Filing Number: 800886
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| Filing Accepted: 1/14/2025 |
| Last/Business Name
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COGNETTI
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First Name |
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MARC AND MARIA |
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| Street Address
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8272 101ST COURT |
| City, State Zip
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SEMINOLE,
FL
33777
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| Email Address
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CFAUNTLEROY@FSATLAW.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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COGNETTI |
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First Name |
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MARC AND MARIA |
| Policy # * |
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1501-2007-2117 |
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Claim #* |
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FL24-0132926-K524 |
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Attorney is Applicable
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| Last Name* |
FAUNTLEROY
First Name *
CHRISTOPHER
Initial
B
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| Street Address* |
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100 S ASHLEY DRIVE, SUITE 600 |
| City, State Zip* |
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TAMPA
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FLORIDA
33602
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| Email Address * |
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CFAUNTLEROY@FSATLAW.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):*
RYAN LASHLEY AND UNIVERSAL PROPERTY AND CASUALTY AND ITS ADJUSTERS
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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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| 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)(e) |
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Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
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| 626.9541(1)(i)(3)(h) |
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Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
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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.
Coverage A:
SECTION I – 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; and
b. Materials and supplies located on or next
to the "residence premises" used to
construct, alter or repair the dwelling or
other structures on the "residence
premises".
2. We do not cover land, including land on which
the dwelling is located.
Coverage B:
B. Coverage B – Other Structures
1. We cover other structures on the "residence
premises" set apart from the dwelling by clear
space. This includes structures connected to
the dwelling by only a fence, utility line, or
similar connection.
2. We do not cover:
a. Land, including land on which the other
structures are located;
b. Other structures rented or held for rental
to any person not a tenant of the dwelling,
unless used solely as a private garage;
c. Other structures from which any
"business" is conducted; or
d. Other structures used to store "business"
property. However, we do cover a
structure that contains "business" property
solely owned by an "insured" or a tenant
of the dwelling, provided that "business"
property does not include gaseous or
liquid fuel, other than fuel in a permanently
installed fuel tank of a vehicle or craft
parked or stored in the structure.
3. The limit of liability for this coverage will not be
more than the amount shown in the
Declarations for Coverage B limit of liability.
Use of this coverage does not reduce the
Coverage A limit of liability.
Loss Payment
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 60 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.
4. Payment of a portion of the claim(s) being
asserted in a loss under this policy does not act
as a waiver on our part to dispute or deny any
unpaid portion of any claim(s) that you may
assert arose from a loss.
Loss Settlement:
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.
***ADDITIONAL STATUTORY PROVISIONS ALLEGED TO HAVE BEEN VIOLATED ARE AS FOLLOWS:***
§624.155(1)(B)(1) Any person may bring a civil action against an insurer when such person is damaged:
By the commission of any of the following acts by the insurer:
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 towards its insured and with due regard for her interests;
2. Making claims payments to insures or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made; or
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.
§624.155 (5) No punitive damages shall be awarded under this section unless the acts giving rise to the violation occur with such frequency as to indicate a general business practice and these acts are:
(a) Willful, wanton, and malicious;
(b) In reckless disregard for the rights of any insured; or
(c) In reckless disregard for the rights of a beneficiaries under a life insurance contract;
(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 and may include an award or judgment in an amount that exceeds the policy limits.
§627.70131 Insurer’s duty to acknowledge communications regarding claims; investigation
(1)(a) Upon an insurer’s receiving a communication with respect to a claim, the insurer shall, within 14 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer which reasonably prevent such acknowledgement. If the acknowledgement is not in writing, a notification indicating acknowledgement shall be made in the insurer’s claim file and dated. A communication made to or by an agent of an insurer with respect to a claim shall constitute communication to or by the insurer.
(4) For purposes of this section, the term “insurer” means any residential property insurer.
§626.9541(i) Unfair Claim Settlement Practices
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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.
In Florida, the work of adjusting insurance claims engages the public trust. Universal Property & Casualty Insurance Company (UPC) has breached this duty in the adjustment of Marc Cognetti’s and Maria Cognetti’s (the Cognettis’) claim.
UPC has failed to adopt and implement proper standards for investigation, evaluation and adjustment of claims; has failed to properly train, manage, supervise and promote claims adjusters so that policy holder receives good faith, fair, prompt adjustment of claim, service and indemnity; has failed to conduct a full and fair investigation of the claim and has failed to provide full reasons and facts to the claimant for delay of the claim resulting in statutory violations as set forth in this notice.
Furthermore, UPC has engaged in unfair claim delay; has used business or outcome-oriented investigations and experts to determine the outcome of the claim; has wrongfully denied the claim without fully stating reasons and reserving unwritten reasons; has looked for ways to, delay payment and otherwise “stonewall” the claim; and has used improper claims practices to rush the claims process and profit from wrongful claims practices.
The Cognettis’ claim results from wind and water damage from Hurricane Milton to their home that occurred on October 10, 2024. Prior to the storm, the Cognettis boarded their windows with tapcon concrete anchors, and despite this the winds were so strong that it ripped the boards off from their windows. The Cognettis also found water on the floor in two of their bedrooms. To mitigate the damages to their home, the Cognettis contacted their insurance company, UPC, to report the damages. As part of the investigation of the Cognettis’ claim, UPC assigned a claim number FL24-0132926-K524 and claims examiner Ryan Lashley. Subsequently, UPC partially denied the claim of damages and did not provide the Cognettis with proper and sufficient monetary coverage to return their property back to pre-loss condition.
In view of the foregoing, it is clear and unequivocal that UPC has failed to provide proper and sufficient compensation to repair the damages caused to the Cognettis’ property. Due to UPC’s handling of the Cognettis’ claim, the Cognettis chose to retain a public adjuster, Southern State Claims Adjusters, to further assess the damages to their home. As such, upon inspection and view of the damages, it was clear that the roof, interior, and fencing of the property required extensive repair. After the inspection, the public adjuster provided an estimate for repairs in the amount of $67,965.46, which is the full amount to return Cognettis’ home back to pre-loss condition. UPC continues to hold their stance for their claim determination concerning the Cognettis’ loss.
The Cognettis have complied with all conditions under the policy. Nonetheless, UPC failed to properly compensate the Cognettis for their loss. The facts of this claim show that for whatever reason, UPC not only substantially misinterpreted the scope of damages to the Cognettis’ property, but also failed to conduct a thorough investigation as to the scope of damages to the roof, interior, and fencing. Upon view of UPC’s claims handling procedures, it is clear UPC conducted a limited and quick outcome orientated investigation in the hopes that the Cognettis would make the required repairs with their own money. The Cognettis now must incur costs for assistance to obtain what should have been paid had they been treated fairly and honestly by UPC.
Florida Statute §626.9744(2) provides that “When a loss requires replacement of items and the replaced items do not match in quality color or size, the insurer shall make reasonable repairs or replacement of items in adjoining areas”. In the instance of UPC, their adjusters and the estimate provided, it is clear that UPC did not adhere to Florida law, as their estimate provides paltry repair items that would result in mismatching areas which fails to acknowledge the true extent of damage of Cognettis’ home as well as the surrounding areas that would need to be replaced. Florida Statute §624.02, defines “insurance” as a contract where one undertakes to indemnify another or pay or allow specified amounts, or a determinable benefit, upon determinable contingencies – inherent is the fact that payment must be made timely and promptly. The fact that payment must be made timely and promptly so that the insureds may mitigate their damages, and to put the insureds back into the position they enjoyed prior to the loss as quickly as possible. UPC has breached this duty by improperly investigating the Cognettis’ claim and failing to properly pay the Cognettis for their loss. UPC has refused and/or failed to tender insurance proceeds as required by the policy and/or Florida law. It has refused and/or failed to settle the claim when under all the circumstances it could have and should have done so if it had acted fairly and honestly towards the Cognettis.
In view of the facts surrounding the Cognettis’ claim, it is evident that UPC has failed to create and implement adequate guidelines for proper investigations to evaluate claims handling for training and supervision of employees in violation of Fla. Stat. §624.155 and §626.9541 statutory regulations, as well as the applicable provisions in the Florida Administrative Code resulting in the statute violations set forth herein. As stated, UPC has failed and/or refused to investigate the insureds’ claim thoroughly, accurately, and completely for damages.
Furthermore, UPC has failed to adopt and implement proper standards for investigation, evaluation, and adjustment of claims; has failed to properly train, manage, supervise, and promote claims adjusters so that policy holder receives good faith, fair, prompt adjustment of claim, service, and indemnity, has failed to conduct a full and fair investigation of the claim.
Florida Statutes Violated by UPC are as applied to the facts in this matter is as follows: § 626.951 engaging in acts defined as “unfair trade practices” relating to the business of insurance in accordance with the intent of congress as expressed in the act of congress of March 9, 1945 (pub. L. No. 15, 79th congress), by defining, or providing for the determination of, all such practices in this state which constitute unfair methods of competition or unfair or deceptive acts or practices and by prohibiting the trade practices so defined or determined.
§ 624.155(1)(b)(1) to tender all insurance proceeds monies due and owing the insured or assist the insured in the mitigation of their damages. The insurer breached these statutory duties. Not attempting in good faith to settle claims when, under all circumstance, insurer could have and should have done so, had the insurer acted fairly and honestly toward its insured and with due regard. § 624.155(1)(b)(3) failing to promptly settle claims, when the obligation to settle the 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 investigations of claims. § 626.9541(1)(i)(3)c Failing to acknowledge and to act promptly upon communications with respect to claims.
Their actions are willful, wanton and in disregard of the rights of its insured and occur with such a frequency as to indicate a general business practice. UPC can cure this default by the following:
A. Create, adopt, and implement adequate standards and/or guidelines for the proper investigation and adjustment of claims.
B. Provide sufficient training and supervision of employees and agents to avoid further violations as set forth in the paragraphs above from occurring in the future.
C. Tender payment to the Cognettis in the amount of $67,965.46, which is the amount to return the Cognettis’ home back to pre-loss condition.
D. Tender prejudgment interest from the date the claim was reported through today.
E. Agree to pay the Cognettis’ reasonable attorney’s fees pursuant to Florida Statute §627.428 and all taxable costs.
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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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