Civil Remedy Notice of Insurer Violations
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Filing Number:     804962
Filing Accepted:  2/4/2025
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Complainant
Last/Business Name *  
FLOYD   First Name   SHAWN
Street Address * 12403 WINDSWEPT AVE
City, State Zip * RIVERVIEW, FL 33569
Email Address * SHAWN@RADDSPORTS.COM UNDELIVERABLE
Complainant Type: * Insured
Insured
Last/Business Name*   FLOYD   First Name   SHAWN
Policy # * 1504-1900-1015 Claim #* FL20-0122644
Attorney
Attorney is Applicable
Last Name* KRAPF First Name * GRANT Initial W
Street Address* 2790 SUNSET POINT RD
City, State Zip* CLEARWATER , FL 33759
Email Address * GRANT@KRAPFLEGAL.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):* JEREMY GOLDWASSER, AND ANY OTHER INDIVIDUAL FROM UNITED PROPERTY & CASUALTY INSURANCE COMPANY WHO WAS INVOLVED IN THE CLAIM AND UNKNOWN TO CLAIMANT.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unfair Trade Practice
Other : Not treating the policyholder with good faith claims conduct
Other : Placing the company's financial interests before the policyholder's interests
Other : Looking for ways to deny full recovery to the Insureds
Other : Failing to implement proper standards for the adjustment and investigation of claims
Other : Looking for ways to delay full recovery to the Insureds
Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made
Other : Misrepresenting the terms of the insurance policy
* 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.
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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Facts of the Case: United Property & Casualty Insurance Company, ("Insurer") has committed the following in handling the Insured's claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the Policy Holder and Claimant; 3) looking for ways to deny benefit payments and otherwise "low ball" or "stone wall" claims; 4) not adjusting the claims promptly and fairly; 5) failing to implement proper standards for the adjustment and investigation of claims; 6) looking for ways to delay benefit payments; 7) misrepresenting the terms of the policy issued by the Insurer; 8) conducting inadequate investigations; and 9) failing to comply with Florida Building Code. The Claimant timely submitted a claim to the Insurer for the damage sustained to the above-referenced insured property as a result of a wind and hailstorm. At the Insurer's inspection of the insured property, the Insurer's adjuster failed to conduct an adequate investigation. As a result, the Insurer wrongfully denied coverage for the damage sustained to the Claimant's roof and interior of the home. Due to the extent of the damage sustained to the roof, patio enclosure, and the interior water damage sustained to the kitchen, living room, dining room, entry area, sub-room, and hallway, Claimant hired a public adjuster who provided an estimate for $57,822.70 in covered damages. It is clear the Insurer and its adjuster colluded to misrepresent the scope and true cause of the damages sustained to the insured property. This was a backhanded attempt to avoid paying to restore damage of the covered peril and place the financial interest of the Insurer over that of the Claimant. The Insurer misrepresented the loss and issued a wrongful denial. In a letter addressed to the Claimant on September 24, 2020, the Insurer denied the Claimant's claim. The Insurer based this denial on the rationale that no storm-related damage was observed to the roof. The Insurer determined that the damage sustained to the roof was a result of "wear, tear, and deterioration from climatic exposure." The adjuster failed to even enter the Claimant's attic to inspect the damage. The adjuster intentionally ignored the damage observed and has failed to make truthful and unbiased reports of the facts after making an investigation. The Insurer cited the policy exclusion for wear and tear, marring, and deterioration. The damage was, however, caused by wind and hail, and the created opening that caused the interior water damage was a result of the wind and hail damage sustained to the roof. Although the Insurer and Insured are in dispute about how the roof was damaged, the Insurer knows or should know that when independent perils converge and no single cause can be considered the sole or proximate cause, it is appropriate to apply the concurring cause doctrine. Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016). The concurring cause doctrine states that coverage may exist where an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause. Id. at 698. A covered peril that meets with an uncovered peril may still provide for coverage under a policy when the covered peril triggered the events that eventually led to the loss. Id. at 697. Regarding the extensive interior water damage, the Insurer's field adjuster failed to conduct an interior inspection of the property. Moreover, upon information and belief, the Insurer wrongfully denied coverage for the Claimant's roof because it knows or should have known that the Claimant needs a new roof in order to comply with the Florida Building Code. More than 25% of the Claimant's roof is damaged. The Insurer is refusing to pay for a full re-roof despite knowing it is obligated to do so. Florida Building Code section 708.1.1 states that not more than 25% of the total roof area or roof section of any existing building or structure shall be repaired, replaced or recovered in any 12-month period unless the entire roofing system or roof section conforms to requirements of this code. The aforementioned circumstances require that the Insurer replace the roof, yet the Insurer has refused to do so. According to Florida Statute 627.7011(1)(b), Insurers have a duty to cover all costs necessary to meet applicable laws and ordinances regulating the repair of any property. Florida Statute 626.9744 requires that the Insurer make reasonable repairs or replacement that match the quality, color or size of the items that needs repair. Additionally, although there was interior water damage the adjuster did not use a water meter. A water meter can be purchased online from Amazon for around $40 before tax. The Insurer could purchase a water meter and assess thousands of properties with one meter. Instead, the Insurer would rather place its financial interests over those of the Claimant by failing to provide the adjuster with the necessary tools to correctly inspect the loss. As a result of the inadequate investigation and surrounding circumstances it is apparent that Insurer significantly underestimated the scope of the loss to the Claimant's property. Insurer and its adjuster have colluded to misrepresent the true scope of damages to the insured property and the true replacement costs of the damages. This is an underhanded attempt to place the financial interest of Insurer over those of the Claimant, to delay the Claimant's claim, and to delay the Claimant in restoring his property to its pre-loss condition. The Insurer continues to fail to adjust this claim and provides no effort to timely effectuate resolution of this matter consistent with its obligation. The Insurer has an ongoing obligation to adjust claims pursuant to Tristar Lodging, Inc. v. Arch Speciality Ins. Co., 434 F. Supp. 2d 1286, 1298 (M.D. Fla. 2006), which holds that "[t]he filing of a lawsuit does not extinguish the Insurer's obligations under the Policy to adjust and pay the claim." This is further exacerbated in this matter as the Insured has no control on the Insurer's adjustment of the claim. "[I]n exchange for this relinquishment of control over settlement and the conduct of the litigation, the insurer obligates itself to act in good faith in the investigation, handling, and settling of claims brought against the insured." Berges v. Infinity Ins. Co., 896 So. 2d 665, 682 83 (Fla. 2004). The foregoing will be proven in the Bad-Faith case when the settlement offers made to date on the claim are presented. After considering same, it is clear the Insurer continues to utilize the overburdened and underfunded Courts in Florida as a method to continue to delay paying claims at the expense of the Insured and for the purpose of unfairly increasing the Insurer's profits. The Insurer has also unfairly leveraged the ongoing pandemic and its impact on Florida's courts to its advantage in delaying payment of claims which only exacerbates the Insured's and State of Florida's problems. The insurer unfairly uses the premiums collected from the Insured while the Insured's is being delayed through litigation to offset it payment obligations. In short, the Insurer is not acting with due regard for the Claimant's interest. In Florida, the work of adjusting insurance claims engages the public trust. The Insurer has breached this duty. The Insurer has significantly underestimated the replacement costs of Insured's property to further frustrate and delay the Claimant's claim. The Insurer's actions amount to but are not limited to the following: 1. Claim delay 2. Claim denial 3. Not treating the Policyholder with good faith claims conduct 4. Looking for ways to reduce recovery to the Claimant 5. Looking for ways to deny recovery to the Claimant 6. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Claimant 7. Failing to implement proper standards for the adjustment and investigation of claims 8. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company's interests before the policyholder's interests 9. Misrepresenting the terms of the policy issued by the Insurer 10. Conducting inadequate investigations Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must: (1) Admit full coverage for the Insured's loss. (2) Tender full benefits owed to the Insureds under the insurance contract, currently totaling $49,952.18. A copy of this form submitted to the FDFS has been sent via Electronic Mail to the following parties providing them notice of the filing of the civil remedy notice. Please email any response to this civil remedy notice to badfaith@krapflegal.com VIA Electronic Mail: Attorneys for Defendant Universal Property & Casualty Ins. Co. 491 Montgomery Place, Suite 2001 Altamonte Springs, FL 32714 el0329@universalproperty.com
Comments
User Id Date Added Comment
jr0405@universalproperty.com 03-26-2025 March 26, 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.: 804962 Filing Date: 2/4/2025 Complainant(s): Shawn Floyd Insured(s): Shawn Floyd Policy No.: 1504-1900-1015 Claim No.: FL20-0122644 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 attorney, Grant W Krapf, on behalf of Complainant, Shawn Floyd (also referenced as “Insured”). As a preliminary matter, attorney Grant Krapf filed a prior Civil Remedy Notice on the same claim referenced above on July 18, 2022, with the Florida Department of Financial Services (“DFS”) under File Number 637601 (“Prior Notice”). This instant Notice is essentially identical to the Prior Notice. On September 2, 2022, Universal properly responded to the Prior Notice outlining the legal deficiencies. None of the legal deficiencies noted in the Prior Notice have been rectified in the subject Notice. The Notice alleges violations of Sections 624.155, 626.9541, 626.9744, and 627.7011, 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 requirement of Section 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. In order to comply with the requirements of Section 624.155, Florida Statutes, 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 requisite specificity as required by Section 624.155, Florida Statutes. Here, the Notice states, “JEREMY GOLDWASSER,” without more. The Notice fails to include any specificity as to how the named individual has knowledge of the facts giving rise to any purported allegation(s) and/or what, if anything, the named individual did or failed to do as it relates to the claim at issue. Furthermore, the Complainant attempts a “catch-all” of “ANY OTHER INDIVIDUAL FROM UNITED PROPERTY & CASUALTY INSURANCE COMPANY WHO WAS INVOLVED IN THE CLAIM AND UNKNOWN TO CLAIMANT,” which not only refers to a different carrier, but significantly prejudices Universal because the Complainant is failing to notify Universal of the individual(s) that purportedly committed statutory violations or the specific statutory violations any individual purportedly committed. Further, the statement clearly defeats the requirement in the DFS Form to provide specificity in order to put the carrier on notice and provide an opportunity to investigate any allegation with a specific individual. Specific identification of a person or persons with the most knowledge within Universal is of particular importance because the Complainant alleges that Universal “misrepresent[ed] the terms of the policy issued by the Insurer.” The Notice fails to include the requisite specificity as to whom made any misrepresentations, what was misrepresented, when any of these misrepresentations occurred nor to whom any alleged misrepresentation was made. Accordingly, Complainant’s Notice is insufficient as a matter of law. Second, the Notice fails to satisfy Sec. 624.155(3)(b)(4), Fla. Stat., in that it fails to reference specific policy language relevant to the alleged violations. Instead, the Notice states “[r]eference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language.” Thus, the Complainant admits that Universal in fact did not violate any policy language but fails to provide any specificity as to whom, when, or how any statutes were violated. As such, the Notice is deficient as a matter of law. See generally Julien v. United Property & Casualty Ins. Co., 311 So.3d 875 (Fla. 4th DCA 2021). Third, with respect to the requirement to set forth with specificity the “facts and circumstances giving rise to the violation,” the Notice fails to allege any specific conduct on the part of Universal that would violate any policy provision or statute. The Complainant provides ten (10) reasons for filing the Notice, however, the Complainant’s allegations regarding these “Reasons for Notice” have no factual support anywhere in the Notice. The Notice asserts general allegations consisting largely of boilerplate, conclusory and inaccurate statements rather than specific allegations of facts regarding any alleged misconduct or statutory violations. As an example, the Notice states in part: “United Property & Casualty Insurance Company, ("Insurer") has committed the following in handling the Insured's claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the Policy Holder and Claimant; 3) looking for ways to deny benefit payments and otherwise "low ball" or "stone wall" claims; 4) not adjusting the claims promptly and fairly; 5) failing to implement proper standards for the adjustment and investigation of claims; 6) looking for ways to delay benefit payments; 7) misrepresenting the terms of the policy issued by the Insurer; 8) conducting inadequate investigations; and 9) failing to comply with Florida Building Code.” The Notice once again refers to a different insurance carrier, and wholly fails to identify any specific facts or circumstances which support any of the above-listed conclusory and/or boilerplate allegations. In addition, the Notice does not state any facts to support the Complainant’s misrepresentation allegations or any of the allegations contained therein. The Notice fails to specify any facts regarding any misrepresentations made by Universal and fails to identify any person or persons who made such misrepresentations nor to whom any misrepresentations were made. Additionally, the Notice states, “the Insurer is not acting with due regard for the Claimant's interest. In Florida, the work of adjusting insurance claims engages the public trust. The Insurer has breached this duty.” The Complainant fails to assert any specific facts to support these conclusory allegations. It is evident that the statement of facts in the Notice 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. A Civil Remedy Notice aims 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). Section 624.155, Florida Statute, however, does not impose on an insurer the obligation to pay whatever amount its insureds demand. Talat, 753 So. 2d at 1282. On the contrary, the Florida Supreme Court holds that the scope of what can be “cured” in responding to a Civil Remedy Notice, is limited to contractual amounts due to the insureds. See Talat, 753 So. 2d at 1281. Notably, Universal asserts that the Insured initiating litigation before filing the Notice prejudices Universal’s ability to cure any purported allegation in the Notice as there is no actual cure period wherein Universal could cure without paying extra-contractual damages. Universal is only obligated to pay contractual amounts owed to cure a civil remedy notice. See id. at 1278. 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, failing 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, failing to reference specific policy language relevant to the alleged violation, failing to allege any specific conduct on the part of Universal that would violate any policy provision or statute, and failing to provide a proper cure. 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 June 25, 2020, Universal was untimely notified by the Insured that the insured location was damaged on February 22, 2020. Universal inspected the property and documented any visible damage. Pursuant to the terms of the named peril Policy, Universal advised the Insured that there was no available coverage for the claim. Thereafter, on October 20, 2020, the Insured initiated litigation against Universal in the Circuit Court in and for Hillsborough County, Case No. 20-CA-8215. Thus, at the time of the instant Notice, the parties were and continue to litigate their disputes to determine what, if any, available coverage exists under the Policy. At no time has Universal breached any duty to its Insured. An Insurer has no obligation to pay whatever amount an insured demands. While an insurance carrier is required to settle claims that should be settled, it is not required to settle claims that are legitimately contested. As outlined above, the alleged statutory violations set forth in the Notice lack specific 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/ Jonathan Rodriguez Jonathan Rodriguez, Esq. 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.

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DFS-10-363
Rev. 10/14/2008