Filing Number: 805845
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| Filing Accepted: 2/8/2025 |
| Last/Business Name
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| Street Address
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1731 GATEWAY LANE |
| City, State Zip
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KISSIMMEE,
FL
34746
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| Email Address
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PLEADINGS@HGWLEGAL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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HUNTER |
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First Name |
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DAVID |
| Policy # * |
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1501-2004-5734 |
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Claim #* |
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FL21-0134700-Q721 |
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Attorney is Applicable
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| Last Name* |
WOODWARD
First Name *
HEW
Initial
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| Street Address* |
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PO BOX 140312 |
| City, State Zip* |
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ORLANDO
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FLORIDA
32814
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| Email Address * |
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HEW@HGWLEGAL.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):*
STEPHEN GOLDSMITH AND TUNISIA ABBAN
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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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Cancellation
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Non-renewal
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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)(1) |
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Attempting to settle claims on the basis of an application, when serving as a binder or intended to become a part of the policy, or any other material document which was altered without notice to, or knowledge or consent of, the insured.
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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)(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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| 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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| 626.9541(1)(i)(3)(j) |
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Altering or amending an insurance adjuster’s report without:
(I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and
(II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or
(III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change;
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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.
THE SUBJECT INSURANCE POLICY PROVIDES COVERAGE FOR DIRECT PHYSICAL LOSS TO DAVID HUNTER’S PROPERTY. MR. HUNTER SUBMITTED A CLAIM FOR WINDSTORM AND ASSOCIATED WATER DAMAGE TO ITS INSURED PROPERTY THAT OCCURRED DURING THE EFFECTIVE POLICY PERIOD. THE LOSS IS NOT EXCLUDED UNDER THE TERMS AND CONDITIONS OF THE POLICY. THE INSURER HAS FAILED TO ISSUE PAYMENT PURSUANT TO THE LOSS SETTLEMENT PROVISIONS OF THE POLICY.
THE FOLLOWING COVERAGES AND POLICY LANGUAGE ARE RELEVANT:
COVERAGE A - DWELLING $414,363
COVERAGE D - LOSS OF USE $41,437
DWELLING REPLACEMENT COST Y
LAW AND ORDINANCE $103,591
HOMEOWNER 3 - SPECIAL FORM
MOLD/ FUNGI $10,000 INCLUDED
LIBERALIZATION CLAUSE
“LOSS SETTLEMENT…REPLACEMENT COST…WE WILL PAY THE COST TO REPAIR OR REPLACE, WITHOUT DEDUCTION FOR DEPRECIATION”
ALL OF THE PROVISIONS IN THE SUBJECT INSURANCE POLICY ARE DICTATED BY THE FOLLOWING FLORIDA STATUTES: § 627.4025 (“RESIDENTIAL COVERAGE AND HURRICANE COVERAGE DEFINED”); § 627.404 (“INSURABLE INTEREST, PERSONAL INSURANCE”); § 627.405 (“INSURABLE INTEREST”); § 627.4091 (“SPECIFIC REASONS FOR DENIAL, CANCELLATION, OR NONRENEWAL”); § 627.40951 (“STANDARD PERSONAL LINES RESIDENTIAL INSURANCE POLICY”); § 627.410 (“FILING, APPROVAL OF FORMS”); § 627.412 (“STANDARD PROVISIONS, IN GENERAL”); § 627.413 (“CONTENTS OF POLICIES, IN GENERAL”); § IDENTIFICATION”); § 627.4131 (“TELEPHONE NUMBER REQUIRED”); § 627.4133 (“NOTICE OF CANCELLATION, NONRENEWAL, OR RENEWAL PREMIUM”); § 627.4135 (“CASUALTY INSURANCE CONTRACTS SUBJECT TO GENERAL PROVISIONS FOR INSURANCE CONTRACTS”); § 627.4143 (“OUTLINE OF COVERAGE”); § 627.4145 (“READABLE LANGUAGE IN INSURANCE POLICIES”); § 627.418 (“VALIDITY OF NONCOMPLYING CONTRACTS”); § 627.419 (“CONSTRUCTION OF POLICIES”); § 627.420 (“BINDERS”); § 627.421 (“DELIVERY OF POLICY”); § 627.425 (“FORMS FOR PROOF OF LOSS TO BE FURNISHED”); § 627.426 (“CLAIMS ADMINISTRATION”); § 627.4265 (“PAYMENT OF SETTLEMENT”); § 627.428 (“ATTORNEY'S FEE”); § 627.442 (“INSURANCE CONTRACTS”); § 627.7011 (“HOMEOWNERS' POLICIES, OFFER OF REPLACEMENT COST COVERAGE AND LAW AND ORDINANCE COVERAGE”); § 627.7015 (“ALTERNATIVE PROCEDURE FOR RESOLUTION OF DISPUTED PROPERTY INSURANCE CLAIMS”); § 627.7016 (“INSURER CONTRACTS WITH BUILDING CONTRACTORS”); § 627.7019 (“STANDARDIZATION OF REQUIREMENTS APPLICABLE TO INSURERS AFTER NATURAL DISASTERS”); § 627.702 (“VALUED POLICY LAW”); § 627.7061 (“COVERAGE INQUIRIES”); § 627.707 (“STANDARDS FOR INVESTIGATION OF SINKHOLE CLAIMS BY INSURERS. NONRENEWALS”); § 627.7072 (“TESTING STANDARDS FOR SINKHOLES”); § 627.7073 (“SINKHOLE REPORTS”); § 627.712 (“RESIDENTIAL WINDSTORM COVERAGE REQUIRED, AVAILABILITY OF EXCLUSIONS FOR WINDSTORM OR CONTENTS”).
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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.
UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY (“UNIVERSAL” OR “INSURER”) BREACHED ITS STATUTORY AND CONTRACTUAL DUTIES DURING ITS ADJUSTMENT AND LITIGATION OF THE INSURANCE CLAIM REPORTED BY DAVID HUNTER (THE “INSURED” OR “INSUREDS”) IN CONNECTION WITH SEVERE DAMAGE TO A RESIDENTIAL BUILDING LOCATED AT 1731 GATEWAY LANE, KISSIMMEE, FLORIDA 34746 ("DWELLING") CAUSED BY WINDSTORM AND WATER INTRUSION OCCURRING ON OR ABOUT APRIL 11, 2021 (“LOSS”).
RATHER THAN ADJUSTING THE CLAIM IN GOOD FAITH, UNIVERSAL’S INDEPENDENT ADJUSTING FIRM UNILATERALLY REDUCED THEIR FIELD ADJUSTER'S ESTIMATE AND REDACTED HIS PHOTOGRAPHS, WITHOUT THE FIELD ADJUSTER'S KNOWLEDGE. THE REVISED ESTIMATE, AND LATER PHOTOGRAPHS, WERE THEN SENT BY UNIVERSAL TO MR. HUNTER WITHOUT THE FIELD ADJUSTER'S KNOWLEDGE. THIS NOT ONLY RESULTED IN AN UNDERVALUATION OF THE CLAIM, BUT ALSO MISREPRESENTED THE FIELD ADJUSTER’S FINDINGS AND MISLED MR. HUNTER. DESPITE CLEAR EVIDENCE THAT THE CLAIMED DAMAGES WERE COVERED BY THE SUBJECT INSURANCE POLICY, UNIVERSAL UNDERTOOK AN EXTENDED ADJUSTMENT PROCESS IN BAD FAITH, AND ULTIMATELY CANCELED OR NON-RENEWED THE POLICY, RESULTING IN SUBSTANTIAL DAMAGE AND DISTRESS AS THE INSURED WAS UNABLE TO REPAIR THE PROPERTY OR PURCHASE AN ANOTHER POLICY WHILE THE CLAIM WAS PENDING.
AFTER UNIVERSAL DENIED THE CLAIM, THE INSURED WAS FORCED TO ENGAGE AN ATTORNEY. AFTER LITIGATION WAS COMMENCED, UNIVERSAL ASSERTED NUMEROUS BASELESS GROUNDS FOR DENYING COVERAGE. DEFENDANT SERVED AN ANSWER WITH AFFIRMATIVE DEFENSES, TOGETHER WITH A RESPONSE TO MR. HUNTER’S REQUESTS FOR ADMISSIONS DENYING BASIC AND INDISPUTABLE FACTS. WITHOUT ANY FACTUAL BASIS WHATSOEVER, UNIVERSAL ALLEGED THAT THE INSURED VIOLATED OTHER UNSPECIFIED CONDITIONS IN THE INSURANCE CONTRACT. FOR EXAMPLE, UNIVERSAL DENIED THAT THE INSURED HELD AN INSURABLE INTEREST IN THE DWELLING, SUSTAINED A LOSS WHICH TRIGGERED COVERAGE, AND COMPLIED WITH POLICY CONDITIONS. IT ALSO DENIED THAT A CLAIM WAS PROPERLY SUBMITTED, THAT MR. HUNTER COOPERATED WITH UNIVERSAL’S INVESTIGATION OF THE CLAIM, AND THAT THE INSURANCE POLICY PROVIDED THE “ALL RISK” AND “REPLACEMENT COST VALUE” COVERAGE. UNIVERSAL LITIGATED THE CLAIM FOR THREE (3) YEARS AND MADE NO REASONABLE SETTLEMENT OFFERS. DESPITE THE FACT THAT AFTER THE INSURED FILED THIS LAWSUIT, CONDUCTED DISCOVERY, AND RETAINED EXPERT WITNESSES, UNIVERSAL REFUSED TO PARTICIPATE IN ANY MEANINGFUL SETTLEMENT NEGOTIATIONS. TO PUNISH MR. HUNTER FOR FILING THE LAWSUIT, INSTEAD, UNIVERSAL CANCELED AND/OR NON-RENEWED THE SUBJECT INSURANCE POLICY ON OR ABOUT JULY 25, 2023. FROM JANUARY 13, 2025 THROUGH JANUARY 21, 2025, MR. HUNTER’S CLAIM WAS TRIED BEFORE A JURY. THE JURY RENDERED A VERDICT IN FAVOR OF MR. HUNTER ON JANUARY 21, 2025. THE JURY CALCULATED ACTUAL CASH VALUE (“ACV”) DAMAGES IN THE AMOUNT OF $200,000, AND REPLACEMENT COST VALUE (“RCV”) DAMAGES IN THE AMOUNT OF $455,800.
UNIVERSAL VIOLATED THE MINIMUM STATUTORY REQUIREMENTS OF ALL INSURERS TO PROVIDE PAYMENT OF ALL UNDISPUTED AMOUNTS DUE AND OWING UNDER THE SUBJECT INSURANCE POLICY IN A TIMELY MANNER. UNIVERSAL KNEW AND/OR SHOULD HAVE KNOWN THAT INSURANCE MONIES WERE DUE AND OWING, HOWEVER, UNIVERSAL HAS NOT MADE ANY PAYMENTS TO THE INSURED. UNIVERSAL’S REFUSAL TO PAY INSURANCE BENEFITS IS AN INTENTIONAL ATTEMPT TO “LOW BALL” THE INSURED’ DAMAGES. UNIVERSAL HAS ACTED IMPROPERLY AND IN BAD FAITH BY IGNORING THE INSURED’ PUBLIC ADJUSTER’S REPAIR ESTIMATE WITHOUT CONDUCTING A FAIR AND REASONABLE INVESTIGATION. IT ALSO ACTED IMPROPERLY AND IN BAD FAITH WHEN IT IGNORED THE REQUEST FOR A CERTIFIED COPY OF THE INSURANCE POLICY. IN SUM, UNIVERSAL DID NOT INVESTIGATE AND FAIRLY OR REASONABLY INTERPRET THE FACTS SURROUNDING THIS CLAIM. UNIVERSAL HAS FAILED TO ISSUE PAYMENT OF THE UNDISPUTED PORTION OF THE INSURED PROPERTY DAMAGE CLAIM WITHIN 90-DAYS, DESPITE THE FACT THAT IT HAD ALL INFORMATION NECESSARY TO CALCULATE THE ISSUE PAYMENT FOR THE UNDISPUTED PORTION OF THE CLAIM.
UNIVERSAL FAILED TO PROMPTLY PAY THE FULL BENEFITS OWED TO THE POLICYHOLDER, THE REASONS FOR THIS MAY BE ATTRIBUTED TO IMPROPER TRAINING, SUPERVISION, AND/OR FAILURE OF ADJUSTERS AND CLAIMS SUPERVISORS TO PROMPTLY AND FAIRLY INVESTIGATE, ADJUST AND PAY FULL BENEFITS AVAILABLE TO ALL BENEFICIARIES. THE INSURER FAILED TO ADOPT PROPER STANDARDS OF INVESTIGATION AND ADJUSTMENT OF LOSSES, OR IS OTHERWISE NOT IMPLEMENTING THOSE STANDARDS BECAUSE FULL PAYMENT AND PROMPT PAYMENT FOR THE LOSS IS NOT OCCURRING. UNIVERSAL HAS FAILED TO CREATE AND IMPLEMENT ADEQUATE GUIDELINES FOR PROPER INVESTIGATION TO EVALUATE CLAIMS HANDLING AND FOR TRAINING AND SUPERVISION OF EMPLOYEES, RESULTING IN STATUTORY VIOLATIONS AS SET FORTH ABOVE. UNIVERSAL HAS FAILED AND/OR REFUSED TO THOROUGHLY, ACCURATELY, AND COMPLETELY INVESTIGATE AND EVALUATE THE INSURED’ INSURANCE CLAIM AND DAMAGES.
UNIVERSAL HAS FAILED AND/OR REFUSED TO ACKNOWLEDGE AND ACT PROMPTLY UPON COMMUNICATION FROM ITS INSURED (OR HER REPRESENTATIVE) WITH RESPECT TO THE INSURANCE CLAIMS. UNIVERSAL HAS FAILED TO PROMPTLY SETTLE THE INSURED’ INSURANCE CLAIMS WHEN THE OBLIGATION TO SETTLE THESE CLAIMS HAD BECOME REASONABLY CLEAR, UNDER AT LEAST ONE PORTION OF THE INSURANCE POLICY’S COVERAGES, IN ORDER TO INFLUENCE THE SETTLEMENTS UNDER OTHER PORTIONS OF THE INSURANCE POLICY COVERAGE. TO DATE, NOTWITHSTANDING THE INSURED’ PLEAS OTHERWISE, UNIVERSAL HAS CONTINUED TO REFUSE TO ACKNOWLEDGE ITS OBLIGATION TO TENDER ALL INSURANCE MONIES DUE AND OWING THE INSURED, OR ASSIST THE INSURED IN THE MITIGATION OF HER DAMAGES. THE INSURED WAS THEN, AND IS STILL, FORCED TO EXPEND MONIES TO SUBMIT THE INSURANCE CLAIM, PAY ATTORNEYS’ FEES AND COSTS, RETAIN EXPERTS AND ADJUSTERS TO INVESTIGATE THE FULL EXTENT AND NATURE OF HER LOSS, AND TO FORCE UNIVERSAL TO HONOR ITS OBLIGATIONS UNDER THE INSURANCE POLICY AND PAY ALL THE INSURANCE PROCEEDS DUE AND OWING THE INSURED.
IN FLORIDA THE WORK OF ADJUSTING INSURANCE CLAIMS ENGAGES THE PUBLIC TRUST. UNIVERSAL BREACHED ITS STATUTORY AND CONTRACTUAL DUTIES AS WELL AS THIS TRUST. TO CURE THE DEFECTS OUTLINED IN THIS CIVIL REMEDY NOTICE, UNIVERSAL MUST: (1) 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 TO AVOID THIS FROM OCCURRING IN THE FUTURE. (2) CREATE AND IMPLEMENT ADEQUATE GUIDELINES FOR THE PROPER INVESTIGATION AND EVALUATION OF WINDSTORM, WIND, RAIN AND WATER INTRUSION CLAIMS, AND FOR THE TRAINING AND SUPERVISION OF EMPLOYEES WITH REGARD TO THESE CLAIMS TO ENSURE THAT UNIVERSAL’ CLAIMS HANDLING PROCEDURES WITH REGARD TO THESE TYPES OF LOSSES ARE ADEQUATE TO STOP UNFAIR AND WRONGFUL TREATMENT OF INSURED. (3) ASSIST THE INSUREDS IN MITIGATING DAMAGES. (4) PROMPTLY AND TIMELY RESPOND TO REQUESTS FOR INFORMATION BY THE INSUREDS OR THE INSUREDS’ PUBLIC ADJUSTER. (5) ACT FAIRLY AND HONESTLY TOWARDS THE INSUREDS AND WITH DUE REGARD FOR HER INTERESTS IN ATTEMPTING TO SETTLE THE INSURED’ CLAIM. (6) IMMEDIATELY TENDER ALL INSURANCE MONIES DUE AND OWING THE INSUREDS. (7) ACKNOWLEDGE IN WRITING TO THE INSURED THAT UNIVERSAL’ HANDLING OF THIS CLAIM IS AND WAS INSUFFICIENT TO PLACE THE INSUREDS BACK INTO THEIR PRE-LOSS CONDITION. (8) TAKE ANY OTHER REASONABLE AND NECESSARY MEASURES TO PLACE THE INSUREDS BACK INTO HER PRE-LOSS CONDITION. (9) ACKNOWLEDGE, IN WRITING, ITS SINCERE APOLOGY TO THE INSURED FOR ITS WRONGFUL CLAIMS HANDLING PRACTICES IN THE ADJUSTMENT OF THIS CLAIM. (10) IMMEDIATELY PAY ALL UNDISPUTED AMOUNTS CLAIMED PLUS INTEREST (BUT SUBTRACT PRIOR PAYMENTS AND DEDUCTIBLE) WHICH AMOUNT(S) IS/ARE EXCLUSIVE ANY CLAIMS FOR FEES, COSTS, BAD FAITH OR EXTRA-CONTRACTUAL DAMAGES.
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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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