Filing Number: 808557
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| Filing Accepted: 2/26/2025 |
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SCOTT
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First Name |
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KEVIN & VALERIE |
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7400 ESTERO BLVD., APT 513 |
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FORT MYERS BEACH,
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33931
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VALSCOTT173@GMAIL.COM |
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Insured |
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| Last/Business Name* |
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SCOTT |
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First Name |
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KEVIN & VALERIE |
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1503-2002-6691 |
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Claim #* |
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FL22-0134920-A322 |
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Attorney is Applicable
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DEPALO
First Name *
JAMES "JIMMY"
Initial
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4887 BELFORT ROAD, SUITE 200 |
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JACKSONVILLE
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32256
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JDEPALO@MERLINLAWGROUP.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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NAIC Company Code 10861 |
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| Name of individual responsible for violation (if any):*
ANNETTE ACOSTA; NICHOL LEWIS; IVONNE OROZCO; ROBERT OSBORN
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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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Claim Denial
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Claim Delay
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Unfair Trade Practice
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Other
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Violations of various statutes and Fla. Admin. code
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Other
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Misconduct toward insured
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Other
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Unreasonable Investigation
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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)(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)(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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
HOMEOWNERS POLICY DECLARATIONS
SECTION I – PROPERTY COVERAGES
COVERAGE A – Dwelling $65,243 (Replacement Cost)
COVERAGE B – Other Structures $0
COVERAGE C – Personal Property $20,000 (Replacement Cost)
COVERAGE D – Loss of Use $8,000
Law and Ordinance - $16,311
Hurricane Deductible –$1,705
Additional Living Expense $8,000
Fair Rental Value $8,000
Civil Authority Prohibits Use $8,000
Loss Assessment $2000
Mold / Fungi $10,000/$20,000
HOMEOWNERS 6 – UNIT-OWNERS FORM
AGREEMENT
We will provide the insurance described in this policy in return for the premium and compliance with all applicable provisions of this policy.
SECTION I – PROPERTY COVERAGES
A. Coverage A – Dwelling
1. We cover:
a. The alterations, appliances, fixtures and improvements which are part of the building contained within the "residence premises";
b. Items of real property which pertain exclusively to the "residence premises";
c. Property which is your insurance responsibility under a corporation or association of property owners agreement; or
d. Structures owned solely by you, other than the "residence premises", at the location of the "residence premises".
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3. Special Limits Of Liability For Cosmetic
And Aesthetic Damage To Floors
The total limit of liability for Coverage A is $10,000 per policy period for cosmetic and aesthetic damages to floors.
a. Cosmetic or aesthetic damage includes but is not limited to:
(1) Chips; (2) Scratches; (3) Dents; or (4) Any other damage; to less than 5% of the total floor surface area and does not prevent typical floor use.
b. This limit includes the cost of tearing out and replacing any part of the building necessary to repair the damaged flooring.
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B. Coverage C – Personal Property
1. Covered Property
We cover personal property owned or used by an "insured" while it is anywhere in the world. After a loss and at your request, we will cover personal property owned by: a. Others while the property is on the part of the "residence premises" occupied by an "insured"; or b. A guest or a "residence employee", while the property is in any residence occupied by an "insured".
2. Limit For Property At Other Locations
a. Other Residences
Our limit of liability for personal property usually located at an "insured's" residence, other than the "residence premises", is 10% of the limit of liability for Coverage C, or $1,000, whichever is greater. However, this limitation does not apply to personal property:
(1) Moved from the "residence premises" because the “residence premises” is:
(a) Being repaired, renovated or rebuilt; and
(b) Not fit to live in or store property in; or
(2) In a newly acquired principal residence for 30 days from the time you begin to move the property there.
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C. Coverage D – Loss Of Use
The limit of liability for Coverage D is the total limit for the coverages in 1. Additional Living Expense, 2. Fair Rental Value and 3. Civil Authority Prohibits Use below.
1. Additional Living Expense
If a loss by a Peril Insured Against under this policy to covered property or the building containing the property makes the "residence premises" not fit to live in, we cover the Additional Living Expense, meaning any necessary increase in living expenses incurred by you so that your household can maintain its normal standard of living. Payment will be for the shortest time required to repair or replace the damage or, if you permanently relocate, the shortest time required for your household to settle elsewhere.
2. Fair Rental Value
If a loss covered under Section I makes that part of the "residence premises" rented to others or held for rental by you not fit to live in, we cover the fair rental value of such premises less any expenses that do not continue while it is not fit to live in. However, we do not cover any fair rental value arising out of or in connection with “homesharing host activities”. Payment will be for the shortest time required to repair or replace such premises.
3. Civil Authority Prohibits Use
If a civil authority prohibits you from use of the "residence premises" as a result of direct damage to neighboring premises by a Peril Insured Against, we cover the loss as provided in 1. Additional Living Expense and 2. Fair Rental Value above for no more than two weeks.
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D. Additional Coverages
1. Debris Removal
a. We will pay your reasonable expense for the removal of:
(1) Debris of covered property if a Peril Insured Against that applies to the damaged property causes the loss; or
(2) Ash, dust or particles from a volcanic eruption that has caused direct loss to a building or property contained in a building. This expense is included in the limit of liability that applies to the damaged property. If the amount to be paid for the actual damage to the property plus the debris removal expense is more than the limit of liability for the damaged property, an additional 5% of that limit is available for such expense.
b. We will also pay your reasonable expense, up to $1,000, for the removal from the "residence premises" of:
(1) Trees you solely own felled by the peril of Windstorm or Hail or Weight of Ice, Snow or Sleet; or (2) A neighbor's trees felled by a Peril Insured Against under Coverage C; provided the trees damage a covered structure. The $1,000 limit is the most we will pay in any one loss, regardless of the number of fallen trees. No more than $500 of this limit will be paid for the removal of any one tree.
This coverage is additional insurance.
2. Reasonable Emergency Measures
a. We will pay up to the greater of $3,000 or 1% of your Coverage A limit of liability for the reasonable costs incurred by you for necessary measures taken solely to protect covered property from further damage, when the damage or loss is caused by a Peril Insured Against.
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7. Loss Assessment
a. We will pay up to $2,000 per occurrence for your share of loss assessment charged during the policy period against you, as owner or tenant of the "residence premises", by a corporation or association of property owners. The assessment must be made as a result of direct loss to property, owned by all members collectively, of the type that would be covered by this policy if owned by you, caused by a Peril Insured Against under Coverage A, other than:
(1) Earthquake; or (2) Land shock waves or tremors before, during or after a volcanic eruption.
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10. Ordinance Or Law
a. You may use up to 25% of the limit of liability that applies to Coverage A for the increased costs you incur due to the enforcement of any ordinance or law which requires or regulates:
(1) The construction, demolition, remodeling, renovation or repair of that part of property covered under Coverage A damaged by a Peril Insured Against;
(2) The demolition and reconstruction of the undamaged part of property covered under Coverage A, when that property must be totally demolished because of damage by a Peril Insured Against to another part of that property covered under Coverage A; or
(3) The remodeling, removal or replacement of the portion of the undamaged part of property covered under Coverage A necessary to complete the remodeling, repair or replacement of that part of the property covered under Coverage A damaged by a Peril Insured Against.
b. You may use all or part of this ordinance or law coverage to pay for the increased costs you incur to remove debris resulting from the construction, demolition, remodeling, renovation, repair or replacement of property as stated in a. above.
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13. “Fungi”, Wet Or Dry Rot, Or Bacteria
a. Subject to c. Each Covered Loss and d. Policy Aggregate below, we will pay for: (1) The total of all loss payable under Section I – Property Coverages caused by “fungi”, wet or dry rot, or bacteria;
(2) The cost to remove “fungi”, wet or dry rot, or bacteria from property covered under Section I – Property Coverages;
(3) The cost to tear out and replace any part of the building or other covered property as needed to gain access to the “fungi”, wet or dry rot, or bacteria; and
(4) The cost of testing of air or property to confirm the absence, presence, or level of “fungi”, wet or dry rot, or bacteria whether performed prior to, during or after removal, repair, restoration or replacement. The cost of such testing will be provided only to the extent that there is a reason to believe that there is the presence of “fungi”, wet or dry rot, or bacteria.
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SECTION I – PERILS INSURED AGAINST
We insure for direct physical loss to the property described in Coverages A and C caused by any of the following perils unless the loss is excluded in Section I - Exclusions. However, loss does not include and we will not pay for any “diminution in value”.
1. Fire Or Lightning
2. Windstorm Or Hail
This peril includes loss to watercraft of all types and their trailers, furnishings, equipment, and outboard engines or motors, only while inside a fully enclosed building. This peril does not include loss to the inside of a building or the property contained in a building caused by rain, snow, sleet, sand or dust unless the direct force of wind or hail damages the building causing an opening in a roof or wall and the rain, snow, sleet, sand or dust enters through this opening.
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SECTION I – CONDITIONS
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C. Duties After Loss
Any claim or reopened claim under an insurance policy that provides property insurance for loss or damage caused by any covered peril is barred unless notice of the claim or reopened claim is given to us in accordance with the terms of the policy and within two years after the date of loss. A supplemental claim is barred unless notice of the supplemental claim is given to us in accordance with the terms of the policy and within three years after the date of loss. For purposes of this section, the term reopened claim means a claim that we have previously closed, but that has been
reopened upon an insured’s request for additional costs for loss or damage previously disclosed to us. Supplemental claim means a claim for additional loss or damage from the same peril which we
previously adjusted or for which costs have been incurred while completing repairs or replacement pursuant to an open claim for which timely notice was previously provided to us. This section does
not affect any applicable limitation on civil actions. Additionally, we have no duty to provide coverage under this policy to you or an “insured” seeking coverage, if the failure to comply with the following duties is prejudicial to us. These duties must be performed either by you, an "insured" seeking coverage, or a representative of either:
1. Give prompt notice to us or our agent; Except for Reasonable Emergency Measures taken under Additional Coverage 2. there is no coverage for repairs that begin before the earlier of:
a. 72 hours after we are notified of the loss; b. The time of loss inspection by us; or c. The time of other approval by us.
2. a. To the degree reasonably possible, retain the damaged property; and b. Allow us to inspect, subject to 2.a. above, all damaged property prior to its removal from the “residence premises.”
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4. Protect the covered property from further damage. If emergency measures are required,
the following must be performed:
a. Take reasonable emergency measures that are necessary to protect the covered property from further damage, as provided under Additional Coverage 2. A reasonable emergency measure under
4.a. above may include a permanent repair when necessary to protect the covered property from further damage or to prevent unwanted entry to the property. To the degree reasonably possible, the damaged property must be retained for us to inspect;
And b. Keep an accurate record of repair expenses;
5. Cooperate with us in the investigation of a claim;
6. Prepare an inventory of damaged personal property showing the quantity, description, actual cash value and amount of loss. Attach all bills, receipts and related documents that justify the figures in the inventory;
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D. Loss Settlement
Covered property losses are settled as follows. However, the valuation of any covered property losses does not include and we will not pay any amount for “diminution in value”:
1. Personal property and grave markers, including mausoleums, at actual cash value at the time of loss but not more than the amount required to repair or replace.
2. Coverage A – Dwelling, other than “sinkhole loss”:
a. At the actual cost to repair or replace.
b. We will initially pay at least the actual cash value of the insured loss, less any applicable deductible. We will then pay any remaining amounts necessary to perform such repairs as work is performed and expenses are incurred, subject to 2.a. above and this item 2.b. If a total loss of a building or structure insured under this policy occurs, the provisions of 2.b. above do not apply and we will pay the replacement cost coverage without reservation or holdback of any depreciation in value, subject to policy limits. This does not prohibit us from exercising our right to repair damaged property in compliance with this policy and pursuant to Florida Statutes.
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K. Loss Payment
We will adjust all losses with you. We will pay you unless some other person is named in the policy or is legally entitled to receive payment. Loss will be payable upon the earliest of the following:
1. 20 days after we receive your proof of loss and reach written agreement with you; or
2. 60 days after we receive your proof of loss and: a. There is an entry of a final judgment; or b.There is a filing of an appraisal award or a mediation settlement with us.
3. Under Florida Statutes we are required to pay or deny an initial, reopened, or supplemental property insurance claim or portion of a claim, within 90 days of notice of such claim unless there are reasonable circumstances which prevent us from so doing. Our failure to comply with this paragraph shall not form the sole basis for an action against us for breach of contract under this policy or for benefits under this policy.
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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.
FLORIDA ADMINISTRATIVE CODE SECTIONS VIOLATED
69B-220.201(3) – Code of Ethics. The work of adjusting insurance claims engages the public trust. An adjuster shall put the duty for fair and honest treatment of the claimant above the adjuster’s own interests in every instance. The following are standards of conduct that define ethical behavior, and shall constitute a code of ethics that shall be binding on all adjusters:
69B-220.201(3)(b) An adjuster shall treat all claims equally. An adjuster shall not provide favored treatment to any claimant. Adjuster shall adjust all claims strictly in accordance with the insurance contract.
69B-220.201(3)(b)(2). An adjuster shall adjust all claims strictly in accordance with the insurance contract.
69B-220.201(3)(c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured.
69B-220.201(3)(d) - An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.
69B-220.201(3)(f) - An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim.
69B-220.201(3)(m) An adjuster shall not knowingly fail to advise a claimant of their rights in accordance with the terms and conditions of the contract and of the applicable laws of this state.
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) Failure to properly train, evaluate and manage adjusters;
7) Looking for ways to deny coverage, pay less, delay payment and otherwise “low ball” or “stone wall” claim;
8) The reasons for this may be attributed to improper training, supervision, and/or motivation of adjusters and claims supervisors to promptly and fairly investigate, adjust and pay full benefits available to all beneficiaries. The UNIVERSAL PROPERTY may 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.
This complaint is made on behalf of KEVIN SCOTT OR VALERIE SCOTT (the “INSUREDS”). The INSUREDS purchased an all-risk homeowner’s insurance policy from UNIVERSAL PROPERTY & CASUALTY INSURANCE COMPANY (“UNIVERSAL PROPERTY”), with an issued Policy No. 1503-2002-6691, effective June 3, 2022, through June 3, 2023 (the “Policy”). This said Policy insured the property located at 7400 Estero Blvd., Apt 513, Fort Myers Beach, Florida 33931 (the “Property”). The INSUREDS paid all premiums on said Policy, and the Policy was in full force and effect at all relevant times herein.
On or about September 28, 2022, while the Policy issued by UNIVERSAL PROPERTY was in full force and effect, the Property sustained significant damage as a result of Hurricane Ian. Hurricane Ian caused extensive damage to the Property, including, but not limited to, damage from powerful winds and debris impacts. The affected areas of the property included, among others, windows, window shutters, sliding door, interior water intrusion due to storm-created openings, kitchen cabinets, bathroom tile and cabinets, as well as appliances (the “Loss”). INSUREDS also notified personal property loss and additional living expenses as a result of the Loss. INSUREDS did what a prudent policyholder would do and contracted with a mitigation company via their Condominium Association to mitigate their damages and prevent further damage to the Property.
INSUREDS promptly notified UNIVERSAL PROPERTY of the damage sustained on September 30, 2022. UNIVERSAL PROPERTY acknowledged receipt of the claim and assigned claim number FL22-0134920-A322 (the “Claim”). Despite having the opportunity to conduct a thorough inspection of the damages, UNIVERSAL PROPERTY has yet to provide the INSUREDS with full and fair compensation for the Loss or a building estimate for the loss. Consequently, the INSUREDS have endured severe financial hardship directly attributable to UNIVERSAL PROPERTY’s bad faith practices. Instead of receiving the compensation necessary to address the extensive damages to their property, the INSUREDS have been left with no choice but to deplete their personal savings to fund crucial repairs. This undue financial burden was imposed solely because UNIVERSAL PROPERTY has failed to issue fair and accurate payment, leaving the INSUREDS to foot the bill for restoring their property to its pre-loss condition. The lack of proper compensation not only exacerbated the stress and financial strain on the INSUREDS but also delayed necessary repairs, further compounding the damage and inconvenience caused by UNIVERSAL PROPERTY ’s negligence and mishandling of the Claim.
In its initial letter to the Insured dated October 23, 2022, UNIVERSAL PROPERTY's litigation examiner, Annette Acosta ("Ms. Acosta"), swiftly denied the Claim, stating that "Pursuant to the investigation, it was determined there is no direct physical loss to covered property, as required by the applicable Policy. Therefore, pursuant to the terms of the Policy, Universal is unable to extend coverage for the claim." Additionally, Ms. Acosta cited several sections of the Policy namely, PERILS INSURED AGAINST, EXCLUSIONS, AND CONDITIONS sections for reason for its denial of the INSUREDS Claim. However, UNIVERSAL PROPERTY and Ms. Acosta failed to provide the INSUREDS with any details of its investigation, estimate or reports detailing or supporting their alleged evaluation of the loss.
Disgusted by the gross denial and misevaluation by UNIVERSAL PROPERTY, the INSUREDS hired a Florida licensed public adjusting company, Ordman Elite Group Inc. (“Ordman”), to represent the INSUREDS in their Claim with UNIVERSAL PROPERTY, evaluate the hurricane damages to the Property, and prepare an estimate of the damages as a result of the Loss.
Ordman prepared a detailed estimate of the damages resulting from the loss dated September 28, 2022. This estimate outlined the costs for repairs and replacements necessary to restore the property to its pre-loss condition.
Ordman calculated a Replacement Cost Value of $51,968.01 for Coverage A - Dwelling. Additionally, the INSUREDS experienced a personal property loss due to Hurricane Ian, exceeding the established policy limit of $20,000 for Coverage B - Personal Property, as detailed in their submission to UNIVERSAL PROPERTY. The INSUREDS also incurred Additional Living Expenses resulting from the covered loss, which exceeded the $8,000 policy limit for Coverage D - Additional Living Expenses as evidenced in their detailed item list. In total, the INSUREDS submitted a Claim to UNIVERSAL PROPERTY for their loss, amounting to $93,243.00. Ordman submitted its estimate to UNIVERSAL PROPERTY for review on April 17, 2023.
On September 4, 2023, UNIVERSAL PROPERTY sent a letter to the INSURED in response to the estimate provided by Ordman. In the letter, UNIVERSAL PROPERTY stated, “On April 17, 2023, Universal received a request for supplemental/additional claim consideration in the form of your Public Adjuster's Estimate attesting to windstorm/water property damages in the amount of $51,968.01.” Further, UNIVERSAL PROPERTY added, “Although coverage has not yet been determined, Universal is continuing with its investigation of the supplemental claim pursuant to a reservation of rights under the Policy.”
At this point, it became evident that UNIVERSAL PROPERTY was treating Ordman’s estimate as a “supplemental” or “additional” claim. However, there was nothing inherently supplemental or additional about this estimate. In fact, UNIVERSAL PROPERTY failed to explain in its letter how this estimate differed from the original Claim filed by the INSURED on September 30, 2022. Furthermore, UNIVERSAL PROPERTY did not assign a new claim number to this so-called “supplemental/additional claim,” which further suggests that the estimate was being treated merely as a continuation of the original Claim, rather than a separate or new claim.
Additionally, UNIVERSAL PROPERTY did not reiterate the several sections of the Policy as it had done in its initial letter dated October 23, 2023. Instead, it only cited the CONDITIONS section and formally requested that the INSUREDS provide certain documentation, including Photos or videos taken by the INSUREDS (or anyone else) at the time of the reported loss; Photos or videos of the damaged property prior to any repairs or Emergency Mitigation Services (EMS) being completed; EMS invoices/documents, dry out logs, and contracts, along with color photos and/or mold-related reports/protocols based on services provided at the time of the reported loss or due to the reported date of loss.
UNIVERSAL PROPERTY further reminded the INSUREDS that “Failure to comply with the conditions governing the policy by providing all of the documents requested to our office may result in the denial of the supplemental claim.” However, notably absent from this request was any explanation of why the claim was now being considered “supplemental.” This omission raises concerns about the lack of clarity and transparency in how UNIVERSAL PROPERTY is handling the Claim and its failure to properly differentiate between the original Claim and the so-called supplemental claim. To note, UNIVERSAL PROPERTY’S September 4, 2023, letter was signed by a new claims adjuster in that of Nichol Lewis (“Ms. Lewis”).
Nevertheless, Ordman followed up on the requests made by UNIVERSAL PROPERTY and Ms. Lewis in the September 4, 2023, letter, sending the additional documentation and information requested. Mrs. Lewis then became unresponsive to Ordman’s communications. Despite several attempts to confirm receipt of the documents, Ms. Lewis did not respond. On September 12, 2023, Ordman reached out to another adjuster and supervisor at UNIVERSAL PROPERTY, whom Ordman knew, in an effort to obtain confirmation of the documents sent to Ms. Lewis or to get in contact with a new adjuster assigned to the Claim.
On March 13, 2024, the INSUREDS and UNIVERSAL PROPERTY participated in mediation, which ended in an impasse. As a result, the INSUREDS, through Ordman, requested an appraisal of the Property in accordance with the terms of the Policy. However, the request was rejected on April 1, 2024, by Ivonne Orozco, a Claims Examiner recently appointed to the Claim by UNIVERSAL PROPERTY.
Following UNIVERSAL PROPERTY’s complete denial, impasse at mediation, and rejection of appraisal, the INSUREDS were left with no other choice but to retain legal representation by the Merlin Law Group. On June 17, 2024, Merlin Law Group sent Letter of Representation (“LOR”) on behalf of the INSUREDS to UNIVERSAL PROPERTY.
On or around August 20, 2024, at the request of UNIVERSAL PROPERTY, the INSUREDS submitted a comprehensive Sworn Proof of Loss, accompanied by a detailed package of supporting documentation. This package included photographs of the damages, an itemized estimate, invoices, and other relevant materials to substantiate their Claim. The counsel communicated with Mr. Robert Osborn (“Mr. Osborn”) the newly appointed Claims Examiner/Field Adjuster on multiples occasions providing Mr. Osborn with the LOR, Sworn Proof of Loss (“SPOL”), additional documentation, including photographs, invoices, letters declaring the building inhabitable for over a year and other relevant information that outlined the inconsistencies between the evaluations conducted by both parties in hopes of resolving the matter.
On September 17, 2024, Mr. Osborn, on behalf of UNIVERSAL PROPERTY, extended a significantly low and informal settlement offer of $15,000 via email to the INSUREDS. This action underscored UNIVERSAL PROPERTY’s position, which appeared to be based on predetermined conclusions and a failure to conduct an impartial and thorough reconsideration of the INSUREDS’ Claim. It is unclear what investigation or analysis that Insurer performed to reach this conclusion as to the pricing and scope of the damages.
The INSUREDS were left both shocked and confused by Mr. Osborn's approach and the grossly inadequate offer. It was evident that UNIVERSAL PROPERTY, along with Mr. Osborn, Ms. Orozco, Mrs. Lewis, and Mrs. Acosta failed to properly evaluate and adjust the Claim in accordance with the substantial evidence and documentation provided. Despite the INSUREDS’ repeated efforts to present comprehensive proof of their loss, Mr. Osborn once again neglected to provide any estimate or report prepared by UNIVERSAL PROPERTY to substantiate their position or justify the offer.
A review of the photographs and claim documents show a loss that has been mishandled and inappropriately adjusted by UNIVERSAL PROPERTY. Wind is a covered peril under the Policy. On information and belief, UNIVERSAL PROPERTY denied this claim as part of a systematic and wide-spread course of conduct toward policy holders like the INSUREDS in order to enhance UNIVERSAL PROPERTY’s revenues and minimize its claims payments.
The concept of insurance in a state like Florida, where adjustment of claims engages the public trust, necessitates UNIVERSAL PROPERTY to fully and fairly value policy holder claims and issue payment for the full value of those claims according to the unambiguous terms of the involved policies. UNIVERSAL PROPERTY failed to do this for INSUREDS’ Claim and thereby breached its duty to the INSUREDS.
The latest offer made by Mr. Osborn on behalf of UNIVERSAL PROPERTY was wholly inconsistent with the extensive damage observed, documented, and presented by the INSUREDS. It demonstrated a disregard for the evidence of loss and the detailed documentation submitted, further highlighting a lack of good faith in handling the Claim. UNIVERSAL PROPERTY’s policy is a replacement cost policy, which implies coverage for the exact replacement of damaged property with like kind and quality. Attempts to undervalue the Claim or provide less than full compensation constitutes bad faith and a breach of the Policy provisions.
UNIVERSAL PROPERTY has failed to act fairly and honestly towards its INSUREDS. Despite multiple inspections and adjustments, the INSUREDS have not received proper compensation for the damages. Specifically, the full cost to restore the Property to its pre-loss condition is $78,263.01. UNIVERSAL PROPERTY has denied necessary repairs and coverage, leading to significant prejudice and financial strain on the INSUREDS.
The INSUREDS have complied with all Policy terms and conditions, promptly notified UNIVERSAL PROPERTY, protected the Property, and cooperated fully with UNIVERSAL PROPERTY ’s investigations. UNIVERSAL PROPERTY ’s conduct represents a failure to uphold its duty of good faith and fair dealing, as required under Florida law.
Within every insurance policy is an implicit duty of good faith and fair dealing. This duty of good faith obligates the UNIVERSAL PROPERTY to handle its INSUREDS’ Claim with “the same degree of care and diligence as a person of ordinary care and prudence should exercise in the management of his own business.” Boston Old Colony Ins. Co. v. Gutierrez, 386 So.2d 783 (Fla. 1980). UNIVERSAL PROPERTY has a duty to act in good faith and with due regard for the interests of the INSUREDS but has consistently failed to do so.
UNIVERSAL PROPERTY has refused and/or failed to fully investigate the loss and tender insurance proceeds to the INSUREDS that are due and owed. UNIVERSAL PROPERTY ’s refusal and/or failure to settle the insurance Claim when under all circumstances it could have and should have done so had it acted fairly and honestly towards the INSUREDS is wrongful conduct. UNIVERSAL PROPERTY ’s adjusters and/or representatives have financially benefitted from such wrongful conduct. This failure is a violation of Section 624.155(1)(b)(1), Florida Statutes and constitutes unfair Claim settlement practices. UNIVERSAL PROPERTY ’s delay has caused the INSUREDS unnecessary hardship and expense, in direct violation of, but not limited to sections 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(c), and 626.9541(1)(i)(3)(d) of the Florida Statutes as well as 69B-220.201(3)(b)(2), 69B-220.201(3)(c), and 69B-220.201(3)(f) of the Administrative Code.
UNIVERSAL PROPERTY’s handling and adjustment of its INSUREDS’ Claim of loss and the conduct of its adjusters, supervisors, management, and individuals associated with or retained by UNIVERSAL PROPERTY in this Claim to date evidence that UNIVERSAL PROPERTY has failed to create and implement adequate guidelines for the proper investigation, evaluation, and handling of claims, as well as training and supervision of employees, resulting in the statutory violations set forth above. UNIVERSAL PROPERTY should have standards for the proper investigation of claims, which includes retaining competent impartial and unbiased adjusters for the investigation of damages and reviewing the reports and documents from these individuals for accuracy before issuing coverage decisions. UNIVERSAL PROPERTY has 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. This failure is a violation of Section 626.9541(1)(i)(3)(a), Florida Statutes.
As a direct result of UNIVERSAL PROPERTY’s actions, the INSUREDS have sustained irreparable harm. Upon information and belief, such actions complained of herein, among others, are effectuated by UNIVERSAL PROPERTY so often as to constitute a general business practice evidencing a motive to enhance UNIVERSAL PROPERTY ’s profits and cause a detrimental effect to its policyholders. UNIVERSAL PROPERTY clearly failed to adopt and implement standards for the proper investigations of claims, most notably in its failure to capture the full value of the loss and efforts to avoid coverage and liability for the damages without merit. As a direct and proximate result of UNIVERSAL PROPERTY ’s handling of the Claim, the INSUREDS sustained extra-contractual damages, including, but not limited to, attorneys’ fees and costs.
The lack of competence demonstrated by UNIVERSAL PROPERTY’s adjusters clearly demonstrates the adjusters were not then competent or knowledgeable as to the terms and conditions of the insurance coverage provided by the policy and/or the Claim exceeded their current expertise.
Through the aforementioned actions and inaction of UNIVERSAL PROPERTY ’s adjusters, UNIVERSAL PROPERTY violated Florida Administrative Code, Chapter 69B-220.201(3), 69B-220.201(3)(b), (69B-220.201(3)(b)(2), 69B-220.201(3)(d), and 69B-220.201(3)(f).
Due to UNIVERSAL PROPERTY ’s failure to properly adjust the Claim, the INSUREDS were forced to retain the professional services of the undersigned attorneys to aid the INSUREDS in obtaining contractual benefits due and owing under the Policy and to further protect the rights of the INSUREDS.
This notice is given in order to perfect the right to pursue the civil remedy authorized by Florida Statute, including any and all bad faith/extra contractual damages should UNIVERSAL PROPERTY fail to cure the violations set forth in this Civil Remedy Notice within the given cure period.
While no specific “cure amount” is required for this Civil Remedy Notice to be valid, the INSUREDS will consider the allegations contained herein “cured” if UNIVERSAL PROPERTY without any requirement for a release completes the following in full:
(1) tender payment in the amount of $78,263.01 which reflects the total amount for the claim less the applicable deductible; (2) pay all outstanding statutory interest on the past due amount, as more than 90 days have elapsed since the Claim was reported and the above payment should have been made; (3) tender payment to the INSUREDS for the reasonable attorneys’ fees and costs incurred as a result of the actions/inactions perpetrated by UNIVERSAL PROPERTY; and (4) continue to adjust the loss with the INSUREDS in good faith moving forward.
If UNIVERSAL PROPERTY disagrees with the extent of the cure requested or asserts that the payment of any of the above cure categories may not be required, UNIVERSAL PROPERTY should cure to the extent it believes it must under the Policy and governing laws to correct the allegations of bad faith contained herein.
The INSUREDS continue to remain open to a fair and reasonable settlement offer from UNIVERSAL PROPERTY in an effort to avoid additional delay, costs and expenses, and hereby requests the same prior to the expiration of the statutory “cure” period. The INSUREDS have provided UNIVERSAL PROPERTY with all necessary estimates, invoices, receipts, etc., in support of their Claim. UNIVERSAL PROPERTY must act fairly and honestly in its response to the INSUREDS’ request for a prompt, fair and reasonable settlement offer and resolution of its Claim.
UNIVERSAL PROPERTY ’s ongoing delays and inadequate handling of the Claim have caused undue hardship. This notice is given to perfect the right to pursue the civil remedy authorized by Fla. Stat. § 624.155.
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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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