Civil Remedy Notice of Insurer Violations
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Filing Number:     798696
Filing Accepted:  12/30/2024
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Complainant
Last/Business Name *  
OSPINA   First Name   MYRIAM
Street Address * 25350 GEDDY DRIVE
City, State Zip * LAND O’ LAKES, FL 34639
Email Address * WITHHELD
Complainant Type: * Insured
Insured
Last/Business Name*   OSPINA   First Name   MYRIAM
Policy # * 1501-2002-8259 Claim #* FL23-0141721-E723
Attorney
Attorney is Applicable
Last Name* SIGEL First Name * MELANIE Initial
Street Address* 800 E. BROWARD BLVD. STE. 510
City, State Zip* FORT LAUDERDALE , FL 33301
Email Address * MDS@WEKLAW.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):* HENRY WIMP, AIDA ALICEA, LOUIS ARNOLD
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unsatisfactory Settlement Offer
Unfair Trade Practice
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)(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)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
* Specific policy language that is relevant to the violation.
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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”. ** 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. ** 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 a. There is an entry of a final judgment; or b. There is a filing of an appraisal award or a mediation settlement with us. 3. Under Florida Statutes we are required to pay or deny an initial, reopened, or supplemental property insurance claim or portion of a claim, within 90 days of notice of such claim unless there are reasonable circumstances which prevent us from so doing. Our failure to comply with this paragraph shall not form the sole basis for an action against us for breach of contract under this policy or for benefits under this policy.
 
* Facts and circumstances giving rise to the violation.
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Myriam Ospina (the "Insured") purchased an insurance policy ("Policy") from Universal Property & Casualty Insurance Company ("UPCIC"), with effective coverage on the date of the loss, on or about August 30th, 2023, and policy number 1501-2002-8259 to insure her home located at 25350 Geddy Drive, Land O’ Lakes, FL 34639 (the "Property"). On or about August 30th, 2023, the aforementioned Property suffered severe damage as the result of the devastating Hurricane Idalia, which caused ensuing damages to the Property including but not limited to the exterior and roofing system of the property. The Insured promptly reported their claim to UPCIC. UPCIC acknowledged receipt of the claim by generating claim number FL23-0141721-E723. After considerable stalling, UPCIC went to inspect the property, as they are required to, and generated an estimate for the damages suffered. UPCIC initially made a low-ball coverage decision that broadly ignored the damage sustained to the Property valuing the damage at $14,844.55 after the application of the deductible. It was clear that UPCIC was trying to reduce their contractual obligation by undervaluing the damage to the Insured’s Property from the start, despite the fact that the Insured actively provided all proof of claim needed to have their claim evaluated fairly. Despondent, the Insured retained Home Safe Claims (“HSC”) to act as their public adjuster, to assist in the evaluation and inspection of damage to the property. HSC investigated the property and generated an estimate for the damages. HSC immediately sent their estimate to UPCIC, which estimated the scope or damage to be $75,485.47 along with a request for supplemental payment, but UPCIC failed to issue any additional payment to the Insured. UPCIC’s dramatically insufficient coverage decision has resulted in further damages to the Insured by preventing them from returning their Property to its pre-loss condition, rather than participating in the settlement process in good faith.???? As a direct consequence of UPCIC’s failure to adjust this loss in good faith and pay what it owed under the policy, the Insured and their family are continuing to sustain considerable hardship. Upon information and belief, UPCIC, as part of its general business practice, initially low-balls its policyholders. UPCIC does this in a calculated and systematic scheme that begins with manipulating the software system used in estimating its property damage claims. It appears that UPCIC issues its adjusters estimating software which contains construction pricing below the fair market value. It also appears that UPCIC trains its claim adjusters to overlook and/or turn a blind eye to a number of routine costs that UPCIC knows most policyholders generally would not know to request but are actually covered under the insured’s policy. Moreover, as part of this scheme, after making one initial low-ball payment – UPCIC stalls and intentionally delays the claim, all under the false pretense that it’s “investigating” the claim. UPCIC has violated Florida Statute § 624.155(1)(b)(1) by continuously not attempting in good faith to settle this claim when it should have done so if it had acted fairly and honestly towards its Insured. UPCIC has also violated Florida Statute § 624.155(1)(b)(3) by failing to promptly settle this obviously covered claim to influence settlement in its favor. Despite being presented all of the indisputable evidence of the amount of damage sustained by this Property, it is a disgrace that the Insured have been treated in this manner by their insurance company after sustaining an obviously covered loss, submitting to every demand of UPCIC, and making a good faith effort to resolve in an attempt to amicably come to a fair resolution. UPCIC violated Florida Statutes § 626.9541(1)(i)(2) and § 626.9541(1)(i)(3)(b) by making material misrepresentations to the Insured for the purpose and with the intent to settle the claim on less favorable terms than those provided and contemplated by the policy. UPCIC was informed multiple times of the discrepancies and inconsistencies of the low-ball payment issued to the Insured. While UPCIC was made aware of this information for the purpose of obtaining the money contractually owed to the Insured under its insurance policy to attempt to return their home to its pre-loss condition in a timely fashion, UPCIC accepted that information and has used it to play the delay game with the Insured, knowing all too well the additional damage and hardship that was being placed on the Insured by its actions. UPCIC violated § 626.9541(1)(i)(3)(a) when it failed to adopt and implement standards for the proper investigations of claims. Under no circumstances is there an excuse for the lack of a proper investigation in this case. UPCIC and their representatives are willfully blind and grossly underqualified to handle a loss such as the one sustained by the Insured. In addition, after being placed on notice as to the blatant underpayment of the Insured’ claim, UPCIC has yet to rectify their actions and do right by the Insured by paying the money they are contractually owed. UPCIC violated § 626.9541(1)(i)(3)(c) by failing to acknowledge and act promptly upon the communications with respect to the claim. There still has yet to be significant action taken by UPCIC to this date, despite UPCIC being presented with the flawed rationale behind their underpayment of the Insured’ claim.? UPCIC violated § 626.9541(1)(i)(3)(g) by failing to promptly notify the Insured of any additional information necessary for processing the claim. The Insured have more than complied with each and every request and there has still been no action by UPCIC. In the event UPCIC is in need of additional information, they have failed to promptly notify the Insured in a timely manner. This pattern of behavior is perpetuated by UPCIC and their representatives undeterred by the Ethical Requirements that are imposed by law on all Adjusters. Fla. Admin. Code Ann. R. (3) explicitly states the adjustment of insurance claims engage the trust of the public, and therefore, an adjuster has a duty of fair and honest treatment of the Insured throughout the insurance claim process. Several duties and responsibilities to the Insured were violated in the handling of this claim, which are specifically listed responsibilities of an Adjuster in the Florida Administrative Code. These breached duties and responsibilities include adjusters from UPCIC approaching the investigation and settlement in a manner prejudicial to the Insured, failing to allow a fair settlement with the Insured, and acting with due diligence in achieving a proper disposition of the claim. In contrast to the legislative intent motivating the enumeration of an Adjuster’s responsibilities outlined in the Administrative Code, the Insured were not afforded the professional duties entrusted on UPCIC by the public. To date, UPCIC has failed to adequately compensate the Insured for the damage that occurred on August 30th, 2023. As a direct result of UPCIC’s delay, the Insured were forced to seek the help of legal counsel to assist them. Due to the amount of time that has passed since the date of loss, this acknowledgement is evidence that UPCIC knowingly and intentionally are delaying the claims process in order to further disadvantage the Insured. The financial detriment caused to the Insured and their family is a direct result of UPCIC’s reckless delay of the claim process. The Insured are dutiful customers who made it a priority to pay their insurance premiums to ensure that in such an event as this devastating incident, their home would be covered. The Insured timely filed their claim and fulfilled all of their post-loss obligations. All requested information and documentation has been turned over to UPCIC and their representatives promptly by the Insured. However, UPCIC failed at every step of the process to adequately establish or identify the basis of its gross mismanagement of the claim, failed to inform the Insured how they may remedy any deficiencies in their claim, and failed to provide them with qualified representatives to ensure the claim was initially adjusted, evaluated, and estimated properly. To deny the Insured the benefit of their bargain after they satisfied all of their obligations is morally and ethically reprehensible, and reeks of Unfair Trade Practice. Upon information and belief, the aforementioned actions complained of, among others, were made by UPCIC so often as to constitute a general business practice, evidencing a motive to enhance UPCIC’s profits, and designed to cause a detrimental effect to its policy holders. UPCIC was aware that the Insured’ damages were covered and took advantage of its Insured in an attempt to force them into an irreparably disadvantaged position, which they hope will force the Insured to settle for less coverage than they are contractually entitled to under the policy. This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should UPCIC 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, UPCIC must: (1) Immediately tender all insurance proceeds due and owing to the Insured that are fairly owed to the Insured under the insurance policy that would reasonably place the Insured back to a pre-loss condition; (2) Agree to reimburse the Insured’ reasonable attorneys’ fees and costs for having to become involved to resolve the claim; (3) Agree to reimburse the Insured 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.
Comments
User Id Date Added Comment
oc1102@universalproperty.com 02-18-2025 February 18, 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.: 798696 Filing Date: 12/30/2024 Complainant(s): Myriam Ospina Insured(s): Myriam Ospina Policy No.: 1501-2002-8259 Claim No.: FL23-0141721-E723 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, Melanie Sigel, on behalf of Complainant Myriam Ospina (also referenced as the “Insured.”) The Notice alleges violations of Sections 624.155 and 626.9541, Florida Statutes and the Florida Administrative Codes. Universal denies that it violated these or any statutes, Florida law, administrative codes, 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. Here, the Notice fails to meet the requirements 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. Second, the Notice fails to reference specific policy language relevant to the alleged violation. 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 specific conduct on the part of Universal that would violate any policy provision or statute. Lastly, the Notice fails to provide a proper means by which Universal can cure the alleged defects in the Notice. Therefore, the Notice is insufficient and fails to satisfy the condition precedent to filing a bad faith cause of action. See 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). Notwithstanding the above referenced deficiencies, the parties have reached an amicable resolution of the disputed claim. Throughout the handling of the Insured’s claim, Universal has acted in good faith toward the interests of its Insured. Universal has timely and fairly investigated the reported loss in accordance with Florida law, the policy provisions, and standard claims handling practices. Notwithstanding, any alleged dispute between the parties has been resolved via an amicable resolution of the disputed claim in exchange for a full Release of Claims. Universal is pending receipt of the original executed Release by the Insured. Thus, it is Universal’s best understanding that the subject claim has been fully adjusted and resolved. Accordingly, the alleged statutory violations and factual allegations of wrongdoing set forth in the Notice are without merit. As previously noted, although the carrier strongly believes it has not been in violation of the Policy or law, circumstances giving rise to any alleged violation(s) have been corrected. 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. If there are any questions, please contact the undersigned. 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.

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DFS-10-363
Rev. 10/14/2008