Civil Remedy Notice of Insurer Violations
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Filing Number:     806808
Filing Accepted:  2/13/2025
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Complainant
Last/Business Name *  
RUDOLPH GONZALES AND DANA­ANNE GONZALES   First Name  
Street Address * 1825 WIND RIDGE CT
City, State Zip * FLEMING ISLAND, FL 32003
Email Address * MGONZO1970@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   RUDOLPH GONZALES AND DANA­ANNE GONZALES   First Name  
Policy # * 1501­2104­8338 Claim #* FL23­0141080
Attorney
Attorney is Applicable
Last Name* DRAKE First Name * VICTORIA Initial
Street Address* 2300 MAITLAND CENTER PKWY STE. 106
City, State Zip* MAITLAND , FL 32751
Email Address * VDRAKE@SERRANOCAGAN.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):* N/A
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
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.
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)(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)(e) 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.
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)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

SECTION I – PROPERTY COVERAGE A. Coverage A – Dwelling (Entire Section) B. Coverage B – Other Structures (Entire Section) C. Coverage C – Personal Property (Entire Section) D. Coverage D – Loss of Use (Entire Section).
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

On or about 05/21/2023, RUDOLPH GONZALES AND DANA­ANNE GONZALES ("Insured"), sustained a covered direct physical loss to Insured's property due to HAIL. Insured reported the loss thereafter to UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY ("Insurer"). Prior to the date of loss, Insurer issued a policy of insurance, believed to be policy # 1501­2104­8338 which afforded coverage for the aforementioned property for losses caused by the covered peril. The policy was in full force and effect on the date of loss. The Insured promptly notified Insurer of the loss, who then assigned the loss claim # FL23­0141080. Insurer was fully afforded any and all opportunity to inspect the loss and document the loss. To date, Insurer has paid $0 to Insured on this claim even after numerous attempts by the Insured to provide documentation of additional damages and compensation owed. Insured had no choice but to retain legal representation on or about 1/25/2025, as the Insurer refused to pay the full amount due and owed to its Insured. Insurer has continually failed to negotiate this claim with Insured’s attorney and/or failed to provide a satisfactory settlement offer to resolve the subject claim. This has severely harmed the Insured's ability to remedy their losses and continue with repairs to the property. The only purpose for Insurer's refusal to negotiate the claim is to increase profits and harm their insured. This is either done intentionally as a pattern and practice of Insurer to deny coverage and harm their insureds, or Insurer has failed to properly train and supervise its adjusters to the harm and detriment of their insureds. This pattern and practice is done for only one reason, which again, is to maximize profits and harm their insureds. Insurer has violated the following statutory provisions: 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)(c): Failing to acknowledge and act promptly upon communications with respect to claims; 626.9541(1)(i)(3)(e): 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; 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. 626.9541(1)(i)(3)(h): Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. 626.9541(1)(i)(3)(i): Unfair claim settlement practices, and any other applicable statutes to the factual allegations included herein. To remedy and/or cure this CRN, Insurer must immediately tender payment in the amount of $102,588.00 less any applicable deductible and prior payment to the Insured to complete the repairs for the Insured property. The payment shall be tendered to the Insured’s attorneys, Serrano Cagan & Cagan at 2300 Maitland Center Parkway, Suite 106, Maitland, Florida 32751.
Comments
User Id Date Added Comment
oc1102@universalproperty.com 04-02-2025 April 2, 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.: 806808 Filing Date: 2/13/2025 Complainant(s): Rudolph Gonzales and Dana-Anne Gonzales insured(s): Rudolph Gonzales and Dana-Anne Gonzales Policy No.: 1501¬2104¬8338 Claim No.: FL23¬0141080 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, Victoria Drake, on behalf of Complainants, Rudolph Gonzales and Dana-Anne Gonzales (also referenced as the “Insureds.”) The Notice alleges violations of Sections 624.155 and 626.9541, Florida Statutes. 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 Complainants 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 Complainants must name the individual(s) involved with specificity as it relates to the purported violation to allow Universal to properly investigate the allegations. The Notice lacks the requisite specificity as required by Section 624.155, Florida Statutes. Here, the Complainants do not identify the person or persons at Universal with the most knowledge of the facts regarding any alleged violation(s), but simply states “N/A.” Therefore, the Notice does not have the requisite specificity as to whom the Complainants are asserting have knowledge as to any allegation to put Universal on Notice of what needs to be cured. Accordingly, the Complainants’ 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 any specific policy language relevant to any alleged violation. Instead, the Notice states, “SECTION I – PROPERTY COVERAGE A. Coverage A – Dwelling (Entire Section) B. Coverage B – Other Structures (Entire Section) C. Coverage C – Personal Property (Entire Section) D. Coverage D – Loss of Use (Entire Section).” The Notice is broad in scope and fails to identify “specific policy language” relevant to any specific alleged violation. Therefore, it is unclear what, if any, policy language pertains to any allegation. General, vague and overbroad references to policy sections and/or provisions do 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. 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 Complainants provide four (4) separate reasons for submitting the Notice: “claim delay, unsatisfactory settlement offer, unfair trade practice, and claim denial.” The Complainants’ allegations have no specific factual support specified in the Notice and therefore is insufficient to meet the threshold notice requirement of the Florida Civil Remedy Statute under Section 624.155, Florida Statutes. Furthermore, the Notice asserts general allegations consisting of conclusory and boilerplate language rather than providing specific facts to support any allegations. As an example, the Notice alleges, “[t]he only purpose for Insurer's refusal to negotiate the claim is to increase profits and harm their insured. This is either done intentionally as a pattern and practice of Insurer to deny coverage and harm their insureds, or Insurer has failed to properly train and supervise its adjusters to the harm and detriment of their insureds. This pattern and practice is done for only one reason, which again, is to maximize profits and harm their insureds.” However, the Notice does not allege any specific facts or provide any examples to support these conclusory allegations. The Complainants are required to provide with specificity the facts and circumstances giving rise to the alleged violation strictly related to the Complainants’ allegations, not conjecture or speculation of what may be a pattern and practice by the Insurer. In addition, the Notice alleges Universal “fail[ed] to adopt and implement standards for the proper investigation of claims.” The Complainants fail to provide any specific facts or examples to support this conclusory statement. To the contrary, Universal promptly investigated the Insureds’ claim and timely advised the Insureds of its coverage decision, pursuant to the terms of the subject Policy. The Notice also asserts general allegations consisting of conclusory and boilerplate statements rather than specific allegations of facts regarding any alleged misconduct or statutory violations. For example, the Notice includes boilerplate recitation of statutory language to allege purported violations of Sections 624.155(1)(B)(1), 624.155(1)(B)(3), 626.9541(1)(I)(3)(A), 626.9541(1)(I)(3)(C), 626.9541(1)(I)(3)(E), 626.9541(1)(I)(3)(F), 626.9541(1)(I)(3)(G), 626.9541(1)(I)(3)(H), and 626.9541(1)(I)(3)(I), Florida Statutes, but fails to assert any specific facts or circumstances that give rise to any of the above purported statutory violations, which could enable Universal to investigate and resolve the Complainants’ allegations. It is evident that the statement of facts falls short of the specificity required by Section 624.155, Florida Statutes. As a result, the Complainants fail 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, without paying benefits which are not due and owing to the Insureds. 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). However, Section 624.155, Florida Statutes, does not impose on an insurer the obligation to pay whatever an insured demands. Talat, 753 So. 2d at 1282. To 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 insured. See Talat, 753 So. 2d at 1281. Notably, Universal asserts that when the Insureds initiated litigation before the expiration of the Notice, it prejudiced 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. In summary, the Complainants 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 specify any relevant policy language, the failure to specify facts and circumstances in support of any allegation, and the failure to provide a proper means whereby Universal can “cure” the alleged defects, without paying benefits which are not due and owing to the Insureds. 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 November 30, 2023, Universal received notice from the Insured, Rudolph Gonzales, the insured location had damage which occurred on May 21, 2023. Universal inspected the property and documented any visible damage. Thereafter, Universal advised the Insureds there was no coverage available for the loss and outlined the basis for the claim denial citing relevant policy language pursuant to the terms of the policy. On March 20, 2025, the Insureds initiated litigation against Universal in Circuit Court of Clay County under case No. 2025CA000275. Thus, at this time the parties continue to litigate their dispute to determine what, if any, available coverage exists under the terms of the Policy. 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 Complainants. 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