Filing Number: 804503
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| Filing Accepted: 1/31/2025 |
| Last/Business Name
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| Street Address
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3516 17TH AVE. W |
| City, State Zip
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BRADENTON,
FL
34205
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| Email Address
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LEIGHDUBOIS7@GMAIL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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DUBOIS |
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First Name |
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LEIGH |
| Policy # * |
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1501-2102-6918 |
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Claim #* |
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FL24-0128838-K524 |
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Attorney is Applicable
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| Last Name* |
OLADIPO
First Name *
ABIDEMI
Initial
A.
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| Street Address* |
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15257 AMBERLY DRIVE |
| City, State Zip* |
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TAMPA
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FLORIDA
33647
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| Email Address * |
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AOLADIPO@MSO.LAW |
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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 PROPERTY & CASUALTY INSURANCE COMPANY, LAWRENCE WOLFE, ALONG WITH ALL ADJUSTERS, SUPERVISORS, MANAGERS, AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY THE INSURER IN THE CLAIM.
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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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| 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)(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)(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)(3)(g) |
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Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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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.
HOMEOWNERS 3 – SPECIAL FORM
AGREEMENT
We will provide the insurance described in this policy in return for the premium and compliance with all applicable provisions of this policy.
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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".
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.
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D. Coverage C – Personal Property
1. Covered Property
We cover personal property owned or used by an "insured" while it is anywhere in the world. After a loss and at your request, we will cover personal property owned by:
a. Others while the property is on the part of the "residence premises" occupied by an "insured"; or
b. A guest or a "residence employee", while the property is in any residence occupied by an "insured".
D. Coverage D – Loss Of Use
The limit of liability for Coverage D is the total limit for the coverages in 1. Additional Living Expense, 2. Fair Rental Value and 3. Civil Authority Prohibits Use below.
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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.
On May 14, 2024, Universal Property & Casualty Insurance Company (“UPCIC”) issued policy number 1501-2102-6918 (the “Policy”) to Leigh DuBois (“Insured”) for her home located at 3516 17th Ave. W, Bradenton, Florida 34205 (“Insured Property”) for the period of May 14, 2024 to May 14, 2025. The Policy provides Coverage A – Dwelling limits of $354,196.00; Coverage B – Other Structure limits of $35,423.00; Coverage C – Personal Property limits of $177,098.00; and Coverage D - Loss of Use limits of $70,840.00. The Policy provides coverage for direct damage to the Insured Property as a result of hurricanes.
On October 9, 2024, Hurricane Milton made landfall in Florida, causing extensive devastation to numerous communities, including Bradenton. Hurricane Milton’s powerful wind gusts and torrential rainfall inflicted direct and substantial damage upon the Insured Property, particularly to its roof, resulting in significant interior water damage that exacerbated the overall damage. The damage to the roof was so severe that, upon Hurricane Milton’s passing, the Insured immediately observed shingles scattered across her yard. Additionally, the high winds caused the complete detachment of the pool enclosure and continued to impact the Insured Property for several hours. The perimeter fence of the Insured Property was also entirely destroyed.
Upon discovering the damage, on October 19, 2024, the Insured promptly reported the loss to UPCIC and provided its representatives with unfettered access to the Insured Property for inspection and assessment. UPCIC assigned claim number FL24-0128838-K524 and initiated its investigation of the claim. As part of this process, UPCIC designated field adjuster Lawrence Wolfe to conduct an inspection of the Insured Property, which took place on October 29, 2024. Regrettably, Mr. Wolfe’s inspection was incomplete, as he either failed to assess or deliberately overlooked certain areas of the Insured Property that were damaged by Hurricane Milton. As a direct consequence of this inadequate inspection, Mr. Wolfe produced an estimate dated November 16, 2024, in which he assessed the damages at a replacement cost value of $29,881.34—an amount grossly insufficient to restore the Insured Property to its pre-loss condition. Based on this flawed assessment, UPCIC issued only a partial payment, deducting the $7,083.92 hurricane deductible and withholding $8,135.15 for recoverable depreciation, resulting in a net disbursement of $13,227.21.
Regrettably, UPCIC has demonstrated a recurrent business practice of engaging adjusters, including Mr. Wolfe, who systematically underestimate damages to insured properties, disregard evident losses, or lack the requisite qualifications to properly assess and adjust claims. This pattern of conduct is not limited to the instant claim but is also prevalent in numerous other hurricane-related claims filed against UPCIC throughout the state of Florida. Such practices not only reflect UPCIC’s failure to adopt and implement appropriate standards for the proper investigation of claims, in direct violation of Section 626.9541(1)(i)(3)(a), Florida Statutes but also constitute a misrepresentation of pertinent facts and policy provisions related to coverage, in violation of Section 626.9541(1)(i)(3)(b), Florida Statutes.
Furthermore, the Insured experienced unprofessional and improper conduct from Mr. Wolfe following UPCIC’s issuance of its coverage determination letter. Specifically, Mr. Wolfe misled the Insured and disregarded her requests for clarification regarding the additional materials required to complete the claim. Instead of providing the necessary guidance, Mr. Wolfe responded with dismissive and unprofessional remarks, thereby violating Section 626.9541(1)(i)(3)(c), Florida Statutes, which mandates that insurers acknowledge and act promptly upon communications regarding claims. Additionally, Mr. Wolfe’s failure to properly inform the Insured of the specific information necessary to process the claim constitutes a violation of Section 626.9541(1)(i)(3)(g), Florida Statutes, which imposes a duty on insurers and their representatives to notify insureds of any additional information required for claim processing.
The Insured has fully complied with all Duties After Loss provisions set forth in the Policy, including the timely reporting of the claim, granting UPCIC and its representatives unfettered access to the Insured Property, and furnishing all relevant documentation related to the claim. In fact, due to UPCIC’s deficient claims investigation and improper adjustment, the Insured was compelled to adjust her own claim. To substantiate the extent of the loss, the Insured provided an itemized estimate for roof repairs totaling $16,839.07, prepared by EBM Atlantic Group, LLC. Additionally, the Insured submitted two separate estimates for the replacement of the pool enclosure: one from Florida Pool Experts, dated October 30, 2024, in the amount of $19,300.00, and another from Francisco Ivo Filho GC, LLC, in the amount of $27,852.00. Furthermore, to establish that the damages sustained were not pre-existing and did not precede Hurricane Milton, the Insured submitted a home inspection report prepared by Owens Construction and Inspection Services, LLC, dated April 7, 2021, which was conducted at the time of the Insured’s purchase of the property. This report unequivocally confirms that the damaged components of the Insured Property were in good and serviceable condition prior to Hurricane Milton.
Despite the Insured’s submission of this comprehensive documentation, UPCIC deliberately disregarded it, further demonstrating its failure to acknowledge and act promptly upon communications related to the claim, in violation of Section 626.9541(1)(i)(3)(c), Florida Statutes. Moreover, UPCIC failed to provide the Insured with a reasonable written explanation of the basis for its denial of the claim or its compromise settlement offer, in violation of Section 626.9541(1)(i)(3)(f), Florida Statutes.
As a result of UPCIC’s inadequate handling of the claim, the Insured was compelled to retain legal representation to assist in presenting her claim. Through her legal counsel, the Insured engaged LSC Construction Consultants, LLC (“LSC”) to conduct an independent inspection of the Insured Property and prepare a general contractor estimate reflecting the actual cost required to restore the property to its pre-loss condition, considering current market prices for materials, labor, and permits in the area. LSC conducted its inspection on January 16, 2025, and subsequently produced a detailed, itemized estimate of damages totaling $ 70,900.88, which was submitted to UPCIC to facilitate the proper adjustment of the claim. Regrettably, UPCIC has willfully ignored the Insured’s repeated efforts and requests for assistance, continuing to withhold payment for the covered loss. As a direct consequence of UPCIC’s unjustified refusal to issue the necessary payment, the Insured remains unable to restore the Insured Property to its pre-loss condition.
In Florida, the work of adjusting insurance claims engages the public trust. UPCIC has breached the public’s trust by its adjustment of the Insured’s claim of loss. UPCIC has failed to create and implement adequate guidelines for the proper investigation and evaluation of claims, claims handling, and for training and supervision of employees resulting in statutory violations as set forth above. UPCIC has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s claim for damages. UPCIC has failed to promptly settle the Insured’s claim when the obligation to settle the insurance claim had become reasonably clear. To date, notwithstanding the Insured’s pleas otherwise, UPCIC has continued to refuse to acknowledge its obligation to conduct a proper investigation.
Moreover, UPCIC has not attempted in good faith to settle the Insured’s claim 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 their interests. UPCIC has done everything possible to delay and/or deny the claim. Furthermore, UPCIC is required to properly investigate and adjust claims and cannot place that burden upon the insureds. This was made clear by the appellate court and the Florida Supreme Court in Allstate Indemnity Co. v. Ruiz, 899 So. 2d 1121 (Fla. 2005)(“The Legislature has clearly chosen to impose on the insurance companies a duty to use good faith and fair dealing in processing and litigating the claims of their insureds…”). UPCIC was timely put on notice of the Insured’s loss and claim for damages. The Insured has complied with all of UPCIC’s requests to date and the carrier has still failed to treat this claim with good-faith. This intentional delay with the claim has led to direct prejudice of the Insured, who continues to be held hostage unless/until UPCIC engages in good faith claims handling. To date, UPCIC has still refused to fully pay the amount owed under the Policy. To make matters worse, the Insured have incurred incredible costs and efforts to adjust their own loss, with detailed and substantiated damages presented to UPCIC in the form of a repair estimate evidencing $70,900.88 in Replacement Cost Valuation. UPCIC’s stubborn and/or negligent refusal to fully indemnify the Insured for the covered damages has resulted in a confluence of consequential damages including, but not limited to, excess damages stemming from UPCIC’s maladroit adjustment of the claim, the unaffordability of the Insured Property given the loss of utility and the indefinite delay to address the ongoing dispute, additional costs and expenses to adjust its own loss that include retaining a public adjuster and an attorney, among many other otherwise unnecessary consequences but for the negligence and nefarious business practices of UPCIC.
It is clear that UPCIC is not treating the Insured with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the Insured; and ignoring the Insured’s pleas for assistance; failing to implement proper standards for the adjustment and investigation of claims by its adjusters and placing UPCIC’s interests before the Insured’s interests; refusing to pay the full amount owed to the Insured despite the fact that UPCIC has been on notice of the damages and looking for ways to delay and/or deny full recovery to the Insured, when a reasonable carrier in a similar position would have tendered a full payment in accordance with both the policy language and statutory requirements. UPCIC’s actions are in violation of Sections 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c), 626.9541(1)(i)(3)(d), 626.9541(1)(i)(3)(e), 626.9541(1)(i)(3)(f), 626.9541(1)(i)(3)(g), and 626.9541(1)(i)(3)(h), Florida Statutes.
All of the aforementioned are part of what appears to be an ongoing pattern and practice of behavior by UPCIC that demonstrates a wanton and reckless disregard for insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, UPCIC must: (1) Create and implement adequate guidelines for the proper investigation and evaluation of these type of claims and for the training and supervision of employees, which will avoid future statutory violations as set forth above, and prevent this from occurring in the future; (2) UPCIC must create and implement adequate guidelines for the proper investigation and evaluation of these type of claims and for the training and supervision of employees with regard to these type of claims to ensure that the claims handling procedure with regard to these types of losses are adequate to prevent other insureds from being treated unfairly and wrongfully; (3) UPCIC must pay the Insured $70,900.88 for all of the damages sustained as a result of the loss, less the applicable deductible, limitations, plus all contractual damages owed, attorney’s fees, costs and interest, under Sections 57.041 and 627.70131(5)(a) Florida Statutes; and (4) UPCIC must act fairly and honestly towards its Insured and with due regard for their interests in attempting to settle its Insured’s claim.
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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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