Civil Remedy Notice of Insurer Violations
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Filing Number:     808138
Filing Accepted:  2/24/2025
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Complainant
Last/Business Name *  
2000 SOUTH DIXIE HWY LLC   First Name  
Street Address * 2000 SOUTH DIXIE HIGHWAY
City, State Zip * MIAMI, FL 33186
Email Address * LETY@3DMGROUP.COM
Complainant Type: * Insured
Insured
Last/Business Name*   2000 SOUTH DIXIE HWY LLC   First Name   ROBERT
Policy # * ORAMPR014021-02 Claim #* 4235152/4243619
Attorney
Attorney is Applicable
Last Name* PEREZ First Name * ROBERT Initial M
Street Address* 3162 COMMODORE PLAZA, SUITE 3E, SUITE 3E
City, State Zip* COCONUT GROVE , FL 33133
Email Address * RPEREZ@RMPLAWPA.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   OLD REPUBLIC UNION INSURANCE COMPANY
NAIC Company Code 31143
 
Name of individual responsible for violation (if any):* ALISE JENKINS, SEDGWICK ACCOUNT MANAGER
Type of Insurance * Commercial Property & Casualty   
Reason for Notice *
Claim Denial
* 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.

Section VII F. Collapse means an abrupt falling down or caving in of a building or any part of a building with the result that the building or part of the building cannot be occupied for its current intended purpose. The Collapse must be caused by or resulting from one or more of the following: 1.Building decay that is hidden from view, unless the presence of such decay is known to the Insured prior to collapse. 4. Use of defective material or methods in construction, remodeling or renovation if the abrupt collapse occurs after the construction, remodeling or renovation is complete, but only if the collapse is caused in part by: a. A cause of loss listed in F.1. or F.2. b. One or more of the Defined Causes of Loss; c. Breakage of building glass; d. Weight of people or personal property; or e. Weight of rain or snow or ice that collects on a roof.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

FACTUAL SUMMARY The claimed damage occurred on or about 06/22/2024 at 2000 South Dixie Highway LLC, Miami, Miami-Dade, FL. The Law Office of Robert M. Perez submitted the claim to Sedgwick on 07/15/2024.The cause of loss was reported as a collapse that caused damage to walls, flooring, electrical, ceiling, ceiling tiles, etc. Sedgwick retained Field Adjuster, Matt Biltswitch with McLarens and set up an initial inspection of the property on 7/22/2024. Mr. Biltswitch also enlisted Mr. Luis Ulloa of LMU Engineering to aid in the determination of the cause(s) of the damage. During the initial inspection, our Licensed Building Contractor and Licensed Public Adjuster, Ramon Rivera informed Mr. Biltswitch that the reported collapse was caused by the progression of unforeseeable events that led to the damage. Mr. Biltswitch and Mr. Ulloa inspected the property and determined there was no storm damage created openings in the roof envelope to allow interior water intrusion. The letter denying coverage specifically concludes there is no coverage for the interior water damages because the exterior was not damaged by wind or hail to allow the rainwater to enter. However, our claim was never storm caused damage. The claim was reported to Sedgwick as an abrupt collapse of the building structure. A collapse caused by the progression of unforeseeable events that led to damage of multiple portions of the building not as a wind or wind-borne debris damage to the roof. Please refer to page 32 of 42, Section VIII- Policy Definition, Letter F, Numbers 1 and 4 from the Policy. It is acknowledged that previous leaks occurred. Those leaks were immediately remediated, and proper maintenance of the roof was always kept. All invoices and photos documenting such remediation and maintenance were submitted at the beginning of the claim. The collapse of the interior was not a result of pre-existing, unattended and visible continuous leakage. It was the result of the progression of NON- VISIBLE events that when accompanied by an aggravator, in this case the unusual and consistent amount of rainfall and its weight, resulted in the abrupt collapse. The expansion joints are concealed/hidden and located under the roofing system. They are not accessible for routine inspection. Water trapped under the roofing membrane could not escape and/or avoid damaging the joints. Please reference section VII, Letter F, number 1 again, where it states: Building Decay that is hidden from view, unless the presence of such decay is known to insured prior to collapse. Therefore, the abrupt collapse caused by building decay that is hidden from you is covered by policy language. Shrinkage cracks are not merely cosmetic but can indicate structural stresses that comprise the integrity of the concrete, contributing to failure over time (ACI 201.1R-08). ACI refers to the American Concrete Institute’s guidelines for visual inspection. Cracks also provide lack of concrete coverage allowing for ingress of moisture that can carry aggressive agents like seawater (property is less than a mile from the ocean) which can lead to corrosion and structural failure (ACI 318-14). A moisture meter was used which confirmed moisture saturation (100% in multiple areas) of the concrete. This reading not only confirms the additional weight the concrete is bearing due to water retention but also strongly suggests moisture has reached the rebar, compromising its integrity and accelerating corrosion. Again, the cause of loss was the result of a slow progression of unforeseeable events that led to an abrupt collapse. The cause of loss was not related or reported as a weather event. Please see policy definition as referenced in the previous bullet point’s response. While there is rust-colored staining on the exterior of the building in various areas, it cannot be confirmed that this staining is a result of rebar corrosion. In locations where metal roofing and metal cap flashing are present, the source of the rust-colored staining can be traced following the staining to its origin confirms it directly correlates to these metal components. In other areas, the same assumption cannot be made. It has been visually confirmed, that water and moisture became trapped beneath the roof membrane, saturating the concrete, including the parapet walls. The parapet walls are finished with stucco on the exterior and are covered with a roof membrane capped with metal on the roof side. There are visible cracks throughout the stucco along the perimeter of the parapet walls that serve as pathways for trapped moisture to escape. When moisture migrates outward, it carries contaminants with it, resulting in staining. The color of the staining in certain areas is more consistent with runoff from roofing sealant, appearing brown rather than red. A key distinction as actual rust from reinforcing steel is typically reddish-orange. Additionally, this process occurs behind the wall, decking, and finish materials (membrane, stucco, and paint. These highly visible areas were power-washed and repainted, further obscuring any past signs of surface staining. Moreover, the expansion joint is located beneath the roofing membrane, making it inaccessible for visual inspection from the roof. On the interior of the building, the expansion joint is hidden behind a drop ceiling and above partition walls, hiding any damage the joint might be experiencing. Spalling was observed and documented in multiple locations throughout the building, with exposed corroded rebar, material loss (concrete), delamination, and cracks directly associated with spalling. These same areas also tested high in moisture retention, confirming excess water weight within the concrete and further supporting evidence of moisture penetration throughout the concrete deck. The presence of high moisture levels and deterioration indicates compromised structural components. Spalling directly affects the original structural design by altering the intended load distribution between the concrete and reinforcement. ACI 201.1R states: • Deterioration is a physical manifestation of failure, including cracking, delamination, scaling, and spalling, caused by environmental exposure, internal stresses, or material decomposition. • Spalling involves material loss, where fragments of concrete detach due to weathering, pressure, expansion within the mass, or corrosion-induced reinforcement failure. • Staining and discoloration further confirm exposure to contaminants, moisture infiltration, and potential chemical degradation. The documented spalling was observed on the bottom side of the roof decking which typically has more tension. The structural implications of spalling are severe, as it reduces the protective concrete cover over the rebar, allowing for further corrosion, weakening the bond between steel and concrete, and decreasing the slab’s load-bearing capacity. The drop ceiling was installed with a permit and met the building requirements at the time of installation. The conclusion that the sagging ceiling tiles in Unit 205 resulted solely from the detachment of a single wire anchor and an insufficient number of hangers fails to consider underlying structural issues that may have contributed to the problem. • Deflection of the concrete slab above. Which is documented in multiple areas. • High moisture saturation in the concrete deck suggests water intrusion, which can weaken the ceiling anchors and compromise the surrounding structure. • If the wire anchor detached it may not simply be a hanger issue, but possibly a concrete integrity issue. • Documented spalling in other areas of the building, including exposed corroded rebar and material loss, suggests that localized failure of the ceiling system could be linked to structural deterioration above.
Comments
User Id Date Added Comment
anowak@butler.legal 04-23-2025 Response to Civil Remedy Notice - to be electronically filed on the Florida DFS website - Complainant/Insured: 2000 South Dixie Hwy LLC DFS Filing Number: 808138 This law firm represents Old Republic Union Insurance Company (“Old Republic”). Please allow this to serve as Old Republic’s formal response to the Civil Remedy Notice of Insurance Violations bearing filing number 808138 (“CRN”), filed on behalf of 2000 South Dixie Hwy, LLC. (“Complainant”), wherein it alleges wrongdoing by Old Republic in relation to a claim for damage submitted in regards to the insured property. The Florida Department of Financial Services (“DFS”) accepted the CRN on February 24, 2025. As such, this response is timely. Without waiving any objections to the CRN, Old Republic expressly denies each and every allegation of wrongdoing contained in the CRN. In addition, Old Republic objects to the CRN’s lack of specificity and submits that there were no violations of any applicable rules, regulations, statutes, or laws, including those set forth in the CRN. As illustrated below, the CRN is deficient for several reasons. As stated by the Florida Supreme Court, the purpose of a CRN is to put an insurer on notice of alleged violations, the circumstances surrounding same, and indicate the details of the alleged violation in order to provide an insurer with 60 days to “cure” the alleged claim defects. See Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So.2d 1278 (Fla. 2000). The purpose of Fla. Stat. Section 624.155 is to provide the insurer with an opportunity to resolve a first-party coverage dispute and otherwise avoid litigation. See Talat Enterprises, Inc.; see also Lane v. Westfield Ins. Co., 862 So.2d 744 (Fla. 5th DCA 2003). Further, a CRN must be sufficiently specific to provide the insurer with an opportunity to cure the alleged violations. This would include i) identifying the specific policy provision(s) at issue, ii) citing the specific language of the statutory provision(s) the insurer allegedly violated, and iii) specifically identifying what actions the insurer must take to remedy the alleged violations. Rousso v. Liberty Surplus Ins. Corp., 2010 WL 7367059 (S.D. Fla. Aug. 13, 2010); Heritage Corp. of South Florida v. National Union Fire Ins. Co. of Pittsburgh, PA, 580 F. Supp. 2d 1294, 1299-1300 (S.D. Fla. 2008). Here, the CRN fails to meet these requirements because it lacks the fundamental information necessary to allow Old Republic to properly respond and/or “cure.” The CRN cites five statutory provisions that the Complainant alleges Old Republic has violated: F.S. § 624.155(1)(b)(1), F.S. § 626.9541(1)(i)(3)(a), F.S. § 626.9541(1)(i)(3)(b), F.S. § 626.9541(1)(i)(3)(d), and F.S. § 626.9541(1)(i)(3)(j). However, the CRN lacks essential factual information and fails to outline the specific circumstances giving rise to the alleged violations. The purpose of a CRN is to notify Old Republic of the alleged wrongdoing and provide them with an opportunity to remedy the issue. A valid CRN must include "the facts and circumstances giving rise to the Insurer's violation as you understand them at this time." Instead, the CRN contains numerous conclusory statements that do not constitute factual assertions, making it insufficient to enable Old Republic to investigate properly and, if appropriate, resolve the insured's claim. These statements, made by the Complainant, fail to provide Old Republic with adequate information necessary for a meaningful review. Among these assertions are claims that the insurer improperly assessed the loss, denying coverage on the basis of a windstorm event rather than a "collapse," and that the Complainant was aware of the damages, rendering them ineligible for coverage under the policy. Additionally, the CRN contains factual misstatements and omits key details in an apparent attempt to portray Old Republic in an unfavorable light. For example, the CRN incorrectly asserts that the coverage denial letter was based solely on a named windstorm event. The CRN explicitly states: "[t]he letter denying coverage specifically concludes there is no coverage for the interior water damage because the exterior was not damaged by wind or hail to allow the rainwater to enter. However, our claim was never storm-caused damage." However, in reality, the denial letter cites multiple grounds for the coverage determination, including exclusions for pre-existing damage, wear and tear, deterioration, and improper installation. Furthermore, the letter directly addresses the issue of collapse coverage, stating: "[a]dditionally, the claim was reported as collapse. However, based on the policy language defining collapse, the cause of loss is not considered collapse." This acknowledgment contradicts the Complainant's assertion that the claim was solely evaluated under the named windstorm provision. Moreover, while the Complainant references policy language to support its argument for coverage, it fails to cite any provisions demonstrating a violation by Old Republic. The CRN does not present any facts or specific conduct supporting the conclusion that Old Republic acted unfairly or dishonestly toward the Complainant. Instead, it includes immaterial information regarding the American Concrete Institute's ("ACI") guidelines for visual inspections, the architecture of the roof and its compromised materials, and past occurrences of leaks at the property. Overall, the CRN relies on broad, conclusory allegations but fails to provide a substantive factual basis to support its claims. Furthermore, the CRN does not specify a definitive amount required to establish a cure or indicate that a cure is even possible. Instead, the CRN presents a factual argument regarding the Policy's Definitions provision, specifically the definition of "collapse," while citing alleged damages to the building. It also references various quotes and "guidelines" obtained from the ACI visual inspection standards. However, these references do not establish any actionable violation by Old Republic. Notwithstanding the above, and without waving any objections to the deficient nature of the CRN, below is a summary of the claim investigation demonstrating that Old Republic has acted in good faith and handled the matter appropriately: The claim was first reported on or about July 15, 2024, as a "collapse causing damage to walls, flooring, electrical systems, plumbing, and other structural elements, with portions of the walls caving in." The Complainant alleged that these damages rendered the building uninhabitable in most areas. That same day, the Complainant’s counsel, Robert M. Perez, Esq., submitted a Letter of Representation for the claim. Upon receipt, Old Republic assigned the claim to its third-party administrator, Sedgwick Delegated Authority (“SDA”), for handling. The following day, SDA representative Alise Jenkins contacted the Complainant’s counsel to acknowledge receipt and request relevant documentation. On July 17, 2024, SDA engaged the independent adjusting firm McLarens to conduct an initial property inspection, assigning Matt Biltswitch as the overseeing adjuster. To assist in the assessment, McLarens retained Luis Ulloa of LMU Engineering to evaluate the damage’s origin, cause, extent, and timeline. The initial inspection occurred on July 22, 2024, with Mr. Biltswitch, Mr. Ulloa, and the Complainant’s licensed building contractor and public adjuster, Ramon Rivera, in attendance. A follow-up inspection was conducted on September 10, 2024, to assess the damage further. Based on LMU Engineering’s inspection findings and the applicable policy provisions, Old Republic issued a coverage denial letter on December 20, 2024. The letter outlined the relevant policy provisions supporting the denial, including those related to Covered Causes of Loss and Policy Definitions. This comprehensive investigation demonstrates that Old Republic conducted a thorough and good-faith evaluation of the claim in full compliance with the policy terms and applicable law. Furthermore, on April 1, 2025, the undersigned issued a letter to Complainant’s counsel seeking additional information and support for the allegations contained in the CRN on or before April 11, 2025. To date, the Complainant has failed to respond. In closing, and without waiving any of the foregoing objections, Old Republic asserts the CRN is invalid. For the reasons discussed in detail above, Old Republic contends the CRN is unwarranted, speculative, and inaccurate. Moreover, the lack of information, absence of factual specificity, and overall inaccuracy of the CRN make it nearly impossible for Old Republic to properly respond to the allegations contained therein or to properly “cure” in any reasonable form. That notwithstanding, Old Republic maintains that it has cured any alleged violations by issuing its coverage decision. Old Republic will continue to work with the Complainant in an effort to resolve the claim. We trust this response addresses the allegations of insurer violation alleged in the CRN. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Butler Weihmuller Katz Craig LLP /s/ David J. Maldoff, Esq. dmaldoff@butler.legal /s/ Andria M. Nowak, Esq. anowak@butler.legal
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