Civil Remedy Notice of Insurer Violations
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Filing Number:     785406
Filing Accepted:  10/2/2024
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Complainant
Last/Business Name *  
DOVE HOLLOW CONDOMINIUM ASSN., INC.   First Name  
Street Address * 16424 TIMBERLAKES DRIVE
City, State Zip * FORT MYERS, FL 33908
Email Address * JBERNZOTT@COMCAST.NET
Complainant Type: * Insured
Insured
Last/Business Name*   DOVE HOLLOW CONDOMINIUM ASSN., INC.   First Name   STEVEN
Policy # * HCP008481-0 Claim #* H100230
Attorney
Attorney is Applicable
Last Name* SIMON First Name * STEVEN Initial
Street Address* 1111 LINCOLN ROAD, SUITE 500
City, State Zip* MIAMI BEACH , FL 33139
Email Address * STEVE@HURRICANELAWGROUP.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY
NAIC Company Code 14407
 
Name of individual responsible for violation (if any):* KURT WOODWARD, JONATHON NIEMAN, NIBOOM TENZIN, RICHY GABOR, SHEILA CULVER, DANIEL TANURY, SHARON KLINE,
Type of Insurance * Commercial Property & Casualty   
Reason for Notice *
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
* Statutory provision(s) which the insurer allegedly violated.
 
624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
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)(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)(j) Altering or amending an insurance adjuster’s report without: (I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and (II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or (III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change;
* Specific policy language that is relevant to the violation.
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Declaration Pages: 16424 Timberlakes Drive, Fort Myers, FL 33908 - Location 1 Structure 1 – Building 1 - RCV $1,359,648 Ordinance or Law Offer Coverage-Extended Coverage A – Limit Included in Building Coverage Ordinance or Law Offer Coverage-Extended Coverage B & C Combined – $67,982 Carports – RCV - $24,600 Carports – RCV - $24,600 Carports – RCV - $24,600 Carports – RCV - $24,600 16430 Timberlakes Drive, Fort Myers, FL 33908 - Location 1 Structure 2 – RCV $1,359,648 Ordinance or Law Offer Coverage-Extended Coverage A – Limit Included in Building Coverage Ordinance or Law Offer Coverage-Extended Coverage B & C Combined – $67,982 Carports – RCV - $24,600 Carports – RCV - $24,600 Carports – RCV - $48,590 16436 Timberlakes Drive, Fort Myers, FL 33908 - Location 1 Structure 3 – RCV $1,359,648 Ordinance or Law Offer Coverage-Extended Coverage A – Limit Included in Building Coverage Ordinance or Law Offer Coverage-Extended Coverage B & C Combined – $67,982 Carports – RCV - $24,600 Carports – RCV - $24,600 Carports – RCV - $48,590 16442 Timberlakes Drive, Fort Myers, FL 33908 - Location 1 Structure 4 – RCV $1,359,648 Ordinance or Law Offer Coverage-Extended Coverage A – Limit Included in Building Coverage Ordinance or Law Offer Coverage-Extended Coverage B & C Combined – $67,982 Carports – RCV - $24,600 Carports – RCV - $24,600 Carports – RCV - $48,590 16448 Timberlakes Drive, Fort Myers, FL 33908 - Location 1 Structure 5 – RCV $1,359,648 Ordinance or Law Offer Coverage-Extended Coverage A – Limit Included in Building Coverage Ordinance or Law Offer Coverage-Extended Coverage B & C Combined – $67,982 Carports – RCV - $24,600 Carports – RCV - $24,600 Carports – RCV - $24,600 Carports – RCV - $24,600 16454 Timberlakes Drive, Fort Myers, FL 33908 - Location 1 Structure 6 – RCV $1,359,648 Ordinance or Law Offer Coverage-Extended Coverage A – Limit Included in Building Coverage Ordinance or Law Offer Coverage-Extended Coverage B & C Combined – $67,982 Carports – RCV - $24,600 Carports – RCV - $36,534 Carports – RCV - $36,534 Pool House – 16454 Timberlakes Drive, Fort Myers, FL 33908 – Building RCV - $89,286 Ordinance or Law Offer Coverage-Extended Coverage A – Limit Included in Building Coverage Ordinance or Law Offer Coverage-Extended Coverage B & C Combined – $1,833 CONDOMINIUM ASSOCIATION COVERAGE FORM Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy the words "you" and "your" refer to the Named Insured shown in the Declarations. The words "we", "us" and "our" refer to the Company providing this insurance. Other words and phrases that appear in quotation marks have special meaning. Refer to Section H., Definitions. A. Coverage We will pay for direct physical loss of or damage to Covered Property at the premises described in the Declarations caused by or resulting from any Covered Cause of Loss. 1. Covered Property Covered Property, as used in this Coverage Part, means the type of property described in this section, A.1., and limited in A.2., Property Not Covered, if a Limit of Insurance is shown in the Declarations for that type of property. a. Building, meaning the building or structure described in the Declarations, including: (1) Completed additions; (2) Fixtures, outside of individual units, including outdoor fixtures; (3) Permanently installed: (a) Machinery; and (b) Equipment; 3. Covered Causes Of Loss See applicable Causes Of Loss Form as shown in the Declarations. 4. Additional Coverages a. Debris Removal (1) Subject to Paragraphs (3) and (4), we will pay your expense to remove debris of Covered Property caused by or resulting from a Covered Cause of Loss that occurs during the policy period. The expenses will be paid only if they are reported to us in writing within 180 days of the date of direct physical loss or damage. 4. Loss Payment a. In the event of loss or damage covered by this Coverage Form, at our option, we will either: (1) Pay the value of lost or damaged property; FLORIDA CHANGES – RESIDENTIAL CONDOMINIUM ASSOCIATIONS – FORM CP 01 91 07 10 A. Building section is replaced by the following: 1. Building, meaning the building or structure described in the Declarations, including: a. Additions, alterations and repairs; b. Fixtures, outside of individual units, including outdoor fixtures; c. Permanently installed: (1) Machinery; and (2) Equipment; d. Personal property owned by you that is used to maintain or service the building or structure or its premises, including: (1) Fire extinguishing equipment; (2) Outdoor furniture; (3) Floor coverings; and (4) Appliances used for refrigerating, ventilating, cooking, dishwashing or laundering that are not contained within individual units; e. If not covered by other insurance, materials, equipment, supplies and temporary structures, on or within 100 feet of the described premises, used for making additions, alterations or repairs to the building or structure; f. Air conditioning and heating equipment, including air conditioning compressors, used to service any part of the building or structure, including individual units and the limited common elements; g. Any other portion of the condominium property located outside of individual units, including improvements, additions and alterations; h. Fixtures, improvements, additions and alterations that are a part of the building or structure and contained within the boundaries of an individual unit, regardless of ownership, if your Condominium Association Agreement requires you to insure such property; and i. Additional property as described in the Schedule or in the Declarations. ORDINANCE OR LAW COVERAGE - CP 04 05 04 02 This endorsement modifies insurance provided under the following: BUILDING AND PERSONAL PROPERTY COVERAGE FORM CONDOMINIUM ASSOCIATION COVERAGE FORM STANDARD PROPERTY POLICY A. Each Coverage – Coverage A, Coverage B and Coverage C – is provided under this endorsement only if that Coverage(s) is chosen by entry in the above Schedule and then only with respect to the building identified for that Coverage(s) in the Schedule. B. Application Of Coverage(s) The Coverage(s) provided by this endorsement apply only if both B.1. and B.2. are satisfied and are then subject to the qualifications set forth in B.3. 1. The ordinance or law: a. Regulates the demolition, construction or repair of buildings, or establishes zoning or land use requirements at the described premises; and b. Is in force at the time of loss. 2. a. The building sustains direct physical damage that is covered under this policy and such damage results in enforcement of the ordinance or law; or b. The building sustains both direct physical damage that is covered under this policy and direct physical damage that is not covered under this policy, and the building damage in its entirety results in enforcement of the ordinance or law. 3. In the situation described in B.2.b. above, we will not pay the full amount of loss otherwise payable under the terms of Coverages A, B, and/or C of this endorsement. Instead, we will pay a proportion of such loss; meaning the proportion that the covered direct physical damage bears to the total direct physical damage. However, if the covered direct physical damage, alone, would have resulted in enforcement of the ordinance or law, then we will pay the full amount of loss otherwise payable under the terms of Coverages A, B and/or C of this endorsement. D. Coverage 1. Coverage A – Coverage For Loss To The Undamaged Portion Of The Building With respect to the building that has sustained covered direct physical damage, we will pay under Coverage A for the loss in value of the undamaged portion of the building as a consequence of enforcement of an ordinance or law that requires demolition of undamaged parts of the same building.
 
* Facts and circumstances giving rise to the violation.
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This civil remedy notice is being filed with the Department of Financial Services. As such, its contents are a matter of public record and thus Heritage Property & Casualty Insurance Company (“Heritage”) is on notice of the alleged bad faith behavior and therefore should not later enjoy the “advice of counsel” defense. The Florida Statutes and Florida Administrative Code set forth comprehensive requirements for insurance companies and insurance adjusters and regulate the adjustment of property insurance claims. The various provisions of the Florida Statutes and Florida Administrative Code requires ethical behavior on the part of insurers and their adjusters so as to provide fair treatment to insureds, and for quick adjustment, payment, and resolution of claims. These principles are generally reflected in Rule 69B-220.201 of the Florida Administrative Code (entitled “Ethical Requirements”), which states, in part: “the work of adjusting insurance claims [in Florida] engages the public trust.” The relevant laws and rules mandate fair and honest treatment of insureds and require that insurance adjusters behave with integrity. More specifically, Florida Administrative Code 69B-220.201(3) states: “[a]n adjuster shall put the duty for fair and honest treatment of the claimant above the adjuster’s own interests in every instance.” This is consistent with Florida Statutes § 624.155(1)(b)(1), which states that an adjuster has a duty to attempt in good faith to resolve claims and act “fairly and honestly” toward an insured with “due regard” for the “interests” of the insured; and Florida Administrative Code 69B-220.201(3)(e), which states that adjusters are required to handle every claim “with honesty” and “integrity.” Florida Administrative Code 69B-220.201(3)(d also states that insurance adjusters are required to make truthful and unbiased reports regarding their investigation of insurance claims. Specifically in regard to this claim, insurance adjusters shall not “approach investigations, adjustments, and settlements in a manner prejudicial to the insured.” Florida Administrative Code 69B-220.201(3)(c). The laws and rules also require insurers and adjusters to act in a manner that effectuates the quick resolution of claims. These laws and rules run hand in hand with the aforementioned ones; if an insurance adjuster acts fairly, honestly, and with integrity, there should be few delays in resolving claims. Insurance adjusters in Florida are required to act “with dispatch and due diligence” in handling and resolving claims. Florida Administrative Code 69B-220.201(3)(f). See also Florida Statute § 624.155(1)(b)(1). Additionally, insurance adjusters are required to adjust and investigate every claim in accordance with the terms and conditions of the insurance policy/policies and the laws of Florida. Florida Statutes § 626.877; Florida Administrative Code 69B-220.201(3)(b)(2); Board of Public Instruction of Dade County v. Town of Bay Harbor Islands, 81 So. 2d 637 (Fla. 1955) (holding that the laws of Florida are a part of every Florida contract.). In this case Heritage and its adjusters and other representatives have breached the Florida Statutes, Florida Administrative Code, the insurance policy at issue, and the associated duties therein, by their handling of the insured’s claim. In doing so, Heritage and its adjusters and representatives have committed ethical violations and acted in bad faith as stated below. On or about September 28, 2022, Hurricane Ian hit Fort Myers Florida as a Category 4 Hurricane. Ian caused over $112 billion in damage in the U.S. and was one of the most powerful tropical cyclones on record. Dove Hollow was subjected to Category 4 winds for an extended period of time estimated to be approximately 12 hours during Ian. Promptly after the storm on September 30, 2022 the Insured submitted a claim to Heritage for damages sustained as a result of Hurricane Ian. Despite the wind speed and strength of the hurricane at the Insured property, and widescale visible damages, Heritage continues to breach the policy and Florida law by refusing to properly pay for covered losses to the roof, , exterior, windows, doors and interiors. Heritage assigned a field adjuster, Kurt Woodward to inspect and photograph the damage and write an estimate of the amount of damages observed in order to put the insured back to where they were before the storm from the wind damage caused by Hurricane Ian. Mr. Woodward on October 10, 2022 inspected the insured property. On October 17, 2022 Mr. Woodward completed a re-inspection of the property. On October 29, 2022 Mr. Woodward completed his estimate of the damages and uploaded the file to Heritage. Mr. Woodward in his deposition, under oath, claimed that he never prepared an estimate of damages based on his own inspection. Instead, he claimed that he received instructions from Heritage to prepare an estimate based on the engineer report from Intertek and later to revise his estimate not based on his own inspection, but based on an estimate prepared by Tornado Construction. Tornado Construction never even inspected the insured property. Neither Mr. Woodward nor Heritage has produced the estimate prepared and uploaded by Mr. Woodward to Heritage on October 29, 2022. The failure to produce this estimate is a violation of Florida Statute 627.70131(3)(e) which requires an insurer to provide the policyholder with any detailed estimate of the amount of the loss within 7 days after the estimate is generated by an insurance adjuster. It is also a violation of Florida Statute 627.70131(7)(a) which requires an insurer to provide a reasonable explanation to the policyholder of the basis in the insurance policy, in relation to the facts or applicable law, for the payment, denial or partial denial of a claim. This same provision requires an insurer to provide a reasonable explanation in writing of the difference between the amount paid is less than the adjusters estimate of the amount of the loss. Based on the fact that Heritage required Mr. Woodward to revise his estimate on two occasions, it was clearly for more than what Heritage ultimately paid. Heritage not only refused to provide the estimate prepared by Mr. Woodward or provide an explanation to the insured as to why it wasn’t paying the amount of Mr. Woodward’s estimate. But, it did not stop there. Heritage then required Mr. Woodward to again revise his estimate to the amount of the Tornado roof repair estimate. Heritage has failed to produce the second estimate prepared by Mr. Woodward and Heritage again failed to advise the insured that the field adjusters estimate was more than what Heritage was willing to pay and provide an explanation to the insured as to why they were paying less than the field adjuster’s estimate. These actions by Heritage are violations of Fla. Stat 624.155(1)(b)(1), 626.9541(1)(i)(2), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(f) and 626.9541(1)(i)(3)(j). The actions of the adjusters handling this claim, demonstrate that they have violated the Adjuster Code of Ethics, the Florida Administrative Code Sections: 69B-220.201(3)(b) An adjuster shall treat all claims equally. An adjuster shall not provide favored treatment to any claimant. 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 insureds. 69B-220.201(3)(d) – An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation. 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)(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 of the applicable laws of this state. Mr. Woodward and Heritage based on their actions, knowingly violated these provisions by acting in the interests of Heritage only and disregarding the interests of its insured. These actions violate Fla. Statutes 626.9541(1)(i)(3)(a) and 626.9541(1)(i)(3)(d). Mr. Woodward also did a re-inspection of the interior of five units on October 17, 2022 and documented damage to sliding glass doors, lanai roofs and plexiglass damage. Mr. Woodward is believed to have failed to put in for replacement of these damages and Heritage again failed to advise the insured as to the basis for refusing to pay for these covered damages. Heritage in its alleged investigation of the claim ignored significant damages. The engineers hired by Heritage found many units with damaged sliding doors and windows. Heritage refused to pay for replacement of most of the doors and windows, even though no repair is possible under the Florida Building Code. Moreover, the shingle roofs, including the shingle carport roofs cannot be repaired and must be replaced based on the damage exceeding 25% of the roof of each building. It is well documented that Heritage as a general business practice has refused to pay for replacement of shingle roofs. This was found to be a general business practice by the Florida Department of Financial Services and also shown by a 60 Minutes program that detailed Heritage criminal actions taken to defraud insureds for payment of legitimate Hurricane Ian damages. In addition, Heritage failed to adequately investigate and pay for replacement of the carport low sloped roofs and the lanai roofs, which cannot be repaired and need to be replaced as documented by Socotec Engineering. Heritage ignored the Socotec report in its entirety, which is also bad faith claims handling in violation of Fla. Stat 624.155(1)(b)(1), 626.9541(1)(i)(2), 626.9541(1)(i)(3)(a), 626.9541(1)(i)(3)(d) and 626.9541(1)(i)(3)(f). An insurer is obligated to make coverage determinations based upon reasonable explanations and reasonable investigations. A fair and reasonable investigation would have found that the full damage to the property, as documented by Socotec Engineering. These damages are covered losses and a reasonable investigation would have provided full coverage and prompt payment to the Insured in the amount of damages provided by the insured to Heritage. In addition to the above items, we have identified the following instances of bad faith conduct on the part of Heritage: • Purposefully minimizing the value of the claim by using biased consultants and adjusters to minimize damages. • Refusing to pay for necessary repairs, ignoring damages and failing to properly consider all applicable statutes and building code requirements both at the state and local level. • Implementing a claim handling process geared to minimize storm related damages, especially roof, door and window damages. This scheme is meant solely to benefit the carrier while hindering the insured from obtaining just compensation for the loss. • Purposefully and deliberately failing to account for all wind damage to the roofs, exterior, and interior of the subject properties. • Misrepresenting that roof repairs where only shingles are replaced are proper repairs, rather than a roof replacement is needed for roofs of the subject property. • Failing to adopt and implement standards for the proper investigation of the claim; failing to conduct a proper investigation of any and all wind damage to the properties, including but not limited to, all wind damage to all of the roofs, doors and windows. • Failing to perform an adequate roof investigation to assess damage to debonded and uplifted shingles and to properly include the debonded and uplifted shingles in the 25% calculation required by the Florida Building Code. • Failing to perform a proper inspection and testing on windows and doors by qualified engineers to assess the window and door damages and to determine whether a repair can be performed under the Florida Building Code. • Instructing the field adjuster to ignore his own estimate of damages and implement lower estimates of damages based on in the pocket paid for engineering firm, Intertek. • Instructing the field adjuster to ignore his own estimate of roof damages and implement pricing of an in the pocket roofing contractor, Tornado Construction. • Accepting estimate of damages from Tornado Construction without Tornado ever inspecting the insured property. These actions are in violation of the insurance policy and the duty of good faith and fair dealing that Heritage owes to its policyholders. Based on conduct to date, these practices occur with such frequency as to constitute a general claims handling process/business practice imbedded within the company’s management of Hurricane Ian claims. To date, Heritage has continued to refuse to acknowledge its obligation to tender all insurance proceed monies due and owing the Insured or assist the Insured in mitigation of the damages. The insurer has failed and refused to acknowledge coverage and restore the Insured to their pre-loss condition. Heritage had sufficient information upon which to evaluate the Insured’s claim for damages, and certainly has been provided with an independent means by which to determine the amount of loss. The Insured has complied with the policy of insurance and Florida law, and Heritage continues to wrongfully refuse to tender the insurance proceeds that are due and owing the Insured. The concept of insurance is the granting of timely and prompt indemnity or security against a contingent loss. Florida Statutes section 624.02 defines "insurance" as a contract whereby one undertakes to indemnify another or pay a specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that the Insured may be put back into the position it was in prior to the loss as quickly as possible. American Coastal breached this duty. Heritage must immediately take steps to rectify the situation and handle this claim in a fair and appropriate manner. This includes providing full and fair compensation for the damages incurred and for any additional costs and expenses incurred as a result of heritage's bad faith conduct, including but not limited to, fees and costs related to the retention of counsel required to challenge Heritage’s improper handling of this claim. As of this moment, the damages found and evaluated by the insured(s) value at minimum $4,500,000.00 in damages, attorney fees, costs and interest. Payment in that sum as a curative measure to the conduct described herein. SUMMARY OF STATUTORY VIOLATIONS: The statutory violations here are many and varied and have occurred simultaneously and concurrently, generally serve as an unfortunate model for insurer unfair claims practices, and they include but are not limited to the following: This intentional, willful, wanton, and wrongful conduct referenced above is a clear violation of multiple Florida Statutes, including but not limited to 624.155(1)(b)(1), 626.9541(1)(i)(3)(a) and 626.9541(1)(i)(3)(i)., and shows that this carrier did not attempt in good faith to settle the Insureds claim(s) when, under all the circumstances, it could have and should have done so, had it acted fairly and honestly toward its Insured and with due regard for the Insureds interests. The insurer is obligated to engage in fair claims practices and make timely coverage determinations based upon reasonable explanations and reasonable investigations. This did not happen. A reasonable investigation would have found that the damage to the insured property was fully covered, and the result of a reasonable investigation would have been to provide coverage and prompt, full payment, which has not been done. The totality of the actions, inactions, obfuscations, and insurer misconduct as set forth above constitutes unfair claims practices. THEREFORE: This insurance carrier, HERITAGE, must: (1) create and implement adequate guidelines for the proper investigation and evaluation of these types of claims and for the training and supervision of employees, which will avoid future statutory violations. (2) create and implement adequate guidelines for the proper investigation and evaluation of these type of claims and for the training and supervision of employees in connection with legitimate claims to ensure that the claims handling procedures are adequate to prevent other insureds from being treated unfairly and wrongfully; and (3) immediately tender all available insurance proceeds to the Insured, presently known to be at least $4,500,000, while continuing to adjust the loss with the Insured, including but not limited to honoring their reciprocal duties and agreement to abide by all Policy terms; and (4) tender to the Insured all amounts representing monies paid for remedial or temporary repairs and less any prior payments, applicable depreciation, and deductibles; and (5) pay interest on untimely payments from the date the carrier was notified of the loss or, upon the election of the Insured, pay such other interest payments as may be available under Florida law, including prejudgment interest; and (6) pay attorney’s fees and costs; and (7) exercise good faith efforts to resolve these claim(s) by acting fairly and honestly towards the Insured and with due regard for the Insureds interests in disclosing all evidence which supports their position, and in attempting to fully settle the entirety of its Insureds claim(s).
Comments
User Id Date Added Comment
ncarlisle@heritagepci.com 11-11-2024 November 11 2024 VIA ELECTRONIC SUBMISSION Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 RE: Complainant: Dove Hollow Condominium Assn., Inc. Insured: Stephen Dove Hollow Condominium Assn., Inc. (sic) Policy Number: HCP008481-0 Claim Number: H100230 Date of Loss (as claimed): September 28, 2022 Loss Location: 16424 Timberlakes Dr., Fort Myers, FL 33908 DFS Filing Number: 785406 Dear Sir or Madam: Please allow this correspondence to serve as Heritage Property & Casualty Insurance Company’s (“Heritage”) official response to the Civil Remedy Notice of Insurer Violation (“CRN”), Filing Number 785406, filed on behalf of Dove Hollow Condominium Association, Inc. (“Complainant”), and accepted by the Department on October 2, 2024. While Heritage welcomes the opportunity to respond to this Civil Remedy Notice of Insurer Violation and specifically denies each and every allegation contained therein, Heritage maintains that the Civil Remedy Notice should be rejected and returned by the Department of Financial Services because it fails to comply with the specific statutory requirements as set forth in Florida Statute §624.155 and Florida Case law. Contrary to the requirement to “describe the facts and circumstances giving rise to the insurer’s violation as you understand them at this time”, the purpose of which is “to enable the insurer to investigate and resolve [the] claim”, the CRN itself contains, unsupported and inaccurate allegations that do not enable Heritage to cure the alleged violations. Moreover, Complainant’s allegations stem only from Complainant’s opinions regarding the adjustment of this claim. Additionally, the tenor and inferences of the allegations in the CRN are wholly without merit and Heritage denies each and every one. Below is a brief timeline of events. On September 30, 2022, Heritage received its first notice of Complainant’s Hurricane Ian loss. Heritage began its investigation and assigned an Independent Adjuster to conduct an inspection of the alleged loss. On or about October 10, 2022, the inspection of the subject property began with the licensed independent adjuster, Kurt Woodward. Board members Richard Garrant and Erv Kumm also attended. The inspection included the exterior of the property He returned to the property on October 17, 2022 to inspect the interiors with reported damage. Heritage also retained Intertek to inspect the property. John Runkle, P.E., Niboom Tenzin, P.E., and Noah Martinez inspected the property between October 23, 2022 and October 28, 2022 on behalf of Intertek. Intertek determined that the most significant damage to the property was caused by the flood/ storm surge, primarily at the first floor sliding glass doors, lanai frame enclosures, and front entry doors due to the water pressure created by the flood. The roofs sustained some damage from elevated winds but primarily on the south and west slopes where wind speeds were expected to be higher. Intertek concluded that the roofs could be divided into sections and that these sections could be replaced without affecting other sections. At the time of Intertek’s inspection, remedial work on the interior units of the first floor had already begun. All the first-floor units had approximately 4 ft of drywalls removed at the lower half of the interior walls. Mike Harbor, the president of the Association, advised Intertek that the roofs had not been inspected yet as there were no reported leaks. Intertek also found damage that was not attributable to Hurricane Ian. There were fishmouths at some of the modified bitumen cap sheet membranes on the low sloped roofs. This condition was consistent with install deficiency and unrelated to wind. There was rotten wood siding above third-floor windows due to long term water damage. There were exterior stucco cracks that had been repaired and painted over, indicating an aged condition. There were also exterior cracks in which the crack was present, but paint was observed inside the crack. There were sections of paint peel consistent with age and anticipated wear and tear. On the interiors, there was evidence of long-term leakages and termite damage to the units in which the wood frames were severely rotted. The majority of the operable windows had missing jamb fasteners consistent with installation deficiency. The voids at the fastener holes had allowed water intrusion over many years and had caused staining below windowsills. Intertek prepared a Preliminary Project Brief with their findings. The report included a summary of observations of conditions attributable to Hurricane Ian, as well as recommendations for repairs. The roofs were divided into different sections. The sections could be replaced without affecting other sections under the Florida Building Code. A copy of this report was provided to the Insured. Heritage also provided copies of Intertek’s report to Mr. Woodward, in order to prepare estimates to repair the damage caused by Hurricane Ian. The estimates were revised to include only covered damage. On or about January 11, 2023, Heritage issued its coverage determination letter. The letter advised that, although there was covered damage to the property, with the exception of one location, the estimates for repairs were less than the deductible. Heritage issued payment in the amount of $1,048.75. The letter set forth the respective location of each structure, the amounts of the replacement cost value and actual cash value, the amount of the deductible, and the net claim. Due to concerns of the insured, Heritage retained a Richard Gabor, a certified roofing contractor, of Tornado Construction of Florida (“Tornado Construction”), to prepare a quote for covered repairs. Mr. Gabor reviewed photographs and other information available that documented the condition of the property in order to prepare the estimate. The estimate did not change the amount of payment due. On October 10, 2023, Heritage reiterated its position in a letter to the insured. That letter also set forth the respective location of each structure, the amounts of the replacement cost value and actual cash value, the amount of the deductible, and the net claim. On October 21, 2024, Heritage filed a Supplemental Response to Request to Produce, and provided all previously withheld estimates of damage. The estimates show that, contrary to the allegations in the CRN, Heritage did not reduce the amount of the initial estimate dated October 29, 2022. The later estimates included the amount of the repair costs as estimated by Tornado Construction. The amount of the estimates increased each time over the amount of the original estimate. Heritage did not ignore the Sototec report. On the contrary, Heritage requested the depositions of the authors of the report and was told by the Complainant’s attorney that Sototec’s investigation was not complete. As of the date of this response, Sototec has not completed its final report. Based on the foregoing, the Complainant’s CRN allegations that Heritage failed to, in good faith, properly investigate the claim is baseless, as it is clear that upon receiving its first notice of the loss, Heritage promptly inspected the subject property in order to thoroughly investigate the full extent of the insured’s alleged damage. Heritage advised that the damage was covered but less than the deductible, provided a detailed estimate of the necessary repairs, and requested the insured notify Heritage of any additional damage. To date the insured has not produced documentation that the actual repairs costs exceeded the amount paid. Under Florida Law, a Civil Remedy Notice requires the Complainant, "pursuant to section 624.155, F.S., to indicate all statutory provisions alleged to have been violated." The notice filed in this matter alleges Heritage violated the following statutory provisions: 1. 624.155(1)(b)(1): Not attempting in good faith to settle claims when, under all circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for his or her interests. Response: Heritage denies the allegation contained herein. As indicated by the facts stated above, Heritage promptly commenced its investigation, and has, at all times, acted fairly and honestly toward the Insured, in accordance with the findings of the assigned Independent Adjuster, licensed engineers, and certified roofing contractor, and governing policy of insurance. 2. 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. Response: Heritage denies the allegation contained herein. As indicated by the facts stated above, Heritage issued payment in accordance with the findings of the assigned Independent Adjuster, licensed engineers, and certified roofing contractor, and governing policy of insurance 4. 626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims. Response: Heritage denies the allegation contained herein. The Complainant fails to describe any facts and/or circumstances regarding the failure to adopt and implement standards for the proper investigation of claims. This is an unsupported, sweeping allegation and is without merit. Rather, as set forth above, upon notice of Complainant’s claim Heritage promptly commenced an investigation. Heritage assigned an Independent Adjuster and licensed engineer to investigate the claim. 7. 626.9541(1)(i)(3)(d): Denying claims without conducting reasonable investigations based upon available information Response: Heritage denies the allegation contained herein. As indicated by the facts stated above, Heritage promptly commenced its investigation, and has, at all times, acted fairly and honestly toward the Insured, and has issued payment to the Insured in accordance with the findings of the assigned Independent Adjuster, licensed engineer, and certified roofing contractor, and governing policy of insurance. 8. 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. Response: Heritage denies the allegation contained herein. This is a sweeping allegation devoid of any factual support for the same. Heritage communicated freely and openly with the Insured during their investigation and provided a coverage determination letter with a full explanation of benefits. 9. 626.9541(1)(i)(3)(j): Altering or amended an insurance adjuster’s report without: (1) Providing a detailed explanation as to why any change that has the effect or reducing the estimate of the loss was made; and (ii) including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered the change; or (iii) retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made and ordered such change. Response: Heritage denies the allegation because it did not alter any report. As detailed by the facts stated above, Heritage did not violate any of the aforementioned statutory provisions. Notwithstanding, Heritage diligently investigated the subject claim. Moreover, while Heritage contends that the requested “cures” stated in the Notice are inappropriate, the Coverage Determination letter sent in January of 2023 effectively addresses the concerns outlined by the Insured. Notwithstanding the previously stated deficiencies with the Notice, the Complainant here has failed to set forth a reasonable cure for which Heritage can comply within the bounds of the governing policy of insurance. In closing, Heritage believes that the CRN should be rejected and returned by the Department of Financial Services due to its failure to comply with Florida Statute §624.155 and Florida Case law, and regardless of the rejection, Heritage denies all allegations contained in the CRN and submits there are no violations. While this response is meant to be comprehensive, Heritage’s response above is based upon the limited information provided in the CRN and the information we have to date. If the Complainant feels that we are not in possession of all the facts, please inform us immediately. Please note that Heritage’s response is not necessarily exhaustive and does not preclude us from asserting any other valid reason for seeking rejection and return of the CRN. Also, this letter or any act or failure to act on the part of Heritage or any agent or representative of Heritage should not be construed as a waiver of any rights or defenses available to it by contract or at law as all such rights and defenses are hereby specifically reserved. We trust that this response addresses the allegations of insurer violation alleged in the Civil Remedy Notice of Insurer Violation. Should you have any question regarding this matter or need anything further, please do not hesitate to contact the undersigned. Sincerely, /s/ Lisa Bernardini Lisa Bernardini, Esq. Fla. Bar No. 813052 LB/llb
Acknowledgement
* The submitter hereby states that this notice is given in order to perfect the rights of the person(s) damaged to pursue civil remedies authorized by Section 624.155, Florida Statutes.

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DFS-10-363
Rev. 10/14/2008