Civil Remedy Notice of Insurer Violations
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Filing Number:     797047
Filing Accepted:  12/16/2024
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Complainant
Last/Business Name *  
VARGAS   First Name   EDWIN AND HANSEE
Street Address * 10262 SW 25 PL
City, State Zip * GAINESVILLE, FL 32608-90
Email Address * EJ.VARGAS@HOTMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   VARGAS   First Name   EDWIN AND HANSEE
Policy # * 1501-2202-0206 Claim #* FL24-0117754-J424
Attorney
Attorney is Applicable
Last Name* DIAZ First Name * JESSE Initial
Street Address* 1540 INTERNATIONAL PARKWAY, (STE 2000)
City, State Zip* LAKE MARY , FL 32746
Email Address * JESSE@DIAZLITIGATION.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):* PROPERTY CLAIMS DEPARTMENT
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Unsatisfactory Settlement Offer
Unfair Trade Practice
Other : Bad Faith
Claim Delay
* 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)(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)(j) Altering or amending an insurance adjuster’s report without: (I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and (II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or (III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change;
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Based on information and belief, the following policy provisions are relevant to this civil remedy notice. 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”. SECTION I – CONDITIONS A. Insurable Interest And Limit Of Liability Even if more than one person has an insurable interest in the property covered, we will not be liable in any one loss: 1. To an "insured" for more than the amount of such "insured's" interest at the time of loss; or 2. For more than the applicable limit of liability. B. Deductible Unless otherwise noted in this policy, the following deductible provision applies: With respect to any one loss: 1. Subject to the applicable limit of liability, we will pay only that part of the total of all loss payable that exceeds the deductible amount shown in the Declarations. 2. If two or more deductibles under this policy apply to the loss, only the highest deductible amount will apply. C. Duties After Loss Any claim or reopened claim under an insurance policy that provides property insurance for loss or damage caused by any covered peril is barred unless notice of the claim or reopened claim is given to us in accordance with the terms of the policy and within one year after the date of loss. A supplemental claim is barred unless notice of the supplemental claim is given to us in accordance with the terms of the policy and within 18 months after the date of loss. For purposes of this section, the term reopened claim means a claim that we have previously closed, but that has been reopened upon an insured’s request for additional costs for loss or damage previously disclosed to us. Supplemental claim means a claim for additional loss or damage from the same peril which we previously adjusted or for which costs have been incurred while completing repairs or replacement pursuant to an open claim for which timely notice was previously provided to us. This section does not affect any applicable limitation on civil actions SECTION 1- D. Loss Settlement In this Condition D., the terms cost to repair or replace and replacement cost do not include the increased costs incurred to comply with the enforcement of any ordinance or law, except to the extent that coverage for these increased costs is provided in Additional Coverage 11. Ordinance Or Law under Section I – Property Coverages. Additionally, the valuation of any covered property losses does not include and we will not pay any amount for “diminution in value”. Covered property losses are settled as follows: 1. Property of the following types: a. Personal property; b. Awnings, carpeting, household appliances, outdoor antennas and outdoor equipment, whether or not attached to buildings; c. Structures, other than screened enclosures, that are not buildings; and d. Grave markers, including mausoleums; at actual cash value at the time of loss but not more than the amount required to repair or replace. ... 2. Buildings and screened enclosures covered under Coverage A or B at replacement cost without deduction for depreciation, subject to the following: a. If, at the time of loss, the amount of insurance in this policy on the damaged building is 80% or more of the full replacement cost of the building immediately before the loss, we will pay the cost to repair or replace, without deduction for depreciation, but not more than the least of the following amounts: (1) The limit of liability under this policy that applies to the building; (2) The replacement cost of that part of the building damaged with material of like kind and quality and for like use; or (3) The necessary amount actually spent to repair or replace the damaged building. If the building is rebuilt at a new premises, the cost described in (2) above is limited to the cost which would have been incurred if the building had been built at the original premises. SECTION 1 – J. Loss Payment 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 will be payable upon the earliest of the following: 1. 20 days after we receive your proof of loss and reach written agreement with you; or 2. 60 days after we receive your proof of loss and SECTION 1 - E. Additional Coverage 11. Ordinance Or Law a. You may use up to 25% of the limit of liability that applies to Coverage A for the increased costs you incur due to the enforcement of any ordinance or law which requires or regulates: (1) The construction, demolition, remodeling, renovation or repair of that part of a covered building or other structure damaged by a Peril Insured Against; (2) The demolition and reconstruction of the undamaged part of a covered building or other structure, when that building or other structure must be totally demolished because of damage by a Peril Insured Against to another part of that covered building or other structure; or (3) The remodeling, removal or replacement of the portion of the undamaged part of a covered building or other structure necessary to complete the remodeling, repair or replacement of that part of the covered building or other structure damaged by a Peril Insured Against. b. You may use all or part of this ordinance or law coverage to pay for the increased costs you incur to remove debris resulting from the construction, demolition, remodeling, renovation, repair or replacement of property as stated in a. above.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Civil Remedy Notice Insured(s) Name: Edwin Vargas and Hansee Vargas Insured Address: 10262 SW 25 Pl, Gainesville FL 32608-9068 Policy Number: 1501-2202-0206 Claim Number: FL24-0117754-J424 Email: ej.vargas@hotmail.com DOL: 8/5/2024 On or about August 5, 2024, the Insureds, Edwin Vargas and Hansee Vargas, suffered damage to their home located at 10262 SW 25 Pl, Gainesville FL 32608-9068 because of Hurricane Debby. During the date of loss, NOAA recorded Hurricane Debby wind gust(s) of 54 mph in Gainesville, Florida. It is safe to say that the property was significantly impacted by Hurricane Debby. Prior to the loss, Universal Property & Casualty Insurance company (“Universal”), had issued a policy of insurance (Policy No.: 1501-2202-0206) for the Insured’s property. Said policy was in full force and effect on date of loss and afforded coverage for damage caused by a Hurricane Debby. Universal was timely notified of the loss by the Insureds and assigned claim number FL24-0117754-J424. During Universal’s investigation, the Insureds made their property available for inspection, provided facts and information surrounding the loss, and complied with Universal’s adjustment of the claim. Despite fully cooperating with Universal’s investigation, Universal impulsively limited coverage for the Insured’s insurance claim even though there was clear evidence of Hurricane Debby damage to covered property. Universal came to its coverage determination by ignoring and undervaluing the relevant facts and information provided by the Insureds and their Public Adjuster, Claims Recovery Solution, which established the damages to the roof, interior, pool cage of the residence was unquestionably the result of Hurricane Debby. While we are happy that Universal did not deny the subject claim, Universal has refused to acknowledge the Insureds and their Public Adjuster’s supplemental coverage request and demand. Universal has failed to communicate and explain pursuant as required by Fla. Stat. §§ 627.70131 and 627.7011. Specifically, the Insureds through their Public Adjuster has attempted on numerous occasions to illustrate and explain why the initial coverage tendered was not sufficient, nevertheless Universal has summarily ignored and/or failed to respond. In fact, communication has been so poor that on October 8, 2024, Mr. Zadezensky of Claims Recovery Solutions had to upload a letter asking Mr. Osborne to return his calls, and emails. Mr. Osborne was provided with all the evidence showing that additional coverage is needed to place the insured in pre-loss condition. The Insureds and their Public Adjusters have done everything possible to avoid litigation, to included demanding Appraisal, nevertheless, Gerri DeTommaso of Universal arbitrarily denied the Insured’s appraisal demand and has offered no explanation as to why, other than stating they do not agree to appraisal. It is clear that has not acted honestly or fairly towards it’s Insured. Universal tendered $4,657.98 in undisputed coverage for the roof and the interior, which is surprising, given the scope of obvious property damage. Universal and its representatives have either failed to conduct a proper investigation of the loss, or are misrepresenting the scope of damages at the residence, and misapplied exclusions in the policy in order to reduce coverage for the Insured’s claim. It has become a general business practice of to not implement proper claims handling procedures, to hire consultants that routinely ignore or intentionally misidentify relevant evidence, and to not settle claims in good faith when under all circumstances it should have. As is the case here, it is a pattern and practice for to arbitrarily deny claims without conducting reasonable investigations based upon information and evidence available to it. Specifically, Universal continues to chronically ignore the Policy’s Ordinance and Law Coverage to delay and later avoid tendering coverage pursuant to Florida’s Section 626.9744 matching statute, as well as the applicable Florida Building codes. Additionally, like on numerous other occasions, has deceitfully limited coverage due to the age, wear and tear of the property’s roof. While at first glance this coverage excuses seem neutral, it is in fact a clear violation of the afore listed bad faith statutes as well as Florida’s Sword and Shield doctrine. It is undisputed that during the underwriting of the property and all times since, had actual knowledge of the age of the roof structure, the property’s permit history, and the property’s insurance claims history. As a risk mitigation business (an insurance company) knew the life expectancy of a similar aged roof in Florida has; as such had (at a minimum) constructive knowledge of the age, wear and tear present at the property prior to Hurricane Debby. With that knowledge determined their premiums and issued the Policy. The older the property, the bigger the risk, the higher the insurance premiums. – But now, that the Insureds have attempted to use the Policy they’ve paid for, unilaterally determined that they are not responsible based on the same information it used to charge the insureds higher premiums. In order to cure this civil remedy notice, Universal must immediately acknowledge in writing that the Insureds’ roof, interior and pool cage were damaged by Hurricane Debbie and said damage is covered by the Policy. Furthermore, Universal shall promptly tender $93,847.02 in Replacement Cost Value or $78,221.91 in Actual Cash Value (less prior payments and the deductible) in coverage; plus 627.6131 interest made payable to “Edwin Vargas and Hansee Vargas and Claims Recovery Solutions”. At this time, attorney Jesse Diaz, of The Law Office of Jesse Diaz, PLLC, was retained to draft this Civil Remedy notice only.
Comments
User Id Date Added Comment
Jesse@DiazLitigation.com 09-22-2025 This Civil Remedy Notice is hereby withdrawn by the Insureds. The allegations are voided.
jr0405@universalproperty.com 02-03-2025 February 3, 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.: 797047 Filing Date: 12/16/2024 Complainant(s): Edwin and Hansee Vargas Insured(s): Edwin and Hansee Vargas Policy No.: 1501-2202-0206 Claim No.: FL24-0117754-J424 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, Jesse Diaz, on behalf of Complainants, Edwin and Hansee Vargas (also referenced as “Insureds”). The Notice alleges violations of Sections 624.155, 626.9541, 626.9744, 627.70131, and 627.7011, 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 the Complainants 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. Because the Notice fails to specify how, if at all, any of these statutes were violated, it does not comply with Section 624.155, Florida Statutes. The Notice fails to provide Universal with the necessary 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. The Notice lacks the requisite specificity required by Sec. 624.155, Fla. Stat., because the Notice states “PROPERTY 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 Complainants are 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 Complainants allege 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, Complainants’ 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 violations. The Notice cites policy headings, section titles and provisions without identifying how, if any, of the referenced language relates to any alleged violation or how, if at all, the cited language is relevant to the subject claim identified in the Notice. As such, Universal is left to wonder what policy provisions the Complainants believe were allegedly violated or breached and why. General, vague, and overbroad references to policy headings, sections and/or provisions do 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 Complainants provide five (5) reasons for submitting the Notice: “Claim Denial,” “Unsatisfactory Settlement Offer,” “Unfair Trade Practice,” “Bad Faith,” and “Claim Delay.” However, the Complainants’ allegations regarding these “Reasons for Notice” have no factual support anywhere in the Notice. The Notice asserts general allegations consisting of boilerplate and conclusory statements rather than specifying facts to support its allegations. For example, the Notice alleges that “Universal and its representatives have either failed to conduct a proper investigation of the loss, or are misrepresenting the scope of damages at the residence, and misapplied exclusions in the policy in order to reduce coverage for the Insured’s claim.” The Complainants fail to specify any facts to support these conclusory statements. Moreover, the Notice does not specify any facts regarding any misrepresentations made by Universal, what findings Universal misrepresented and does not identify the person or persons who made such misrepresentations. As an additional example, the Notice alleges “[i]t has become a general business practice of [sic] to not implement proper claims handling procedures, to hire consultants that routinely ignore or intentionally misidentify relevant evidence, and to not settle claims in good faith when under all circumstances it should have.” The Notice does not specify any facts to support these speculative and conclusory statements. The Complainants are required to provide with specificity the facts and circumstances giving rise to the alleged violation strictly related to Complainants’ allegations, not conjecture or speculation of what may be 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 Complainants 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. 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). 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. Here, Complainants demand an amorphous cure unrelated to payment of contractual amounts due. As such, the Notice is deficient as it does not provide Universal an opportunity to “cure” the alleged violations without imposing obligations on Universal not contemplated by the Policy. 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 Complainants failed 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 August 7, 2024, Universal was notified by the Insureds’ agent that the insured location was damaged on August 5, 2024. Universal inspected the property and documented any visible damage. Universal, in accordance with the terms and conditions of the Policy, issued payments in the full amount of its estimate, less 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. On or about September 10, 2024, Universal received an estimate from Claims Recovery Solutions totaling $93,847.02 on behalf of the Insureds. Universal timely advised the Insureds of its determination as to the supplemental claim. To date, Universal has not received any documentation showing an amount above the undisputed payments are owed in accordance with the terms of the Policy. At no time has Universal breached any duty to its Insureds. 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 adjustment 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 Complainants. 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