Filing Number: 785686
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| Filing Accepted: 10/3/2024 |
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KELLY LAW OFFICE
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First Name |
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| Street Address
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5000 SW 75TH AVE |
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MIAMI,
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33155
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| Email Address
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EKELLY@KELLYLAWFL.COM |
| Complainant Type:
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Other |
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| Last/Business Name* |
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LEAL NODARSE |
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First Name |
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ANILEYDYS |
| Policy # * |
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HOH186455 |
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Claim #* |
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H112731 |
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Attorney is Applicable
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| Last Name* |
DE LA PUENTE
First Name *
GUILLERMO
Initial
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| Street Address* |
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5000 SW 75TH AVE |
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MIAMI
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FL
33155
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| Email Address * |
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GDELAPUENTE@KELLYLAWFL.COM |
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| Insurer Type
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 Authorized Insurer
 Unauthorized Insurer
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| Insurer Name |
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| Insurer Name* |
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HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY
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| Insurer Name* |
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| Street Address* |
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,
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NAIC Company Code 14407 |
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| Name of individual responsible for violation (if any):*
HERITAGE'S CORPORATE REPRESENTATIVE
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| Type of Insurance
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Residential Property & Casualty
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| Reason for Notice
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Unsatisfactory Settlement Offer
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Statutory provision(s) which the insurer allegedly violated.
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| 624.155(1)(b)(1) |
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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.
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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
INSURANCE CONTRACT, A GENERAL ALL-RISK POLICY, NO. HOH186455, THAT IS RELEVANT
TO THE VIOLATIONS INCLUDES, BUT IS NOT LIUMITED TO, THE FOLLOWING: ALL COVERAGE
PROVISIONS, ALL COVERAGE PROVIDED BY ENDORSEMENT OR RIDER, THE DECLARATIONS
PAGE, LOSS PAYMENT OR SETTLEMENT PROVISIONS, PROVISIONS PERTAINING TO THE
DUTIES IN THE EVENT OF A LOSS, ALL TERMS AND CONDITIONS PERTAINING TO ALL
SECTIONS OF THE INSURANCE POLICY, THE INSURANCE POLICY’S DEFINITIONS SECTION,
THE INSURANCE POLICY’S EXCLUSION OF COVERAGE PROVISIONS, ALL INSURANCE POLICY
PROVISIONS THAT PROVIDE COVERAGE TO THE INSURED PROPERTY; AND ALL OTHER
RELEVANT POLICY PROVISIONS.
THE POLICY LANGUAGE RELEVANT TO THE VIOLATIONS INCLUDES ALL APPLICABLE POLICY
COVERAGES, VALUATION PROVISIONS, AND OTHER TERMS AND CONDITIONS OF THE
POLICY. WE WILL PROVIDE THE INSURANCE DESCRIBED IN THE POLICY, WHICH INCLUDES
THE DECLARATIONS AND ATTACHED ENDORSEMENTS OR SCHEDULES IN RETURN FOR THE
PREMIUM AND COMPLIANCE WITH ALL POLICY PROVISIONS.
SEE:
(A) SECTION I – PROPERTY COVERAGES
(B) COVERAGE PROVISIONS UNDER COVERAGE A;
(C) COVERAGE PROVISIONS UNDER COVERAGE B;
(D) VALUATION PROVISIONS;
(E) ALL ADDITIONAL COVERAGES PROVISIONS;
(F) THE DECLARATIONS PAGE;
(G) LOSS PAYMENT AND SETTLEMENT PROVISIONS;
(H) DUTIES IN EVENT OF LOSS POLICY PROVISIONS; AND
(I) ALL TERMS AND CONDITIONS OF SECTION I OF THE INSURANCE POLICY;
(J) ALL ENDORSEMENTS TO THE POLICY INCLUDING FLORIDA ENDORSEMENT.
Governed by the cited authorities, the subject Policy provides coverage for sudden and accidental losses and damages arising from the direct physical loss to other structures and personal property resulting from a CATASTROPHIC HURRICANE. The loss payment provision and governing law provides that the insurer has a fiduciary duty to in good faith promptly investigate, adjust, and issue payment of the undisputed amount of the loss and damages and once reasonable proof of same has been provided.
IN ADDITION OF THE ABOVE STATUTORY PROVISIONS TO HAVE BEEN VIOLATED, SEE
ALSO THE FOLLOWING STATUES:
F.S. §624.1555(1)(A)1 – ANY PERSON MAY BRING A CIVIL ACTION AGAINST AN INSURER WHEN
SUCH PERSON IS DAMAGED: (A) BY VIOLATION OF ANY OF THE FOLLOWING PROVISIONS BY THE
INSURER: (1) SECTION 626.9541(1)(I), (O), OR (X)
F.S. §626.954(1)(I)(4) – FAILING TO PAY UNDISPUTED AMOUNTS OF PARTIAL OR FULL BENEFITS
OWED UNDER FIRST-PARTY PROPERTY INSURANCE POLICIES WITHIN 90 DAYS AFTER AN
INSURER RECEIVES NOTICE OF A RESIDENTIAL PROPERTY INSURANCE CLAIM, DETERMINES THE
AMOUNTS OR PARTIAL OR FULL BENEFITS, AND AGREES TO COVERAGE, UNLESS PAYMENT OF
THE UNDISPUTED BENEFITS IS PREVENTED BY AN ACT OF GOD, PREVENTED BY THE
IMPOSSIBILITY OF PERFORMANCE, OR DUE TO ACTIONS BY THE INSURED OR CLAIMANT THAT
CONSITUTE FRAUD, LACK OF COOPERATION, OR INTENTIONAL MISREPRESENTATION REGARDING THE CLAIM FOR WHICH BENEFITS ARE OWED.
69B-220.201(3)(B) AN ADJUSTER SHALL TREAT ALL CLAIMANTS EQUALLY.
69B-220.201(3)(B)(1) 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 INSURED.
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)(E) AN ADJUSTER SHALL HANDLE EVERY ADJUSTMENT AND SETTLEMENT WITH
HONEST AND INTEGRITY, AND ALLOW A FAIR ADJUSTMENT OR SETTLEMENT TO ALL PARTIES
WITHOUT ANY REMUNERATION TO HIMSELF EXCEPT THAT TO WHICH HE IS LEGALLY ENTITLED.
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 THE
CLAIMANT’S CLAIM RIGHTS IN ACCORDANCE WITH THE TERMS AND CONDITIONS OF THE
CONTRACT AND OF THE APPLICABLE LAWS OF THIS STATE. AN ADJUSTER SHALL EXERCISE CARE NOT TO ENGAGE IN THE UNLICENSED PRACTICE OF LAW AS PRESCRIBED BY THE FLORIDA BAR.
F.S. §626.877 – EVERY ADJUSTER SHALL ADJUST OR INVESTIGATE EVERY CLAIM, DAMAGE , 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.
F.S. §626.878 – AN ADJUSTER SHALL SUBSCRIBE TO THE CODE OF THE ETHICS SPECIFIED IN THE
RULES OF THE DEPARTMENT (FORMERLY THE DEPARTMENT OF INSURANCE).
F.S. §627.7015(2) – AT THE TIME A FIRST-PARTY CLAIM WITHIN THE SCOPE OF THIS SECTION IS
FILED, THE INSURER SHALL NOTIFY ALL FIRST-PARTY CLAIMANTS OF THEIR RIGHT TO
PARTICIPATE IN THE MEDIATION PROGRAM UNDER THIS SECTION. THE DEPARTMENT SHALL
PREPARE A CONSUMER INFORMATION PAMPHLET FOR DISTRIBUTION TO PERSONS
PARTICIPATING IN MEDIATION UNDER THIS SECTION.
F.S. §627.70131(1)(A)- UPON AN INSURER’S RECEIVING A COMMUNICATION WITH RESPECT TO
A CLAIM, THE INSURER SHALL, WITHIN 14 CALENDAR DAYS, REVIEW AND ACKNOWLEDGE
RECEIPT OF SUCH COMMUNICATION UNLESS PAYMENT IS MADE WITHIN THAT PERIOD OF TIME
OR UNLESS THE FAILURE TO ACKNOWLEDGE IS CAUSED BY FACTORS BEYOND THE CONTROL OF THE INSURER WHICH REASONABLY PREVENT SUCH ACKNOWLEDGEMENT. IF THE
ACKNOWLEDGMENT IS NOT IN WRITING, A NOTIFICATION INDICATING ACKNOWLEDGEMENT
SHALL BE MADE IN THE INSURER’S CLAIM FILE AND DATED. A COMMUNICATION MADE TO OR
BY AN AGENT OF AN INSURER WITH RESPECT TO A CLAIM SHALL CONSITUTE COMMUNICATION
TO OR BY THE INSURER.
F.S. §627.70131(5)(A)- WITHIN 90 DAYS AFTER AN INSURER RECEIVES NOTICE OF A PROPERTY
INSURANCE CLAIM FROM A POLICYHOLDER, THE INSURER SHALL PAY OR DENY SUCH CLAIM OR
A PORTION OF THE CLAIM UNLESS THE FAILUER TO PAY SUCH CLAIM OR A PORTION OF THE
CLAIM IS CAUSED BY FACTORS BEYOND THE CONTROL OF THE INSURER WHICH REASONABLY
PREVENT SUCH PAYMENT. ANY PAYMENT OF A CLAIM OR PORTION OF A CLAIM PAID 90 DAYS
AFTER THE INSURER RECEIVES NOTICE OF THE CLAIM, OR PAID MORE THAN 15 DAYS AFTER
THERE ARE NO LONGER FACTORS BEYOND THE CONTROL OF THE INSURER WHICH REASONABLY PREVENTED SUCH PAYMENT, WHICHEVER IS LATER, SHALL BEAR INTEREST AT THE RATE SET FORTH IN S. 55.03. INTEREST BEGINS TO ACCRUE FROM THE DATE THE INSURER RECEVIES NOTICE OF THE CLAIM. THE PROVISIONS OF THIS SUBSECTION MAY NOT BE WAIVED, VOIDED, OR NULLIFIED BY THE TERMS OF THE INSURANCE POLICY. IF THERE IS A RIGHT TO
PREJUDGMENT INTEREST, THE INSURED SHALL SELECT WHETHER TO RECEIVE PREJUDGMENT
INTEREST OR INTEREST UNDER THIS SUBSECTION. INTEREST IS PAYABLE WHEN THE CLAIM OR
PORTION OF THE CLAIM IS PAID. FAILURE TO COMPLY WITH THIS USBSECTION CONSTITUTES A
VIOLATION OF THIS CODE. HOWEVER, FAILURE TO COMPLY WITH THIS SUBSECTION SHALL NOT
FORM THE SOLE BASIS FOR A PRIVATE CAUSE OF ACTION.
F.S. §627.7011(3)- IN THE EVENT OF A LOSS FOR WHICH A DWELLING OR PERSONAL PROPERTY
IS INSURED ON THE BASIS OF REPLACEMENT COSTS, THE INSURER SHALL PAY THE
REPLACEMENT COST WITHOUT RESERVATION OR HOLDBACK OF ANY DEPRECIATION IN VALUE,
WHETHER OR NOT THE INSURED REPLACES OR REPAIRS THE DWELLING OR PROPERTY.
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Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY AND ITS AGENTS HAVE FAILED AND/OR REFUSED TO PROPERLY INVESTIGATE THE LOSS, HAVE FAILED AND/OR REFUSED TO ADMIT COVERAGE FOR THE LOSS, AND HAVE FAILED AND/OR REFUSED TO TENDER ANY INSURANCE PROCEEDS DUE AND OWING TO THE INSURED UNDER THE POLICY. ADDITIONALLY, HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY IS REFUSING FULL COVERAGE ON THE BASIS THAT THERE WAS A HURRICANE CONTRIBUTING TO THE LOSS, WHEN IN FACT THERE WAS A CATASTROPHIC HURRICANE CONTRIBUTING TO THIS LOSS.
HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY'S CONDUCT IS CONTRARY TO THE PROVISIONS OF THE CONTRACT, INCLUDING BUT NOT LIMITED TO, THE COVERAGE AGREEMENTS, THE LOSS SETTLEMENT PROVISION, THE LOSS PAYMENT PROVISION, AND THE IMPLIED COVENANT OF GOOD FAITH AND FAIR DEALING.
ANILEYDYS LEAL NODARSE HAS REQUESTED THAT HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY ADMIT COVERAGE AND PAY THEIR DAMAGES; HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY HAS FAILED AND/OR REFUSED TO DO SO AND CONTINUES TO REFUSE TO ADMIT COVERAGE AND PAY THE DAMAGES DESPITE KNOWING IT IS REQUIRED TO DO SO. ANILEYDYS LEAL NODARSE, AS A RESULT OF A CATASTROPHIC HURRICANE, HAS SUFFERED DAMAGE TO THE INSURED PROPERTY. TO DATE, HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY HAS REFUSED TO ADMIT COVERAGE AND TENDER ANY INSURANCE BENEFITS TO ASSIST ITS INSUREDS. HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY HAS A DUTY TO PAY ALL UNDISPUTED DAMAGES, BUT IT HAS FAILED TO/REFUSED TO DO SO IN THIS CLAIM.
THE CONCEPT OF INSURANCE IS THAT INSURANCE IS THE INSURER’S GRANTING OF TIMELY AND
PROMPT INDEMNITY OR SECURITY AGAINST A CONTINGENT LOSS. FLORIDA STATUTE SECTION
624.02 DEFINES INSURANCE AS A CONTRACT WHEREBY ONE UNDERTAKES TO INDEMNIFY
ANOTHER OR PAY OR ALLOW 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 MITIGATE HIS/HER DAMAGES AND TO PUT
THEM BACK INTO THE POSITION THEY WERE PRIOR TO LOSS AS QUICKLY AS POSSIBLE. HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY HAS BREACHED THIS DUTY.
HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY HAS NOT ADMITTED COVERAGE AND/OR TENDERED ANY INSURANCE MONIES DUE AND OWING THE INSURED AS REQURED BY THE POLICY AND THE FACTS AND CIRCUMSTANCES OF THE CLAIM.
HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY HAS REFUSED AND/OR FAILED TO TENDER ALL INSURANCE PROCEEDS TO THE INSURED UPON DEMAND. THE INSUREDS HAVE DEMANDED THAT HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY ADMIT COVERAGE AND TENDER THEM INSURANCE MONIES PURSUANT TO THE POLICY TO MAKE REPAIRS TO THE INSURED PROPERTY, BUT HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY HAS REFUSED.
HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY HAS FAILED AND/OR REFUSED TO THOROUGHLY, ACCURATELY, AND COMPLETELY INVESTIGATE AND EVALUATE THE INSURED’S INSURANCE CLAIM FOR DAMAGES. HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY HAS REFUSED AND/OR FAILED TO ADMIT COVERAGE AND TENDER ALL INSURANCE PROCEEDS TO THE INSUREDS UPON DEMAND AS REQUIRED BY THE POLICY AND/OR LAW. REFUSAL AND/OR FAILURE TO SETTLE THE INSURED’S CLAIM WHEN UNDER ALL THE CIRCUMSTANCES IT COULD HAVE AND SHOULD HAVE DONE SO HAD IT ACTED FAIRLY AND HONESTLY TOWARDS THE INSURED’S IS WRONG. THE ACTIONS TAKEN BY HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY IN THE HANDLING/ADJUSTMENT OF THE INSURE’S CLAIM WERE WILLFUL, WANTON, AND IN DISREGARD FOR THE RIGHTS OF ITS INSUREDS AND HAVE OCCURRED WITH SUCH A FREQUENCY AS TO INDICATE A GENERAL BUSINESS PRACTICE, AND FURTHER, AND ARE IN VIOLATION OF FLORIDA STATUTES §624.155 AND §626.9541.
HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY'S ABOVE-DESCRIBED ACTIONS AMOUNT TO, BUT ARE NOT LIMITED TO, THE FOLLOWING WRONGFUL CONDUCT:
1. CLAIM DELAY
2. CLAIM DENIAL
3. NOT CONDUCTING FULL AND PROMPT INVESTIGATION
4. NOT TREATING POLICYHOLDERS WITH GOOD FAITH CLAIMS CONDUCT
5. LOOKING FOR WAYS TO DENY RECOVERY TO INSURED
6. LOOKING FOR WAYS TO REDUCE RECOVERY TO INSURED
7. LOOKING FOR WAYS TO DELAY FULL RECOVERY TO INSURED
8. HOLDING BACK AND FAILING TO PAY PORTIONS OF CLAIM CLEARLY OWED
9. NOT ADJUSTING CLAIM AND EVALUATING LOSS PROPERLY, PROMPTLY AND FAIRLY TO
PROVIDE FULL AND PROMPT INDEMNITY TO INSURED
10. FAILING TO IMPLEMENT PROPER STANDARDS FOR THE ADJUSTMENT AND INVESTIGAITON
OF CLAIMS.
11. NOT TRAINING, SUPERVISING OR MANAGING ADJUSTERS PROMPERLY SO THAT PROMPT
AND FULL PAYMENTS ARE MADE, BUT RATHER PLACING THE COMPANY’S INTERESTS
BEFORE THE POLICYHOLDER’S INTERESTS
12. ESTABLISHING SEVERITY CONTROL INITIATIVE AND OTHERWISE ESTABLISHING A CULTURE
OF NOT FULLY AND PROMPTLY PAYING CLAIMS FOLLOWING LOSSES.
THEREFORE, TO CURE THE DEFECTS OUTLINED IN THIS CIVIL REMEDY NOTICE, HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY MUST:
(1) ADMIT COVERAGE FOR THE LOSS AND DAMAGES TO THE INSURED PROPERTY.
(2) TENDER INSURANCE PROCEEDS IN AN AMOUNT TOTALING AT LEAST $200,000.00; AND
(3) PAY STATUTORY INTEREST FROM THE DATE OF THE LOSS.
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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.
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DFS-10-363
Rev. 10/14/2008
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