Civil Remedy Notice of Insurer Violations
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Filing Number:     799643
Filing Accepted:  1/7/2025
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Complainant
Last/Business Name *  
MOSS   First Name   SHARON & LEWIS
Street Address * 29902 PRAIRIE FALCON DR.
City, State Zip * WESLEY CHAPEL, FL 33545
Email Address * LEWMOSS@YAHOO.COM
Complainant Type: * Insured
Insured
Last/Business Name*   MOSS   First Name   SHARON & LEWIS
Policy # * 1501-1501-1656 Claim #* FL20-0100675
Attorney
Attorney is Applicable
Last Name* KIMMEL First Name * GINA Initial
Street Address* 20 NORTH ORANGE AVE. SUITE 1600
City, State Zip* ORLANDO , FLORIDA 32801
Email Address * GKIMMEL@FORTHEPEOPLE.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):* RYAN ODELL
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Unsatisfactory Settlement Offer
Unfair Trade Practice
Cancellation
* 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.
* 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 Page 14 of 34 A. Coverage A- Dwelling And Coverage 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 Page 22 of 34 2.d. We will initially pay at least the actual cash value of the insured loss, less any applicable deductible. We will then pay any remaining amounts necessary to perform such repairs as work is performed and expenses are incurred, subject to 2.a. and 2.b. above.
 
* 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 May 5, 2019, Insureds’ property was damaged because of a storm. Upon learning of the damage, Insureds promptly reported the claim for damage to Insurer. Soon thereafter, Insurer retained an adjuster to inspect the loss and create an estimate of damages totaling $986.90. On February 4, 2020, Insurer partially covered damage to the roof, but effectively denied the claim by alleging the loss was below the deductible. No payment was issued. On or about April 11, 2021, Insureds’ property was further damaged because of a second storm. Insurer assigned a date of loss of January 17, 2022, the date the claim was reported. Insurer investigated both claims, inspected the property, and rendered two unfavorable claim decisions. As a result of Insurer’s insufficient payment, Insured provided Insurer with notice to supplement the claim and provided itemized supporting estimate of damages and photographs. Thereafter, Insured filed the requisite Notices of Intent to Initiate Litigation contending damages based upon a supporting estimate of damages and exclusive of payment for any statutory attorney’s fees and costs, to which Insured may be entitled. In response, Insurer relayed a settlement offer which amounted to less than what was necessary to restore the property to its pre-loss condition. Insureds filed suit on September 20, 2022. On November 29, 2023, Insureds placed the Insurer on notice of their intention to repair the home and the damages resulting from these claims. That following year, Insureds replaced the roof, the subject of the dispute. On October 16, 2024, the Honorable Alicia Polk entered an Order Setting Jury Trial, Mediation, Calendar Call and Pre-Trial Conference. The Order set a trial date for March 3, 2025, with the parties to disclose their expert witnesses no later than December 28, 2024. On December 31, 2024, Insurer filed an expert disclosure naming John Minor, a licensed General Contractor, who is expected to testify as to the cause an origin of the damages. The disclosure notes that Mr. Minor will be testifying based upon his observations, review of all documents and photos, all data and measurements as well as scientific studies supporting his conclusions. Notably, Mr. Minor will be testifying about his observations, but as of this date, he has never been out to the property. He never observed the property in its damaged state post loss. Insureds properly placed Insurer on notice of their plan to replace the roof, yet Insurer declined to investigate the damage further. This conduct rises to the level of failing to conduct a reasonable investigation of the claim and misrepresentation of information by relying on inadequately informed experts. Insurer’s actions of deferring to a non-credible witness also rises to the level of unfair claim settlement practices. Bad faith discovery will likely reveal that it is a business practice of Insurer to retain experts, only when trial is imminent, who have not conducted a proper investigation into the cause and origin of a loss without ever having been to the damaged subject property. To cure this violation, Insurer should agree, in writing, to pay the Insured for the Replacement Cost Value of the damages paid to Roof Bear, minus the deductible, arising from Case No. 2022-CA-002429. If the Insurer pays the damages alleged herein, any claims for additional insurance proceeds will be submitted to the Insurer pursuant to the policy's loss settlement provision. This payment is exclusive of Insured’s claims for statutory attorney fees, costs, and interest pursuant to Florida law: “[D]amages recoverable in a first- party bad faith suit under section §624.155, Florida Statutes (1989), are those damages which are the natural, proximate, probable, or direct consequence of the insurer's bad faith actions.” Adams v. Fidelity and Cas. Co. of New York, 591 So.2d 929, 930 (Fla. 1992). “[E]xcess judgment ... is not the sole measure of damages in bad faith cases [–e.g.,] punitive damages, attorney fees and other direct consequential damages may be recoverable in appropriate cases.” Dunn v. National Sec. Fire and Cas. Co., 631 So.2d 1103, 1106 (Fla. 5DCA 1993). “The damages recoverable pursuant to this section shall include those damages which are a reasonably foreseeable result of a specified violation of this section by the authorized insurer.” §624.155(8), Florida Statutes (2019). “The statute [§624.155] also provides for fees as a form of damages. See § 624.155(8) (‘The damages recoverable pursuant to this section shall include those damages which are a reasonably foreseeable result of a specified violation of this section by the authorized insurer.’ ” Milling v. Travelers Home and Marine Insurance Company, 311 So.3d 289, 292 (Fla. 2DCA 2020). This matter and Insurer’s business practices with respect to loss adjustment and claims handling should be investigated further by the Office of the Insurance Consumer Advocate. According to the Department of Financial Services website, as of the date of this filing, 19,996 Civil Remedy Notices have been filed against Insurer.
Comments
User Id Date Added Comment
kmixon@gspalaw.com 01-29-2025 To Whom It May Concern: 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 Gina Kimmel on behalf of the Insureds, Sharon and Lewis Moss. The Notice alleges violations of Florida Statutes, including Sections 624.155 and 626.9541. Universal specifically denies each and every allegation contained in the Notice filed in relation to this claim. Additionally, Universal denies that it violated these or any statutes, Florida law or policy provisions and disputes any and all allegations regarding the claim adjudication of this matter. With that said, Universal asserts that the Notice fails to comply with the specific notice and information requirements set forth in the Civil Remedy Notice of Insurer Violation document provisions, Florida Statute §624.155 and Florida law. Here, the Notice fails to meet the requirements of Fla. Stat. § 624.155 on several grounds. First, the Notice fails to allege sufficient facts to notify Universal of the alleged violations. Second, the Notice fails to satisfy Fla. Statute § 624.155(3)(b)(4) in that it fails to reference specific policy language relevant to the alleged violation. Finally, the Complainant fails to respond to each of the fields set forth on the DFS Form with the requisite specificity, therefore the Notice is insufficient and fails to satisfy the condition precedent to filing a bad faith action. See Pin-Pon Corp. v. Landmark American Ins. Co., 2020 WL 6588379 (S.D. 2020); see Julien v. United Property & Casualty Ins. Co., 2020 WL 5652364. Notwithstanding the above referenced deficiencies, the parties have reached an amicable resolution of the disputed claim in exchange for a full Release of Claims, thus curing any alleged violations. Throughout the handling of the Insureds’ claim, Universal acted in good faith toward the interests of its Insureds. 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 in exchange for a full Release of Claims. Thus, it is Universal’s best understanding that the subject claim has been fully adjusted and concluded. Accordingly, the alleged statutory violations and factual allegations of wrongdoing set forth in the Notice is without merit. Universal has complied with all policy provisions and applicable Florida law regarding the adjudication of this matter. Very truly yours, GROELLE & SALMON, P.A. /s/ Tyler R. Groelle Tyler R. Groelle, Esq. For the Firm
gthomas@forthepeople.com 01-27-2025 Insureds hereby notify the Department and all interested parties that the issues presented in the Civil Remedy Notice of Insurer Violations have been resolved. Insureds hereby request the Department to take no further action other than to mark the file as resolved and close it.
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