Civil Remedy Notice of Insurer Violations
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Filing Number:     807458
Filing Accepted:  2/19/2025
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Complainant
Last/Business Name *  
LAFOND   First Name   GUY, JUDITH
Street Address * 220 POINCIANA LANE
City, State Zip * BELLEAIR BLUFFS, FL 33770
Email Address * CONTACT@CONSTABLE-LAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   LAFOND   First Name   GUY, JUDITH
Policy # * 1501-2008-1275 Claim #* FL240141995K324
Attorney
Attorney is Applicable
Last Name* CONSTABLE First Name * JAMES Initial
Street Address* 139 6TH AVENUE SOUTH
City, State Zip* SAFETY HARBOR , FLORIDA 34695
Email Address * CONTACT@CONSTABLE-LAW.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):* THE INSURANCE COMPANY AND ITS ADJUSTERS
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unfair Trade Practice
Unsatisfactory Settlement Offer
Other : UNREASONABLE INVESTIGATION
Other : FAILURE TO ACT ON CLAIM
* 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)(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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

VARIOUS LANGUAGE THROUGHOUT THE POLICY, INCLUDING BUT NOT LIMITED TO PROVISIONS GOVERNING COVERAGE FOR HURRICANE DAMAGE, ROOF DAMAGE, WATER DAMAGE, MOLD, HAIL DAMAGE, AND/OR WINDSTORM DAMAGE, THE LOSS PAYMENT PROVISION(S), THE PROVISIONS GOVERNING THE DUTIES AND OBLIGATIONS OF THE INSURER; AS WELL AS COVERAGE FOR THE DWELLING, ADDITIONAL LIVING EXPENSES, AND PERSONAL PROPERTY.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

1) FAILURE TO PAY CLAIM IN FULL; 2) FAILURE TO PROMPTLY INVESTIGATE CLAIM; 3) FAILURE TO PROPERLY INVESTIGATE CLAIM; 4) FAILURE TO ADJUST LOSS; 5) FAILURE TO ACT IN DUE DILIGENCE AND GOOD FAITH TO RESOLVE CLAIM; 6) PLACING FINANCIAL INTEREST OF INSURER BEFORE THAT OF POLICY HOLDERS AND CLAIMANTS; 7) FAILURE TO PROPERLY TRAIN, EVALUATE AND MANAGE ADJUSTERS; 8) LOOKING FOR WAYS TO DENY COVERAGE, PAY LESS, DELAY PAYMENT AND OTHERWISE “LOW BALL” OR “STONE WALL” CLAIM; 9) THE REASONS FOR THIS MAY BE ATTRIBUTED TO IMPROPER TRAINING, SUPERVISION, AND/OR MOTIVATION OF ADJUSTERS AND CLAIMS SUPERVISORS. THE INSURER APPEARS TO HAVE 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. THE INSURANCE COMPANY ISSUED A POLICY OF INSURANCE TO THE INSURED WHICH PROVIDED COVERAGE FOR CERTAIN LOSSES. DURING THE POLICY PERIOD, THE INSURED PROPERTY SUFFERED DAMAGE DUE TO HURRICANE HELENE AND HURRICANE MILTON, WHICH WAS AND IS COVERED BY THE INSURANCE POLICY. THE INSURED PROMPTLY REPORTED THE LOSS TO THE INSURANCE COMPANY AND HAS COMPLIED WITH ALL CONDITIONS OF THE POLICY. FOLLOWING A DELAYED AND INSUFFICIENT CLAIM INVESTIGATION, THE INSURANCE COMPANY HAS FAILED TO ADEQUATELY INVESTIGATE THE CLAIMS, FAILED TO TIMELY RENDER A COVERAGE DETERMINATION AND FAILED AND/OR REFUSED TO TIMELY ISSUE ANY PAYMENT ON THE CLAIM. PURSUANT TO FLA. STAT. §627.70131(5)(A), THE INSURANCE COMPANY HAD NINETY (90) DAYS AFTER RECEIVING NOTICE OF THE PROPERTY INSURANCE CLAIM TO PAY OR DENY SUCH CLAIM OR A PORTION OF THE CLAIM UNLESS THE FAILURE TO PAY IS CAUSED BY FACTORS BEYOND THE CONTROL OF THE INSURER WHICH REASONABLY PREVENT SUCH PAYMENT. THE INSURANCE COMPANY HAS FAILED TO RENDER A TIMELY COVERAGE DECISION AND THERE ARE NO FACTORS BEYOND THE CONTROL AND DISCRETION OF THE INSURER WHICH HAVE DELAYED THE INVESTIGATION OF THIS LOSS AND/OR THE RENDERING OF A COVERAGE POSITION. SUCH CONDUCT VIOLATES FLORIDA STATUTES AND THE POLICY OF INSURANCE. DUE TO CONCERNS WITH THE DELAY IN THE INVESTIGATION AND THE INSURANCE COMPANY’S FAILURE AND REFUSAL TO PAY THE FULL AMOUNTS NECESSARY TO RETURN THE INSURED PROPERTY TO ITS PRE-LOSS CONDITION, THE INSURED RETAINED AN ESTIMATE OF DAMAGES IN THE AMOUNT OF $117,824.10(RCV)/$113,657.52(ACV). THE INSURED ALSO PREPARED A LIST OF DAMAGED CONTENTS IN THE AMOUNT OF $27,765.50 AND HAD TO PAY $28,200 TO RESIDE ELSEWHERE TO MAINTAIN THEIR STANDARD OF LIVING DUE TO THE PROPERTY BEING UNINHABITABLE. THE INSURED HAS PREPARED CORRESPONDING SWORN STATEMENTS IN PROOF OF LOSS FOR THE AMOUNT OF DAMAGED PROPERTY, DAMAGED CONTENTS AND LOSS OF USE. THE ESTIMATE, PROOFS OF LOSS, AND AMOUNT OF DAMAGED PROPERTY WERE PROVIDED TO THE INSURANCE COMPANY. HOWEVER, THE INSURANCE COMPANY FAILED AND/OR REFUSED TO RESPOND TO THE INSURED’S ESTIMATES OF DAMAGE, PROOFS OF LOSS AND AMOUNTS OF DAMAGED PROPERTY. FURTHER, THE INSURANCE COMPANY STILL FAILED AND/OR REFUSED TO ISSUE ANY COVERAGE DETERMINATION OR PAYMENT ON THE CLAIM. PURSUANT TO FLA. STAT. §627.70131(1)(A), THE INSURANCE COMPANY HAD 14 DAYS TO REVIEW AND ACKNOWLEDGE THE COMMUNICATION FROM THE INSURED. THE INSURANCE COMPANY FAILED TO PROVIDE ANY SUCH ACKNOWLEDGEMENT WHICH IS IN VIOLATION OF FLORIDA STATUTES AND THE POLICY OF INSURANCE. THE INSURED HAS MADE AN APPLICATION FOR INSURANCE BENEFITS UNDER THE POLICY BUT THE INSURANCE COMPANY HAS FAILED AND/OR REFUSED TO PAY THE FULL BENEFITS TO WHICH THE INSURED IS ENTITLED FOR THE LOSS. THE INSURANCE COMPANY HAS BREACHED THE POLICY OF INSURANCE BY FAILING TO PAY ALL OF THE BENEFITS DUE UNDER THE POLICY. THE INSURANCE COMPANY HAS FAILED TO SATISFACTORILY SETTLE THIS CLAIM AND HAS DEPRIVED THE INSURED OF A PROPER RESOLUTION OF THIS CLAIM. THE INSURANCE COMPANY HAS FAILED AND/OR REFUSED TO PROPERLY INVESTIGATE THE LOSS AND HAS FAILED AND/OR REFUSED TO TENDER THE PROPER AMOUNT OF INSURANCE BENEFITS DUE AND OWING TO THE INSURED. IN ORDER TO CURE THE CONDUCT GIVING RISE TO THE VIOLATIONS DESCRIBED HEREIN, THE INSURANCE COMPANY MUST COMPLETE THE PROPER EVALUATION OF THE DAMAGES VIA QUALIFIED PROFESSIONALS AND ISSUE PAYMENT FOR ALL THE COVERED DAMAGES. IN ADDITION, THE INSURANCE COMPANY MUST ISSUE PAYMENT TO THE INSURED FOR REASONABLE ATTORNEYS’ FEES, COSTS, AND PRE-JUDGMENT INTEREST IF REQUIRED BY THE APPLICABLE FLORIDA STATUTES. AS AN ALTERNATIVE CURE OPTION, THE INSURANCE COMPANY MAY CURE THE ALLEGATIONS GIVING RISE TO THIS NOTICE BY TENDERING A CHECK IN THE AMOUNT OF $173,789.60, LESS THE APPLICABLE DEDUCTIBLE, WITHIN THE 60 DAY CURE PERIOD, JOINTLY PAYABLE TO THE INSURED AND CONSTABLE LAW.
Comments
User Id Date Added Comment
jr0405@universalproperty.com 04-10-2025 April 10, 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.: 807458 Filing Date: 2/19/2025 Complainant(s): Guy, Judith LaFond Insured(s): Guy, Judith LaFond Policy No.: 1501-2008-1275 Claim No.: FL240141995K324 DFS File No.: 807464 Filing Date: 2/19/2025 Complainant(s): Guy, Judith LaFond Insured(s): Guy, Judith LaFond Policy No.: 1501-2008-1275 Claim No.: FL240142000K524 Dear Sir/Madam: Please allow this to serve as Universal Property & Casualty Insurance Company’s (“Universal”) formal response to the above-referenced Civil Remedy Notices (“Notices”) filed by attorney, James Constable, on behalf of Complainants, Guy, Judith LaFond (also referenced as “Insureds.”) The Notices allege violations of Secs. 624.155, 626.9541, and 627.70131, Fla. Stat. Universal specifically denies each allegation contained in the Notices. Additionally, Universal denies it violated these or any statutes, Florida law, or policy provisions regarding the claim adjustment of these matters. With that said, Universal asserts the Notices fail to comply with the specific notice and information requirements as set forth in Civil Remedy Notice of Insurer Violation document provisions, Sec. 624.155, Fla. Stat. and Florida law. The Notices are deficient as a matter of law as they fail to comply with Sec. 624.155, Fla. Stat. 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 Sec. 624.155(3)(b), Fla. Stat., the Notices “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 sets out fifteen (15) requirements the Complainant(s) must respond to with specificity. The Florida Supreme Court holds Sec. 624.155, Fla. Stat. “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) 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 Notices fail to meet the requirements of Sec. 624.155, Fla. Stat., on several grounds. First, regarding the requirement to set forth with specificity the “facts and circumstances giving rise to the violation,” the Notices fail to allege any specific conduct on the part of Universal that would violate any policy provision or statute. The Complainants provide five (5) separate reasons for submitting each Notice: “Claim Delay,” “Unfair Trade Practice,” “Unsatisfactory Settlement Offer,” “Unreasonable Investigation” and “Failure To Act On Claim.” However, the Complainants’ allegations regarding these “Reasons for Notice” have no factual support anywhere in the Notices. The Notices also assert general allegations consisting largely of conclusory and inaccurate statements rather than specific allegations of facts regarding any alleged misconduct or statutory violations. As an example, the Notices allege in part: “1) FAILURE TO PAY CLAIM IN FULL; 2) FAILURE TO PROMPTLY INVESTIGATE CLAIM; 3) FAILURE TO PROPERLY INVESTIGATE CLAIM; 4) FAILURE TO ADJUST LOSS; 5) FAILURE TO ACT IN DUE DILIGENCE AND GOOD FAITH TO RESOLVE CLAIM; 6) PLACING FINANCIAL INTEREST OF INSURER BEFORE THAT OF POLICY HOLDERS AND CLAIMANTS; 7) FAILURE TO PROPERLY TRAIN, EVALUATE AND MANAGE ADJUSTERS; 8) LOOKING FOR WAYS TO DENY COVERAGE, PAY LESS, DELAY PAYMENT AND OTHERWISE “LOW BALL” OR “STONE WALL” CLAIM; 9) THE REASONS FOR THIS MAY BE ATTRIBUTED TO IMPROPER TRAINING, SUPERVISION, AND/OR MOTIVATION OF ADJUSTERS AND CLAIMS SUPERVISORS. THE INSURER APPEARS TO HAVE 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.” The Complainants fail to specify any facts to support the above referenced boilerplate and/or conclusory statements. Moreover, the Notices generally allege Universal violated Sec. 626.9541(1)(i)(3)(b), Fla. Stat., by “[m]isrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.” However, the Notices do not specify any facts regarding any misrepresentations made by Universal, what was allegedly misrepresented and does not identify the person or persons who made such misrepresentations. The Notices mainly consist of vague and generic conclusory assertions which are unsupported by facts and do not provide a sufficient explanation as to how Universal allegedly violated any policy provision or statute. 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 the statement of facts in each of the Notices falls short of the specificity required by Sec. 624.155, Fla. Stat. As a result, the Complainants fail to comply with Sec. 624.155(3)(b)(2), Fla. Stat. Second, the Notices fail to satisfy Sec. 624.155(3)(b)(4), Fla. Stat., because they fail to reference specific policy language relevant to the alleged violation. The Notices do not reference any specific policy language but instead state in pertinent part: “VARIOUS LANGUAGE THROUGHOUT THE POLICY, INCLUDING BUT NOT LIMITED TO PROVISIONS GOVERNING COVERAGE FOR HURRICANE DAMAGE, ROOF DAMAGE, WATER DAMAGE, MOLD, HAIL DAMAGE, AND/OR WINDSTORM DAMAGE, THE LOSS PAYMENT PROVISION(S), THE PROVISIONS GOVERNING THE DUTIES AND OBLIGATIONS OF THE INSURER; AS WELL AS COVERAGE FOR THE DWELLING, ADDITIONAL LIVING EXPENSES, AND PERSONAL PROPERTY.” The Notices are broad in scope and fail to identify the “specific policy language” relevant to any alleged violation. The Notices broadly reference a number of purported policy sections and provisions but fail to specify any actual facts regarding how those sections or provisions were violated. Moreover, by stating “various language throughout the policy,” without limitation, the Complainants have in essence cited the entire policy which provides no guidance or explanation, such that Universal is left to wonder what policy provisions Complainants believe were allegedly violated. Therefore, it is unclear what, if any, policy language pertains to any allegation. General, vague, or overbroad references to the entire policy do not satisfy the specificity required by Sec. 624.155(3)(b)(4), Fla. Stat. As such, the Notices are deficient as a matter of law. See generally Julien v. United Property & Casualty Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021). Third, the Notices fail 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. To comply with Sec. 624.155, Fla. Stat., the Complainants must name the individual(s) involved with specificity related to the purported violation(s) to allow Universal to investigate the allegations properly. The Notices lack the requisite specificity required by Sec. 624.155, Fla. Stat., because the Notices state “THE INSURANCE COMPANY AND ITS ADJUSTERS,” which clearly defeats the requirement in the DFS Forms to provide specificity in order to put the carrier on Notice and provide an opportunity to investigate any allegation with a specific individual. The Notices do not have the requisite specificity as to whom the Complainants are asserting has knowledge as to any allegation contained in the Notices. Specific identification of a person or persons with the most knowledge within Universal is of particular importance because, as noted, the Complainants allege Universal has “[m]isrepresent[ed] pertinent facts or insurance policy provisions relating to coverages at issue.” The Notices fail to include sufficient specificity as to whom made any misrepresentations, what was misrepresented, and when any of these misrepresentations were made. Accordingly, Complainants’ Notices are insufficient as a matter of law. Fourth, the Notices do not provide a proper means whereby Universal can “cure” the alleged defects without paying benefits not due and owing to the Insureds. 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). However, Sec. 624.155, Fla. Stat., does not impose on an insurer the obligation to pay whatever amount its insureds demand. Id. 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 insured. See Id. at 1281. The Notices demand, among other things, to cure the alleged defects, Universal “must issue payment to the Insured for reasonable attorneys’ fees, costs…if required by the applicable Florida Statutes” or “as an alternative cure option, the insurance company may cure the allegations giving rise to this notice by tendering a check in the amount of $173,789.60, less the applicable deductible, within the 60 day cure period, jointly payable to the Insured and Constable Law.” As phrased, it is unclear whether the amount requested of $173,789.60 contains any amounts not due and owing under the Policy, such as extra-contractual damages. Universal is only obligated to pay contractual amounts owed to cure a civil remedy. See id. at 1278. As such, the Notices are deficient as they do not provide Universal an opportunity to “cure” as proscribed under Florida law. In summary, the Complainants failed to respond to each of the fields set forth on the DFS Forms with the requisite specificity, including but not limited to, failing to identify the person or persons representing the insurer who are most responsible for and/or knowledgeable of the facts giving rise to the allegations in the Notices; failing to reference specific policy language relevant to any alleged violation; failing to provide Universal with an opportunity to cure the Notices without potentially paying extra-contractual benefits which are not required to cure a civil remedy notice; and failing to provide sufficient facts and circumstances giving rise to the alleged violations. Therefore, the Notices are legally deficient and fail to satisfy the condition precedent to filing a bad faith action. See Julien v. United Property & Casualty Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021). Accordingly, the Notices are 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 the claims, which shall demonstrate Universal did not violate any Policy terms or statutory provisions. On November 12, 2024, Universal was notified by the Insureds’ representative that the insured location was damaged on September 26, 2024, and October 9, 2024. Claim numbers FL24-0141995-K324 and FL24-0142000-K524 were assigned, respectively. Universal inspected the property and documented any visible damage for each claim. With regard to claim FL24-0141995-K324, pursuant to the terms of the Policy, Universal advised the Insured that the estimated cost of repairs for the direct physical loss to property, at that time, fell below the applicable deductible. With regard to claim FL24-0142000-K524, Universal, in accordance with the terms and conditions of the Policy, issued payment in the full amount of its estimate, less depreciation and applicable deductible. The subject Policy initially pays at least the actual cash value of the insured loss, less any applicable deductible. Then, it will pay any remaining amounts necessary to perform such repairs as work is performed and expenses are incurred. Subsequently, Universal also advised the Insureds on each claim that certain claimed damages were not covered as they were due to flood and/or surface water, and that the purported roofing property damage was not covered under the terms of the Policy. At no time has Universal breached any duty to its Insureds. An Insurer is not required to pay whatever amount its insureds demand. 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 Notices lack factual support and are without merit. Therefore, the Notices are legally deficient and fail to satisfy the condition precedent to filing a bad faith action. Universal has complied with all policy provisions and applicable Florida law regarding the adjustment of these claims. We trust that the foregoing is sufficient to advise you of Universal’s position regarding these matters and fully responds to the Notices filed by the Complainants. 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