Filing Number: 650350
|
| Filing Accepted: 10/6/2022 |
| Last/Business Name
*
|
|
|
SCOTT
|
|
First Name |
|
OLLIEDIANN |
|
| Street Address
*
|
|
9248 ROSEWATER LANE |
| City, State Zip
*
|
|
JACKSONVILLE,
FL
32256
|
| Email Address
*
|
|
WITHHELD |
| Complainant Type:
*
|
|
Insured |
|
| Last/Business Name* |
|
SCOTT |
|
First Name |
|
OLLIEDIANN |
| Policy # * |
|
HOH645722 |
|
Claim #* |
|
H46882 |
|
Attorney is Applicable
|
| Last Name* |
LEWIS
First Name *
ADAM
Initial
M
|
| Street Address* |
|
16578 NORTH DALE MABRY HWY |
| City, State Zip* |
|
TAMPA
,
FL
33618
|
| Email Address * |
|
ALEWIS@PLTLAWGROUP.COM |
|
|
| Insurer Type
*
|
|
 Authorized Insurer
 Unauthorized Insurer
|
|
|
| Insurer Name |
|
|
| Insurer Name* |
|
HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY
|
| Insurer Name* |
|
|
| Street Address* |
|
|
| City, State Zip* |
|
,
|
|
NAIC Company Code 14407 |
|
|
| Name of individual responsible for violation (if any):*
ROSEMARY MATHEWS, GARY ROWEN
|
| Type of Insurance
*
Residential Property & Casualty
|
|
|
| Reason for Notice
*
|
|
|
Claim Denial
|
|
|
Unsatisfactory Settlement Offer
|
|
|
Claim Delay
|
|
|
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.
|
|
| 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)(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.
|
|
*
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 ARE AS FOLLOWS:***
§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.
§Insurer’s duty to acknowledge communications regarding claims; investigation
(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.
FLORIDA ADMINISTRATIVE CODE SECTIONS & OTHER APPLICABLE STATUTES
Fla. Stat. §626.877 Every adjuster shall adjust or investigate every claim, dam-age, or loss made or
occurring under an insurance contract, in accordance with the terms and conditions of the contract and of the applicable laws of this state.
69B-220.201(3)(b)(2) An adjuster shall adjust all claims strictly in accordance with the insurance contract.
69B-220.201(3)(c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured.
69B-220.201(3)(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.
69B-220.201(3)(j) An adjuster shall not knowingly fail to advise a claimant of the claimant’s claim options in accordance with the terms and conditions of the insurance contract.
69B-220.201(3)(m) An adjuster shall not knowingly fail to advise a claimant of their rights in accordance with the terms and conditions of the contract and applicable laws of the state of Florida.
626.9744 Claim settlement practices relating to property insurance.—Unless otherwise provided by the policy, when a homeowner’s insurance policy provides for the adjustment and settlement of first-party losses based on repair or replacement cost, the following requirements apply:
(1) When a loss requires repair or replacement of an item or part, any physical damage incurred in making such repair or replacement which is covered and not otherwise excluded by the policy shall be included in the loss to the extent of any applicable limits. The insured may not be required to pay for betterment required by ordinance or code except for the applicable deductible, unless specifically excluded or limited by the policy.
(2) When a loss requires replacement of items and the replaced items do not match in quality, color, or size, the insurer shall make reasonable repairs or replacement of items in adjoining areas. In determining the extent of the repairs or replacement of items in adjoining areas, the insurer may consider the cost of repairing or replacing the undamaged portions of the property, the degree of uniformity that can be achieved without such cost, the remaining useful life of the undamaged portion, and other relevant factors.
(3) This section shall not be construed to make the insurer a warrantor of the repairs made pursuant to this section.
(4) Nothing in this section shall be construed to authorize or preclude enforcement of policy provisions relating to settlement disputes.
Reference specific policy language that is relevant to violation:
Based upon Scott’s best belief the following are relevant:
HPCH03 DEC1 01 19 –Law and Ordinance $87,500.00
HO-3 04 91 Homeowners 3 – Special Coverage
SECTION I – PROPERTY COVERAGES
COVERAGE A – Dwelling
We cover:
1. The dwelling on the "residence premises" shown in the Declarations,
including structures attached to the dwelling; and
2. 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."
This coverage does not apply to land, including land on which the dwelling is located.
HOMEOWNERS 3 SPECIAL FORM, HO 00 03 04 91, policy of insurance, as amended by SPECIAL PROVISIONS FOR FLORIDA, HPCHO3 09 SP 02 19
SECTION I – PERILS INSURED AGAINST
COVERAGE A – DWELLING and COVERAGE B – OTHER STRUCTURES
We insure against risk of direct loss to property described in Coverages A and B only if that loss is a physical loss to property. We do not insure, however, for loss:
…
2. Caused by:
…
e. Any of the following:
(1) Wear and tear, marring, deterioration;
(2) Inherent vice, latent defect, mechanical
breakdown;
…
If any of these cause water damage not otherwise
excluded or limited elsewhere in the Policy, from a
plumbing, heating, air conditioning or automatic fire
protective sprinkler system or household appliance,
we cover loss caused by the water, including the cost
to tear out and repair only that part or portion of a
building or other structure covered under COVERAGE
A or B, on the “residence premises”, necessary to
access the system or appliance.
(1) The cost that we will pay for the tear out and
repair of the part or portion of the building or
other structure covered under COVERAGE A or B
as specified above is limited to only that part or
portion of the covered structure or other
structure which is necessary to provide access to
the part or portion of the system or appliance
that caused the covered loss, whether the system
or appliance, or any part or portion of the system
or appliance, is repairable or not.
(2) In no event we pay for the repair or the
replacement of the system or appliance that
caused the covered loss.
f. Loss caused by constant or repeated seepage or leakage of
water or steam over a period of 14 or more days,
whether hidden or not, and results in damage such as
wet or dry rot, “fungi”, deterioration, rust decay or
corrosion.
…
h. To a plumbing system, whether above or
below the ground, caused by:
(1) Age, collapse, obsolescence, wear, tear;
(2) Fading, oxidation, weathering;
(3) Deterioration, decay, marring, delamination,
crumbling, settling, cracking;
(4) Shifting, bulging, racking, sagging, bowing, bending,
leaning;
(5) Shrinkage, expansion, contraction, bellying,
corrosion;
(6) The unavailability or discontinuation of a part or
component of the system; or
(7) Any other age or maintenance related issue;
i. To the plumbing system, whether above or below the
ground, caused by the impairment, state or condition of
the system, which prohibits repair or replacement
including access, necessary to connect the adjoining parts
of appliances, pipes or system.
***
HOMEOWNERS 3 SPECIAL FORM, HO 00 03 04 91as amended by SPECIAL PROVISIONS FOR FLORIDA, HPCHO3 09 SP 02 19
SECTION I – EXCLUSIONS, which states in part:
…
2. We do not insure for loss to property described in
Coverages A and B caused by any of the following.
However, any ensuing loss to property described in
Coverages A and B not excluded or excepted in this
policy is covered.
…
c. Faulty, inadequate or defective:
…
(2) Design, specifications, workmanship, repair,
construction, renovation, remodeling, grading,
compaction;
(3) Materials used in repair, construction,
renovation or remodeling; or
(4) Maintenance;
of part or all of any property whether on or off the
"residence premises."
HOMEOWNERS 3 SPECIAL FORM, HO 00 03 04 91, as amended by SPECIAL PROVISIONS FOR FLORIDA, HPCHO3 09 SP 02 19, under SECTION I – CONDITIONS, which states in part:
SECTION I – CONDITIONS
…
2. Your Duties After Loss.
In case of a loss to covered property, we have no duty to
provide coverage under this Policy if the failure to comply
with the following duties is prejudicial to us. These duties
must be performed either by you, an "insured" seeking
coverage, or a representative of either:
a. Give prompt notice to us or our agent; Except for
reasonable emergency measures taken under
SECTION I – Property Coverages, Reasonable
Emergency Measures, there is no coverage for repairs
that begin before the earlier of:
(1) 72 hours after we are notified of the loss;
(2) The time of loss inspection by us; or
(3) The time of other approval by us.
If you unreasonably deny us access to inspect the loss
during the period in a.(1) above, coverage for repairs
beyond reasonable emergency measures begins the
earlier of when we are given access to inspect the loss
or when we fail to appear at a scheduled loss
inspection.
…
d. Protect the covered property from further
damage. The following must be performed:
(1) Take reasonable emergency measures that are
necessary to protect covered property from
further damage, as provided under Additional
Coverage 2.
A reasonable emergency measure under d.(1)
above 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; and
(2) Keep an accurate record of repair expenses;
…
f. As often as we reasonably require:
(1) Show the damaged property;
(2) Provide us with records and documents we
request and permit us to make copies; and
(3) You or any “insured” under this policy must
submit to examination under oath and recorded
statements, which may be videotaped, and
which will be at the location insured if requested
by us, while not in the presence of any other
“insured” and sign the same.
(4) Your agents, your representatives, including any
public adjusters engaged on your behalf, and
anyone insured under this policy, other than an
“insured” in (3), must submit to examination
under oath and recorded statements, which may
be videotaped, and which will be at the location
insured if requested by us, while not in the
presence of any other “insured” and sign the
same.
g. Send to us, within 60 days after our request, your
signed, sworn proof of loss which sets forth, to
the best of your knowledge and belief:
(1) The time and cause of loss;
(2) The interest of the "insured" and all others
in the property involved and all liens on the
property;
(3) Other insurance which may cover the loss;
(4) Changes in title or occupancy of the
property during the term of the policy;
(5) Specifications of damaged buildings and
detailed repair estimates;
(6) The inventory of damaged personal property
described in 2.e. above;
(7) Receipts for additional living expenses
incurred and records that support the fair
rental value loss; and
h. At our request, provide to us or execute an
authorization which allows us to obtain on your
behalf, records and documentation we deem
relevant to the investigation of your loss.
…
The duties listed apply regardless of whether you, an
“insured” seeking coverage, or a representative of either
retains or is assisted by a party who provides legal advice,
insurance advice or expert claim advice, regarding an
insurance claim under this Policy.
HO 00 03 04 91
SECTION I – CONDITIONS
3. Loss Settlement
Covered property loses are settled as follows:
b. Buildings covered under Coverage A or B at
replacement cost without deduction for
depreciation, subject to the following:
(1). If, at the time of loss, the amount of
insurance in this policy on the damaged
building is 80% or more of the full
replacement cost of the building
immediately before the loss, we will pay the
cost to repair or replace, without deduction
for depreciation, but not more than the least
of the following amounts:
(a) The limit of liability under this policy that
applies to the building;
(b) The replacement cost of that part of the
building damaged for like construction and use on the same premises; or
(c) The necessary amount actually spent to
repair or replace the damaged building.
HPCH03 09 SP 02 19 pg. 10 of 14
10. Loss Payment.....
Florida Statute §626.9744 which is incorporated by law
|
| |
*
Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
In Florida, the work of adjusting insurance claims engages the public trust. Heritage Property & Casualty Insurance Company (Heritage) has breached this duty in the adjustment of Olliediann Scott’s (Scott) claim. Further, upon information and belief, Heritage has breached its duty against numerous insureds in the state of Florida who have sustained roof damage. This breach is a business model of attempting to avoid paying for valid roof claims. In doing so, Heritage has decided to ignore industry standards on repair-ability, repair factors, matching, building code issues and Florida law on concurrent damage and damage created by repairing a loss. Further, upon information and belief, Heritage either misrepresents and/or fails to fully inform their insureds of these rights and laws in an orchestrated scheme to underpay and deny roof claims.
Heritage has failed to adopt and implement proper standards for investigation, evaluation and adjustment of claims; has failed to properly train, manage, supervise and promote claims adjusters so that policy holder receives good faith, fair, prompt adjustment of claim, service and indemnity; has failed to conduct a full and fair investigation of the claim and has failed to provide full reasons and facts to the claimant for denial of the claim resulting in statutory violations as set forth in this notice.
Moreover, Heritage has engaged in unfair claim denial and claim delay; has used business or outcome oriented investigations and experts to determine the outcome of the claim; has wrongfully denied the claim without fully stating reasons and reserving unwritten reasons; has looked for ways to deny coverage, delay payment and otherwise “stonewall” the claim; and has used secret claims practices to reduce claim severity and profit from wrongful claims practices.
Specific Facts:
Scott’s claim results from damage to the roof of her home as the result of a storm that occurred on or about December 24, 2020. The storm is well known the Jacksonville area having occurred on Christmas Eve and produced substantial wind, hail, and flying debris. The storm damaged numerous roofs in Scott’s neighborhood and surrounding area. Following the storm, Scott had her roof inspected by a roofer to determine the cause and extent of damage. After the inspection the roofer advised that Scott’s roof sustained severe damage from the recent storm and was in need of replacement.
Scott reported the claim to Heritage on February 10, 2021 after becoming aware that she sustained damage that warranted an insurance claim. Heritage responded to the notification of the loss and damage by assigning claim number H46882, Rosemary Mathews as the desk adjuster to oversee the handling of the claim and Gary Rown as the field adjuster to inspect the reported loss. Heritage also issued a reservation of rights letter the date they received the claim which advised as follows:
“Dear Olliediann Scott:
We are writing you concerning the claim you reported to Heritage Insurance Company, Inc., on February 10, 2021, 49 days after the date of loss reported as December 24, 2020, for roof damage to our insured’s home from Wind. You submitted this claim under policy number HOH645722 effective November 14, 2020 to November 14, 2021.
In reviewing the coverage afforded under our insured’s policy for the damages you are claiming, we identified the following questions that may restrict, limit or preclude recovery of the damages reported:
• When the damages claimed first occurred.
• Whether the damages occurred as the result of a single event or multiple events.
• Whether the damages are the result of a sudden and accidental occurrence, long term exposure, or some other cause.
• Whether the damages claimed are covered under the policy.
• Whether our insured and / or their representatives complied with policy conditions.
At this time, we respectfully request that you allow access to our insured’s residence by a field adjuster, licensed Florida contractor, and/or a professional engineer, in order to perform a full site inspection and scope so that we may accurately assess the claimed damages. At this time, in keeping with the Duties under this policy we also respectfully request the following of our insured:
1. Please provide us an opportunity to obtain a recorded statement from our insured.
Contact Heritage Insurance Company with a date and time that best fits our insureds schedule.
2. Please ensure that our insured is present and available for any and all inspections.
3. Permit access to your residence by vendors we hire to investigate your loss including, but not limited to, leak detection technicians, water mitigation technicians, engineers, etc.
Please note that the HO-3 04 91 Homeowners 3 – Special Coverage policy of insurance is a contract between our insured and Heritage Insurance Company, Inc that contains the following provisions relevant to this claim:
SECTION I – PROPERTY COVERAGES
COVERAGE A – Dwelling
We cover:
1. The dwelling on the "residence premises" shown in the Declarations,
including structures attached to the dwelling; and
2. 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."
This coverage does not apply to land, including land on which the dwelling is located.
Please also direct your attention to the terms of the HOMEOWNERS 3 SPECIAL FORM, HO 00 03 04 91,
policy of insurance, as amended by SPECIAL PROVISIONS FOR FLORIDA, HPCHO3 09 SP 02 19, under
SECTION I – PERILS INSURED AGAINST, which states in part:
COVERAGE A – DWELLING and COVERAGE B – OTHER
STRUCTURES
We insure against risk of direct loss to property described
in Coverages A and B only if that loss is a physical loss to
property. We do not insure, however, for loss:
…
2. Caused by:
…
e. Any of the following:
(1) Wear and tear, marring, deterioration;
(2) Inherent vice, latent defect, mechanical
breakdown;
…
If any of these cause water damage not otherwise
excluded or limited elsewhere in the Policy, from a
plumbing, heating, air conditioning or automatic fire
protective sprinkler system or household appliance,
we cover loss caused by the water, including the cost
to tear out and repair only that part or portion of a
building or other structure covered under COVERAGE
A or B, on the “residence premises”, necessary to
access the system or appliance.
(1) The cost that we will pay for the tear out and
repair of the part or portion of the building or
other structure covered under COVERAGE A or B
as specified above is limited to only that part or
portion of the covered structure or other
structure which is necessary to provide access to
the part or portion of the system or appliance
that caused the covered loss, whether the system
or appliance, or any part or portion of the system
or appliance, is repairable or not.
(2) In no event we pay for the repair or the
replacement of the system or appliance that
caused the covered loss.
f. Loss caused by constant or repeated seepage or leakage of
water or steam over a period of 14 or more days,
whether hidden or not, and results in damage such as
wet or dry rot, “fungi”, deterioration, rust decay or
corrosion.
…
h. To a plumbing system, whether above or
below the ground, caused by:
(1) Age, collapse, obsolescence, wear, tear;
(2) Fading, oxidation, weathering;
(3) Deterioration, decay, marring, delamination,
crumbling, settling, cracking;
(4) Shifting, bulging, racking, sagging, bowing, bending,
leaning;
(5) Shrinkage, expansion, contraction, bellying,
corrosion;
(6) The unavailability or discontinuation of a part or
component of the system; or
(7) Any other age or maintenance related issue;
i. To the plumbing system, whether above or below the
ground, caused by the impairment, state or condition of
the system, which prohibits repair or replacement
including access, necessary to connect the adjoining parts
of appliances, pipes or system.
***
We also direct your attention to the terms of the HOMEOWNERS 3 SPECIAL FORM, HO 00 03 04 91, policy
of insurance that you have with us, as amended by SPECIAL PROVISIONS FOR FLORIDA, HPCHO3 09 SP 02
19, under SECTION I – EXCLUSIONS, which states in part:
…
2. We do not insure for loss to property described in
Coverages A and B caused by any of the following.
However, any ensuing loss to property described in
Coverages A and B not excluded or excepted in this
policy is covered.
…
c. Faulty, inadequate or defective:
…
(2) Design, specifications, workmanship, repair,
construction, renovation, remodeling, grading,
compaction;
(3) Materials used in repair, construction,
renovation or remodeling; or
(4) Maintenance;
of part or all of any property whether on or off the
"residence premises."
Lastly, please direct your attention to the terms of the HOMEOWNERS 3 SPECIAL FORM, HO 00 03 04 91,
policy of insurance that you have with us, as amended by SPECIAL PROVISIONS FOR FLORIDA, HPCHO3 09
SP 02 19, under SECTION I – CONDITIONS, which states in part:
SECTION I – CONDITIONS
…
2. Your Duties After Loss.
In case of a loss to covered property, we have no duty to
provide coverage under this Policy if the failure to comply
with the following duties is prejudicial to us. These duties
must be performed either by you, an "insured" seeking
coverage, or a representative of either:
a. Give prompt notice to us or our agent; Except for
reasonable emergency measures taken under
SECTION I – Property Coverages, Reasonable
Emergency Measures, there is no coverage for repairs
that begin before the earlier of:
(1) 72 hours after we are notified of the loss;
(2) The time of loss inspection by us; or
(3) The time of other approval by us.
If you unreasonably deny us access to inspect the loss
during the period in a.(1) above, coverage for repairs
beyond reasonable emergency measures begins the
earlier of when we are given access to inspect the loss
or when we fail to appear at a scheduled loss
inspection.
…
d. Protect the covered property from further
damage. The following must be performed:
(1) Take reasonable emergency measures that are
necessary to protect covered property from
further damage, as provided under Additional
Coverage 2.
A reasonable emergency measure under d.(1)
above 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; and
(2) Keep an accurate record of repair expenses;
…
f. As often as we reasonably require:
(1) Show the damaged property;
(2) Provide us with records and documents we
request and permit us to make copies; and
(3) You or any “insured” under this policy must
submit to examination under oath and recorded
statements, which may be videotaped, and
which will be at the location insured if requested
by us, while not in the presence of any other
“insured” and sign the same.
(4) Your agents, your representatives, including any
public adjusters engaged on your behalf, and
anyone insured under this policy, other than an
“insured” in (3), must submit to examination
under oath and recorded statements, which may
be videotaped, and which will be at the location
insured if requested by us, while not in the
presence of any other “insured” and sign the
same.
g. Send to us, within 60 days after our request, your
signed, sworn proof of loss which sets forth, to
the best of your knowledge and belief:
(1) The time and cause of loss;
(2) The interest of the "insured" and all others
in the property involved and all liens on the
property;
(3) Other insurance which may cover the loss;
(4) Changes in title or occupancy of the
property during the term of the policy;
(5) Specifications of damaged buildings and
detailed repair estimates;
(6) The inventory of damaged personal property
described in 2.e. above;
(7) Receipts for additional living expenses
incurred and records that support the fair
rental value loss; and
h. At our request, provide to us or execute an
authorization which allows us to obtain on your
behalf, records and documentation we deem
relevant to the investigation of your loss.
…
The duties listed apply regardless of whether you, an
“insured” seeking coverage, or a representative of either
retains or is assisted by a party who provides legal advice,
insurance advice or expert claim advice, regarding an
insurance claim under this Policy.
We have not yet confirmed nor denied through our investigation whether the reported damages are the result of a covered cause of loss or losses to property covered under this policy. We are continuing our investigation regarding the circumstances related to this claim.
Heritage Insurance Company, reserves each and every right that it has under and pursuant to this policy of insurance. Heritage Insurance Company will continue investigate your claim subject to this Reservation of Rights. Neither you, nor anyone acting on your behalf, should construe any statements or actions, either previously or in the future, by Heritage Insurance Company or any of its agents, attorneys or representatives, to constitute a waiver of any rights given to Heritage Insurance Company under the insurance policy, nor is it the purpose of this letter to waive any of the policy terms or conditions.
This letter is not intended to be a full disclosure of all policy coverages, conditions and exclusions. For a full disclosure, we encourage you to refer to a copy of your insurance policy for complete details.
I am the in-house examiner assigned to this claim and I can be reached at: (727) 362-7200, ext. 7417.
Sincerely,
Rosemary Matthews
Claims Examiner
rmatthews@heritagepci.com”
Why such a letter was needed before inspecting a loss that occurred less than a month a half before it was reported is unclear other than Heritage setting up a denial of full or partial coverage of Scott’s loss. This is especially true in the context of first party claims as reservation of rights letters are not required like they are in liability claims due to the nature of the case law in Florida. As such, Heritage has a pattern of improperly sending out such unnecessary letters for the reason set forth above or have failed to properly train their adjusters.
Mr. Rowen conducted his inspection on February 12, 2021. Upon information and belief, Mr. Rowan is not a licensed roofer, engineer or contractor. His inspection was quick and cursory of the roof of Scott’s home. The inspection completely missed areas creased shingles and impact marks. He also did not perform any testing to determine the reparability of the roof. Heritage did not retain an engineer, or any other qualified professional to inspect the roof to determine the cause and origin of damage. Instead, it relied solely upon Mr. Rowen.
Mr. Rowen finished his estimate the same day of the inspection. The estimate provided for the replacement of the 15 shingles that were determined to be damage by Mr. Rowen. Five (5) days later, Heritage issued a denial letter to Scott stating the following:
“We have completed our investigation of your claim for Wind damages and prepared an estimate of repair totaling $732.65. I am enclosing a copy of the estimate, regrettably, the amount of your claim falls under your $1,000.00 deductible.
Dwelling / Structure $ 732.65
“Other” Structure(s) $ 0.00
Personal Effects (Contents) $ 0.00
Loss of Use/Additional Living Expense (ALE) $ 0.00
Other Damages $ 0.00
Gross Loss $ 732.65
Less Recoverable Depreciation $ 0.00
Less Non-Recoverable Depreciation $ 0.00
Less Deductible $ 1,000.00
Less Previous Payments $ 0.00
NET AMOUNT PAID $ Below Deductible
If you discover damages not included in our estimate or arrive at a different dollar value from our estimate; please contact us before the repairs are started.
We appreciate you allowing us the opportunity to insure your property. Please contact me at the telephone number listed above if you have any questions regarding your claim.”
Scott had several concerns following receipt of the letter, especially in light of a licensed contractor advising that she needed a roof replacement and not a minor repair and the damages to other roofs in the neighborhood, so she called Ms. Mathews on February 24, 2021 to express her concerns and disagreement with the decision. Scott followed up the call with an email expressing her concerns as follows:
“Rosemary, I am confirming our telephone conversation of today regarding the above claim. I would like to request a re-inspection of my roof for the following reason.
On December 24, 2020 a tornado passed through Jacksonville, causing extensive roof damage to many homes in the Sweetwater del Webb community.
Homes directly next door to me on BOTH side and directly across the street received extensive damaged, causing replacement.
It is inconceivable to me that my home has only 15 shingles that need to be replaced, when all those surrounding me suffered extensive damage.
These lots are only 50 feet wide.
Your consideration in re-inspecting would be greatly appreciated.”
Ms. Mathews responded via email that day:
02/24/21 – 6:29PM E-Mail from Rosemary Matthews to Olliediann Scott:
“This is acknowledgment of your email. Please allow time for me to review and respond. If you have any questions, please contact us to discuss the matter further.”
As of March 4, 2021, Scott had not heard from Ms. Mathews, so she sent the following email:
03/04/21 – 4:19PM E-Mail from Olliediann Scott to Rosemary Matthews:
“Following up on re-inspection. Have not heard from an adjuster. Can you please advise time line for the re inspection?”
Scott also retained the services of a home inspector to document the damage to her property and provided another report to Heritage to dispute its decision. In the meantime, Heritage sent out the same adjuster, Mr. Rowen, to perform a re-inspection. Scott called Ms. Mathews on March 12 to discuss the claim and her continued disagreement with the loss. She also sent the following email on March 15, 2021 confirming the conversation:
“This email will confirm our telephone conversation of March 12, 2021.
I am forwarding to you the private home inspection report I had done by All Pro Home Inspectors Inc.
When I requested a reinspection, I did not think you would send the same inspector. I expected a different inspectors opinion regardless of what the results would be.
Sending Mr. Rowan back only irritated him. He was not pleased and did not ask for an in-house inspection. I had to remind him of that, which consisted of 3 or 4 photos. He also left behind his notes and clipboard. Therefore, he would have to go back to his original report for reference. That does not give me a fair nor an impartial opinion.
Heritage is aware that a tornado passed through this neighborhood as there is another house on this street insured by Heritage that has been approved.
As I stated earlier, roofs both right and left and directly across the street as well as many others on the street have suffered from the December 24 tornado and are being replaced.
Bases on the private report I am submitting, it is inconceivable to me that Heritage has deemed my roof damage to be minimal.
Please acknowledge receipt of this email. I await your response.”
Shockingly, as Mr. Rowen did not change his opinion and on March 17, 2021, Heritage sent the following letter standing by its denial of the claim:
“This letter is in relation to the claim that was submitted to Heritage Property & Casualty Insurance Company (Heritage) for loss reported to have taken place December 24, 2020, located at 9248 Rosewater Lane Jacksonville, FL 32556. Heritage Insurance received notice of this claim on February 10, 2021 for damages from wind caused by Hurricane Irma. (this is incorrect and clear mishandling of the claim)
On February 12, 2021, we inspected our insured’s dwelling damages and concluded the damages totaled $683.43, which was less than your deductible of $1,000.00.
Based upon the re-inspection on March 11, 2021, our position regarding the roof repairs to your roof stands, due to no additional damage to the roof and exterior elevations and no damages to the interior.
We appreciate you allowing us the opportunity to insure your property. Please contact me at the telephone number listed above if you have any questions regarding your claim.”
In response, Scott sent an email to Ms. Mathews:
03/18/21 – 1:20PM E-Mail from Olliediann Scott to Rosemary Matthews:
“I sent you the home inspection report from All Pro Home Inspectors, Inc. on Monday, March 15 via eMail. As of today, I have not received an acknowledgment.
If you did not receive it, I will send it Certified Mail. Please respond.”
Ms. Mathews responded as follows:
03/18/21 – 1:44PM E- Mail from Rosemary Matthews to Olliediann Scott:
“This is acknowledgment of your email. Please allow time for me to review and respond. If you have any questions, please contact us to discuss the matter further.”
Ms. Scott then responded shortly thereafter:
03/18/21 – 7:32PM E-Mail from Olliediann Scott to Rosemary Matthews:
“Rosemary, Thanks for replying to my email.
Since I received two email with 30 minutes of one another, I am confused as to which one of my emails you are replying to.
Was the Uphold Re-Inspection report findings determined before you received the inspection report from All Pro Home Inspectors, Inc. or after Mr. Rowan’s second report., which deemed less damage than his first report.
Since he didn’t have his notes, I fail to see how he could give and informed inspection.
I anticipate hearing from you.”
Ms. Mathews did not respond and it was clear that Heritage was deliberately ignoring information from Scott and not changing its position despite her best efforts, so Scott retained the services of a public adjuster, Thomas Napolitano of Property Damage Experts to assist her with her claim. Mr. Napolitano inspected Scott’s home on April 15, 2021, at which time he took 68 photographs of the property and damage. Mr. Napolitano determined the roof absolutely sustained more damage than allotted for by Heritage and the roof could not be repaired. He relayed this information to Scott who asked that her assist them in trying to obtain what was truly due and owing to her under their policy of insurance. Unfortunately for Scott, Heritage’s handling of the claim actually became worse after Mr. Napolitano got involved with blatant misrepresentations of facts and policy issues. Heritage even tried to close her claim citing a failure to respond despite numerous letters and emails from Mr. Napolitano attempting to resolve Scott’s claim.
The following is the facts following Mr. Napolitano’s retention and communications between the parties that further illustrate Heritage’s improper handling of the claim:
04/19/21 – 1:58PM E-Mail from Thomas Napolitano to Rosemary Matthews:
“Please find attached the contract between PDE and the insured. Also attached is the estimate and photos for the damage that occurred to the insureds property. We understand that the adjuster who came out to the property on behalf of Heritage was Gary Rowen. It is our understanding that you have been put on notice of Mr. Rowen's unethical claim practices and the lack of time he took to inspect this loss.
You were also informed on how rude and nasty he was to the insured as well at the time of the inspection. I have personally dealt with him in the past on other claims that I handled with Heritage and this seems to be a pattern with this adjuster. I know that Heritage has been put on notice of his actions several times for several different claims and for some reason Heritage still chooses to retain him to adjuster claims on their behalf. It seems as if Heritage condones this behavior and is allowing Mr. Rowen to act unethical and adjust claims unfairly as the outcome befits Heritage. If that were to be true, that would be bad faith on behalf of Heritage.
I have inspected the roof and there are several times the amount of damage to the roof then what Mr. Rowen estimated for. He does not properly inspect the loss and he is always in a rush to move on to the next claim. You were informed that on his original inspection he was only there a few minutes. This is very concerning. Please review my estimate and photos and I think you will clearly see with the amount of damage to the roof and the condition its in that a repair is not possible and a full replacement is owed. Please advise how you would like to proceed after you review what I have sent in.”
04/23/21 – E-Mail from Rosemary Matthews to Thomas Napolitano:
“This is acknowledgment of your email. As discussed, please allow time for me to review and respond. If you have any questions, please contact us to discuss the matter further.
04/27/21 – Reservation of Rights from Rosemary Matthews to Olliediann Scott:
“Dear Madam: We are writing you concerning the claim you reported to Heritage Insurance Company, Inc., on February 10, 2021, 49 days after the date of loss reported as December 24, 2020, for roof damage to our insured’s home from Wind. You submitted this claim under policy number HOH645722 effective November 14, 2020 to November 14, 2021.
In reviewing the coverage afforded under our insured’s policy for the damages you are claiming, we identified the following questions that may restrict, limit or preclude recovery of the damages reported:
• When the damages claimed first occurred.
• Whether the damages occurred as the result of a single event or multiple events.
• Whether the damages are the result of a sudden and accidental occurrence, long term exposure, or some other cause.
• Whether the damages claimed are covered under the policy.
• Whether our insured and / or their representatives complied with policy conditions. At this time, in keeping with the Duties under this policy we also respectfully request the following of our insured:
1. Enclosed is the Heritage Insurance Company approved Proof of Loss form; please ensure the insured completes and returns the Proof of Loss form as per the policy provisions.
2. Forward any and all estimates or invoices for repairs of damages that are the result of this loss.
3. Forward copies of invoices for any and all previous work or maintenance completed on the roofing system.
Please note that the HO-3 04 91 Homeowners 3 – Special Coverage policy of insurance is a contract between our insured and Heritage Insurance Company, Inc that contains the following provisions relevant to this claim:
SECTION I – PROPERTY COVERAGES
COVERAGE A – Dwelling
We cover:
1. The dwelling on the "residence premises" shown in the Declarations,
including structures attached to the dwelling; and
2. 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."
This coverage does not apply to land, including land on which the dwelling is located.
Please also direct your attention to the terms of the HOMEOWNERS 3 SPECIAL FORM, HO 00 03 04 91,
policy of insurance, as amended by SPECIAL PROVISIONS FOR FLORIDA, HPCHO3 09 SP 02 19, under
SECTION I – PERILS INSURED AGAINST, which states in part:
COVERAGE A – DWELLING and COVERAGE B – OTHER
STRUCTURES
We insure against risk of direct loss to property described
in Coverages A and B only if that loss is a physical loss to
property. We do not insure, however, for loss:
…
2. Caused by:
…
e. Any of the following:
(1) Wear and tear, marring, deterioration;
(2) Inherent vice, latent defect, mechanical
breakdown;
…
If any of these cause water damage not otherwise
excluded or limited elsewhere in the Policy, from a
plumbing, heating, air conditioning or automatic fire
protective sprinkler system or household appliance,
we cover loss caused by the water, including the cost
to tear out and repair only that part or portion of a
building or other structure covered under COVERAGE
A or B, on the “residence premises”, necessary to
access the system or appliance.
(1) The cost that we will pay for the tear out and
repair of the part or portion of the building or
other structure covered under COVERAGE A or B
as specified above is limited to only that part or
portion of the covered structure or other
structure which is necessary to provide access to
the part or portion of the system or appliance
that caused the covered loss, whether the system
or appliance, or any part or portion of the system
or appliance, is repairable or not.
(2) In no event we pay for the repair or the
replacement of the system or appliance that
caused the covered loss.
f. Loss caused by constant or repeated seepage or leakage of
water or steam over a period of 14 or more days,
whether hidden or not, and results in damage such as
wet or dry rot, “fungi”, deterioration, rust decay or
corrosion.
…
h. To a plumbing system, whether above or
below the ground, caused by:
(1) Age, collapse, obsolescence, wear, tear;
(2) Fading, oxidation, weathering;
(3) Deterioration, decay, marring, delamination,
crumbling, settling, cracking;
(4) Shifting, bulging, racking, sagging, bowing, bending,
leaning;
(5) Shrinkage, expansion, contraction, bellying,
corrosion;
(6) The unavailability or discontinuation of a part or
component of the system; or
(7) Any other age or maintenance related issue;
i. To the plumbing system, whether above or below the
ground, caused by the impairment, state or condition of
the system, which prohibits repair or replacement
including access, necessary to connect the adjoining parts
of appliances, pipes or system.
***
We also direct your attention to the terms of the HOMEOWNERS 3 SPECIAL FORM, HO 00 03 04 91, policy
of insurance that you have with us, as amended by SPECIAL PROVISIONS FOR FLORIDA, HPCHO3 09 SP 02
19, under SECTION I – EXCLUSIONS, which states in part:
…
2. We do not insure for loss to property described in
Coverages A and B caused by any of the following.
However, any ensuing loss to property described in
Coverages A and B not excluded or excepted in this
policy is covered.
…
c. Faulty, inadequate or defective:
…
(2) Design, specifications, workmanship, repair,
construction, renovation, remodeling, grading,
compaction;
(3) Materials used in repair, construction,
renovation or remodeling; or
(4) Maintenance;
of part or all of any property whether on or off the
"residence premises."
Lastly, please direct your attention to the terms of the HOMEOWNERS 3 SPECIAL FORM, HO 00 03 04 91,
policy of insurance that you have with us, as amended by SPECIAL PROVISIONS FOR FLORIDA, HPCHO3 09
SP 02 19, under SECTION I – CONDITIONS, which states in part:
SECTION I – CONDITIONS
…
2. Your Duties After Loss.
In case of a loss to covered property, we have no duty to
provide coverage under this Policy if the failure to comply
with the following duties is prejudicial to us. These duties
must be performed either by you, an "insured" seeking
coverage, or a representative of either:
a. Give prompt notice to us or our agent; Except for
reasonable emergency measures taken under
SECTION I – Property Coverages, Reasonable
Emergency Measures, there is no coverage for repairs
that begin before the earlier of:
(1) 72 hours after we are notified of the loss;
(2) The time of loss inspection by us; or
(3) The time of other approval by us.
If you unreasonably deny us access to inspect the loss
during the period in a.(1) above, coverage for repairs
beyond reasonable emergency measures begins the
earlier of when we are given access to inspect the loss
or when we fail to appear at a scheduled loss
inspection.
…
d. Protect the covered property from further
damage. The following must be performed:
(1) Take reasonable emergency measures that are
necessary to protect covered property from
further damage, as provided under Additional
Coverage 2.
A reasonable emergency measure under d.(1)
above 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; and
(2) Keep an accurate record of repair expenses;
…
f. As often as we reasonably require:
(1) Show the damaged property;
(2) Provide us with records and documents we
request and permit us to make copies; and
(3) You or any “insured” under this policy must
submit to examination under oath and recorded
statements, which may be videotaped, and
which will be at the location insured if requested
by us, while not in the presence of any other
“insured” and sign the same.
(4) Your agents, your representatives, including any
public adjusters engaged on your behalf, and
anyone insured under this policy, other than an
“insured” in (3), must submit to examination
under oath and recorded statements, which may
be videotaped, and which will be at the location
insured if requested by us, while not in the
presence of any other “insured” and sign the
same.
g. Send to us, within 60 days after our request, your
signed, sworn proof of loss which sets forth, to
the best of your knowledge and belief:
(1) The time and cause of loss;
(2) The interest of the "insured" and all others
in the property involved and all liens on the
property;
(3) Other insurance which may cover the loss;
(4) Changes in title or occupancy of the
property during the term of the policy;
(5) Specifications of damaged buildings and
detailed repair estimates;
(6) The inventory of damaged personal property
described in 2.e. above;
(7) Receipts for additional living expenses
incurred and records that support the fair
rental value loss; and
h. At our request, provide to us or execute an
authorization which allows us to obtain on your
behalf, records and documentation we deem
relevant to the investigation of your loss.
…
The duties listed apply regardless of whether you, an
“insured” seeking coverage, or a representative of either
retains or is assisted by a party who provides legal advice,
insurance advice or expert claim advice, regarding an
insurance claim under this Policy.
We have not yet confirmed nor denied through our investigation whether the reported damages are the result of a covered cause of loss or losses to property covered under this policy. We are continuing our investigation regarding the circumstances related to this claim.
Heritage Insurance Company, reserves each and every right that it has under and pursuant to this policy of insurance. Heritage Insurance Company will continue investigate your claim subject to this Reservation of Rights. Neither you, nor anyone acting on your behalf, should construe any statements or actions, either previously or in the future, by Heritage Insurance Company or any of its agents, attorneys or representatives, to constitute a waiver of any rights given to Heritage Insurance Company under the insurance policy, nor is it the purpose of this letter to waive any of the policy terms or conditions.
This letter is not intended to be a full disclosure of all policy coverages, conditions and exclusions. For a full disclosure, we encourage you to refer to a copy of your insurance policy for complete details. I am the in-house examiner assigned to this claim and I can be reached at: (727) 362-7200, ext. 7417.”
SAME LETTER PREVIOUSLY SENT ON THE FIRST DATE THE CLAIM WAS REPORTED FOR SOME REASON WITH BLATANT LIE THAT THEY HAD NOT CONFIRMED OR DENIED THE CLAIMED DAMAGES.
05/12/21 - Letter from Rosemary Matthews to Olliediann Scott:
“To date we have not heard back from you. Please contact me at the phone number listed below if you still want to pursue the claim loss. If we do not hear back from you within 10 days, we will close the file due to lack of interest.
We appreciate you allowing us to insure your property. Please contact me if you have any questions regarding your claim.”
ANOTHER BLATANT LIE AND MISREPRESENTATION ABOUT THE FACTS OF THE CLAIM THAT MR. NAPOLITANO WOULD ADDRESS
05/17/21 – 4:25PM from Thomas Napolitano to Rosemary Matthews:
“I just received your letter dated May 12. It states if we do not contact you within 10 days you’re going to close the claim for lack of interest. The last correspondence from you stated you were going to review all the documentation I sent in and respond and you haven’t. Where exactly is there a lack of interest on our behalf? You were supposed to review my estimate and photos and respond back to me and you have not done so. At this point we are waiting on you. The only item you have requested is the proof of loss and we will be sending that in shortly as the insured was out of town and will be back at the end of this week and you will have it by next Monday. With that being said you requested that two weeks ago and we have 60 days from the time you requested it to send it in so we are well within that timeframe. See your email below where you stated you would review everything then get back in contact with me.”
05/17/21 – 4:36PM from Thomas Napolitano to Rosemary Matthews:
“Also please forward a copy of the policy ASAP. I have requested a copy and have not received one yet.”
IMPROPER FOR A CARRIER NOT TO PROVIDE A COPY OF THE POLICY TO ITS INSURED OR REPRESENTATIVE
05/19/21 – 9:59AM from Thomas Napolitano to Rosemary Matthews:
“This is the 2nd response to your letter. We have followed up several times with no response from you. I want to make clear that we are waiting on you per your email on 4/23 for you to review the estimate and photos and the email I sent in.
Also this is now my 3rd request for a copy of the policy. The only thing at this point in time holding up the insured from sending in the POL is not having the correct and accurate information needed from the policy. Please forward a copy ASAP.”
05/19/21 – 2:33PM E-Mail from Rosemary Matthews to Thomas Napolitano:
“Attached is a copy of the policy requested.”
05/25/21 – Signed Sworn Statement in Proof of Loss from Olliiediann Scott:
Total Loss and Damage - $25,510.77
Deductible – ($1,000.00)
Amount Claimed – 24,510.77
05/27/21 – 11:12PM E-Mail from Thomas Napolitano to Rosemary Matthews:
“Estimate and POL attached.”
05/28/21 - 7:46AM E-Mail from Rosemary Matthews to Thomas Napolitano:
“This is acknowledgment of your email. Please allow time for me to review and respond. If you have any questions, please contact us to discuss the matter further.”
05/28/21 – Letter Acknowledging/Denying PDE Estimate from Rosemary Matthews to Olliediann Scott:
“We are in receipt of an estimate from your public adjuster totaling $25,510.77. We have prepared an estimate of repair totaling $732.65 which regrettably the amount falls under your $1,000.00 deductible.
The estimate is based on the information obtained during the investigation of your claim, including the inspections of your property on February 21, 2021 and March 11, 2021 Any information learned from speaking with you and your representative on February 10, 2021, February 16, 2021, February 24, 2021, February 25, 2021, March 12, 2021, March 24, 2021, April 7, 2021 in April 23, 2021. At this time it appears that your estimate accounts for damages that were not substantiated during the course of our investigation. If additional damages have occurred since we last spoke of your property, or if further hidden damages have been uncovered, please call us to discuss as another inspection may be necessary. Additionally, please provide us any documentation regarding the damages claimed in your estimate, including photographs and/or contractor estimates/proposals. Should we not hear from you or receive any additional formation, we will assume you have been previously indemnified fully for your claim in your file will be closed.”
THERE ARE NUMEROUS ISSUES AND MISREPRESENTATIONS IN THIS LETTER, INCLUDING THAT ADDITIONAL DAMAGE SUSTAINED AFTER THE DATE OF LOSS WOULD BE COVERED. NEW DAMAGES AFTER THE DATE OF LOSS WOULD BE A NEW LOSS AND SUBJECT TO A NEW CLAIM. THIS SHOWS GROSS MISMANAGMENT OF CLAIMS OR A LACK OF CARE OF INSUREDS
05/28/21 – Letter Rejecting SPOL from Rosemary Matthews to Olliediann Scott:
“This letter is in reference to the above-referenced claim, submitted to Heritage Property & Casualty Insurance Company (Heritage) on February 10, 2021.
We are in receipt of the sworn proof of loss that Thomas Napolitano submitted to us via email. The sworn proof of loss was received by us on May 27, 2021 and is dated May 25, 2021. Per the sworn proof of loss, we understand that you are claiming , under oath, that the amount of loss is $25,510.77
To ensure that all parties understand what is being claimed, it appears that you are claiming that the amount of damage related to Wind claimed to have occurred on December 24, 2020 is $25,510.77. If this is not true, we request that the sworn proof of loss be amended and submitted to accurately reflect your claim.
The policy of insurance requires you to submit a sworn proof of loss within sixty (60) days of our request. However, your sworn proof of loss is rejected because it is deficient.
The policy of insurance requires that you submit a sworn proof of loss setting forth the following,
1. the time and cause of loss;
2. the interest of the “insured” and all others in the property involved and all liens on the property;
3. other insurance which may cover the loss;
4. changes in title or occupancy of the property during the term of the policy;
5. specifications of damaged buildings and detailed repair estimates;
6. the inventory of damaged personal property;
7. receipts for additional living expenses incurred and records that support the fair rental value loss.
The sworn proof of loss received is deficient in the following way(s):
o Incomplete lines
? Title and interest missing
? Mortgagee missing or does not match policy
? Policy Information
We are aware that you did not prepare the estimate, but rather the public adjuster did. However, it is important that you understand what is being claim. You are ultimately responsible for the claims being made. As such we are requesting that you review the estimate in detail with your public adjuster to ensure that what you are claiming on the estimate and your sworn proof of loss, is what you are claiming to be related to the loss that you have reported to us.”
AGAIN, MISREPRESENTATIONS BY HERITAGE WHAT WOULD BE ADDRESSED BY MR. NAPOLITANO
06/03/21 – 4:14PM E-Mail from Thomas Napolitano to Rosemary Matthews:
“Please allow this to follow up the letter that was received dated May 28, 2021. It states you are rejecting the POL as it has "MISSING LINES" which is an inaccurate statement. After reviewing the POL all areas are completed. You state the following lines are incomplete –
Title and Interest - on the POL for Title - Owner is listed as she is the owner / Interest - N/A is listed as there are no other leans on the property and it is paid in full.
You have mortgage does not match - there is no mortgage that's why it say N/A in that spot. Policy information - all the policy information is correct as well.
At this point this seems like a stall tactic on behalf of Heritage as this is not the first piece of inaccurate information in letters that has been sent out. Your last letter stated you were going to close the claim in 10 days due to a lack of interest on behalf of the insured and myself after your acknowledgment letter and email requesting time to review what I sent in. Then when I sent in an email explaining that was a false statement you didn't even respond. At this point we are demanding appraisal. If for some reason you chooses not to participate in the appraisal process the insured will be seeking legal counsel. Please see the attached demand and name your appraiser within the 20 day time period.”
NO RESPONSE
06/03/21 – Demand for Appraisal Letter from Thomas Napolitano to Rosemary Matthews:
“To Whom It May Concern:
Please be advised the above-referenced insured disagrees with your estimate of their damages and hereby demands appraisal pursuant to the provisions of their policy with you.
The insured appoints:
Jeremy Edward Brynildson Integrity Claims Specialist Office: 904-930-4464 Fax: 904-930-4487 Cell: 731-225-5821
As their appraiser and requests that you appoint your appraiser and have him/her contact Jeremy Edward Brynildson within the specified 20-day period. Keep in mind if a payment is issued as a result of this claim, please include Property Damage Experts as a payee, and send any payment to the above address as indicated by the policyholder in our contract in order to avoid additional delays.
Please contact us with any questions.”
NO RESPONSE
06/14/21 – 9:02AM E-Mail from Thomas Napolitano to Rosemary Matthews:
“Good morning,
It has been 11 days since I sent you a replay to your letter and the demand for appraisal. You still have not responded. Is Heritage going to participate in the appraisal process?
If so, please name your appraiser ASAP. If not, you need to explain in writing that Heritage is going to opt out and why. Please keep in mind per Florida statue you have 14 days to respond to any correspondences received. Again, today is day 11 so please respond by Thursday 6/17/21 to avoid acting in bad faith.”
NO RESPONSE
06/23/21 – 10:40AM E-Mail from Thomas Napolitano to Rosemary Matthews:
“Good morning,
Today is the 20th day from when the appraisal demand was sent into Heritage. We also sent in a follow up email on 6/14/21 that Heritage never responded to as well. There has been no response to the email that was sent on 6/3/21 with the appraisal demand and the response to your last letter regarding the POL proving the information you stated in that letter was incorrect. This is not the first time you have put something in writing that has been proven to be false and inaccurate. You are required to respond within 14 days of any correspondences received and you have failed to do so. At this point I believe both Heritage and yourself have shown a clear pattern that you have acted, and are still acting in bad faith in regards to this claim. Please respond by the by the end of business today in regards to the appraisal demand. If no response is received by the end of business today 6/23/21 we will assume Heritage is going to continue to act in bad faith and forfeit all its claim wrights in regards to this claim and the insured will pursue it legally.”
NO RESPONSE, SO SCOTT WAS FORCED TO RETAIN COUNSEL (PEREZ, SALGADO, THOMAS + LEWIS, PA (PSTL)
08/24/21 – 10:18AM E-Mail from PSTL to Rosemary Matthews:
“Good morning,
Please see attached from Mr. Lewis.
Thank you,”
“Dear Ms. Matthews:
Please be advised that this law firm has the pleasure of representing Olliediann Scott with regard to her insurance claim for damages to the insured premises located at: 9248 Rosewater Lane, Jacksonville, FL 32556.
At this time, I would request that you please promptly provide me with a certified copy of the subject homeowner’s insurance policy, including but not limited to, declarations page, all endorsements, riders and/or amendments that were in effect at the time of the above referenced claim. Additionally, please provide me with a copy of any reports and/or cosmetic estimates performed on your behalf, as well as any correspondence between Heritage and the insureds and/or their agents.
Your file may contain documents and/or exhibits which only you may have and therefore, as this matter may be pending for quite some time before those various documents are identified, please consider this my client’s written demand that no file documents, exhibits, hand written notes, telephone messages, etc., in any way be compromised, purged or otherwise lost, destroyed or mishandled in any fashion, but that they be guarded carefully until this matter is concluded.
Florida recognizes spoliation and that it may be raised as a defense where the proponent of the evidence did not take the adequate steps to preserve the evidence for further inspection. The insurance carrier’s failure to preserve this evidence will be considered intentional and/or grossly negligent. This may result in sanctions against the insurance carrier which may include the striking of pleadings, the entry of a default on the issue of liability, exclusion of expert testimony, the imposition of evidentiary presumption and even dismissal of the claim if this matter is litigated.
So there is no misunderstanding, nothing in this letter is meant of a waiver of my clients rights. Further, my clients reserve all rights they may have under the subject insurance contract and applicable laws of Florida, including, but not limited to, supplementing their claim should such cause arise.
Thank you for your cooperation and assistance in this matter.”
NO RESPONSE WITHIN 14 DAYS
09/10/21 – 3:26PM Mail from Rosemary Matthews to PSTL:
“This is acknowledgment of your email. Attached please find the following documents requested:
ROR
Final draft
Below deductible
Reinspection request
Final draft
Uphold reinspection
If you have any questions, please let me know.”
09/10/21 – 7:28PM Mail from Rosemary Matthews to PSTL:
“This is acknowledgment of your email. Attached please find the following documents requested:
Property Damage
2nd ROR
Policy
POL3
SPOL rejection
ADR
POL4”
09/10/21 – Follow-up Letter from Rosemary Matthews to Olliediann Scott/PSTL:
“This is a follow-up letter in response and email acknowledgment to the letter of representation Heritage received on August 26, 2021, for claim H46882.
In addition, confirming receipt of the Certified Policy Request. Our office has not received an estimate for repairs and is requesting a copy be emailed direct to the claim claims@heritagepci.com.
Heritage Property & Casualty Insurance Company does not waive any rights or defenses which it may have.
If you feel that there are additional facts that should be considered, please feel free to contact the undersigned.”
09/10/21 – 8:50PM E-mail from PSTL to Rosemary Matthews:
“Received. Thank you ma’am. Have a great weekend.”
09/13/21 – Letter Acknowledging LOR from Rosemary Matthews to PSTL:
“Dear Sir/Madam:
This is a follow-up letter in response and email acknowledgment to the letter of representation Heritage received on August 26, 2021, for claim H46882.
In addition, confirming receipt of the Certified Policy Request. Our office has not received an estimate for repairs and is requesting a copy be emailed direct to the claim claims@heritagepci.com.
Heritage Property & Casualty Insurance Company does not waive any rights or defenses which it may have.
If you feel that there are additional facts that should be considered, please feel free to contact the undersigned.”
09/15/21 – 8:53AM E-Mail from Adam Lewis to PSTL:
“Good morning Ms. Matthews: In review of the claim file it appears Heritage has determined the repairs are below deductible and rejected my client's dispute and proposal for settlement. Is this correct? I also do not see any further request from my client. If I am incorrect, please advise. thanks,”
09/15/21 – 11:39AM E-Mail from Adam Lewis to PSTL:
“Thank you for the quick response. Do you know when we will receive a copy of the policy as I did not see that in your prior email to Eliza. Thanks,”
09/15/21 – 2:56PM E-Mail from Rosemary Matthews to PSTL
“That is correct. The property was inspected twice. And there are no further requests from the insured.”
09/15/21 – 3:59PM E-Mail from Rosemary Matthews to PSTL:
“Attached is a copy.”
09/24/21 – Request for Information Letter from Rosemary Matthews to PSTL:
“Dear Sir/Madam:
This correspondence will serve to advise that we have not received the necessary documentation related to the claim you submitted for wind damages claimed. As of this date I have not received any documentation or supporting information to move forward with your loss.
At this time, we still require the following:
1. Please complete and return the enclosed, Heritage Insurance approved, Proof of Loss form and have insured sign and date the same.
2. Forward any and all estimates or invoices for repairs of damages that are the result of this loss.
3. Forward copies of invoices for any and all previous work or maintenance completed on the home.
Please send the requested documentation to the address shown below as soon as possible. This information is needed to assist in the investigation of your client’s loss. Please make a note of the claim number and refer to it in all future communication.
I am the in-house examiner assigned to this claim and I can be reached at: (727) 727-362-7200, Ext 7417.”
10/11/21 –Second Uphold Reinspection Letter from Rosemary Matthews to Olliediann Scott:
“This letter is in relation to the claim that was submitted to Heritage Property & Casualty Insurance Company (Heritage) for loss reported to have taken place December 24, 2020, located at 9248 Rosewater Lane Jacksonville, FL 32556. Heritage Insurance received notice of this claim on February 10, 2021 for damages from wind caused by Hurricane Irma.
On February 12, 2021, we inspected our insured’s dwelling damages and concluded the damages totaled $683.43, which was less than your deductible of $1,000.00.
As discussed today, based upon the re-inspection on March 11, 2021, our position regarding the roof repairs to your roof stands, due to no additional damage to the roof and exterior elevations and no damages to the interior.
We appreciate you allowing us the opportunity to insure your property. Please contact me at the telephone number listed above if you have any questions regarding your claim.”
10/12/21 – 11:54AM E-Mail from PSTL to Rosemary Matthews:
“Good morning Rosemary, Please let this e-mail confirm our telephone conversation yesterday in which you informed me that Heritage is standing by its decision and there are no outstanding requests for our clients to respond to. Further, you stated you would provide a copy of the decision that Heritage is standing by.”
10/28/21 – 2:58PM E-Mail from PSTL to Rosemary Matthews:
“Good afternoon Ms. Matthews: I am in receipt of the attached letter dated October 11, 2021, which advised that Heritage was standing by its decision. On September 24, 2021, you sent a letter to our office requesting 3 things, including a sworn statement in proof of loss. Please confirm that in light of the October 11, 2021 letter, you are not requesting that the insured provide with the documents requested in your September 24, 2021 letter, including a proof of loss.”
10/28/21 – 3:12PM E-Mail from Rosemary Matthews to PSTL:
“If you have information you would like to submit for consideration and review, please do so. If you have any questions, please let me know.”
10/28/21 – 3:18PM E-Mail from PSTL to Rosemary Matthews:
“Thank you for the response, but it did not answer the question. Specifically, are you asking that the insured provide those documents in your letter or are you not because you made your decision in the October letter. Please advise. Also, I would point out a POL was submitted long ago by the insured’s public adjuster. Thank you”
10/28/21 – 4:15PM E-Mail from PSTL to Rosemary Matthews:
“For reference, here is the proof of loss with supporting estimate, and the email string showing it was provided to you long ago. The estimate attached is the only estimate of invoice in my clients' possession, which alleviates two of the categories you asked for in your September letter despite already having. I am not sure if she has any other maintenance related records, which was the third and final category. Please let me know if you would like me to find out, or if you stand by your October letter and nothing more is needed on this claim. Have a nice night,”
10/28/21 – 4:24PM E-Mail from Rosemary Matthews to PSTL:
“This is acknowledgment of your email and documents. Please allow time for me to review and respond in writing. If you have any questions, please contact us to discuss the matter further”
BASED ON THE NUMEROUS TIMES THIS HAS BEEN THE RESPONSE TO EMAILS IT IS CLEAR THE CLAIM’S DEPARTMENT AT HERITAGE IS TRAINED TO JUST REPLY THEY RECEIVED DOCUMENTS AND WILL EVENTUALLY REVIEW THEM
11/01/21 – Letter Confirming Receipt of Additional documents from Rosemary Matthews to PSTL:
“This letter is to confirm receipt of the documentation submitted for supplement consideration regarding the above referenced claim. Your claim has been reopened and will be reviewed by an adjuster.
Before we can consider any additional damage and/or payment(s), we must agree the damage is related to the above loss. Heritage Property & Casualty Insurance reserves the right to reinspect the property and/or require additional information prior to the release of any additional funds.
This correspondence is not and should not be considered a waiver of any policy conditions, rights or requirements in addition to those described above.”
11/10/21 – 9:32PM E-Mail from PSTL to Rosemary Matthews:
“Good afternoon: I am following up on the below as my client needs to understand your position to move forward. Thanks.”
NO RESPONSE
Issues/Violations as applied to the specific facts of this claim:
There are numerous issues and violations of Florida law by Heritage in its handling and ultimate decision on Scott’s claim. As stated before, upon information and belief, Heritage has instituted a corporation wide policy of handling roof claims regardless of the specific facts of the claim. This is institutional bad faith and a pattern and practice of bad faith handling claims. Part of the practices and issues on display in Scott’s claim are as follows (this is not exhaustive):
Insufficient investigation, including the number of shingles accounted for in the estimate – Violation of Fl. Stat. §624.155(1)(b)(1); Fl. Stat. §626.9541(1)(i)3a; Fl. Stat. §626.9541(1)(i)3b; Fl. Stat. §626.9541(1)(i)3d – The photographs of the damage clearly show more than the 15 shingles on the roof allotted for by Heritage sustained wind damage. The inspection was also done by an adjuster and not a roofer or engineer and Heritage’s failure to retain someone with a higher level of knowledge, especially after it had been informed of the issues and provided with a contract by a licensed contractor, is failing to properly investigate the claim and part of its overall scheme to rely on insufficient data and claim it was sufficient because a licensed adjuster inspected the roof. Accordingly, Heritage clearly underpaid the loss based on its own estimate. All of this is direct violation of Florida law in the proper standards of handling of claims, misrepresents pertinent facts or insurance policy provisions relating to coverages at issue, and denies a portion of the claim without a proper investigation based upon available information.
Heritage underpaid the claim by ignoring industry its own estimating software – Violation of Fl. Stat. §624.155(1)(b)(1); Fl. Stat. §626.9541(1)(i)3a; Fl. Stat. §626.9541(1)(i)3b; Fl. Stat. §626.9541(1)(i)3d – As stated above Heritage only paid for the replacement of 15 shingles on the roof. Heritage’s own estimating software, and that of almost 90% of insurers, Xactimate, states “[d]ue to the potential creation of additional damage, and the inability to warranty their work, many roofers will not perform nor quote prices on per shingle repair. As such, this item cost is based on an assumed allowance of estimate time and material need to effect the per shingle repair.” (Proof will be provided if necessary during any bad faith suit) This statement provides clear evidence in support of Scott’s position that roofers do not repair only certain shingles and the industry understands this issue. Further, it says the number is “assumed”. Scotts’s policy does not provide for “assumed” costs; it provides for the payment to actually make repairs. This is another direct violation of Florida law cited above of by not attempting in good faith to resolve the claim, failing to have proper standards of handling of claims, misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue, and denying a portion of the claim without a proper investigation based upon available information cited.
Mr. Rowen’s estimate only accounts for the exact amount of shingles he allegedly determined to be damaged by wind without a “repair factor”. – Violation Fl. Stat. §624.155(1)(b)(1); Fl. Stat. §626.9541(1)(i)3a; Fl. Stat. §626.9541(1)(i)3b; Fl. Stat. §626.9541(1)(i)3d; Florida statute §626.9744(1) incorporated by reference – A “repair factor” is an accounting of the number of shingles that will be damaged by repairing the damaged shingles assuming the repairs are performed properly. Industry standard is to apply a repair factor of at least three times the number of damaged shingles; however, most roofers will tell you the repair factor should be five to six. Here, even assuming you could repair Scott’s roof, a repair factor of least three should have been applied as 3 additional shingles will be damaged as part of repairing each of the 3 damaged shingles found by Heritage. As Scotts’s policy provides for payment of all damages not excluded, and damage caused by proper repair is not excluded, they are entitled to payment for the additional shingles. Further, Florida statute §626.9744(1) states as follows: “[w]hen a loss requires repair or replacement of an item or part, any physical damage incurred in making such repair or replacement which is covered and not otherwise excluded by the policy shall be included in the loss to the extent of any applicable limits. The insured may not be required to pay for betterment required by ordinance or code except for the applicable deductible, unless specifically excluded or limited by the policy.” This is why there is an industry standard that is customarily applied, but ignored by Heritage. This statute is incorporated into the policy per Florida law and a failure to follow it is a direct violation of the policy, Florida law and violates proper claims handling protocol. Further, by informing its insured they are only entitled to certain repairs and failing to advise of these additional requirements, Heritage misrepresented facts and policy provisions relating to coverage provisions in direct violation of Florida law
Failure to perform testing or acknowledge inability to repair Scott’s roof – Violation of Fl. Stat. §624.155(1)(b)(1); Fl. Stat. §626.9541(1)(i)3a; Fl. Stat. §626.9541(1)(i)3b; Fl. Stat. §626.9541(1)(i)3d; policy; Florida statute §626.9744(1) which is incorporated by reference – Scott sustained a loss clearly covered under the policy; however, Heritage and/or its agents did not perform any testing of the roof to determine if the repairs set forth in its estimate could actually be performed and/or if attempted would cause additional damage as discussed above. The inability to repair the roof would trigger full payment under the policy as would any damage caused by proper repairs that were just not possible due to the age of the roof. Florida statute §626.9744(1) states as follows: “[w]hen a loss requires repair or replacement of an item or part, any physical damage incurred in making such repair or replacement which is covered and not otherwise excluded by the policy shall be included in the loss to the extent of any applicable limits. The insured may not be required to pay for betterment required by ordinance or code except for the applicable deductible, unless specifically excluded or limited by the policy.” This is yet another example of Heritage’s direct violation of Florida law cited above of by not attempting in good faith to resolve the claim, failing to have proper standards of handling of claims, misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue, and denying a portion of the claim without a proper investigation based upon available information cited.
Failure to determine whether the repairs in Heritage’s estimate match the current shingles on Scott’s roof and/or inform them of additional money that may be owed due to same – Violation of Fl. Stat. §624.155(1)(b)(1); Fl. Stat. §626.9541(1)(i)3a; Fl. Stat. §626.9541(1)(i)3b; Fl. Stat. §626.9541(1)(i)3d; policy; Florida statute §626.9744(2) incorporated by reference – Florida statute §626.9744(2) states as follows: “[w]hen a loss requires replacement of items and the replaced items do not match in quality, color, or size, the insurer shall make reasonable repairs or replacement of items in adjoining areas. In determining the extent of the repairs or replacement of items in adjoining areas, the insurer may consider the cost of repairing or replacing the undamaged portions of the property, the degree of uniformity that can be achieved without such cost, the remaining useful life of the undamaged portion, and other relevant factors.” Here, Heritage ignored this statute and Scott’s ordinance and law coverage as it did not determine if the shingles it allotted to repair would match adjoining areas. Heritage may argue this only applies in case of incurred costs based on recent case law; however, that does not explain its failure to inform Scott of their ability to obtain additional payment under the policy if they incurred additional costs to relating to matching as they have ordinance and law coverage that would cover same if incurred. Once again, Heritage has directly violated Florida law cited above of by not attempting in good faith to resolve the claim, failing to have proper standards of handling of claims, misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue, and denying a portion of the claim without a proper investigation based upon available information cited.
Misrepresentation of Florida law on multiple perils – Violation of Fl. Stat. §624.155(1)(b)(1); Fl. Stat. §626.9541(1)(i)3a; Fl. Stat. §626.9541(1)(i)3b; Fl. Stat. §626.9541(1)(i)3d; policy – Heritage’s coverage letter advised Scott that a portion of the damage was being covered because it was caused by a storm, which is a peril insured against; while the remainder of the loss was being denied as being caused by several excluded perils. This is incorrect in light of the facts of this case and loss. Even if the roof had some form of damage from the cited exclusions the full loss as claimed by Scott would still be covered. In this regard, if a covered peril (wind) causes damage in conjunction with a non-covered peril (wear and tear) the loss is covered under the policy of insurance absent anti-concurrent causation language. Sebo v. Am. Home Assur. Co., 208 So. 3d 694 (2016) The same would go for any damages caused in repairs as proper repairs that cause damage are not excluded under the policy of insurance. Here, the exclusions cited by Heritage do not have anti-concurrent causation language which means Scott’s full claim should have been covered. This is another direct violation of Florida law cited above of by not attempting in good faith to resolve the claim, failing to have proper standards of handling of claims, misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue, and denying a portion of the claim without a proper investigation based upon available information cited.
The above facts also clearly show Heritage made misrepresentations in its letters to Scott and her representatives about not receiving documents, documents allegedly being incomplete, and also failed to timely respond to correspondence and inquires into Scott’s claim. These are all violations of the statutes cited in this Notice.
The above are only a few of the specific examples of Heritage’s complete mishandling of this claim. Upon information and belief, additional issues will be found if Scott is allowed to explore the areas of general practices set forth earlier in this CRN.
As stated above, due to Heritage’s refusal to properly compensate Scott for her loss, Scott contacted counsel to review their claim. Counsel retained Byron K. Anderson, P.E., C.G.C. of Structural Engineering and Inspections, Inc. (SEI) to perform an independent investigation of the home to determine the cause and origin of the damages and necessary scope of repair to restore the home to its pre-loss condition. Mr. Anderson is a licensed engineer and general contractor in the state of Florida. Mr. Anderson and SEI were chosen as they have impeccable credentials and are known to be unbiased in their evaluations. They are routinely hired by insurance companies to perform investigations to determine the cause and origin of storm damage, as well as the scope to repair any observed damages. SEI personally inspected the property and determined that the storm caused damage to roof and the roof required replacement.
A review of the photographs and claim documents show a loss that has been completely mishandled by Heritage and improperly underpaid and denied. The facts of the claim show the roof sustained damages from the storm and a loss that unquestionably should have been fully covered as set forth in Mr. Napolitano’s estimate. Even if the roof had some form of wear and tear, the replacement of the roof would be covered for all the reasons set forth in this notice. For whatever reason, Heritage completely dropped the ball on the handling of this claim and looked to deny payment instead of looking for ways to provide coverage as required under Florida law. It is clear that Heritage conducted a limited and quick outcome orientated investigation in the hopes that Scott accepted the denial and made the required repairs with their own money. As stated above, upon information and belief, this is not an isolated event, but a systematic attempt to underpay roof claims by Heritage.
The concept of insurance involves the insurer’s granting of timely and prompt indemnity or security against a contingent loss. Inherent is the fact that payment must be made timely and promptly so that an insured may mitigate his damages, and to put the insured back into the position they enjoyed prior to the loss as quickly as possible. Heritage has breached this duty.
Heritage has refused and/or failed to tender insurance proceeds as required by the policy and/or Florida law. It has refused and/or failed to settle the claim when under all the circumstances it could have and should have done so if it had acted fairly and honestly towards Scott.
As a result of the foregoing, Scott was forced to first retain a public adjuster and then retain counsel to assist them in contesting Heritage’s coverage decision, assist them to compel Heritage to properly and accurately investigate the full extent and nature of the loss and assist them in force Heritage to honor its obligations under the insurance policy.
There may be further wrongful conduct which has not been made known to Scott. Certain conduct or actions cannot be verified without a review of Heritage’s claim file, claim guidelines, and other internal documentation.
Their actions are willful, wanton and in disregard of the rights of its insured and occur with such a frequency as to indicate a general business practice. Heritage can cure this default by the following:
A. Tender $27,488.05 which is the amount of Mr. Napolitano’s updated estimate less the policy’s deductible.
B. Tender prejudgment interest from the date of notice of claim (February 10, 2021) through date the payment is issued. (As of October 6, 2022, interest on $27,488.053 stands at $1,961.80)
C. Stipulate to the entitled to Scott’s reasonable attorney’s fees in the suit filed to enforce the terms of the contract.
Failure to cure all defects during the 60-day safe harbor period may result in additional extra-contractual damages.
|
|
|
*
|
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.
|
DFS-10-363
Rev. 10/14/2008
|