Civil Remedy Notice of Insurer Violations
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Filing Number:     813553
Filing Accepted:  3/27/2025
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Complainant
Last/Business Name *  
BAILLIO   First Name   HELEN
Street Address * 1619 STANFORD ROAD
City, State Zip * GULF BREEZE, FL 32563
Email Address * N/A
Complainant Type: * Insured
Insured
Last/Business Name*   BAILLIO   First Name   HELEN
Policy # * 1501-2004-2345 Claim #* FL20-0142409-O920
Attorney
Attorney is Applicable
Last Name* ELIMELECH First Name * REBECCA Initial R
Street Address* 1500 N.E. 162ND ST.
City, State Zip* MIAMI , FLORIDA 33162
Email Address * RELIMELECH@ILGPA.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):* N/A
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
* Statutory provision(s) which the insurer allegedly violated.
 
624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
624.155(1)(b)(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.
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
* 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". B. Coverage B – Other Structures 1. We cover other structures on the "residence premises" set apart from the dwelling by clear space. This includes structures connected to the dwelling by only a fence, utility line, or similar connection. D. 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". 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”. B. Coverage C – Personal Property We insure for direct physical loss to the property described in Coverage 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”. 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 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.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Helen Baillio (hereinafter the “Insured”), paid for a policy of insurance with Universal Property & Casualty Insurance Company (hereinafter, “Insurer”) bearing policy number 1501-2004-2345 (the “Policy”). The Policy provides coverage for damage to the Insured’s property located at 1619 Stanford Rd., Gulf Breeze, FL 32563 (the “Property”), including the significant damage that occurred as a result of Hurricane Sally on or about September 16, 2020 (the “loss”). Specifically, the Insured’s Property sustained substantial damage to the interior and exterior of the home as well as to her personal property. There was an extensive ceiling leak and damage, structural shifting, cracking in the floors, and sinking of some floors. There was damage to the outside walls, the boat port and the outside deck. The Insured promptly reported their claim to the Insurer. On October 9, 2020, the Insurer sent a letter to the Insured advising that the damages to the Property totaled $157.34 for coverage A dwelling and $203.29 for coverage C contents for a grand total of $360.63. On October 10, 2020, the Insurer issued checks in the same amounts of $157.34 and $203.29. The Insured subsequently contacted the United Damage Adjusters, who conducted a thorough inspection of the property and compiled an estimate of damages. United Damage Adjusters, on behalf of the Insured, forwarded said estimate which fully detailed the Insured’s damages and total $127,150.62. However, the Insurer refuses to resolve the Insured’s claim and pay for all damages to the Property. The Insurer’s conduct is in bad faith and violates Florida’s statutes concerning the adjustment of insurance claims. First, Florida Statute § 624.155(1)(B)(1) requires good faith in the settlement of claims. The Insurer is in violation of this Statute for failing to provide a reasonable repair estimate. What is more, the Insurer violated Florida Statute § 624.155(1)(b)(3) by failing to promptly settle the claim, when the obligation to settle the claim became reasonably clear. Again, the Insurer failed to make a good faith offer to settle this claim and failed to account for the full scope of the damage. They failed to respond to the estimate provided by United Damage Adjusters, on the Insured’s behalf, in a timely manner. They are obligated to provide coverage for all damages to the Insured’s Property, and not attempt to resolve this claim with lowball offers. Additionally, the Insurer’s conduct violates Florida Statute § 626.9541, which prohibits unfair settlement practices. More specifically, the Insurer has violated Florida Statute § 626.9541(1)(i)(3)(a) by failing to adopt and implement standards for the proper investigation of claims. Further, the Insurer has violated Florida Statute § 626.9541(1)(i)(3)(c) by failing to acknowledge and act promptly with the Insured and its counsel. As mentioned above, the Insurer failed to account for the full scope of the damage and has additionally failed to respond to the estimate provided by United Damage Adjusters, on behalf of the Insured, in a timely manner, delaying the resolution of this claim. Had the Insurer done so, it would have immediately settled this claim on a fair and reasonable basis and provided full coverage to its Insured. Therefore, to cure the defects outlined in this Civil Remedy Notice, the Insurer must: (1) create and implement adequate guidelines for the proper investigation and evaluation of claims and for the training and supervision of employees, which will avoid future statutory violations and avoid this from occurring in the future; (2) immediately tender all insurance proceeds due and owing its Insured under the Policy in the amount of $127,150.62 (less the deductible and any prior payments), plus all statutory interest; (3) act fairly and honestly towards its Insured and with due regard for her interests in attempting to settle their Insured’s claim; (4) hold the claim open in the event that its errors and delay does or may cause the Insured to suffer either further loss and/or damage; and, (5) stipulate to the Insured’s entitlement to attorney’s fees and court costs pursuant to Florida Statutes §§ 627.428 and 626.9373. Acknowledgment This notice is given in order to perfect the right to pursue the civil remedy authorized by Florida Statutes section 624.155, should Universal Property & Casualty Insurance Company fail to cure the violations set forth in this Civil Remedy Notice within the given cure period.
Comments
User Id Date Added Comment
lsolis@gspalaw.com 04-23-2025 April 23, 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.: 813553 Filing Date 3/27/2025 Complainant: Helena Baillio Insured: Helena Baillio Claim No.: FL20-0142409-O920 Policy No.: 1501-2004-2345 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 Rebecca R. Elimelech, Esq., on behalf of Complainant, Helena Baillio. The Notice alleges violations of Florida Statutes Sections 624.155, and 626.9541, Florida Statutes. Universal denies that it violated these or any statutes, Florida law or policy provisions regarding the claim adjudication 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, Florida Statute §624.155 and Florida law. The Notice filed by the Insured is deficient as a matter of law as it fails to comply with Fla. Stat. §624.155. See 316, Inc. v. Maryland Cas. Ins. Co., 526 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 § 624.155(3)(b), Fla. Stat., 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 created form DFS-10-363, which lays out 15 requirements that the Complainant(s) must respond to with specificity. The Florida Supreme Court holds that Fla. Stat. § 624.155 “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(s) has specifically complied with all statutory requirements. Pin-Pon Corp. v. Landmark American Ins. Co., 2020 WL 6588379 (S.D. 2020); Julien v. United Property & Casualty Ins. Co., 2021 WL 824438. The Notice is defective on several grounds. First, the Notice fails to comply with form DFS-10-363 in that it fails to provide the electronic mailing address of the Complainant. Instead, the Notice states; “N/A”. As submitted, the Notice is not properly complete, as it does not provide available and required information for the designated fields. As such, the Notice is defective as a matter of law. Second, 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. The Notice states: “N/A”. The Notice lacks the requisite specificity as required by Fla. Stat. § 624.155 in that the Notice fails to specify the knowledge and/or involvement of any individual with the alleged violations. In order to comply with the requirements of Fla. Stat. § 624.155, 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. Third, the Notice fails to satisfy Fla. Statute § 624.155(3)(b)(4), in that it fails to reference specific policy language relevant to the alleged violation. The Notice does not reference any specific policy language. Instead of the required provisions, the Notice states: 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". B. Coverage B – Other Structures 1. We cover other structures on the "residence premises" set apart from the dwelling by clear space. This includes structures connected to the dwelling by only a fence, utility line, or similar connection. D. 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". 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”. B. Coverage C – Personal Property We insure for direct physical loss to the property described in Coverage 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”. 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 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. General, vague and overbroad references to an entire policy generally does not satisfy the specificity required by § 624.155(3)(b)(4), Fla. Stat. In particular, the Notice does cites provisions under the Policy, but fails to provide the complete policy language. As such, the Notice is deficient as a matter of law. See Julien v. United Property & Casualty Ins. Co. 2021 WL 824438. Fourth, the Notice fails with respect to its requirement to specify how Universal may “cure” the alleged violations. The purpose of a Civil Remedy Notice is to provide a carrier with one last opportunity to “cure” the alleged violations. In this instance, the only real “cure” that the Notice is seeking is full payment of a random sum unilaterally determined by Plaintiff, notwithstanding Universal’s right to investigate and adjust the loss. 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). The Notice does not serve this purpose. Specifically, the Notice does not provide a proper means whereby Universal can “cure” the alleged defects, short of paying additional benefits which are not due and owing. This failure to provide a proper opportunity to cure renders the Notice improper. Longpoint Condominium Associations v. Allstate Insurance Co., 2005 WL 131580 (N.D. Fla. June 2, 2005). Moreover, the method for curing the violations alleged in a civil remedy notice are not determined by the insured. In Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So.2d 1278 (Fla. 2000), the Florida Supreme Court accepted and quoted the reasoning of the court below in its opinion which stated in relevant part, as follows: Section 624.155 does not impose on an insurer the obligation to pay whatever the insured demands. . . . Section 624.155(2)(d) would have no effect or purpose under such an interpretation. The law does not support such an expansive and illogical reading of Fla. Stat. Ann. §624.155(2)(d). . . . To cure an alleged violation and to avoid a civil action, an insurer must pay the claim . . . before the sixty days expire. Talat, 753 So2d at 1282 citing Talat Enterprises Inc. v. Aetna Cas. & Sur. Co., 952 F.Supp. 773, 777-778 (M.D. Fla. 1996). In addition, the Notice seeks remedies that are “extra-contractual”. Specifically, the Notice includes a request to “create and implement adequate guidelines for the proper investigation and evaluation of claims and for the training and supervision of employees…”; for “all statutory interest” and “to act fairly and honestly …” A demand for a cure is properly limited to the four corners of the policy and thus the extra-contractual demands render the Notice insufficient on its face. In fact, the Florida Supreme Court has recognized that a Civil Remedy Notice is invalid if the curative action demands more than the payment of contractual benefits under the insurer’s policy. See, Talat Enterprises, Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). Subsequent to Talat, Florida courts, and federal courts applying Florida law, reaffirmed the rule articulated in Talat. See, Do v. Geico Gen. Ins. Co., 1:17-CV-23041-JLK, 2019 WL 331295, at *1 (S.D. Fla. Jan. 25, 2019) (finding that a plaintiff’s Civil Remedy Notice was invalid as a matter of law because the curative actions demanded did not concern payment of contractual benefits owned under the insurer’s policy). Here, Universal properly adjusted the claim and issued payment, after application of the deductible, for the undisputed damages. The Insured has not produced evidence the Insureds are entitled to the damages demanded. For the aforementioned reasons, the Notice is insufficient as a matter of law. Nonetheless, the following shall provide you with the accurate facts and circumstances regarding this matter, which shall demonstrate that Universal has not violated any Policy or statutory provisions. Universal issued Policy Number 1501-2004-2345 for the period of June 24, 2020, through June 24, 2021, to the Insured for the real property located at 1619 Stanford Rd, Gulf Breeze, Florida 32563 (the “Insured Property”). On September 22, 2020, the insured reported “roof damage. deck damage. piece of wood siding damage. glass door damage” allegedly occurred on September 16, 2020. Universal immediately assigned the loss Claim Number FL20-0142409-O920 and assigned a field adjuster to handle the property inspection for the claim. Universal’s field adjuster inspected the Insured Property on September 29, 2020. On October 9, 2020, after taking in consideration the applicable deductible and recoverable depreciation Universal issued payment to the Insured for the undisputed amount of $157. 34, under Coverage A, and $203.29, under Coverage C. On March 5, 2021, Universal received an estimate prepared by America Property Claims, of $62,871.35 (RCV). On August 2, 2021, Universal received the insured’s sworn proof of loss and a second estimate prepared by America Property Claims of $82,296.24. However, on September 13, 2022, Universal received a third estimate prepared by United Damage Adjusters of $118,318.90 (RCV). On November 15, 2022, Universal sent a letter to the insured informing Universal had issued payment to JD Restorations Inc, in the amount of $7,654.74. On July 7, 2023, the insureds’ counsel filed notice of intent to initiate litigation against Universal. Universal sent letter to the insureds’ counsel extending a pre-suit settlement offer on July 18, 2023. The Insured had not submitted any additional documentation to rebut Universal’s evaluation. The Insured without the statutorily required notice of intent filed suit against Universal on December 19, 2022. Universal received notice of service of process of the Insured’s Complaint on December 20, 2022. While an insurance company is required to settle claims that should be settled, it is not required to settle claims that are legitimately contested. Florida law continually affirms the principle that an insurer has the right to investigate claims presented for payment. An insurance company is expressly afforded an opportunity to evaluate its rights and liabilities. Universal stands behind its determination on the alleged claim and maintains the Insureds’ claim was properly investigated and adjusted in good faith. The Notice lists: “Claim Delay, Unsatisfactory Settlement Offer, and Unfair Trade Practice” as “Reasons for Notice”. The Notice also alleges a violation to the following statutory provisions: 624.155(1)(b)(1); 624.155(1)(b)(3); 626.9541(1)(i)(3)(a); and 626.9541(1)(i)(3)(c), F.S. After reviewing the Civil Remedy Notice, Universal conducted a thorough review of its handling of the Insured’s claim. First, Universal denies each reason listed in the Notice. Second, Universal denies that it violated any statutes, administrative code provisions, or ethical rules or obligations in connection with its investigation and handling of the Insured’s claim. Similarly, Universal unequivocally denies each and every allegation asserted in the Civil Remedy Notice. Universal asserts it has complied with all policy provisions and applicable Florida law regarding the adjudication of this claim to date. We trust that the foregoing is sufficient to advise you of Universal’s position with regard to this matter and fully responds to the alleged violations in the Notice filed by the Complainant. Very truly yours, SALMON & SALMON, P.A. /s/ Laura Solis, Esq. Laura Solis, Esq. For the Firm cc: Via email only Rebecca R. Elimelech, Esq. relimelech@ilgpa.com
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