Filing Number: 803392
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| Filing Accepted: 1/24/2025 |
| Last/Business Name
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PATANE
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First Name |
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ALFREDO |
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| Street Address
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3430 GALT OCEAN DR., 801 |
| City, State Zip
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FORT LAUDERDALE,
FL
33308
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| Email Address
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ALFREDOPM24@GMAIL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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PATANE |
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First Name |
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ALFREDO AND JOSEPHINE |
| Policy # * |
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1503-1500-6129 |
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Claim #* |
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FL23-0134543 |
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Attorney is Applicable
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| Last Name* |
SCHILLING
First Name *
JEREMY
Initial
T
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| Street Address* |
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1700 NW 64TH ST SUITE 460 |
| City, State Zip* |
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FORT LAUDERDALE
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FLORIDA
33309
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| Email Address * |
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AGRONDIN@SCHILLINGSILVERS.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):*
UNIVERSAL CLAIMS ADJUSTER
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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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Unfair Trade Practice
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Unsatisfactory Settlement Offer
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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)(2) |
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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.
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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)(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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| 626.9541(1)(i)(4) |
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Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
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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.
Please refer to the pertinent parts of your homeowner’s policy form UPCIC HO6 15 10 21:
SECTION I – PERILS INSURED AGAINST
We insure for direct physical loss to the property described in Coverages A and C caused by
any of the following perils unless the loss is excluded inSection I - Exclusions.
…
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.
10. Assignee(s) Or Third Parties, meaning we will not be responsible for payment under
Section I and II – Conditions, E. Assignment, to any assignee(s) or third parties, for payments
on losses that are not covered under this policy.
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SECTION I – CONDITIONS
…C
. Duties After Loss
Any claim or reopened claim under an insurance policy that provides property insurance for
loss or damage caused by any covered peril is barred unless notice of the claim or reopened
claim is given to us in accordance with the terms of the policy and within two years after the
date of loss.
A supplemental claim is barred unless notice of the supplemental claim is given to us in
accordance with the terms of the policy and within three years after the date of loss. For
purposes of this section, the term reopened claim means a claim that we have previously
closed, but that has been reopened upon an insured’s request for additional costs for loss or
damage previously disclosed to us. Supplemental claim means a claim for additional loss or
damage from the same peril which we previously adjusted or for which costs have been
incurred while completing repairs or replacement pursuant to an open claim for which timely
notice was previously provided to us. This section does not affect any applicable limitation on
civil actions.
Additionally, we have no duty to provide coverage under this policy to you or an “insured”
seeking coverage, 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 records and documents we request and permit us to make copies;
… 8. 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 interests 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 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.
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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.
Alfedo Patane (“Insured”) purchased an Insurance Policy (“Policy”) from UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY (“Universal”), bearing policy number 1503-1500-6129, for the property located at 3430 Galt Ocean Dr., 801, Fort Lauderdale, FL 33308 (“Property.”)
On or about September 13, 2023, a leak occurred in a pipe leading to the Insured’s cooling tower within the Commodore Condominiums development. The leak resulted from Commodore damaging the Insured’s water line, causing water intrusion into the walls of the Insured’s property. The following day, Commodore engaged a mitigation team to install fans within the Insured’s property to address the water intrusion.
On or about September 15, 2023, Universal sent the Rapid Recovery Team to the Insured’s condominium to mitigate the water damage. However, instead of properly addressing the issue, the mitigation team caused further damage to the property. Their actions included drilling holes in the walls and placing air blowers and dehumidifiers, which remained on the property until September 21, 2023.
Subsequently, on or about September 27, 2023, Universal issued correspondence to the Insured denying the claim on the grounds that "an inspector completed an inspection of your property and found no direct, physical loss." This denial raises significant concerns, as it is contradictory to the actions taken by Universal's own mitigation team, which installed equipment and conducted remediation efforts for nearly a week—actions that would not have been necessary in the absence of damage.
The water intrusion resulted in substantial and pervasive damage throughout the Insured’s property, affecting the living room, kitchen, hallways, master bedroom, guest bedroom, and office. The damage caused the tile flooring to lift and separate from the subfloor. In response, the Insured retained Express Public Adjusting to conduct an independent assessment, including a comprehensive estimate and photographic documentation of the damage.
On or about February 16, 2024, the Insured engaged Mold Corp Environmental LLC to perform a mold inspection. Their findings confirmed water damage on walls and flooring, and air quality testing conducted in the living room, dining room, hallways, and bedrooms identified the need for extensive remediation. Mold Corp recommended the removal and disposal of water-damaged materials, including sections of the East and West walls, two to four feet of visibly damaged materials, and baseboards and insulation in the hallways to prevent mold development. Furthermore, numerous furnishings and contents within the affected areas required replacement due to contamination.
The Insured subsequently submitted estimates and photographic evidence to Universal to refute the initial denial of coverage and demonstrate the extent of the damage. Nevertheless, Universal maintained its position and upheld the denial of the claim.
In accordance with Florida Statute 627.70152, the Insured filed a Notice of Intent to Litigate (Notice Number 217320) on November 12, 2023, which included estimates from Spartan Mitigation, a mold remediation invoice, and a rebuild estimate. Pursuant to §627.70152(4)(a), an insurer responding to a notice following a denial of coverage must either:
1. Accept coverage,
2. Continue to deny coverage, or
3. Reinspect the property.
Instead of complying with these statutory obligations, Universal responded by offering $15,000.00 to settle the dispute and avoid litigation expenses. This response demonstrates an attempt by Universal to circumvent its legal obligations and improperly settle a claim it previously denied. Universal's conduct suggests an acknowledgment of coverage while simultaneously attempting to mislead the Insured into believing their loss was not covered under the policy.
Universal’s handling of this claim reflects a substandard investigation that has significantly prejudiced the Insured. The insurer’s failure to conduct a thorough and good-faith evaluation of the claim has resulted in the Insured being undercompensated. Due to Universal’s gross mismanagement, failure to properly investigate the loss, and refusal to adjust the claim in good faith, the Insured has been compelled to retain legal counsel to initiate litigation for breach of contract. It was clear that Universal performed a subpar investigation of the claim to the detriment of the Insureds. Due to Universal’s gross mismanagement of the claim, the failure to properly investigate the loss and adjust this loss in good faith, the Insured continues to be underpaid on the claim. As such, the Insured was forced to retain counsel to file suit against Universal for breach of the insurance policy.
By stating the above detailed facts, it is clear that Universal 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 insured and with due regard for her or his interests;
o Universal failed to act in good faith by denying the claim and offering an unreasonably low settlement despite clear evidence of damage and their own mitigation efforts.
• 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.
o Universal failed to promptly settle the claim when their obligation to do so was reasonably clear, attempting to influence the insured into accepting an inadequate settlement.
• 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;
o Universal made material misrepresentations to the insured regarding coverage in an effort to settle the claim on less favorable terms than those provided under the policy.
• 626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims;
o Universal failed to implement proper standards for claims investigation, as evidenced by their insufficient assessment and subsequent denial of coverage.
• 626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue;
o Universal misrepresented pertinent facts and policy provisions by asserting no physical damage existed despite photographic and expert evidence proving otherwise.
• 626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information;
o Universal denied the claim without conducting a reasonable and thorough investigation based on the 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;
o Universal failed to provide a reasonable written explanation of the claim denial in relation to the insurance policy and factual evidence.
• 626.9541(1)(i)(4) Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 90 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by an act of God, prevented by the impossibility of performance, or due to actions by the insured or claimant that constitute fraud, lack of cooperation, or intentional misrepresentation regarding the claim for which benefits are owed.
o Universal failed to pay undisputed amounts of benefits owed within the statutory 90-day period, despite receiving notice and determining the extent of the loss.
As a direct result of Universal’s breach of the Policy, the Insured was forced to seek the help of legal counsel to assist. Based on the above, it is irrefutable evidence that Universal knowingly and intentionally, performs sub-par investigations into its claim in order to further disadvantage the Insureds. The financial detriment caused to the Insured is a direct result of Universal’s reckless investigation. Upon information and belief, the aforementioned actions complained of, among others, were made by Universal so often as to constitute a general business practice, evidencing a motive to enhance Universal’s profits, and designed to cause a detrimental effect to its policyholders.
The above clearly depicts that Universal adjusted this claim in bad faith and that Universal is in direct violation of Unfair Claims Practices, by knowingly underpaying a covered claim.
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: Create and implement adequate guidelines for proper investigation and evaluation as to claims handling and for the training and supervision of employees, which will avoid future statutory violations as set forth above, and to avoid this from occurring in the future; Universal must create and implement adequate guidelines for the proper investigation and evaluation of these types of claims, and for the training and supervision of employees with regard to these types of claims to ensure Universal’ claims handling procedures with regard to these types of losses are adequate; Universal must act fairly and honestly towards the Insureds with due regard for their best interests in attempting to settle the claim; Universal must immediately tender all insurance benefits due and owing to the Insureds under the Policy pursuant to the relevant policy provisions provided therein that would reasonably place the property back to its pre-loss condition, including, but not limited to all interest due and owing under applicable Florida Statutes; and Universal must pay the Insureds the fair value of the insurance claim in the amount of $126,571.00The Insureds expect Universal to respond to this CRN stating that it does not comply with Florida Statutes and Universal will ignore the specific allegations herein and fail to refute them with any factual basis.
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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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