Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 783155

Filing Accepted: 9/17/2024

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Complainant

Last/Business Name *

PARKWAY PLACE CONDOMINIUM

First Name

Street Address *

4803 SW SANTA BARBARA COURT

City, State Zip *

CAPE CORAL, FL 33914

Email Address *

JODI@LAWHUGGINS.COM

Complainant Type: *

Insured

Last/Business Name*		PARKWAY PLACE CONDOMINIUM		First Name
Policy # *		HCP007623		Claim #*		H105286

Attorney

Attorney is Applicable

Last Name*	PETERS First Name * JODI Initial
Street Address*		6421 N FLORIDA AVE D-598
City, State Zip*		TAMPA , FLORDIA 33604
Email Address *		JODI@LAWHUGGINS.COM

Violation

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):* ROBERT PETERS, DUSTIN L. BAKER
Type of Insurance * Commercial Property & Casualty

Reason for Notice *

	Claim Denial
	Claim Delay
	Unsatisfactory Settlement Offer
	Unfair Trade Practice

* Statutory provision(s) which the insurer allegedly violated.

	624.155(1)(b)(1)		Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
	624.155(1)(b)(2)		Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
	624.155(1)(b)(3)		Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
	626.9541(1)(i)(3)(a)		Failing to adopt and implement standards for the proper investigation of claims.
	626.9541(1)(i)(3)(b)		Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
	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)(i)		Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).

* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The violations described herein derive from Florida law concerning insurers’ obligations to their insured. See, e.g., Fla. Stat. Chapters 626, 627. Specific policy language that may be relevant to the violations include, but are not limited to, the following: Building Coverage provisions, All Additional Coverages provisions, All Coverages provided by Endorsement or Rider, The Declarations, Page Loss Payment, Settlement provision, and the insurance policy's definition section.

* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

- The Insurer’s adjuster(s) assigned to this claim were/are: Robert Peters, Dustin L. Baker,. Hereinafter referred to as the “Adjuster” or “Adjusters”. - The Insured suffered a loss due to Hurricane Ian, which occurred on or about September 28, 2022. The Insured’s covered property was damaged by the loss. - On February 1, 2023, the Insurer admitted that the Property sustained damage from the Loss that was covered by the Insured’s insurance policy (policy number stated above; hereinafter the “Policy”)—for which the Insurer assessed a replacement cost value of $ 21,211.11 (“Insurer Estimate”), a mere 11% of the Insured’s estimate to repair the property. The Insurer Estimate was prepared and authored by Adjuster Baker. The Insurer Estimate was patently deficient in that it omitted entire categories of damage that would have been visible to and recognizable by any person viewing the damaged Property, let alone a qualified insurance adjuster. It is important to note that some of these damages are not latent; they are patent and easily observable through cursory investigation. Upon review of the Insurer’s estimate, it became clear to the Insured that the Insurer patently undervalued the replacement cost value of the Property by omitting obvious damages and that the Insured would not fully restore the Property to the condition it was in prior to the loss by failing to pay the Insured all the benefits to which the Insured is entitled under the Policy for the loss. In this way, the Insurer violated the provisions of Florida Statute § 624.155(1)(b)(1) by failing to attempt in good faith to resolve this claim 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 his interests. The insurer violated the provisions of Florida Statute § 624.155(1)(b)(2) by making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made. The insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(a) by failing to adopt and implement standards for the proper investigation of claims. The Insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(f) by 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 the offer of a compromise settlement. Moreover, the Insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(d) by denying claims without conducting reasonable investigations based upon available information. And, the insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(i) by conducting unfair claim settlement practices. - The Insured hired Premier Claims (“Premier”) to assist in the proper administration of the insurance claim. Having conducted thorough investigations and analysis, Premier prepared an estimate of costs to repair the damaged property in the amount of RCV $192,114.91. Premier sent the Insurer a letter of representation on April 3, 2023, providing Premier’s claim file and requesting information—including a copy of the policy, claim payment history, and other claim documents. - On February 1, 2023, Adjuster Peters sent a letter underpaying the claim based upon a report from the insurer’s field adjuster that failed to account for the proper repair of the observed damages. The Insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(f) by 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. The Insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(i) by conducting unfair claim settlement practices as a result. - The roof damage is consistent with hurricane force wind, showing impact from flying debris. Due to the extent of damages and the requirement of a proper repair under Florida law, a full roof replacement would be warranted under the Policy. Desirous to avoid this cost, Adjuster Peters wrongfully underpaid the insurance claim by making the above misrepresentations. The Insurer violated the provisions of Florida Statute § 624.155(1)(b)(1) by failing to attempt in good faith to resolve this claim 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 his interests. The Insurer violated the provisions of Florida Statute § 624.155(1)(b)(3) by failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage. The Insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(d) by denying claims without conducting reasonable investigations based upon available information. The Insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(f) by 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. The Insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(i) by conducting unfair claim settlement practices. - On February 1, 2023, Adjuster Peters sent the Insured correspondence indicating that $9,338.99 (approximately 5%) of the Claim would be paid. However, he provided scant rationale as to how he arrived at this figure/percentage despite the detailed corroborative information provided by the Insured. In this way, the insurer violated the provisions of Florida Statute § 624.155(1)(b)(1) by failing to attempt in good faith to resolve this claim 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 his interests. The insurer violated the provisions of Florida Statute § 624.155(1)(b)(2) by making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made. The insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(a) by failing to adopt and implement standards for the proper investigation of claims. The insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(f) by 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 the offer of a compromise settlement. - Moreover, Adjuster Peters denied approximately 95% of the Claim. However, in this correspondence or at no point did Adjuster Peters meaningfully explain why 95% of the Claim was being denied. Here, the insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(d) by denying claims without conducting reasonable investigations based upon available information. The insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(f) by 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. And, the insurer violated the provisions of Florida Statute § 626.9541(1)(i)(3)(i) by conducting unfair claim settlement practices. - The Insurer’s conduct in this case is one instance a pattern of business practice designed to avoid or delay coverage determinations for claims, supplemental claims, and/or additional claims by failing to render a determination when requested, failing to make payments of undisputed amounts of claims, and 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. - To cure the conduct giving rise to the violations described herein, insurer must: (i) pay the total replacement cost value of the Insured’s Claim in the amount of $192,114.91, less prior payments and the deductible; (ii) make payment of any pre-judgment interest owed under Florida law; (iii) make payment for the additional expense incurred by the Insured in hiring an attorney; and (iv) implement appropriate standards and procedures for claims investigations and resolution in regard to the outstanding amount of this Claim.

Comments

User Id		Date Added		Comment
emily@lawhuggins.com		03-13-2025		The Insureds hereby withdraw this CRN in its entirety.
swallaker@heritagepci.com		11-06-2024		Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Complainant/Insured: Parkway Place Condominium Policy Number: HCP007623 Claim Number : H105286 Date of Loss (as claimed): September 28, 2022 DFS Filing Number: 783155 DFS Acceptance Date: September 17, 2024 Dear Madam and/or Sir: Please allow this correspondence to serve as Heritage Property & Casualty Insurance Company’s (“Heritage”) official response to the Civil Remedy Notice of Insurer Violation (“Notice”), Filing Number 783155 filed on behalf of Heritage’s insured, Parkway Place Condominium. (“Complainant/Insured”), and accepted by the department on September 17, 2024. Without waiving Heritage’s arguments that the subject Civil Remedy Notice is legally insufficient and non-compliant with Florida law, Heritage has at all times performed its obligations under the insurance policy in a prompt and diligent manner with due regard for the interest of its insured, Parkway Place Condominium. Specifically, Heritage first conducted an inspection of the subject property with the help of independent adjuster, Dustin Baker to determine the alleged cause and origin of all reported damages, as well as the price and scope of the same. This first inspection took place with Complainant’s association representative on October 21, 2022. During the course of the inspection) by said adjuster(s), Heritage found storm damaged areas including the roof, exterior elevations, interior, some of the carports, and swimming pool cover for which there were coverage determinations made by Heritage that the association’s damages totaled $21,211.11 RCV. However, after applying the applicable deductible and Recoverable Depreciation, this claim resulted in payment in the amount of $9,338.99. The Complainant’s Civil Remedy Notice includes speculation and unsupported facts as well as improper proprietary information/inadmissible claims handling assertions made against Heritage. Nonetheless, Heritage made its coverage decision based on the totality of its investigation and all readily available facts and observations relative to this claim. Overall, the Notice contains a list of violations which are alleged to have been committed by Heritage. In fact, none of the listed violations/allegations have occurred and Heritage categorically denies any violations of §624.155 and §626.9541, Fla. Stat., as well as any and all other statutes/regulations/codes/rules. The Notice contains speculative allegations as to proprietary/claims handing information that is neither true, nor rises to the level of any violations of §624.155 and §626.9541, Fla. Stat., as well as any and all other statutes/regulations/codes/rules. As such, Heritage denies any and all allegations of any kind referenced in the Civil Remedy Notice. Sincerely, /s/ Andrew Bruce, Esq. Andrew Bruce, Esq. AB/ah cc: Jodi Peters, Esq.; jodi@lawhuggins.com Premier Claims

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. 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