL 33432
Email Address * JDAVIS@KPATTORNEY.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):* CLAIMS DEPARTMENT
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unfair Trade Practice
Claim Denial
* 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)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
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.

Loss settlement provision
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The carrier was immediately put on notice of the insureds’ storm claim. Subsequently, the insureds prepared a loss package in the amount of $68,440.64 needed to restore the property back to its pre-loss condition. Whereas, the carrier has failed to prudently inspect the insureds’ property, come to a fair coverage determination and promptly pay the claim. The carrier improperly determined that the loss was not covered under the policy and wrongfully denied the claim. In turn, the insureds have complied with all of the carrier’s requests to date and the carrier has still failed to treat this claim with good faith. This intentional delay with the claim has led to direct prejudice of the insureds. About three years and four months have passed since the original date of loss. The carrier has still refused to pay the fully covered amount owed under the policy. The carrier is aware of the damage sustained by the insured’s property and has not taken any meaningful ensuing action. Additionally, on July 25, 2024, notwithstanding carrier’s previous denial to the roof portion of this claim, the carrier made the decision to open coverage for remediation services provided by ACE Restoration Services, LLC (“ACE”) in the amount $9,990.00. ACE provided remediation service during litigation process for the damages resulting from the roof. To date, the carrier has yet to disperse payment for ACE’s services. The reasoning provided was as follows: “[a]fter further review, the [Direction To Pay] . . . check wasn’t sent after the claims department realized the case was in litigation.” This information is purposely being withheld in order to obtain a tactical advantage in this matter. It is evident the carrier is engaging in bad faith tactics by withholding information and payment from the insured. Universal owes money to the Insured for the ACE services performed and has refused to pay them. It is clear that the carrier is not treating the insureds with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insureds; failing to implement proper standards for the adjustment and investigation of claims by its adjusters and placing the company’s interests before the insureds’ interests; refusing to pay the full amount owed to the insureds despite the fact that the carrier has been on notice of the damages and looking for ways to delay full recovery or any recovery to the insureds, when a reasonable carrier in a similar position would have tendered a full payment in accordance with both the policy language and statutory requirements. The carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c) and 626.9541(1)(i)(3)(f), as well as Section I- Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss; and the loss payment provision under Section I- Conditions requiring payment of a claim within 90 days. All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless disregard for the insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $68,440.64, less any prior payments and less any applicable policy deductible; and 2.) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been sent to the carrier. Please do not hesitate to contact the undersigned or Erica De Jesus at (561)-892-9874 if you have any questions or concerns. Sincerely, Jared Davis Attorney at Law
Comments
User Id Date Added Comment
jr0405@universalproperty.com 01-30-2025 January 30, 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.: 796785 Filing Date: 12/13/2024 Complainant: Rommel M. Lopez Insured: Rommel M. Lopez Policy No.: 1501-2002-3563 Claim No.: FL22-0118249 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, Jared Davis, on behalf of Complainant, Rommel M. Lopez (also referenced as “Insured”). The Notice alleges violations of Sections 624.155 and 626.9541, Florida Statutes. Universal specifically 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 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, 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). To begin, the Notice fails to meet the requirement of Section 624.155, Florida Statutes, on several grounds. 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. 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. The Notice lacks the requisite specificity required by Sec. 624.155, Fla. Stat., because the Notice states “CLAIMS DEPARTMENT,” which clearly defeats the requirement in the DFS Form to provide specificity in order to put the carrier on notice and provide it with an opportunity to investigate any allegation with a specific individual. The Notice does not have the requisite specificity as to whom the Complainant is asserting has knowledge as to any allegation in the Notice. Specific identification of a person or persons with the most knowledge within Universal is of particular importance because the Complainant alleges Universal has “[m]isrepresent[ed] pertinent facts or insurance policy provisions relating to coverages at issue.” The Notice fails to include any specificity as to whom made any misrepresentations, what was misrepresented, and when any of these misrepresentations were made. Accordingly, Complainant’s Notice is insufficient as a matter of law. Second, the Notice fails to satisfy Sec. 624.155(3)(b)(4), Fla. Stat., because it fails to reference any specific policy language relevant to any alleged violation. Instead, the Notice only states, “Loss settlement provision.” The Notice provides no guidance or explanation, such that Universal is left to wonder when, how or by whom this policy provision title was violated. Therefore, it is unclear what, if any, policy language pertains to any allegation. General, vague, or overbroad references to a policy provision title does not satisfy the specificity required by Sec. 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). Third, regarding the requirement to set forth with specificity the “facts and circumstances giving rise to the violation,” the Notice fails to specify sufficient facts that would put Universal on notice that it violated any policy provision or statute. The Complainant lists three (3) reasons for filing the Notice: “Claim Denial,” “Claim Delay,” and “Unfair Trade Practice.” 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 inaccurate, boilerplate and conclusory statements in lieu of specifying facts to support its allegations. For example, the Notice states in part “the insureds [sic] prepared a loss package in the amount of $68,440.64 needed to restore the property back to its pre-loss condition. … This intentional delay with the claim has led to direct prejudice of the insureds [sic].” The Complainant fails to assert any facts to support these conclusory statements. Further, there are no facts to support that the amount claimed by the Complainant is what is owed for the claim at issue, let alone a single fact to support that there has been any delay. The Complainant also alleges “[t]he carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c) and 626.9541(1)(i)(3)(f), as well as Section I- Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss; and the loss payment provision under Section I- Conditions requiring payment of a claim within 90 days.” However, the Complainant fails to specify any facts or examples to support the above referenced boilerplate statutory violations and alleged violation of the Policy. Further, 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. As to the Complainant’s general reference to an alleged violation of the Policy “requiring payment of a claim within 90 days,” Universal asserts as phrased, this is misleading, and Universal relies on the actual Policy language itself. Further, there are no facts asserted to support this allegation. In addition, the Notice states “[a]ll the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless disregard for the insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida.” The Complainant fails to specify facts to support these conclusory and speculative allegations. The Complainant does not specify any facts concerning when, how or whom, violated the Insured’s rights. The Complainant is required to specify the facts and circumstances giving rise to the alleged violation strictly related to the Complainant’s allegations, not conjecture or speculation of the carrier’s business practices. 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. Lastly, the Notice does not provide a proper means whereby Universal can “cure” the alleged defects. 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). Section 624.155, Florida Statute, however, 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 the Insured initiating litigation before filing the Notice, prejudices 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. Universal is only obligated to pay contractual amounts owed to cure a civil remedy notice. See id. at 1278. 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 proper cure. 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 June 8, 2022, Universal was untimely notified by the Insured’s public adjuster, Claim Pros, LLC, that the insured location was damaged on July 22, 2021. 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. Additionally, Universal timely advised the Insured that the roofing property damage was not covered under 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. It will then pay any remaining amounts necessary to perform such repairs as work is performed and expenses are incurred. On October 31, 2022, the Insured initiated litigation against Universal in the Circuit Court in and for Palm Beach County under Case No. 2022-CA-010685. Thus, at this time, the parties continue to litigate their dispute to determine what, if any, additional available 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 an insured demands. 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. Universal has 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 with regard to this matter and fully responds to the Notice filed by the Complainant. Sincerely, /s/ Jonathan Rodriguez Jonathan Rodriguez, 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