Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 803990

Filing Accepted: 1/28/2025

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Complainant

Last/Business Name *

ABUJABER

First Name

EDWARD

Street Address *

4165 CHABLIS ST SW

City, State Zip *

VERO BEACH, FL 32968

Email Address *

ED3569@GMAIL.COM

Complainant Type: *

Insured

Last/Business Name*		ABUJABER		First Name		EDWARD
Policy # *		150323003642		Claim #*		FL250101163

Attorney

Attorney is Applicable

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 10861

Name of individual responsible for violation (if any):* HENRY WIMP
Type of Insurance * Residential Property & Casualty

Reason for Notice *

Claim Denial

* 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)(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)(d)		Denying claims without conducting reasonable investigations based upon 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.
	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.
Enter all words or phrases (one at a time) that should be used to filter.

HOMEOWNERS–UNIT-OWNERSFORMUPCICHO6150723 D. Additional Coverages 7. Loss Assessment a. We will pay up to $2,000 per occurrence for your share of loss assessment charged during the policy period against you, as owner or tenant of the "residence premises", by a corporation or association of property owners. The assessment must be made as a result of direct loss to property, owned by all members collectively, of the type that would be covered by this policy if owned by you, caused by a Peril Insured Against under Coverage A, other than: (1) Earthquake; or (2) Land shock waves or tremors before, during or after a volcanic eruption. However, the maximum amount of loss assessment coverage for any one property loss, regardless of the number of assessments, shall be an amount equal to your unit-owner's loss assessment coverage limit in effect one day before the date of the occurrence. Any changes to the limits of your unit-owner's coverage for loss assessments made on or after the day before the date of the occurrence are not applicable to such loss. A deductible amount, not to exceed the lesser of: (3) The deductible amount under this policy equal to that which applies to the peril of fire; or (4) $250; applies to loss covered under this Additional Coverage. We will pay only that part of the total of all loss payable under this Additional Coverage that exceeds that deductible amount. However, if a deductible was or will be applied to other property loss sustained by you resulting from the same direct loss, then no deductible applies to this coverage. b. We do not cover assessments charged against you or a corporation or association of property owners by any governmental body. c. Paragraph Q. Policy Period under Section I– Conditions does not apply to this coverage. This coverage is additional insurance.

* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

I respectfully challenge the denial conclusion and interpretation of the coverage for the following reasons: 1. I am aware that other residents within our condominium community, who hold policies with UPCIC, had similar claims approved. This inconsistency raises questions about the fairness and uniformity of the claims evaluation process. 2. The letter from The Club at St. Lucie West clearly states that the special assessment is due to the roofs failing and the necessity of replacing them to ensure the integrity and safety of the buildings. These expenses are directly related to maintaining property integrity, which I believe aligns with the intent of the loss assessment coverage in my policy. 3. I believe your interpretation of the policy exclusion is overly narrow and does not consider the broader context of this assessment. The expenses outlined are directly connected to an occurrence of a covered loss, and therefore, coverage should apply. Given these points, I respectfully request that UPCIC reconsider my claim. For your convenience, I have included a letter from the Homeowners’ Association to provide additional clarification.

Comments

User Id		Date Added		Comment
ry0419@universalproperty.com		03-20-2025		March 20, 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.: 803990 Filing Date: 1/28/2025 Complainant: Edward Abujaber Insured: Edward Abujaber Policy No.: 150323003642 Claim No.: FL250101163 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 Complainant, Edward Abujaber (also referenced as “Insured.”) The Notice alleges violations of Sections 624.155 and 626.9541, Florida Statutes. Universal specifically denies each allegation contained in the Notice. Additionally, Universal denies that it violated these or any statutes, Florida law, or policy provisions 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 as set forth in Civil Remedy Notice of Insurer Violation document provisions, Section 624.155, Florida Statutes and Florida law. The Notice is deficient as a matter of law as it fails to comply with Section 624.155, Florida Statutes. See 316, Inc. v. Maryland Cas. Ins. Co., 625 F. Supp. 2d 1187 (N.D. Fla. 2008); Rousso v. Liberty Surplus Ins. Corp., 2010 WL 7367059, (S. D. Fla. 2010); Heritage Corp. of South Fla. v. Nat’l Union Fire Ins. Co. of Pittsburgh, P.A., 580 F. Supp. 2d 1294 (S.D. Fla. 2008); Talat Enterprises, Inc. v. Aetna Cas. & Surety Co., 753 So. 2d 1278 (Fla. 2000). Pursuant to Section 624.155(3)(b), Florida Statutes, the Notice “shall state with specificity” the following information: 1. The statutory provision, including the specific language, which the authorized insurer allegedly violated; 2. the facts and circumstances giving rise to the violation; 3. the name of any individual involved in the violation; 4. reference to specific policy language that is relevant to the violation, if any...; 5. a statement that the Notice is given in order to perfect the right to pursue the civil remedy authorized by this section. Moreover, the Department of Financial Services (“DFS”), created form DFS-10-363, which lays out 15 requirements that the Complainant(s) must respond to with specificity. The Florida Supreme Court holds that Section 624.155, Florida Statutes “must be strictly construed.” Talat Enterprises, Inc. v. Aetna Cas. and Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). Strict construction is appropriate as “this statute is in derogation of the common law.” Id. When interpreting a statute in derogation of the common law, “[a] court will presume that such a statute was not intended to alter the common law other than as clearly and plainly specified in the statute.” Time Ins. Co., Inc. v. Burger, 712 So. 2d 389, 393 (Fla. 1998). Such an interpretation would mean that statutory bad faith cases cannot proceed unless the Complainant(s) has specifically complied with all statutory requirements. 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). The Notice fails to meet the requirements of Sec. 624.155, Fla. Stat., 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. To comply with the requirements of Sec. 624.155, Fla. Stat., the Complainant must name the individual(s) involved with specificity as it relates to the purported violation(s) to allow Universal to properly investigate the allegations. The Notice lacks the necessary specificity as required by Sec. 624.155, Fla. Stat., because the Notice states “HENRY WIMP,” without more. The Complainant fails to specify what, if anything, the named individual is knowledgeable about and/or what if anything the named individual did or failed to do regarding the claim at issue. Specific identification of a person or persons with the most knowledge within Universal is of particular importance because the Complainant alleges Universal has “[m]isrepresent[ed] pertinent facts or insurance policy provisions relating to coverages at issue.” The Notice fails to include sufficient specificity as to whom made any misrepresentations, what was misrepresented, and when any of these misrepresentations were made. Therefore, the Notice does not have the requisite specificity as to whom the Complainant is asserting has knowledge as to any allegation contained in the Notice. The failure to provide the requisite specificity precludes Universal from taking any corrective action and potentially curing any purported allegation. Accordingly, Complainant’s Notice is insufficient as a matter of law. Second, with respect to the requirement to set forth with specificity the “facts and circumstances giving rise to the violation,” the Notice fails to specify sufficient facts that would put Universal on notice it violated any policy provision or statute. The Complainant lists eight (8) alleged statutory violations but fails to provide any facts to support the same. The Notice asserts general allegations consisting largely of conclusory statements rather than specifying facts to support any of the alleged misconduct or statutory violations to support its conclusory allegations. Further, the Notice generally alleges that Universal violated Section 626.9541(1)(i)(3)(b), Florida Statutes by “[m]isrepresenting pertinent facts or insurance policy provisions relating to the coverages at issue.” However, the Notice does not specify any facts regarding any misrepresentations made by Universal, state what was allegedly misrepresented, does not identify the person or persons who made such misrepresentations or to whom any misrepresentations were made. It is evident the statement of facts falls short of the specificity required by Section 624.155, Florida Statutes. As a result, the Complainant failed to comply with the requirements provided in Section 624.155(3)(b)(2), Florida Statutes. Lastly, the Notice does not provide a proper means whereby Universal can “cure” the alleged defects. The purpose of a Civil Remedy Notice is to provide the insurer an opportunity to “cure” the alleged wrongdoing. Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So.2d 1278 (Fla. 2000). Here, the Notice fails to specify what particular remedy the Insured is seeking from Universal. If a Complainant fails to assert a “cure,” the Notice is deficient as it does not provide Universal an opportunity to “cure” as proscribed under Florida law. In summation, as outlined above, the Complainant failed to respond to each of the fields set forth on the DFS Form with the requisite specificity, including but not limited to, the failure to identify all listed policyholders, the failure 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, the failure to allege any specific conduct on the part of Universal that would violate any policy provision or statute and the failure to provide a means whereby Universal can “cure” the alleged defects as proscribed under Florida law. Therefore, the Notice is legally deficient and fails to satisfy the condition precedent to filing a bad faith action. 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). For the aforementioned reasons, the Notice is deficient as a matter of law. Nonetheless, and without waiving the above-referenced deficiencies, the following shall provide you with the facts and circumstances regarding this claim, which shall demonstrate that Universal has not violated any Policy terms or statutory provisions. On January 9, 2025, Universal was notified by Insured, Edward Abujaber, of a loss assessment claim at his condo, The Club at St. Lucie West. On or about January 24, 2025, Universal was provided with a correspondence from The Club St. Lucie West that stated, “[t]he existing roofs, which have exceeded 20 years of service, are now failing and require replacement to ensure the integrity and safety of the buildings.” Pursuant to the terms of the Policy, a loss assessment assessed for these reasons and/or caused by wear and tear, or deterioration are not covered. Universal cannot discuss the coverage determinations to other policyholders in this Building as each claim is evaluated on its respective facts and applicable Policy language. As outlined above, the alleged statutory violations set forth in the Notice lack factual support and are without merit. Therefore, the Notice is legally deficient and fails to satisfy the condition precedent to filing a bad faith action. Universal has complied with all policy provisions and applicable Florida law regarding the adjudication of this claim. We trust that the foregoing is sufficient to advise you of Universal’s position regarding this matter and fully responds to the alleged violations in the Notice filed by the Complainant. Sincerely, /s/ Rose Y. Valentine Rose Y. Valentine, Esq. Senior Managing 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. 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