Civil Remedy Notice of Insurer Violations
Login

Filing Number:     797816
Filing Accepted:  12/20/2024
         Print Filing
Complainant
Last/Business Name *  
AUGUSTIN   First Name   JIMMY
Street Address * 209 MERIDIAN ST
City, State Zip * DAVENPORT, FL 33837
Email Address * DJIMMY725@YAHOO.FR
Complainant Type: * Insured
Insured
Last/Business Name*   AUGUSTIN   First Name   JIMMY
Policy # * 1501-2103-6477 Claim #* FL24-0101191
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):* ? BENJAMIN DEUTSCHMANN, FIELD ADJUSTER ON BEHALF OF ALDER ADJUSTING A SUBSIDY OF UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY; ? JODI FOUNTAIN-SPILOTRAS, CLAIMS EXAMINER ON BEHALF OF ALDER ADJUSTING A SUBSIDY OF UNIVERSAL PROPERTY & CASUALTY INSU
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Unfair Trade Practice
Other : Improper 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)(2) A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
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)(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 04 23 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 *** 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[.]” *** 4. Protect the covered property from further damage. If emergency measures are required, the following must be performed: a. Take reasonable emergency measures as provided under Additional Coverage 2; b. Keep an accurate record of repair expenses; 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 January 2, 2024, Jimmy Augustin (Complainant(s)) suffered a loss to their Property, located at the address listed above due to water damage. After discovering the damage, Complainant(s) promptly reported the loss to Universal Property & Casualty Insurance Company (“Insurer”) on or about January 12, 2024. 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. Claim Facts Upon discovering the damages, Complainant entered into a contract with Adjuster’s Group (hereinafter “Public Adjuster”) on or about January 3, 2024. On or about January 10, 2024, Complainant retained Luciano Pro Services to replace the shower mixing valve, with an invoice estimating $380 for the replacement costs. Later that same day, Complainant retained Centurion Restoration Florida to conduct emergency water mitigation services. Upon completing the services, Centurion Restoration Florida produced an estimate on or about January 13, 2024, totaling $6,913.81. On or about January 22, 2024, the assigned claim Field Adjuster, Benjamin Deutschmann, inspected Complainant's property. Merely three days later, on or about January 25, 2024, Insurer issued a coverage determination letter, attaching an estimate with an egregiously low actual cash value of $412.05. While Insurer claimed that "damages were covered," it was evident that Insurer had no intention of providing meaningful coverage. Instead, upon information and belief, Insurer intentionally undervalued the damages to deny coverage, basing the denial on the adjusted value falling below the policy deductible. On or about January 26, 2024, the Public Adjuster conducted an inspection of the property and took photographs. Shortly after, on or about January 30, 2024, the Public Adjuster produced an estimate totaling $66,561.21 in actual cash value, nearly 66 times the amount determined by Insurer. Despite the glaring discrepancy between the two estimates, Insurer failed to conduct any further investigation or reconcile the differences. On or about February 3, 2024, Insurer merely acknowledged receipt of the Public Adjuster’s estimate and issued a revised determination providing coverage of only $6,176.39. This determination fell egregiously short of the Public Adjuster’s estimate and even short of the emergency mitigation services provided. Insurer’s letter was vague, overly broad, and entirely devoid of any meaningful reasoning for the underpayment. The only aspect of the Public Adjuster’s estimate addressed was the labor costs, which accounted for merely 4.21% of the total estimate, or $2,800. Even if the disputed labor costs were excluded, Insurer’s revised coverage determination still fell over $55,847.40 short of the Public Adjuster’s estimate after accounting for deductibles and the prior payment. Furthermore, despite the significant and obvious discrepancy between Insurer’s own estimate and the Public Adjuster’s estimate, Insurer made no attempt to reconcile the difference. Insurer neither revised the initial estimate nor engaged an expert to verify or challenge the findings in the Public Adjuster’s estimate. Instead, Insurer summarily dismissed the Public Adjuster’s findings, and included only a 6-line estimate of the damages without conducting any additional investigation, a violation of Fla. Stat. 626.9541(1)(i)(3)(d) which requires Insurer to conduct reasonable investigations based upon available information. A reasonable investigation requires more than a cursory review of the evidence. It demands an active effort to gather relevant facts, retain necessary expertise, and assess all available information to arrive at a fair and informed decision. Insurer’s failure to address the Public Adjuster’s estimate in its entirety, beyond a superficial reference to labor costs, demonstrates a clear lack of proper investigation processes. Insurer blatantly disregarded significant components of the Public Adjuster’s estimate, focusing solely on a limited valuation of damages in the hall bathroom. In stark contrast, the Public Adjuster’s estimate comprehensively addressed damages to the bathroom, hallway, family room, kitchen, pantry, laundry room, and all other areas of the home where damage was documented. Despite claiming that "damages" were covered, Insurer’s correspondence failed to specify where these damages were located or how they were calculated. Instead, Insurer merely attached an estimate without context, relying on the assumption that an unqualified recipient would be unable to decipher the values or identify the omissions. This conduct is a clear misrepresentation of material information, designed to minimize the payout to Complainant. By failing to provide transparency regarding the scope and location of the damages Insurer allegedly evaluated, Insurer misled Complainant regarding the extent of the covered loss. This deliberate misrepresentation constitutes a violation of Fla. Stat. 626.9541(1)(i)(2), which prohibits insurers from knowingly misrepresenting pertinent facts or policy provisions to reduce or deny valid claims. Additionally, Insurer’s expedited determination timeline, issuing a revised decision only a few days after receiving the Public Adjuster’s estimate, further evidences the lack of intent to conduct a meaningful investigation. The claim file was open for a mere 22 days, during which Insurer inspected the property, produced an initial estimate, issued a denial letter, and then responded to the Public Adjuster’s estimate without addressing the contents or undertaking any additional efforts to investigate. Insurer’s rushed determination and handling of the claim process demonstrate a clear pattern of conducting the investigation in a manner that falls well below the standards required by law, constituting a violation of Fla. Stat. 626.9541(1)(i)(3)(a). Upon information and belief, Insurer has implemented an unreasonable company-wide policy to rely solely and heavily upon homeowners, most of whom have no background or knowledge in any of the trades involved in diagnosing a loss, to report losses with almost expert accuracy. This policy is not in line with Insurer’s duty a “fair and honest treatment of the claimant” as it seeks only to protect Insurer’s interests. Based on the events described above, it is clear that Insurer conducted an improper and haste investigation 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 $66,679.00, 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
oc1102@universalproperty.com 02-07-2025 February 7, 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.: 797816 Filing Date: 12/20/2024 Complainant(s): Jimmy Augustin Insured(s): Jimmy Augustin Policy No.: 1501-2103-6477 Claim No.: FL24-0101191 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 Complainant Jimmy Augustin (also referenced as the “Insured”.) The Notice alleges violations of Sections 624.155 and 626.9541, Florida Statutes. 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). 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. 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 “BENJAMIN DEUTSCHMANN… JODI FOUNTAIN-SPILOTRAS.” The Notice fails to specifically explain what the named individuals have knowledge of as it relates to the claim, or what if anything they did or failed to do. Therefore, the Notice does not have the requisite specificity as to whom the Complainant is asserting have knowledge as to each specific allegation contained in the Notice. Specific identification of a person or persons with the most knowledge within Universal is of particular importance because, the Complainant alleges that Universal made “[a] material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy” and “misrepresented pertinent facts and/or policy provisions” 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. 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 specific policy language relevant to any alleged violation. Instead, the Notice is broad in scope and fails to identify any “specific policy language” relevant to any alleged violation. Notably, the Notice cites to the “Duties After Loss” Section, however, this provision applies to the Insured’s obligations under the Policy, and therefore not applicable to the carrier. The broad references to various provisions in the Policy provide no guidance or explanation, such that Universal is left to wonder what policy provisions the Complainant believes were allegedly violated or breached and why. Thus, it is unclear what, if any, policy language, pertaining to any allegation have been violated. General, vague and overbroad references to section headings and/or policy 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). Third, 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 lists “claim denial, unfair trade practice, and Improper Investigation” as the “Reasons for Notice.” However, the Complainant’s allegations regarding the “Reasons for Notice” are unsupported by facts in the Notice. The Notice also asserts general allegations consisting of conclusory and boilerplate statements rather than specific allegations of facts regarding any alleged misconduct or statutory violations. For example, the Notice alleges Universal violated Sections 624.155(1)(b)(1), 626.9541(1)(i)(3)(a), and 626.9541(1)(i)(3)(d), Florida Statutes, but fails to assert any specific facts or circumstances that give rise to any of the above purported statutory violations, which could enable Universal to investigate and resolve the Complainant’s allegations. Moreover, the Notice alleges, “[u]pon information and belief, Insurer has implemented an unreasonable company-wide policy to rely solely and heavily upon homeowners, most of whom have no background or knowledge in any of the trades involved in diagnosing a loss, to report losses with almost expert accuracy. This policy is not in line with Insurer’s duty a “fair and honest treatment of the claimant” as it seeks only to protect Insurer’s interests. Based on the events described above, it is clear that Insurer conducted an improper and haste investigation 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.” The Complainant is required to provide with specificity the facts and circumstances giving rise to the alleged violation strictly related to their allegations, not conjecture or speculation of what may be a business practice by the carrier. The Complainant fails to provide any facts or examples to support the above conclusory allegations. It is evident that the statement of facts falls short of the specificity required by Section 624.155, Florida Statutes. Additionally, the Notice does not specify any facts regarding any misrepresentations made by Universal, state what was misrepresented and does not identify the person or persons who made such misrepresentations. As a result, the Complainant fail to comply with the requirements provided in Section 624.155(3)(b)(2), Florida Statutes. 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). However, Section 624.155, Florida Statutes, does not impose on an insurer the obligation to pay whatever an insured demands. Talat, 753 So. 2d at 1282. Notably, Universal asserts that by the Insured initiating litigation before the filing of the Notice, prejudice 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. As such, the Notice is deficient. 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, the failure to sufficiently allege facts and circumstances giving rise to any violation, and the failure to provide a means whereby Universal can “cure” the alleged defects. 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 January 12, 2024, Universal received notice from the Insured’s public adjuster, Adjuster Groups LLC, the insured location had damage which occurred on January 2, 2024. Universal inspected the property and documented any visible damage. Thereafter, Universal issued an undisputed payment to the Insured in the full amount of its estimate less the applicable policy 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. It will then pay any remaining amounts necessary to perform such repairs as work is performed and expenses are incurred. On December 5, 2024, the Insured initiated litigation against Universal in Circuit Court of Polk County under case No. 2024-CA-004549-0000-00. Thus, at the time the instant Notice was filed, the parties were and continue to litigate their dispute to determine what, if any, additional coverage exists under the terms of the Policy. As outlined above, the alleged statutory violations set forth in the Notice lack factual support and are without merit. We trust that the foregoing is sufficient to advise you of Universal’s position regarding this matter and fully respond to the alleged violations in 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.

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