Civil Remedy Notice of Insurer Violations
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Filing Number:     797638
Filing Accepted:  12/19/2024
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Complainant
Last/Business Name *  
CARSON   First Name   GARY R. AND CYNTHIA S.
Street Address * 135 SW FERNLEAF TRAIL
City, State Zip * PORT ST. LUCIE, FL 34953
Email Address * STEVEN@PLG.LAWYER
Complainant Type: * Insured
Insured
Last/Business Name*   CARSON   First Name   GARY R. AND CYNTHIA S.
Policy # * 1501-1004-1260 Claim #* FL24-0105788-F423
Attorney
Attorney is Applicable
Last Name* HOFFMAN First Name * STEVEN Initial
Street Address* 1790 HIGHWAY A1A, SUITE 209
City, State Zip* SATELLITE BEACH , FL 32937
Email Address * STEVEN@PLG.LAWYER
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):* UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY’S ADJUSTERS, EMPLOYEES, REPRESENTATIVES, AGENTS, VENDORS, AND/OR ENGINEERS AND CONTRACTORS WHO HANDLED THE CLAIM, SPECIFICALLY CHRIS LYON AND DIANA WILMONT.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unfair Trade Practice
Other : Underpayment
* 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)(d) Denying claims without conducting reasonable investigations based upon available information.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The Policy language relevant to the violations includes all applicable loss payment, duties after loss, and coverage provisions of Policy Number 1501-1004-1260, including the declarations page and all endorsements to the Policy.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Claim #FL24-0105788-F423; DOL: November 15, 2023 Gary R. and Cynthia S. Carson (“Insureds”) are the owners of a property with a policy of insurance issued by Universal Property & Casualty Insurance Company (“Carrier”). The Insureds’ residence is located at 135 SW Fernleaf Trail, Port St. Lucie, FL 34953 (the “Property”). On November 15, 2023, a wind event caused extensive damage to the Property. The Insureds timely reported an insurance claim for this damage to the Carrier and fully cooperated with all requests for inspection and information. Insured provided all requested documentation, if any, and complied with all post loss policy conditions reasonably and timely requested. The Insureds obtained representation from a public adjuster and an estimate for repair of dwelling for $76,446.22, deductible subtracted, with supporting documentation and photographs. Upon reporting the loss, the Carrier assigned a field adjuster who prepared an estimate totaling $4,069.36. The Carrier issued payment for the undisputed amount of the claim in the amount of $2,781.67, deductible and recoverable depreciation subtracted. This a gross underpayment for a repair to a roof that is unrepairable. Further, since sending the undisputed payment, Carrier has failed to respond to communications with Insured and Insured's representative. Public Adjuster has reached out several times to Diana Wilmont without a response. Section 624.02, Florida Statutes, defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit based on determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. The Carrier has breached this duty by refusing to properly and timely adjust the loss. The Carrier has more than enough information and is still refusing to accept full coverage for this claim. This continued and repeated reckless claim delay, unfair claim handling, failure to communicate, and failure to settle a claim in full that they should have, will result in a significant punitive damage award. The Carrier can avoid a lawsuit for bad faith by immediately accepting full coverage under the subject insurance policy and by paying the Insureds $73,664.55, deductible and the Carrier’s prior payment subtracted. Further, the Carrier should pay the interest accrued from notice of the claim until the date that the Carrier pays $73,664.55, per Section 627.70131 Florida Statutes.
Comments
User Id Date Added Comment
jr0405@universalproperty.com 02-06-2025 February 6, 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.: 797638 Filing Date: 12/19/2024 Complainant(s): Gary R. and Cynthia S. Carson Insured(s): Gary R. and Cynthia S. Carson Policy No.: 1501-1004-1260 Claim No.: FL24-0105788-F423 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, Steven Hoffman, on behalf of Complainants, Gary R. and Cynthia S. Carson (also referenced as “Insureds.”) The Notice alleges violations of Secs. 624.02, 624.155, and 626.9541, Fla. Stat. Universal specifically denies each allegation contained in the Notice. Additionally, Universal denies that it violated these or any statutes, Florida law, or policy provisions regarding the 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, Sec. 624.155, Fla. Stat. and Florida law. The Notice is deficient as a matter of law as it fails to comply with Sec. 624.155, Fla. Stat. 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 Sec. 624.155(3)(b), Fla. Stat., 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 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 fifteen (15) requirements that the Complainant(s) must respond to with specificity. The Florida Supreme Court holds that Sec. 624.155, Fla. Stat. “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, regarding 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 Complainants provide three (3) reasons for submitting the Notice: “Claim Delay,” “Unfair Trade Practice,” and “Underpayment.” However, the Complainants’ allegations regarding these “Reasons for Notice” have no factual support anywhere in the Notice. The Notice asserts general allegations consisting largely of conclusory statements rather than providing facts to support any allegation. As an example, the Notice states “[t]his continued and repeated reckless claim delay, unfair claim handling, failure to communicate, and failure to settle a claim in full that they should have, will result in a significant punitive damage award.” The Complainants fail to provide any facts to support these conclusory allegations, let alone any facts to support allegations of delay. Additionally, the Complainants allege that Universal has breached Section 624.02, Florida Statutes, which defines “insurance.” However, there are no facts specified to place the carrier on notice of how this statute was breached. It is evident that the statement of facts falls short of the specificity required by Section 624.155, Florida Statutes. As a result, the Complainants fail to comply with the requirements provided in Section 624.155(3)(b)(2), Florida Statutes. 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 the requirements of Sec. 624.155, Fla. Stat. the Complainants must name the individual(s) involved with specificity as it relates to the purported violation to allow Universal to properly investigate the allegations. Here, the Notice states “CHRIS LYON AND DIANA WILMONT,” however, the Notice fails to include sufficient specificity as to what facts each named individual has knowledge of that gave rise to any purported allegation(s) and/or what, if anything, each named individual did or failed to do as it relates to the claim at issue. Further, the Complainants attempt a “catch-all” by stating “UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY’S ADJUSTERS, EMPLOYEES, REPRESENTATIVES, AGENTS, VENDORS, AND/OR ENGINEERS AND CONTRACTORS WHO HANDLED THE CLAIM...,” which significantly prejudices Universal, as Universal has not been properly notified by the Complainants of the individual(s) that purportedly committed statutory violations or the specific statutory violations any individual purportedly committed. The failure to provide the requisite specificity precludes Universal from taking any corrective action and potentially curing any purported allegation. 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 states, “[t]he Policy language relevant to the violations includes all applicable loss payment, duties after loss, and coverage provisions of Policy Number 1501-1004-1260, including the declarations page and all endorsements to the Policy.” The Notice is broad in scope and fails to identify “specific policy language” relevant to any specific alleged violation. As such, Universal is left to wonder what policy provisions Complainants believe were allegedly violated or breached and why. General, vague and overbroad references to policy provisions, endorsements and the declarations page do not satisfy the specificity required by § 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). In summary, as outlined above, the Complainants fail 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 provide specific policy language relevant to any alleged violation and failing to provide sufficient facts and circumstances giving rise to the alleged violations. Therefore, the Notice is legally deficient and fails to satisfy the condition precedent to filing a bad faith action. See Julien, 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 March 11, 2024, Universal was untimely notified by the Insureds’ public adjuster, Omega Public Adjusting, that the insured location was damaged on November 15, 2023. 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. 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. To date, Universal has not received any documentation showing the amount necessary to perform such repairs or that expenses have been incurred in excess of the payment issued by Universal to the Insureds. At no time has Universal breached any duty to its Insureds. An Insurer is not required to pay whatever amount its insureds demand. While an insurance carrier 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 set forth in the Notice lack factual support and are therefore without merit. Therefore, 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 regarding 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.

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