Filing Number: 811196
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| Filing Accepted: 3/14/2025 |
| Last/Business Name
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| Street Address
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1034 BIG TORCH ST. |
| City, State Zip
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RIVIERA BEACH,
FL
33407
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| Email Address
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WITHHELD |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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AHAMED |
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First Name |
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KAZI |
| Policy # * |
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1501-1803-0216 |
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Claim #* |
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FL24-0111509-A322 |
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Attorney is Applicable
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| Last Name* |
DANIELS
First Name *
MONICA
Initial
E
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| Street Address* |
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560 VILLAGE BOULEVARD, SUITE 110 |
| City, State Zip* |
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WEST PALM BEACH
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FLORIDA
33409
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| Email Address * |
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MDANIELS@THEDANIELS-LAWGROUP.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):*
GERRI DETOMMASO, MICHAEL MCDOWELL, AND ANY AND ALL OTHER ADJUSTERS, MANAGERS, SUPERVISORS, AND INDIVIDUALS ASSOCIATED WITH THE CLAIM.
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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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Unfair Trade Practice
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Unsatisfactory Settlement Offer
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Claim Denial
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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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| 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
F. Additional Coverages
2. Reasonable Emergency Measures
c. If, however, form UPCIC 201 15 is a 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.
SECTION I – PERILS INSURED AGAINST
A. Coverage A – Dwelling And Coverage B –
Other Structures
1. We insure against direct physical loss to
property described in Coverages A and B.
However, loss does not include and we will not
pay for any “diminution in value”.
SECTION I – CONDITIONS
J. Loss Payment
We will adjust all losses with you.
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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.
Kazi Ahamed (the “Insured”) purchased an insurance policy from Universal Property & Casualty Insurance Company (“Insurer”), with Policy number 1501-1803-0216 (the “Policy”), to cover property located at 1034 Big Torch St., Riviera Beach, FL 33407 (the “Property”). On September 28, 2022, Hurricane Ian struck the Property. The excessive winds from Ian caused overwhelming damage to the roof of the Property—necessitating a complete replacement of same—as well as to various portions of the interior, which require repairs in the following areas to return the Property to its pre-loss condition: garage, bedroom, living room, and dining room. The Insured reported the loss to Insurer, mitigated the damages, complied with all applicable post-loss obligations. He also retained a public adjuster to guide him through this difficult time.
The Insurer acknowledged the loss and assigned claim number FL24-0111509-A322 (the “Claim”) as well as claims adjuster Gerri DeTommaso. The Insurer ultimately inspected the Property through field adjuster Michael McDowell to evaluate the damages, who prepared a woefully deficient initial estimate that failed to address the full scope of damages and repairs necessary to return the Property to its pre-loss condition. The Insurer’s evaluation of the Property’s loss was insultingly barren given the observable damages and incurred costs of the Insured.
The Insured’s public adjuster promptly provided the Insurer with a true and accurate estimate of the damages, extensive photographs of the damage, an executed Sworn Proof of Loss, opened the Property for inspection, and complied with all of the Insurer’s requests for information and documentation However, despite providing all documentation to the Insurer, the Insurer failed to take action to adequately evaluate the Claim and provide just compensation to the Insured for the Property. The Insurer ultimately acknowledged coverage and admitted liability for ensuing damages to the Property, along with roof repairs. The Insured disputes that the amount unilaterally determined by the Insurer is sufficient to restore the Property to its pre-loss condition. Namely, the Insurer seemingly miscalculated the roof repairs as 16 tiles as opposed to 16 squares given that the Insurer estimated 16 squares of roofing felt and modified bitumen. However, the roof tiles were inaccurately estimated at 16 roof tiles instead of 16 roof squares, which has led to the Insurer grossly undervaluing the Claim.
The Insured understandably became extremely frustrated by the Insurer’s clear delay tactics, failure to properly indemnify him for this Claim in a timely fashion, and failure to adjust the Claim in good-faith. To combat any further attempts by the Insurer to delay the Claim and its failure to make the Insured whole, the Insured had no choice but to retain legal counsel to assist with the Claim. Without sufficient funds to repair his property, the Insured may continue to suffer additional damages. Despite providing all necessary documentation to the Insurer to make good on its duty to restore the Property to its pre-loss condition, Insurer grossly undervalued the claim and only contemplated a fraction of the amount of Insured’s damages. The scope of damages considered by the Insurer is an insult to the Insured and is far less money than necessary to complete the repairs to the Property.
The Insurer’s refusal to properly investigate, adjust, and fully compensate the Insured for this Claim undoubtedly evidences the Insurer’s violation of Section 626.9541(1)(i)(3)(a), Florida Statutes, which requires the Insurer to “adopt and implement standards for the proper investigation of claims.” All available information leads to one conclusion – the Property was damaged by a covered cause of loss for which the Insured is entitled to full and complete compensation. The Insurer’s obligation to promptly settle the Insured’s claim is undeniable, and therefore, the Insurer has also violated Fla. Stat. Section 624.155(1)(b)(1) and 624.155(1)(b)(3).
The Insurer’s conduct continues to be egregious because the Insurer retained biased and inexperienced individuals who approached the loss with an eye towards underpayment. The actions taken by the Insurer in the handling and adjustment of the Claim are willful, wanton, and in disregard for the rights of the Insured, and have occurred with such frequency as to indicate a general business practice in violation of the law. This practice includes the Insurer hiring biased and inexperienced adjusters and failing to properly and timely pay for obvious damages owed to its Insured. The Insurer’s actions amount to, but are not limited to:
A. “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 the insured and with due regard for her or his interests;”
B. “Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue”;
C. “Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear;”
D. “Failing to adopt and implement standards for the proper investigation of claims;”
E. Claim Delay;
F. Unsatisfactory Settlement Offers; and
G. Unfair Trade Practices.
In addition to the above statutory violations, the Insurer’s adjuster violated the following ethical requirements of the Florida Administrative Code 69B-220.201:
(3) Code of Ethics . . . 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:
(b) An adjuster shall treat all claimants equally.
2. An adjuster shall adjust all claims strictly in accordance with the insurance contract.
(c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured.
(d) An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.
(e) An adjuster shall handle every adjustment and settlement with honesty and integrity, and allow a fair adjustment or settlement to all parties without any remuneration to himself except that to which he is legally entitled.
(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.
(o) An adjuster shall not undertake the adjustment of any claim concerning which the adjuster is not currently competent and knowledgeable as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster’s current expertise.
To summarize, the Insured is a dutiful policyholder who made it a priority to pay his insurance premiums and to ensure that in such an event as the one here, his property would be covered. The Insured timely filed a claim and fulfilled all post-loss obligations. Insurer acknowledged the loss, assigned a claim number, and then improperly evaluated the claim. Insurer has failed to provide the Insured with qualified representatives to ensure the claim was initially adjusted, evaluated, and paid properly. To deny the Insured the benefit of the bargain after he satisfied all obligations is morally and ethically reprehensible, and reeks of Unfair Trade Practice. Insurer is putting its profits ahead of its contractual and statutory obligations.
In Florida the work of adjusting insurance claims engages the public trust. The Insurer has failed to create and implement adequate guidelines for proper investigation to evaluate claims handling and for training and supervision of employees. The Insurer has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s insurance claim and damages. Therefore, the Insurer breached its statutory and ethical duties, and has put profits ahead of the duties it owed to its Insured when he most needed the insurance coverage he had paid for.
Florida Statute § 624.02 defines “insurance” as a contract where one undertakes to indemnify another or pay or allow specified amounts, or determinable benefit, upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly. This timely and prompt payment allows the insured to mitigate their damages and place them back to the position they were in prior to the loss, as quickly as possible. The Insurer breached this duty. The Insurer has refused and failed to tender all insurance proceeds to the Insured upon demand. The Insurer’s refusal and/or failure to settle the insurance claim when it, under all circumstances, should have done so, is wrongful conduct. The Insurer is failing to promptly settle the Insured’s claim as it is required to do so by contract, in order to influence settlements.
To cure the defects outlined in this civil remedy notice, the Insurer must (1) immediately, and under no circumstances no later than sixty (60) days from the date of this civil remedy notice, tender all insurance monies due and owing to the Insured, specifically $127,718.89 under, which is the amount of the insured’s Dwelling estimate, second tarp estimate, and EMS estimate, less prior payment and deductible; (2) ensure that payment made would be adequate to place the Insured back in his pre-loss condition, minus all appropriately applicable deductibles; and (3) reimburse the Insured’s attorney’s fees and costs, since the Insured was forced to hire legal counsel in order to receive adequate payment. Should the Insurer fail to comply with the demands set forth in this civil remedy notice, the Insurer must prepare to pay the full cost of its failure to rightfully indemnify the Insured, including all future damages that come about as a result of the Insurer’s failure to comply with the demands set forth in this civil remedy notice, including but not limited to payment of policy limits should the Insured’s property become structurally unsound as a result of the Insurer’s refusal to adhere to the terms of its own policy. This Notice is given in order to perfect the right to pursue the civil remedy authorized by section 624.155(3)(b), Florida Statutes.
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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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