Civil Remedy Notice of Insurer Violations
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Filing Number:     806507
Filing Accepted:  2/12/2025
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Complainant
Last/Business Name *  
SMILIE   First Name   ABRAHAM
Street Address * 6790 NW 21ST COURT
City, State Zip * SUNRISE, FL 33313
Email Address * CLAY@THEKRFIRM.COM
Complainant Type: * Insured
Insured
Last/Business Name*   SMILIE   First Name   ABRAHAM
Policy # * 1504-1700-3459 Claim #* FL24-0115334-A322
Attorney
Attorney is Applicable
Last Name* KUHN First Name * CLAYTON Initial
Street Address* 2110 WEST PLATT STREET
City, State Zip* TAMPA , FLORIDA 33606
Email Address * CLAY@THEKRFIRM.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):* ANY AND ALL PERSONS ASSOCIATED WITH THE CLAIMS HANDLING FROM UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unsatisfactory Settlement Offer
Unfair Trade Practice
* 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)(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)(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.

THE POLICY LANGUAGE RELEVANT TO THE VIOLATIONS INCLUDES ALL APPLICABLE LOSS PAYMENT AND COVERAGE PROVISIONS OF POLICY NUMBER 1504-1700-3459, INCLUDING THE DECLARATIONS PAGE AND ALL ENDORSEMENTS TO THE POLICY, WITH RESPECT TO COVERAGES A, B, C, AND D. ADDITIONALLY, ANY SECTIONS RELIED UPON BY THE INSURER IN ITS DENIAL TO FULLY PAY THE CLAIM, INCLUDING THE DUTIES IN THE EVENT OF LOSS PROVISIONS AND THE POLICY'S EXCLUSION OF COVERAGE PROVISIONS.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Abraham Smilie (hereinafter “Insured”) is a homeowner insured with an all-risks policy issued by Universal Property & Casualty Insurance Company (hereinafter “Carrier”). On or about September 28, 2022, Insured’s home located at 6790 NW 21st Court, Sunrise, Florida 33313 sustained significant damage as a result of a windstorm event. Specifically, Hurricane Ian created multiple openings to the roof of Insured’s property. This resulted in interior water damage to various areas of the interior of Insured’s property including but not limited to, the shed, living room, kitchen, master bedroom, guest bedroom, converted bedroom, laundry room, entrance, hallway, dining room, and patio. The Loss is covered under Insured’s policy issued by Carrier. The Insured mitigated damages by contacting Family First Mold and Water Restoration who performed mitigation services and placed a tarp on the roof of the subject property. All of the relevant documents were provided to Carrier. Insured promptly reported the claim and fully cooperated with all requests for inspections. Carrier assigned Claim No. FL24-0115334-A322 to the loss. The Insured has fully cooperated with Carrier’s investigation of the claim, including providing all requested documentation and complying with all post-loss policy conditions. Specifically, the Insured, with assistance from their public adjuster, submitted an estimate for $136,113.16, which was a fair and reasonable assessment for the repair/replacement of damages. Family First Mold and Water Restoration has an outstanding balance in the amount of $30,584.42 for their mitigation and tarp placement. After reporting the claim, Carrier retained an unqualified and biased field adjuster, Gabriel Cristian, to adjust the loss. This adjuster had a financial incentive to adjust the loss in a manner that would minimize Carrier’s losses. This adjuster performed a mere cursory inspection of the property on July 23, 2024. Instead of adjusting the claim fairly, honestly, in good faith, and with due regard for the Insured’s interests, this adjuster made a conscious effort to ignore evidence of covered losses to the property. Worse still, Carrier failed to retain qualified experts necessary to identify the repairs necessary to restore the property to its pre-loss condition. Despite Insured providing Carrier with a detailed estimate, Carrier failed to pay Insured the amount necessary to repair/replace the damaged property, less the applicable deductible. Instead, Carrier gave Insured a lowball estimate that failed to encompass all covered damages. The carrier only offered to pay $7,127.50, after applicable deductible of $3,790.00, a gross underpayment for all the damage associated with this claim. Under the circumstances surrounding this claim, had Carrier acted fairly and honestly toward the Insured and with due regard for the Insured’s interests, Carrier could and should have attempted in good faith to settle this claim. Carrier did not and, instead, dishonestly, and unfairly placed its own interests well ahead of those of the Insured. In doing so, Carrier violated Section 624.155(1)(b)(1), Florida Statutes. Carrier’s use of unqualified and biased adjusters, and failure to retain experts necessary to identify the repairs necessary to restore the property to its pre-loss condition, evidence Carrier’s failure to adopt and implement standards for the proper investigation of claims in violation of Section 626.9541(1)(i)(3)(a), Florida Statutes. Carrier’s use of unqualified and biased adjusters, and failure to retain experts necessary to identify the repairs necessary to restore the property to its pre-loss condition, evidence Carrier’s failure to conduct a reasonable investigation based upon available information. In denying full coverage for this claim without conducting reasonable investigations based upon available information, Carrier has violated Section 626.9541(1)(i)(3)(d), Florida Statutes. By representing to Insured that the Policy does not afford full coverage for this loss, Carrier is misrepresenting pertinent facts and/or insurance policy provisions relating to coverages at issue, in violation of Section 626.9541(1)(i)(3)(b), Florida Statutes. When applying the facts present here to Florida law, it is clear that Carrier is acting in bad faith. Florida Statute § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit based on determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. Carrier has breached this duty by refusing to properly and timely adjust the loss. Moreover, Section 69B-220.201 of the Florida Administrative Code defines Carrier’s adjusters conduct here as an unfair claims settlement practice. Specifically, Section 69B-220.201(3) provides that “[a]n adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured” and that “[a]n adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.” As detailed above, Carrier’s investigation and adjustment of this claim was done in a manner prejudicial to Insured, was incomplete, and lacked truthful and unbiased reports of the facts. Carrier has more than enough information and is still refusing to accept coverage for the Insured’s claim. This continued and repeated reckless claim delay and denial of coverage will result in a significant punitive damage award if a bad faith lawsuit is filed. Carrier can cure the defects outlined in this Civil Remedy Notice and avoid a lawsuit for bad faith by immediately accepting full coverage under the subject insurance policy for this claim and by paying Insured’s estimate of damages $136,113.16, and Family First Mold and Water Restoration in the amount of $30,584.42, less applicable deductible and prior payments, which is the reasonable amount of the covered loss pursuant to the policy. A copy of this form has been submitted to the Florida Department of Financial Services who has transmitted the same to the following parties providing them notice of the filing of this Civil Remedy Notice: Universal Property & Casualty Insurance Company
Comments
User Id Date Added Comment
oc1102@universalproperty.com 04-01-2025 April 1, 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.: 806507 Filing Date: 2/12/2025 Complainant(s): Abraham Smilie Insured(s): Abraham Smilie Policy No.: 1504-1700-3459 Claim No.: FL24-0115334-A322 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, Clayton Kuhn, on behalf of Complainant, Abraham Smilie (also referenced as the ‘Insured”). The Notice alleges violations of Sections 624.155, 624.02 and 626.9541, Florida Statutes and Florida Administrative Code Section 69B-220.201. Universal denies the allegations contained in the Notice. Additionally, Universal denies that it violated these or any statutes, Florida law or policy provisions regarding the claim adjustment 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 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 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). To begin, the Notice fails to meet the requirements of Section 624.155, Florida Statutes, 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. The Complainant attempts a “catch-all” of “ANY AND ALL PERSONS ASSOCIATED WITH THE CLAIMS HANDLING FROM UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY,” which significantly prejudices Universal, as Universal has not been properly notified by Complainant of the individuals 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 “misrepresented pertinent facts and/or policy provisions” in the Notice. The Notice, however, fails to include the requisite specificity as to whom made any misrepresentations or when any of these misrepresentations occurred. Accordingly, the Notice is insufficient as a matter of law. Second, the Notice fails to satisfy Section 624.155(3)(b)(4), Florida Statutes in that it fails to reference specific policy language relevant to the alleged violation. Instead, the Notice simply states, “THE POLICY LANGUAGE RELEVANT TO THE VIOLATIONS INCLUDES ALL APPLICABLE LOSS PAYMENT AND COVERAGE PROVISIONS OF POLICY NUMBER 1504-1700-3459, INCLUDING THE DECLARATIONS PAGE AND ALL ENDORSEMENTS TO THE POLICY, WITH RESPECT TO COVERAGES A, B, C, AND D. ADDITIONALLY, ANY SECTIONS RELIED UPON BY THE INSURER IN ITS DENIAL TO FULLY PAY THE CLAIM, INCLUDING THE DUTIES IN THE EVENT OF LOSS PROVISIONS AND THE POLICY'S EXCLUSION OF COVERAGE PROVISIONS.” As written, the Notice provides no guidance or explanation, such that Universal is left to wonder what policy provisions Complainant believes were allegedly violated or breached and why. The Notice fails to cite any specific policy language relevant to any alleged statutory violation and lacks the requisite specificity to put Universal on Notice of any alleged policy violations. General, vague and overbroad references to potential or possible policy language does not satisfy the specificity required by Section 624.155(3)(b)(4), Florida Statutes. As such, the Notice is deficient as a matter of law. Lastly, 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. As an example, the Notice states: “Carrier’s use of unqualified and biased adjusters, and failure to retain experts necessary to identify the repairs necessary to restore the property to its pre-loss condition, evidence Carrier’s failure to conduct a reasonable investigation based upon available information. In denying full coverage for this claim without conducting reasonable investigations based upon available information, Carrier has violated Section 626.9541(1)(i)(3)(d), Florida Statutes. By representing to Insured that the Policy does not afford full coverage for this loss, Carrier is misrepresenting pertinent facts and/or insurance policy provisions relating to coverages at issue, in violation of Section 626.9541(1)(i)(3)(b), Florida Statutes.” However, the Notice fails to provide sufficient facts or examples to support these allegations. Moreover, the Notice does not set forth any facts regarding any misrepresentations made by Universal and does not identify the person or persons who made such misrepresentations. The Notice does not state any facts to support the Complainant’s misrepresentation allegations or any of the allegations contained therein. Furthermore, the Notice alleges Universal breached section 624.02, Florida Statutes, by “refusing to properly and timely adjust the loss.” The Complainant fails to specify any facts or circumstances to support the allegations in the Notice which could enable Universal to investigate and resolve the Complainant’s allegations. Moreover, the recitation of the Adjuster’s Code of Ethics has no factual support to provide the Insurer notice as to how and/or if there has been a violation. A written notice which is vague and “shotgun” in nature or is written in general terms fails to satisfy the specificity requirement of the statute. See Heritage Corp. of South Fla., 580 F. Supp. 2d at 1300; 316, Inc., 625 F. Supp. 2d at 1193; see also Rousso, 2010 WL 7367059 at *3-6; Valenti v. Unum Life Ins. Co. of America, 2006 WL 1627276 (M.D. Fla. 2006). It is evident that the statement of facts falls short of the specificity required by Section 624.155, Florida Statutes. As a result, the Complainant fails to comply with the requirements provided in Section 624.155(3)(b)(2), Florida Statutes. In summary, 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 specify an individual with the most knowledge as to the allegations, the failure to identify specific statutory provisions alleged to have been violated, the failure to specify relevant policy language, and the failure to specify facts and circumstances in support of any allegations. Therefore, the Notice is legally deficient and fails to satisfy the condition precedent to filing a bad faith action. See 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 July 8, 2024, Universal received untimely notice from a representative of the Insured the insured location had damage which occurred on September 28, 2022. Universal inspected the property and documented any visible damage. Thereafter, Universal issued an undisputed payment to the Insured in the full amount of its estimate less the applicable policy deductible and the recoverable depreciation, pursuant to the terms of the Policy. Under the terms of the Policy, Universal will initially pay at least the actual cash value of the insured loss, less any applicable deductible. It will then pay any remaining amounts necessary to perform such repairs as work is performed and expenses are incurred. On February 13, 2025, Universal received the Insured’s Intent to Initiate Litigation (“NOI”) demanding $169,570. In a good faith effort to amicably resolve any remaining dispute, Universal responded to the Insured’s NOI invoking the mediation provision under the terms of the Policy. The parties currently await a mutually convenient date from the Department of Financial Services to complete the mediation. Universal denies the allegations asserted in the Notice. An insurer is not required to pay whatever amount an insured demands. As outlined above, the alleged statutory violations set forth in the Notice are devoid of factual support and are without merit. We trust that the foregoing is sufficient to advise you of Universal’s position with regard to this matter and fully responds to the Notice file by the Complainant. Sincerely, /s/ Ozzy Cudila Ozzy Cudila, 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