Civil Remedy Notice of Insurer Violations
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Filing Number:     813722
Filing Accepted:  3/28/2025
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Complainant
Last/Business Name *  
ROTH   First Name   MICHAEL & IVY
Street Address * 850 NW 118 AVENUE
City, State Zip * PLANTATION, FL 33325
Email Address * ERIK@DIENERFIRM.COM
Complainant Type: * Insured
Insured
Last/Business Name*   ROTH   First Name   MICHAEL & IVY
Policy # * 1501-1403-8839 Claim #* FL21-0115995
Attorney
Attorney is Applicable
Last Name* DIENER First Name * ERIK Initial D
Street Address* 5599 S. UNIVERSITY DR. #305
City, State Zip* DAVIE , FL 33328
Email Address * ERIK@DIENERFIRM.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):* UNKNOWN
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unsatisfactory Settlement Offer
Unfair Trade Practice
Claim Delay
Other : Failure to pay interest required by section 627.70131, F.S.
* 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.
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.
626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

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: . . . 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.
 
* 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 suffered a vehicle impact loss to their home on April 21, 2021. The home sustained significant damage to its walls, ceilings, floors, windows, and roofing system resulting in the City of Plantation declaring the home an “Unsafe Structure” on April 22, 2021. The insureds reported a claim to Universal Property & Casualty Insurance Company on April 26, 2021, after confirming the at fault driver did not have sufficient insurance coverage to cover the loss. Universal did not retain an architect, engineer, or contractor to evaluate the damage but assigned field adjuster Derick Garcia. Mr. Garcia graduated from college with a bachelor’s degree in business administration and management and sports management in 2020 and became licensed as an all-lines adjuster on March 1, 2021, which was less than two months prior to the subject loss. Mr. Garcia inspected the loss on May 11, 2021. Universal wrote the insureds on May 13, 2021, demanding the insureds comply with their policy obligation to provide documents. Specifically, Universal demanded that the insureds provide a structural engineer report and a contractor estimate or contract. The insureds hired and paid professional engineer John Pepper of Pepper Engineering a/k/a PE Group Consulting Engineers, Inc., to provide the structural engineering report demanded by Universal. Mr. Pepper, who primarily works for insurance companies as opposed to insureds, prepared a report dated June 4, 2021. The insureds uploaded the Pepper Engineering report, photographs, and email/invoice to Universal’s claim document submission website on June 8, 2021. Universal mailed a $25,000 undisputed payment on July 26, 2021, after applying the policy’s $2,500 deductible. This payment was mailed 91 days after Universal was notified of the vehicle impact loss that is undeniably covered under the subject policy. Universal did not include an estimate or otherwise explain how it determined the loss was only worth $27,500 before applying the policy deductible. $25,000 is the exact amount of the at fault driver’s insurance coverage for the accident, which Universal eventually collected from the at fault driver’s insurance carrier on October 18, 2021. Universal did not include interest as required by section 627.70131(5)(a), F.S. (2021). Universal ignores its obligation to pay interest under section 627.70131(5)(a) as a regular business practice. Universal mailed a second undisputed payment on October 15, 2021, for $27,166.07. Once again, Universal did not include interest as required by section 627.70131(5)(a), F.S. (2021), in accordance with Universal’s bad faith business practice of ignoring its obligation to pay interest under section 627.70131(5)(a). This payment was accompanied by a $65,916.09 RCV / $55,905.98 ACV estimate prepared by Universal adjuster Leonardo Pimentel but had Mr. Garcia’s name on it instead of Mr. Pimentel’s name, which does not appear anywhere on the estimate. The estimate is dated October 7, 2021, which was approximately five and a half months after Universal first received notice of this covered loss involving structural damage to the insureds’ home on April 26, 2021; five months after Mr. Garcia inspected the loss on May 11, 2021; and three months after Mr. Pimentel inspected the loss on July 9, 2021. Mr. Pimentel testified under oath that he did not know whether the home had structural damage after he completed his inspection or before he prepared his estimate despite obvious structural damage, a bright sticker from the City of Plantation labeling the dwelling an “Unsafe Structure”, and the Pepper engineering report that the insured uploaded to Universal’s website on June 8, 2021, clearly identifying structural damage. Mr. Pimentel arbitrarily applied 30% depreciation to all building materials with the exception of two-line items for roof to wall flashing and roof valley flashing, to which he applied 7% and 12.5% depreciation, respectively. Mr. Pimentel testified in deposition that he did not know why he applied 7% and 12.5% depreciation to the flashings. Mr. Pimentel did not allow overhead or profit for the roof replacement contained in his estimate even though a licensed roofing contractor is necessary to replace a roof and Florida law requires overhead and profit to be included in an insurer’s ACV payment. See Goff v. State Farm Florida Insurance Company, 999 So.2d 684, 689 (Fla. 2 DCA 2008) and Trinidad v. Florida Peninsula Ins. Co., 121 So.3d 433, 443 (Fla. 2013). Mr. Pimentel's estimate failed to include line items for open and obvious damage that was pointed out to him and Universal in the Pepper Engineering report. Mr. Pimentel testified that he did not review the Pepper Engineering report Universal made the insureds pay for and provide to Universal prior to completing his estimate. Mr. Pimentel emailed the insured on December 17, 2021 confirming that Mr. Pimentel had the Pepper Engineering report that the insured uploaded to Universal's website on June 8, 2021. Mr. Pimentel's estimate did not contain any line items/benefits to repair of the roof truss damage described in the Pepper Engineering report. Mr. Pimentel's estimate did not contain any line items/benefits to repair the open an obvious soffit damage caused when part of the support column the vehicle struck flew up and penetrated the soffit and roof. Mr. Pimentel's estimate did not contain any line items/benefits to repair the electrical wiring or to replace the light fixture that was located on the column destroyed by the vehicle impact. Mr. Pimentel and Universal routinely fail to allow contractor overhead and profit in estimates under circumstances where it is necessary to hire a contractor to perform repairs as a business practice to save money by underpaying insureds. Mr. Pimentel and Universal routinely under scope losses as a business practice to save money by underpaying insureds. These routine business practices are clearly evidenced by the estimates prepared in this claim by Universal adjusters Leonardo Pimentel, Kevin Chernoff, and Nancy Lipscomb, none of which include contractor overhead and profit for the roof replacement, which cannot be completed without a licensed roofing contractor. These routine business practices are clearly evidenced by the estimates prepared in this claim by Universal adjusters Leonardo Pimentel, Kevin Chernoff, and Nancy Lipscomb, all of which ignore open an obvious damage caused by the vehicle impact. Universal mailed the insureds a third check in reimbursement of the insured’s $2,500 deductible on November 11, 2021. Once again, Universal did not include interest as required by section 627.70131(5)(a), F.S. (2021), in accordance with Universal’s bad faith business practice of ignoring its obligation to pay interest under section 627.70131(5)(a). The insureds provided Universal a contractor estimate from Wareham Construction on December 16, 2021. Wareham Construction is a vendor of Universal Property & Casualty Insurance Company that prepares comparative estimates for Universal on disputed claims. Universal never paid the Wareham Construction estimate and never advised the insureds of any disagreements with the Wareham Construction estimate. Universal advised the insureds that Universal would try to come to an agreement with Wareham Construction on the scope of repairs but never did. Wareham Construction abandoned the insureds and refused to take the job because Universal would not agree with Wareham Construction's estimate/scope of repairs. Neither Wareham Construction nor Universal ever advised the insureds what repairs were in dispute. The Wareham Construction estimate is the lowest estimate to return the home to its pre-loss condition the insureds were able to obtain from any contractor. All other contractor estimates to return the home to its pre-loss condition were higher than the Wareham Construction estimate and provided to Universal prior to the insureds filing suit. Universal never responded to any of the contractor estimates provided by the insureds and never advised the insureds of any disputes with any of the contractor estimates. Universal has not obtained any contractor estimates of its own. Universal had its employees Kevin Chernoff and Nancy Lipscomb prepare comparative estimates after receiving the Wareham Construction estimate. Both Chernoff and Lipscomb's estimates were significantly higher than Universal's undisputed estimate prepared by Pimentel. Universal never provided either of its comparative estimates to the insureds pre-suit, nor did Universal ever issue additional payment based on the comparative estimates. Universal never advised the insureds of the existence of the comparative estimates so the insureds could try to find a contractor willing to repair the insured property for the amounts of the comparative estimates. Universal failed 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. Specifically, Universal failed to respond to the contractor estimates provided by the insureds and failed to advise the insureds of any disagreements with any of the contractor estimates Universal was provided. Universal failed to adopt and implement standards for the proper investigation of claims. Specifically, Universal failed to adopt and implement standards for determining when overhead and profit is owed and failed to adopt and implement standards for paying interest owed pursuant to section 627.70131(5)(a), F.S. Universal failed 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. Universal also failed to promptly notify the insured of any additional information necessary for the processing of their claim and failed to clearly explain the nature of the requested information and the reasons why such information is necessary. Specifically, Universal failed to notify the insureds in writing of Universal's disagreements with the contractor estimates provided by the insured, failed to clearly explain what information the insureds needed to provide to obtain additional payment, and failed to clearly explain why additional information was needed to obtain additional payment. Universal "hid the ball" by preventing the insureds from knowing the truth or Universal's intentions. Universal denied the insureds' claims for additional payment without conducting reasonable investigations based upon available information. Specifically, Universal ignored the Pepper engineering report Universal made the insureds purchase and supply Universal and ignored the insureds' requests for additional payment. Universal also ignored the insureds' requests for Universal's agreement to authorize and/or pay for the repairs in the contractor estimates the insureds provided to Universal. Universal failed to acknowledge and act promptly upon communications with respect to claims by failing to respond to the contractor estimates provided by the insureds pre-suit. In addition to the Wareham Construction estimate, the insureds provided several other contractor estimates that were all higher than the Wareham Construction estimate. Universal never responded to the contractor estimates. Specifically, Universal never advised of disagreements with the estimates, nor did Universal agree to pay or authorize the repairs in the contractor estimates. Universal failed to attempt in good faith to settle the insureds' claims when, under all the circumstances, Universal could and should have done so, had it acted fairly and honestly toward its insured and with due regard for their interests. It is Universal's routine business practice to severely underpay claims and to refuse to acknowledge or clearly respond to requests for additional payment. Universal puts pressure on its insureds to perform repairs with insufficient funds by increasing the premiums Universal charges to unaffordable amounts knowing the insureds cannot switch insurance companies and obtain alternative insurance without performing repairs with the insufficient benefits paid by Universal. If the insureds file suit, Universal blames its insureds for not hiring contractors and performing repairs despite the insureds' inability to pay contractors when payment is due. It is Universal's routine business strategy to put its insureds in the untenable position of having to choose between performing inadequate repairs with the insufficient amounts paid by Universal or risking foreclosure of a construction lien if the insureds hire a contractor to perform repairs for an amount they cannot pay without Universal paying the benefits it owes, which Universal will not agree to do absent prolonged litigation. It is Universal's business strategy to make its insureds suffer the inconvenience and dangers of living in damaged properties for years in the hopes the insureds find a way to make repairs with insufficient funds, sell their homes at a loss, lose their homes in foreclosure after being unable to switch property insurers or afford Universal's annual premium increases, or die. Universal can correct the foregoing violations by agreeing to pay the difference between its prior payments and Universal's determination of the actual cash value of the Wareham Construction estimate (which is the lowest contractor estimate received by the insureds to date) plus interest owed pursuant to section 627.70131(5)(a), F.S., after applying the policy deductible. Curing this civil remedy notice will not be deemed a complete and final settlement of the insureds' claims. The insureds reserve their rights to claim incurred replacement costs and their statutory claims for attorney fees and costs.
Comments
User Id Date Added Comment
jr0405@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.: 808559 Filing Date: 2/26/2025 Complainants: Michael & Ivy Roth Insureds: Michael & Ivy Roth Policy No.: 1501-1403-8839 Claim No.: FL21-0115995 Re: DFS File No.: 808573 Filing Date: 2/26/2025 Re: DFS File No.: 813722 Filing Date: 3/28/2025 Dear Sir/Madam: Please allow this to serve as Universal Property & Casualty Insurance Company’s (“Universal”) formal response to the above-referenced Civil Remedy Notices (“Notices”) filed by attorney, Erik Diener, on behalf of Complainants, Michael & Ivy Roth (also referenced as “Insureds.”) The Notices allege violations of Sections 624.155, 626.9541, and 627.70131, Florida Statutes. Universal specifically denies the allegations contained in the Notices. 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 Notices fail 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 Notices are deficient as a matter of law as they fail 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 Notices “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(s) 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(s) 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). All three Notices fail to meet the requirements of Fla. Stat. § 624.155 on several grounds. First, all three Notices fail 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. To comply with Sec. 624.155, Fla. Stat., the Complainant(s) must name the individual(s) involved with specificity related to the purported violation(s) to allow Universal to investigate the allegations. All three Notices lack the requisite specificity required by Sec. 624.155, Fla. Stat., because all three Notices state “UNKNOWN.” This clearly defeats the requirement in the DFS Forms to provide specificity to put the carrier on notice and provide an opportunity to investigate any allegations with a specific individual. All three Notices lack the requisite specificity as to whom the Complainants are asserting has knowledge as to any allegations in any of the Notices. Accordingly, Complainants’ Notices are insufficient as a matter of law. Second, all three Notices fail to satisfy Section 624.155(3)(b)(4), Florida Statutes, in that they fail to reference specific policy language relevant to any alleged violation. Instead of identifying specific policy language the Complainants believe is relevant to any alleged violation, the Complainants broadly reference policy provisions but fail to specify how the purported cited language applies to the alleged violations. The Complainants’ broad reference to policy provisions provides no guidance or explanation, such that Universal is left to wonder what policy provisions Complainants believe were allegedly violated or breached and why. It is therefore unclear as to what, if any, policy language pertains to any purported allegation or how it relates to the allegations. General, vague, or overbroad references to policy provisions does not satisfy the specificity required by Section 624.155(3)(b)(4), Florida Statutes. As such, the Notices are deficient as a matter of law. See generally Julien v. United Property & Casualty Ins. Co. 311 So. 3d 875 (Fla. 4th DCA 2021). Third, regarding the requirement to set forth with specificity the “facts and circumstances giving rise to the violation,” all three Notices fail to specify sufficient facts that would put Universal on notice that it violated any policy provision or statute. The Notices assert general allegations consisting of inaccurate and conclusory statements rather than providing specific facts to support its allegations. For example, the “facts and circumstances” section of each Notice states “Universal ignores its obligation to pay interest under section 627.70131(5)(a) as a regular business practice.” The Complainants are required to provide with specificity the facts and circumstances giving rise to the alleged violation strictly related to Complainant’s allegations, not conjecture or speculation of what may be the carrier’s business practices. Notices 808559 and 808573 also allege “Universal routinely fails to allow contractor overhead and profit in its estimates under circumstances where it is necessary to hire a contractor to perform repairs as a business practice to save money by underpaying its insureds,” while Notice 813722 similarly alleges “…Universal routinely fail to allow contractor overhead and profit in estimates under circumstances where it is necessary to hire a contractor to perform repairs as a business practice to save money by underpaying insureds.” The Complainants once again fail to provide sufficient facts to support this conclusory and speculative statement. It is evident that the statement of facts in each Notice falls short of the specificity required by Sec. 624.155, Fla. Stat. As a result, the Complainants fail to comply with Sec. 624.155(3)(b)(2), Fla. Stat. Lastly, the Notices do not provide a proper means whereby Universal can “cure” the alleged defects. 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 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. Notably, the Complainants initiated litigation before filing any of the three Notices, thus there was no cure period available without Universal paying extra-contractual damages. Universal is only obligated to pay contractual amounts owed to cure a civil remedy notice. See id. at 1278. As such, all three Notices are legally deficient as they do not provide Universal an opportunity to “cure” any alleged violation without imposing obligations on Universal not contemplated by the Policy. In summary, as outlined above, the Complainants in all three Notices fail to respond to each of the fields set forth on the DFS Forms with the requisite specificity including, but not limited to, failing 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, failing to allege any specific conduct on the part of Universal that would violate any policy provision or statute, failing to reference specific policy language relevant to any alleged violation and failing to provide a cure as proscribed by Florida law. Therefore, all three of the Notices are legally deficient and fail 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 Notices are deficient as a matter of law. Nonetheless, and without waiving the above-referenced deficiencies, the following shall provide you with Universal’s response to each of the three Notices. On April 26, 2021, Universal was notified by Insured, Michael Roth, that the insured location was damaged on April 21, 2021. Universal inspected the property and documented any visible damage. Universal, in accordance with the terms and conditions of the Policy, issued payments to the Insureds. Under the terms of the Policy, Universal will initially pay at least the actual cash value of the insured loss, less any applicable deductible. It will then pay any remaining amounts necessary to perform such repairs as work is performed and expenses are incurred. On May 30, 2024, the Complainants initiated litigation against Universal in the Circuit Court in and for Broward County, under Case No. CACE-24-007546. Thus, at the time the three Notices were filed, the parties were and continue to litigate their disputes to determine what, if any, additional available coverage exists under the terms of the Policy. At no time has Universal breached any duty to its Insureds. An insurer is not required to pay whatever amount its insured demands. While an insurance company is required to settle claims that should be settled, it is not required to settle claims that are legitimately contested. As outlined above, the alleged statutory violations set forth in the Notices are devoid of factual support and are without merit. Therefore, the Notices are legally deficient and fail to satisfy the condition precedent to filing a bad faith action. We trust that the foregoing is sufficient to advise you of Universal’s position regarding this matter and fully responds to the Notices filed by the Complainants. Sincerely, /s/ Jonathan Rodriguez Jonathan Rodriguez, 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