Filing Number: 810874
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| Filing Accepted: 3/12/2025 |
| Last/Business Name
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KEMP
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First Name |
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LEROY AND CHEYSHAN |
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| Street Address
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8216 GALAXIE DR |
| City, State Zip
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JACKSONVILLE,
FL
32244
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| Email Address
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YIA17@YOURINSURANCEATTORNEY.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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KEMP |
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First Name |
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LEROY AND CHEYSHAN |
| Policy # * |
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1504-2000-5776 |
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Claim #* |
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FL21-0136971 |
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Attorney is Applicable
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| Last Name* |
MESSINA
First Name *
MATTHEW
Initial
S
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| Street Address* |
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2300 MAITLAND CENTER PKWY, SUITE 122 |
| City, State Zip* |
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MAITLAND
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FLORIDA
32751
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| Email Address * |
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MMESSINA@YOURINSURANCEATTORNEY.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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| Insurer Name* |
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| Street Address* |
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| City, State Zip* |
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,
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NAIC Company Code 10861 |
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| Name of individual responsible for violation (if any):*
CORPORATE REPRESENTATIVE OF UNIVERSAL PROPERTY AND CASUALTY INSURANCE COMPANY, STEPHEN J. DONAGHY, SCOTT BARRETT, VANESSA COBAS
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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 Delay
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Unfair Trade Practice
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Unsatisfactory Settlement Offer
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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)(2) |
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Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
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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)(2) |
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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.
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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)(b) |
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Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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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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| 626.9541(1)(i)(3)(e) |
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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.
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| 626.9541(1)(i)(3)(f) |
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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.
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| 626.9541(1)(i)(3)(g) |
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Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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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.
SECTION I – PROPERTY COVERAGES
A. Coverage A – Dwelling
1. We cover:
a. The dwelling on the "residence premises"
shown in the Declarations, including
structures attached to the dwelling; and
b. Materials and supplies located on or next
to the "residence premises" used to
construct, alter or repair the dwelling or
other structures on the "residence
premises".
2. We do not cover land, including land on
which the dwelling is located.
F. 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.
F. Additional Coverages
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.
b. We will not pay more than the amount in
a. above, unless we provide you approval
within 48 hours of your request to us to
exceed the limit in a. above. In such
circumstance, we will pay only up to the
additional amount for the measures we
authorize.
If we fail to respond to you within 48
hours of your request to us and the
damage or loss is caused by a Peril
Insured Against, you may exceed the
amount in a. above only up to the cost
incurred by you for the reasonable
emergency measures necessary to
protect the covered property from further
damage.
c. If, however, form UPCIC 201 15 is part of
your policy and a covered loss occurs
during a “hurricane occurrence”, the
amount we pay under this additional
coverage is not limited to the amount in
a. above.
d. A reasonable measure under this
Additional Coverage 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.
e. This coverage does not:
(1) Increase the limit of liability that
applies to the covered property; or
(2) Relieve you of your duties, in case of
a loss to covered property, as set
forth in Section I – Condition C.
(3) Pay for property not covered, or for
repairs resulting from a peril not
covered, or for loss excluded from
this policy.
F. Additional Coverages
5. Property Removed
We insure covered property against direct
loss from any cause while being removed
from a premises endangered by a Peril
Insured Against and for no more than 30
days while removed.
This coverage does not change the limit of
liability that applies to the property being
removed.
F. Additional Coverages
7. Loss Assessment
a. We will pay up to $1,000 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.
The limit of $1,000 is the most we will
pay with respect to any one loss,
regardless of the number of
assessments. We will only apply one
deductible, per unit, to the total amount of
any one loss to the property described
above, regardless of the number of
assessments.
b. We do not cover assessments charged
against you or a corporation or
association of property owners by any
governmental body.
c. Paragraph Q. Policy Period under
Section I – Conditions does not apply to
this coverage.
This coverage is additional insurance
F. Additional Coverages
9. 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 a covered building or
other structure damaged by a Peril
Insured Against;
(2) The demolition and reconstruction of
the undamaged part of a covered
building or other structure, when that
building or other structure must be
totally demolished because of
damage by a Peril Insured Against to
another part of that covered building
or other structure; or
(3) The remodeling, removal or
replacement of the portion of the
undamaged part of a covered
building or other structure necessary
to complete the remodeling, repair or
replacement of that part of the
covered building or other structure
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.
c. We do not cover:
(1) The loss in value to any covered
building or other structure due to the
requirements of any ordinance or
law; or
(2) The costs to comply with any
ordinance or law which requires any
"insured" or others to test for,
monitor, clean up, remove, contain,
treat, detoxify or neutralize, or in any
way respond to, or assess the effects
of, pollutants in or on any covered
building or other structure.
Pollutants means any solid, liquid,
gaseous or thermal irritant or
contaminant, including smoke, vapor,
soot, fumes, acids, alkalis, chemicals
and waste. Waste includes materials
to be recycled, reconditioned or
reclaimed.
This coverage is additional insurance.
F. Additional Coverages
11. “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.
b. The coverage described in 11.a. only
applies when such loss or costs are a
result of a Peril Insured Against that
occurs during the policy period and only if
all reasonable means were used to save
and preserve the property from further
damage at and after the time the Peril
Insured Against occurred.
c. Each Covered Loss:
$10,000 is the most we will pay for the
total of all loss or costs payable under
this Additional Coverage resulting from
any one covered loss.
d. Policy Aggregate
$20,000 is the most we will pay for the
total of all loss or costs payable under
this Additional Coverage for all covered
losses, regardless of the:
(1) Number of locations insured; or
(2) Number of claims made.
e. If there is covered loss or damage to
covered property not caused, in whole or
in part, by "fungi", wet or dry rot, or
bacteria, loss payment will not be limited
by the terms of this Additional Coverage,
except to the extent that "fungi", wet or
dry rot, or bacteria cause an increase in
the loss. Any such increase in the loss
will be subject to the terms of this
Additional Coverage.
This coverage does not increase the limit of
liability applying to the damaged covered
property.
SECTION I – PERILS INSURED AGAINST
We insure for direct physical loss to the property
described in Coverages A, B 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 “diminution in value”.
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.
SECTION I – CONDITIONS
J. 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.
The Insureds’, Leroy Kemp and Cheyshan Kemp, home was damaged by a windstorm (the “Loss”) on August 22, 2021. The claim was initially reported by the Insureds on or about October 18, 2021.
Universal’s Field Adjuster Matt Stancil inspected the Property on October 26, 2021. After the inspection, Heritage delayed providing the insured with a coverage decision. Universal took more than 90 days from receipt of the claim to issue a coverage determination. A claim must be paid or denied within 90 days after receipt of the claim and Universal failed to comply with this provision of the Florida Statutes 627.6131. Universal issued its coverage determination on October 20, 2023. The Insured contends that there is absolutely no reason to justify the delay in the adjustment of the loss.
The coverage determination states that Universal “must deny must deny coverage concerning the water damage to the interior of the dwelling portion of the claim. The wind damage to the roof applicable to the above referenced loss, is covered. However, the estimated cost of repair for the direct physical loss to property for the above-referenced claim does not exceed your applicable policy deductible of $2,500.00. Therefore, the Policy does not extend allowance for the claim. A copy of the estimate that forms the basis of the covered damage is enclosed for your review.”
The copy of the estimate that formed the basis of the coverage determination was prepared by Barrett Claims Management, Inc., an adjusting firm that Universal hired for utilization of an independent adjuster to inspect the property for damages related to the Loss. The estimate that Universal provided to the Insureds on October 20, 2023, totaled $683.62 and contained one line item labeled “Roofing Repair -Minimum Charge – Labor and Material.”
Matt Stancil is the Independent Adjuster that inspected the Loss on behalf of Universal and Barrett Claims Management, Inc. Mr. Stancil inspected the property on October 26, 2021, and also submitted his findings to Barrett Claims Management, Inc., on October 26, 2021. Matt Stancil prepared an estimate for damage he observed to the property during his inspection and submitted the same to Barrett Claims Management on October 26, 2021. However, the estimate that Mr. Stancil prepared was never produced to the Insureds. Instead, the estimate was altered and submitted to the Insureds. The altered estimate was then utilized by Universal to claim that the damages from the Loss did not exceed the policy’s $2,500 deductible, therefore resulting in a net payment to the Insureds of $0 for the Loss.
There is a blatant delay in providing a coverage determination as, per Universal’s own coverage determination letter, it relied upon the estimate of damages prepared by Barrett Claims Management, Inc., in making its determination, and the same was submitted to Universal on or about October 26, 2021, nearly two years prior to the coverage determination.
Further, Universal clearly and materially misrepresented facts of its investigation to the Insureds as it provided a substantively altered estimate of damages to the Insureds from the estimate that Matt Stancil was retained to prepare for Universal. The altered estimate was then used to underpay the Insureds for the Loss.
Thereafter, the Insureds retained Your Insurance Attorney PLLC ( the “Law Firm”) to further assist in the adjustment of the Loss due to the unsatisfactory settlement offers, improper investigative standards, and unreasonable delays on behalf of Universal. The Law Firm submitted a Letter of Representation to Universal on March 6, 2023.
The Policy of Insurance issued by Universal that insured the Loss required the Insureds to take action to mitigate damages. The insureds complied with their post-loss obligations by hiring Truview Mold, LLC to perform a mold assessment of the property in relation to the Loss. Truview Mold, LLC found mold growth on the ceilings of two bedrooms, the hallway, kitchen pantry, and garage ceiling – all locations where the property sustained roof leaks from the Loss. On April 26, 2023, the Law Firm provided the Mold Assessment documentation and an invoice for the mold assessment to Universal. Universal denied to pay for the mold assessment invoice.
Additionally, the insureds submitted a Sworn Proof of Loss to Universal through the Law Firm on August 1, 2023, affirming that the whole loss and damage at the time amounted to $97,868.10, based on an estimate of damages prepared by Leading Public Adjusters on behalf of the insureds.
To date, Universal has failed to issue payment for the Loss. It is clear that Universal has not attempted in good faith to settle the Loss when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward the insureds and with due regard for their interests.
To cure Universal’s bad faith claims handling of this particular claim, Universal can immediately tender to the insured’s payment under Coverage A of $97,868.10, “new money”, and $50,000.00 in attorney’s fees and costs.
Total Damages to resolve this entire CRN, conditioned on a release, is $147,868.10 exclusive of any pending invoices from TruView Mold, LLC.
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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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