Civil Remedy Notice of Insurer Violations
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Filing Number:     809086
Filing Accepted:  3/2/2025
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Complainant
Last/Business Name *  
LIMA   First Name   WINIFRED
Street Address * 2609 SW CADET CIR
City, State Zip * PORT ST. LUCIE, FL 34953
Email Address * INSURED@MCDONALDBARNHILL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   LIMA   First Name   WINIFRED
Policy # * 1501-2004-5150 Claim #* FL24-0108646
Attorney
Attorney is Applicable
Last Name* GONTRUM First Name * RYAN Initial L
Street Address* 505 S. MAGNOLIA AVENUE
City, State Zip* TAMPA , FL 33606
Email Address * TAL@MCDONALDBARNHILL.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):* SHANTEL DUNKLEY
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.
 
626.9541(1)(i)(1) Attempting to settle claims on the basis of an application, when serving as a binder or intended to become a part of the policy, or any other material document which was altered without notice to, or knowledge or consent of, the insured.
626.9541(1)(i)(2) A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
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.
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)(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)(4) Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
626.9541(1)(i)(3)(j) Altering or amending an insurance adjuster’s report without: (I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and (II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or (III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change;
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

***ADDITIONAL STATUTORY PROVISIONS ALLEGED TO HAVE BEEN VIOLATED AS FOLLOWS:*** §624.155(1)(a) Any person may bring a civil action against an insurer when such person is damaged: By the commission of any of the following acts by the insurer: 1. Section 626.9541(1)(i), (o), or (x); §624.155(1)(a) Any person may bring a civil action against an insurer when such person is damaged: By the commission of any of the following acts by the insurer: 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 towards its insured and with due regard for his interests; 2. Making claims payments to insures or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made; or 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. §624.155 (5) No punitive damages shall be awarded under this section unless the acts giving rise to the violation occur with such frequency as to indicate a general business practice and these acts are: a. Willful, wanton, and malicious; b. In reckless disregard for the rights of any insured; or c. In reckless disregard for the rights of a beneficiary under a life insurance contract; (8) The damages recoverable pursuant to this section shall include those damages which are a reasonably foreseeable result of a specified violation of this section by the authorized insurer and may include an award or judgment in an amount that exceeds the policy limits. §627.70131 Insurer’s duty to acknowledge communications regarding claims; investigation (1)(a) Upon an insurer’s receiving a communication with respect to a claim, the insurer shall, within 14 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer which reasonably prevent such acknowledgement. If the acknowledgement is not in writing, a notification indicating acknowledgement shall be made in the insurer’s claim file and dated. A communication made to or by an agent of an insurer with respect to a claim shall constitute communication to or by the insurer. (b) As used in this subsection, the term “agent” means any person to whom an insurer has granted authority or responsibility to receive or make such communications with respect to claims on behalf of the insurer. (c) This subsection shall not apply to claimants represented by counsel beyond those communications necessary to provide forms and instructions. (2) Such acknowledgement shall be responsive to the communication. If the communication constitutes a notification of a claim, unless the acknowledgement reasonably advises the claimant that the claim appears not to be covered by the insurer, the acknowledgement shall provide necessary claim forms, and instructions, including an appropriate telephone number. (3) Unless otherwise provided by the policy of insurance or by law, within 10 working days after an insurer receives proof of loss statements, the insurer shall begin such investigation as is reasonably necessary unless the failure to begin such investigation is caused by factors beyond the control of the insurer which reasonably prevent the commencement of such investigation. (4) For purposes of this section, the term “insurer” means any residential property insurer. (5) Within 90 days after an insurer receives notice of a property insurance claim from a policyholder, the insurer shall pay or deny such claim unless the failure to pay such claim is caused by factors beyond the control of the insurer which reasonably prevent such payment. Failure to comply with this subsection constitutes a violation of this code. ***Specific policy language that is relevant to the violation*** Universal Property & Casualty Insurance Company (“Universal”) failed to adequately adjust and pay the claim covered under the subject insurance policy. Specifically, but not limited to, Universal failed to properly apply the Loss Settlement and Loss Payment provisions of the policy. In addition to the policy sections specifically cited herein, any endorsements or changes to said sections are relevant to the Insured’s claim for civil remedy. There may be additional policy language relevant to this violation that may be discovered.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Winifred Lima’s claim results from water damage due to a shower pan leak leak on or about April 2, 2024, to his property located at 2609 SW Cadet Cir., Port St. Lucie FL 34953. The water leak caused damage to the walls, floors, and other building materials throughout the master bathroom and living room. The property was insured under policy number 1501-2004-5150. The claim was reported to Universal Property & Casualty Insurance Company (“Universal”) and was assigned the claim number FL24-0108646. The carrier assigned Shantel Dunkley as the desk adjuster, and sent a field adjuster to inspect the property. This field adjuster’s name does not appear on their estimate, which completely failed to account for the scope of the damages. This estimate totaled just $470.24, and the only actual repair it included was 106 square feet of carpet. This was unsurprisingly below the deductible, and Universal issued no payment for the loss. Mr. Lima hired Stellar Public Adjusting Services Inc. (“Stellar”) to represent his interests in the claim. Stellar inspected the property and found $94,637.79 worth of damages to the dwelling. Meanwhile, Total Care Restoration completed EMS totaling $4,389.07, and Brickhouse Inspections, Inc. prepared a mold remediation estimate totaling $10,811.94. Stellar submitted its estimate, along with photos and other relevant documentation to Universal, and the only additional consideration made by Universal was to issue partial payments for the estimated mold damage, and for EMS, a total of $6,577.92 and $4,288.27 respectively There is no evidence Universal did anything further to adjust the loss or ever considered the information provided by Stellar. Universal’s course of action has continuously delayed indemnification while the Insured’s costs continue to rise. In Florida, the work of adjusting insurance claims engages the public trust. Universal has breached this duty in the adjustment of this loss by failing to investigate the claim, refusing to provide proper indemnity, unnecessarily delaying resolution of the claim, and failing to take into consideration documentation provided to them which would support further compensation. Universal has failed to create and implement adequate guidelines for proper investigation of claims handling and for training and supervision of employees and representatives which have resulted in some of the statutory violations set forth above. Universal charged the Insureds a substantial premium for these coverages but has refused to tender proper payment when under all circumstances it should have done so, had they acted fairly and honestly. As a result, the Insureds have been forced to consider legal counsel to protect their interests. Therefore, to cure the defects outlined in this Civil Remedy Notice, Universal must: 1. Immediately tender all insurance monies due to the Insured for the loss; 2. Act fairly and honestly towards the Insured and with due regard for his interests in attempting to settle the claim; 3. Pay statutory interest on the amount of unpaid contractual damages from the date the claim was reported; 4. Cease and desist all present and future bad faith actions with regard to the Insured’s claim; Failure to cure all defects during the 60-day safe harbor period may result in additional extra-contractual damages.
Comments
User Id Date Added Comment
oc1102@universalproperty.com 04-16-2025 April 16, 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.: 809086 Filing Date: 3/2/2025 Complainant(s): Winifred Lima Insured(s): Winifred Lima Policy No.: 1501-2004-5150 Claim No.: FL24-0108646 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, Ryan L Gontrum, on behalf of Complainant, Winifred Lima (also referenced as the “Insured.”) The Notice alleges violations of Sections 624.155, 626.9541, and 627.70131, 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 Complainant must respond to with specificity. The Florida Supreme Court holds that Section 624.155, Florida Statutes “must be strictly construed.” Talat Enterprises, Inc. v. Aetna Cas. and Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). Strict construction is appropriate as “this statute is in derogation of the common law.” Id. When interpreting a statute in derogation of the common law, “[a] court will presume that such a statute was not intended to alter the common law other than as clearly and plainly specified in the statute.” Time Ins. Co., Inc. v. Burger, 712 So. 2d 389, 393 (Fla. 1998). Such an interpretation would mean that statutory bad faith cases cannot proceed unless the Complainant has specifically complied with all statutory requirements. Pin-Pon Corp. v. Landmark American Ins. Co., 500 F. Supp. 3d 1336 (S.D. Fla. 2020); Julien v. United Property & Casualty Ins. Co., 311 So.3d 875 (Fla. 4th DCA 2021). First, the Notice fails to satisfy the requirement to identify the person or persons representing the insurer most responsible for or knowledgeable of the facts giving rise to the allegations. In order to comply with the requirements of Section 624.155, Florida Statutes, the Complainant must name the individual(s) involved with specificity as it relates to the purported violation(s) to allow Universal to properly investigate the allegations. The Notice lacks the requisite specificity as required by Section 624.155, Florida Statutes. Here, the Notice states “SHANTEL DUNKLEY.” Other than identifying Ms. Dunkley as the desk adjuster, the Notice does not state what knowledge Ms. Dunkley has giving rise to any allegation or what she did or failed to do related to the claim at issue. The Complainant has effectively specified no one in particular on behalf of Universal with the most knowledge of the facts giving rise to any of the purported allegations in the Notice. Specific identification of a person or persons with the most knowledge within Universal is of particular importance because the Complainant alleges that Universal misrepresented pertinent facts or insurance policy provisions. Thus, the Notice fails to include the requisite specificity as to whom made any misrepresentations. Accordingly, the Complainant’s Notice is insufficient as a matter of law. Second, the Civil Remedy Notice requires the Complainant “pursuant to section 624.155, Florida Statutes, please indicate all statutory provisions alleged to have been violated.” The Notice filed by Complainant in this matter includes almost every statutory provision that could be claimed against an insurance company, without the requisite specificity as to how, if at all, they are relevant or applicable to any facts alleged in the Notice. Because the Notice fails to identify any specific statutes, Universal is unable to properly respond and it does not comply with Section 624.155, Florida Statutes. Third, 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(s). The Notice does not reference any specific policy language allegedly violated, but instead the Notice improperly cites to Sections 624.155 and 627.70131, Florida Statutes. However, these sections are not contained within the Policy. Additionally, the Notice states in pertinent part the following: “Universal Property & Casualty Insurance Company (“Universal”) failed to adequately adjust and pay the claim covered under the subject insurance policy. Specifically, but not limited to, Universal failed to properly apply the Loss Settlement and Loss Payment provisions of the policy. In addition to the policy sections specifically cited herein, any endorsements or changes to said sections are relevant to the Insured’s claim for civil remedy. There may be additional policy language relevant to this violation that may be discovered.” The Complainant failed to state any specific policy provisions and instead broadly makes references to various policy sections which provide no guidance or explanation, such that Universal is left to wonder what policy provisions Complainant believes were allegedly violated. General, vague, and overbroad references to possible or potential policy provisions does not satisfy the specificity required by Section 624.155(3)(b)(4), Florida Statutes. As such, the Notice is deficient as a matter of law. See generally Julien v. United Property & Casualty Ins. Co., 311 So.3d 875 (Fla. 4th DCA 2021). Fourth, 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 Complainant provides four (4) reasons for submitting the Notice: “Unsatisfactory Settlement Offer,” “Claim Denial,” “Claim Delay,” and “Unfair Trade Practice.” The Complainant’s allegations have no specific factual support specified in the Notice. The Notice asserts general allegations consisting of conclusory and boilerplate allegations. As an example, the Notice alleges “Universal has breached this duty in the adjustment of this loss by failing to investigate the claim, refusing to provide proper indemnity, unnecessarily delaying resolution of the claim, and failing to take into consideration documentation provided to them which would support further compensation. Universal has failed to create and implement adequate guidelines for proper investigation of claims handling and for training and supervision of employees and representatives which have resulted in some of the statutory violations set forth above.” The Complainant fails to provide any specific facts or examples to support these conclusory statements. Moreover, the Notice alleges Universal violated Section 626.9541(1)(i)(3)(b), Florida Statutes, “[m]isrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.” The Notice does not set forth any facts regarding any misrepresentations made by Universal and does not identify the person or persons who made such misrepresentations, nor does it identify to whom any misrepresentations were made. The Notice does not state any facts to support the Complainant’s misrepresentation allegations or any of the allegations contained therein. The Notice fails to adequately identify or explain how Universal violated the provisions of Florida law cited in the Notice or how the alleged violations relate to the facts of the Complainant’s claim. Therefore, the statement of facts falls short of the specificity required by Section 624.155, Florida Statutes. As a result, the Complainant fails to comply with the requirements provided in Section 624.155(3)(b)(2), Florida Statutes. 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 Insured. 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. Here, the Notice contains “cures” that are not available under the policy of insurance or under the Civil Remedy Statute. Universal is only obligated to pay contractual amounts owed to cure a civil remedy notice. See id. at 1278. In summary, as outlined above, the Complainant fails 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 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, the failure to reference specific policy language relevant to the alleged violation, the failure to allege any specific conduct on the part of Universal that would violate any policy provision or statute, and the failure to provide a proper means whereby Universal can “cure” the alleged defects. Therefore, the Notice is legally deficient and fails to satisfy the condition precedent to filing a bad faith action. 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 April 15, 2024, Universal received untimely notice from the Insured’s public adjuster, Stellar Public Adjusting Services, the insured location had damage which occurred on April 2, 2024. Universal inspected the property and documented any visible damage. Thereafter, Universal advised the Insured it accepted coverage for the loss, however the estimated cost for repairs fell below the applicable policy deductible. Additionally, Universal provided the Insured with a copy of its estimated cost for repairs for the covered portion of the loss. Universal denies the allegations asserted in the Notice. An insurer is not required to pay whatever amount an insured demands. As outlined above, the alleged statutory violations set forth in the Notice are devoid of factual support and are without merit. We trust that the foregoing is sufficient to advise you of Universal’s position with regard to this matter and fully responds to the Notice file by the Complainant. Sincerely, /s/ Ozzy Cudila Ozzy Cudila, Esq. Associate General Counsel
Acknowledgement
* The submitter hereby states that this notice is given in order to perfect the rights of the person(s) damaged to pursue civil remedies authorized by Section 624.155, Florida Statutes.

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DFS-10-363
Rev. 10/14/2008