Filing Number: 797923
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| Filing Accepted: 12/23/2024 |
| Last/Business Name
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| Street Address
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1256 SOUTHWEST 1ST TERRACE |
| City, State Zip
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POMPANO BEACH,
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33060
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| Email Address
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PF@WEKLAW.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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BRUENING |
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First Name |
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KYLE |
| Policy # * |
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150115031302 |
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Claim #* |
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FL220106213 |
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Attorney is Applicable
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| Last Name* |
FERNANDEZ
First Name *
PATRICIA
Initial
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| Street Address* |
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800 E BROWARD BLVD, SUITE 510 |
| City, State Zip* |
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FORT LAUDERDALE
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FL
33301
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| Email Address * |
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PF@WEKLAW.COM |
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| Insurer Type
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 Authorized Insurer
 Unauthorized Insurer
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| Insurer Name |
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| Insurer Name* |
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UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY
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| Insurer Name* |
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| Street Address* |
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| City, State Zip* |
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,
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NAIC Company Code 10861 |
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| Name of individual responsible for violation (if any):*
LEONARDO PIMENTAL
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| Type of Insurance
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Residential Property & Casualty
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| Reason for Notice
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Claim Denial
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Claim Delay
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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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Statutory provision(s) which the insurer allegedly violated.
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| 624.155(1)(b)(1) |
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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.
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| 624.155(1)(b)(3) |
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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.
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| 626.9541(1)(i)(3)(a) |
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Failing to adopt and implement standards for the proper investigation of claims.
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| 626.9541(1)(i)(3)(b) |
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Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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| 626.9541(1)(i)(3)(c) |
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Failing to acknowledge and act promptly upon communications with respect to claims.
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| 626.9541(1)(i)(3)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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| 626.9541(1)(i)(3)(f) |
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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.
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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
SECTION I – PERILS INSURED AGAINST
A. Coverage A – dwelling And Coverage BOther
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”.
2. We do not insure, however, for loss:
***
c. Caused by:
***
(5) Constant or repeated seepage or leakage of water or steam or the presence or
condensation of humidity, moisture, or vapor, over a period of weeks, months, or
years; unless such seepage or leakage of water or steam or the presence or
condensation of humidity, moisture or vapor, and the resulting damage is unknown
to all “insureds” and is hidden within the walls or ceilings or beneath the floors or
above the ceilings of a structure;
SECTION I – EXCLUSIONS
A. We do not insure for loss caused directly or indirectly by any of the following.
Such loss is excluded regardless of any other cause or event contributing
concurrently or in any sequence to the loss. These exclusions apply whether or not
the loss event results in widespread damage or affects a substantial area.
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5. Neglect
Neglect means neglect of an "insured" to use all reasonable means to save and
preserve property at and after the time of a loss.
SECTION I – PERILS INSURED AGAINST
A. Coverage A – dwelling And Coverage BOther
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”.
2. We do not insure, however, for loss:
***
c. Caused by:
***
(7) Any of the following:
(a) Wear and tear, “marring”, deterioration;
We do not insure for loss to property described in Coverage A and B caused by
any of the following. However, any ensuing loss to property described in Coverage
A and B not precluded by any other provision in this policy is covered.
***
3. Faulty, inadequate or defective:
a. Planning, zoning, development, surveying, siting;
b. Design, specifications, workmanship, repair, construction, renovation,
remodeling, grading, compaction;
c. Materials used in repair, construction, renovation or remodeling; or
d. Maintenance;
of part or all of any property whether on or off the "residence premises."
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C. Duties After Loss.
In case of a loss to covered property, we have no duty to provide coverage under this
Policy if the failure to comply with the following duties is prejudicial to us. These
duties must be performed either by you, an “insured” seeking coverage, or a
representative of either:
1. Give prompt notice to us or our agent.
Except for Reasonable Emergency Measures taken under Additional Coverage 2.
there is no coverage for repairs that begin before the earlier of:
a. 72 hours after we are notified of the loss;
b. The time of loss inspection by us; or
c. The time of other approval by us.
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.”
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4. Protect the covered property from further damage. If emergency measures are
required, the following must be performed:
a. Take reasonable emergency measures that are necessary to protect the covered
property from further damage, as provided under Additional Coverage 2.
A reasonable emergency measure under 4.a. above may include a permanent repair
when necessary to protect the covered property from further damage or to prevent
unwanted entry to the property. To the degree reasonably possible, the damaged
property must be retained for us to inspect; and
b. Keep an accurate record of repair expenses;
5. Cooperate with us in the investigation of a claim;
6. Prepare an inventory of damaged personal property showing the quantity,
description, actual cash value and amount of loss. Attach all bills, receipts and related
documents that justify the figures in the inventory;
7. As often as we reasonably require:
a. Show us the damaged property and the cause of loss, if reasonably
possible, except as to any repairs performed under Section I – Additional
Coverages, 2. Reasonable Emergency Measures:
b. Provide us with the records and documents we request and permit us to make
copies;
c. Any and all “insureds” must submit to recorded statements when requested by
us;
d. In the County where the “residence premises” is located, you, your agents, your
representatives and any and all “insureds” must submit to examination under oath,
while not in the presence of another “insured”, and sign the same when requested
by us;
At your or our request, the examinations will be conducted separately and not in
the presence of any other persons except legal representation;
e. Permit is to take samples of damages and undamaged property for inspection,
testing and analysis; and
f. Any and all “insureds” must execute all authorizations for the release of
information when requested by us.
8. You must give notice of a claim, a supplemental claim, or a reopened claim for loss
or damage caused by the peril of windstorm or hurricane, with us in accordance with
the terms of this policy and within three years after the hurricane first made landfall
or the windstorm caused the covered damage. For purposes of this section, the term
supplemental claim or reopened claim means any additional claim for recovery from
us for losses from the same hurricane or windstorm which we have previously adjusted
pursuant to the initial claim. This section does not affect any applicable limitations on
civil actions for claims, supplemental claims, or reopened claims timely filed under
this section.
9. Send to us, within 60 days after our request, your signed, sworn proof of loss which
sets forth, to the best of your knowledge and belief:
a. The time and cause of loss;
b. The interest of all "insureds" and all others in the property involved and
all liens on the property;
c. Other insurance which may cover the loss;
d. Changes in title or occupancy of the property during the term of the
policy;
e. Specifications of damaged buildings and detailed repair estimates;
f. The inventory of damaged personal property described in C.6. above;
g. Receipts for additional living expenses incurred and records that
support the fair rental value loss; and
h. Evidence or affidavit that supports a claim under the F.6. Credit Card,
Electronic Fund Transfer Card or Access Device, Forgery and Counterfeit
Money under Section I – Property Coverages, stating the amount and cause
of loss.
The duties above apply regardless of whether you, an “insured” seeking coverage, or
a representative of either retains or is assisted by a party who provides legal advice,
insurance advice or expert claim advice, regarding an insurance claim under this
policy.
***
H. Suit Against Us.
No action can be brought against us unless there has been a full compliance with all of
the terms under Section I of this policy …
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Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Angela Mazzurco and Kyle Bruening ("Insureds") purchased an insurance policy ("Policy") from UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY ("Universal" or “Carrier”) with effective coverage on the date of loss, on or about February 20, 2022, and Policy number FL220106213 to insure their property located at 1256 Southwest 1st Terrace, Pompano Beach, FL 33060 (the "Property").??
On or about February 20, 2022, the Property sustained a plumbing leak. Specifically, the kitchen sink angle stop failed, which caused damage to the Property. ("Loss"). The Insureds immediately called a plumber, Erica’s Plumbing Air Conditioning and Restoration (“Erica’s Plumbing”), to stop the leak and dry out the property and then reported the claim to Universal.
Upon reporting the Loss, the Carrier acknowledged the claim and assigned claim number FL220106213 ("Claim") to the Loss. Thereafter, the Carrier sent a field adjuster, Mr. Gabriel Cristian, to the Property to inspect and document his observations regarding damages to the Property. The inspector found damage at the property caused by the angle stop leak and prepared an estimate of the damage. His estimate undervalued the entire claim in scope and cost and failed to fully assess and evaluate the Loss.
Universal sent correspondence to the Insureds on or about March 1, 2022 acknowledging coverage for the Loss and issuing payment. The Loss was severely undervalued as is customary for the Universal.
The Insureds, via their contractor, Erica’s Plumbing, submitted invoices and estimates to Universal for the water dryout, mold remediation, and rebuild. Following the initial inspection and payment, Universal communicated directly with Erica’s Plumbing and continually requested revision after revision to their estimates based on a discrepancy over the measurements of one kitchen cabinet. In or around August 2022, after multiple inspections and requests to Erica’s Plumbing to revise their estimate, Universal’s Field Supervisor, Leonardo Pimental, acknowledged additional amounts owed to the Insureds in the amount of $38,500. However, instead of issuing the supplemental undisputed payment, Universal attempted to chase a settlement release by waving around the undisputed amount as an offer to settle. To date, Universal has failed to issue all undisputed amounts due and owing to the Insureds. Universal’s bad faith conduct has continued into litigation, constantly delaying the case and mispresenting the facts of the claim. Throughout the process, the Insureds have complied with Universal’s requests, including making their property available for multiple inspections. Despite providing uncontroverted proof that the covered damages exceed Universal’s adjustment and payments, Universal has refused to compensate the Insureds for same. The Insureds protected their property by mitigating the damages including installing completing water mitigation and mold assessment. The Insureds have complied with post loss duties and the Carrier needs to fulfill its obligations.
Since the Insureds became aware of the damages to the Property, they have acted promptly in reporting the claim and mitigating further damage to the Property. They have cooperated in all ways possible with every request of the Carrier. The Insureds have fully complied with all applicable Policy provisions requiring cooperation with the investigation; however, the Carrier has unequivocally failed to properly adjust this Claim, as further elaborated above. Rather than paying the actual damages and/or trying to settle with the Insureds, the Carrier has failed to act in good faith, delaying any prompt resolution of the claim. The Carrier has not attempted, in good faith, to settle this claim when, under the circumstances, it could and should have done so had it acted fairly and honestly toward the policyholders and with due regard to the policyholders' interests. As a result of this incident, the Insureds have suffered damage to the building on the subject Property and loss of use of the Property and possessions therein.
As a direct consequence of the Carrier’s failure to adjust this Loss in good faith and make any payment, the Insureds continue to be without adequate compensation for the damages sustained at their home.
By stating the above detailed facts, it is clear that the Carrier has violated the following Florida statutes:
• 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 Insureds and with due regard for their interest;
• 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)(d) Denying claims without conducting reasonable investigations based upon available information.
• 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.
To date, the Carrier has acted in bad faith, and failed to provide coverage under the Policy to the Insured. The Insureds’ property continues to be in disarray as the Insureds are without funds to put his property into its pre-loss condition. As a direct result of Carrier’s denial of the Claim and breach of the Florida Statutes, the Insureds were forced to seek the help of licensed professionals to assist them, including legal counsel. Due to the amount of time that has passed since the date of loss and the information discussed above, there is irrefutable evidence that Carrier knowingly and intentionally, and in bad faith delays the settlement process in order to further disadvantage the Insureds. The financial detriment caused to the Insureds is a direct result of the Carrier’s reckless treatment of the claims process. The Insureds submitted all documents requested in a timely fashion, made their property available for inspection, submitted estimates and requests. However, the Carrier failed at every step of the process to adequately establish or identify the basis of its gross mismanagement of the claim.
To deny the Insured the benefit clearly due and owing under the Policy, for which she has time and time again been making premium payments for and after she has satisfied all of her obligations is morally and ethically reprehensible, and reeks of Unfair Claims Practice and Bad Faith. Upon information and belief, the aforementioned actions complained of, among others, were made by the Carrier so often as to constitute a general business practice, evidencing a motive to enhance the Carrier’s profits, and designed to cause a detrimental effect to its policyholders. The above clearly depicts that the Carrier adjusted this claim in bad faith, continue to act in bad faith towards its Insured, and that the Carrier is in direct violation of Unfair Claims Practices.
This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should Universal fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, Universal must: (1) Immediately tender all proceeds due and owing to the Insureds that are fairly owed to the Insureds under the insurance policy that would reasonably compensate the Insured in order to put the loss property back to its pre-loss condition; (2) Immediately afford coverage for the repairs to the subject property necessary to put the property back into its pre-loss condition (3) Agree to reimburse the Insureds’ reasonable attorneys’ fees and costs for having to become involved to resolve the claim; and (4) Agree to reimburse the Insureds for interest on the amount of benefits that was found to be?due and owing to the Insured, relating back to the date of loss.
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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.
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DFS-10-363
Rev. 10/14/2008
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