Civil Remedy Notice of Insurer Violations
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Filing Number:     785880
Filing Accepted:  10/4/2024
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Complainant
Last/Business Name *  
SCHAEFER   First Name   DANIEL AND VICTORIA
Street Address * 2153 CORK OAK STREET
City, State Zip * SARASOTA, FL 34232
Email Address * WITHHELD
Complainant Type: * Insured
Insured
Last/Business Name*   SCHAEFER   First Name   DANIEL AND VICTORIA
Policy # * HPH014002 Claim #* H103287
Attorney
Attorney is Applicable
Last Name* DANIELS First Name * MONICA Initial E
Street Address* 560 VILLAGE BOULEVARD, SUITE 110
City, State Zip* WEST PALM BEACH , FLORIDA 33409
Email Address * MDANIELS@THEDANIELS-LAWGROUP.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):* ANITA DYE, NATALIE CAMARENO, AND ANY AND ALL OTHER ADJUSTERS, MANAGERS, SUPERVISORS, AND INDIVIDUALS ASSOCIATED WITH THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unfair Trade Practice
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
* 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)(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)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
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.

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. 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. SECTION I – CONDITIONS 10. Loss Payment. We will adjust all losses with you.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Daniel Schaefer and Victoria Schaefer (the “Insureds”) purchased an insurance policy from Heritage Property & Casualty Insurance Company (“Insurer”), with Policy number HPH014002 (the “Policy”), to cover their property located at 2153 Cork Oak Street, Sarasota, FL 34232 (the “Property”). On September 28, 2022, Hurricane Ian struck the Property. The excessive winds from Ian caused overwhelming damage to the roof, necessitating a complete replacement of same, in addition to repairs being necessary in the following areas to return the Property to its pre-loss condition: exterior elevations, pool decking and enclosure, dining room, living room, kitchen, a bedroom, and a bathroom. The Insureds immediately reported the loss to Insurer, mitigated the damages, and complied with all applicable post-loss obligations. They also hired a public adjuster to help guide them through the damages and claims process. The Insurer assigned claim number H103287 (the “Claim”) to the claim, as well as claims adjuster Anita Dye. The Insurer inspected the Property and prepared a woefully deficient initial estimate that failed to address the full scope of damages and repairs necessary to return the Property to its pre-loss condition. The Insurer’s evaluation of the Property’s loss was insultingly low given the observable damages. The Insureds’ public adjuster provided the Insurer with a true and accurate estimate of the related damages, extensive detailed photographs of the damages, a properly executed sworn proof of loss, and complied with all of the Insurer’s requests for documentation and information. The Insurer acknowledged coverage and admitted liability for damages to the Property. The Insureds dispute that the amount unilaterally determined by the Insurer is sufficient to restore their Property to its pre-loss condition. The Insureds understandably became extremely frustrated by the Insurer’s clear delay tactics, failure to properly indemnify them for this Claim in a timely fashion, and failure to adjust the Claim in good-faith. To combat any further attempts by the Insurer to delay the Claim and its failure to make the Insureds whole, the Insureds had no choice but to retain legal counsel to assist with the Claim. Without sufficient funds to repair their property, the Insureds continue to suffer additional damages. The Insurer failed to make any meaningful effort to inspect the Property or adjust the Claim despite the Insureds expressing their clear disagreement with the Insurer’s handling of the Claim. Despite providing all necessary documentation to the Insurer to make good on its duty to restore the Insureds to their pre-loss condition, Insurer grossly undervalued the claim and only contemplated a fraction of the amount of Insureds’ damages. The scope of the damages considered by the Insurer is an insult to the Insureds and is far less money than necessary to complete the repairs to their well-maintained Property. The Insurer’s refusal to properly investigate, adjust and fully compensate the Insureds for this Claim undoubtedly evidences the Insurer’s violation of Section 626.9541(1)(i)(3)(a), Florida Statutes, which requires the Insurer to “adopt and implement standards for the proper investigation of claims.” All available information leads to one conclusion – the Property was damaged by a covered cause of loss for which the Insureds are entitled to full and complete compensation. The Insurer’s obligation to promptly settle the Insureds’ claim is undeniable, and therefore, the Insurer has also violated Fla. Stat. Section 624.155(1)(b)(1) and 624.155(1)(b)(3). The Insurer’s conduct continues to be egregious because the Insurer retained biased and inexperienced individuals who approached the loss with an eye towards underpayment. The actions taken by the Insurer in the handling and adjustment of the Claim are willful, wanton, and in disregard for the rights of the Insureds, and have occurred with such frequency as to indicate a general business practice in violation of the law. This practice includes the Insurer hiring biased and inexperienced adjusters and failing to properly and timely pay for obvious damages owed to its Insureds. The Insurer’s actions amount to, but are not limited to: A. “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 the insured and with due regard for her or his interests;” B. “Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue”; C. “Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear;” D. “Failing to adopt and implement standards for the proper investigation of claims;” E. Claim Delay; F. Unsatisfactory Settlement Offers; and G. Unfair Trade Practices. In addition to the above statutory violations, the Insurer’s adjuster violated the following ethical requirements of the Florida Administrative Code 69B-220.201: (3) Code of Ethics . . . An adjuster shall put the duty for fair and honest treatment of the claimant above the adjuster’s own interests in every instance. The following are standards of conduct that define ethical behavior, and shall constitute a code of ethics that shall be binding on all adjusters: (b) An adjuster shall treat all claimants equally. 2. An adjuster shall adjust all claims strictly in accordance with the insurance contract. (c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured. (d) An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation. (e) An adjuster shall handle every adjustment and settlement with honesty 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. (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. (o) An adjuster shall not undertake the adjustment of any claim concerning which the adjuster is not currently competent and knowledgeable as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster’s current expertise. The Insureds are dutiful customers who made it a priority to pay their insurance premiums and to ensure that in such an event as the one here, their property would be covered. The Insureds timely filed their claim and fulfilled all post-loss obligations. Insurer acknowledged the loss, assigned a claim number, inspected the property, accepted coverage for the loss, and then grossly undervalued the claim. Insurer has failed to provide the Insureds with qualified representatives to ensure the claim was initially adjusted, evaluated, and paid properly. To deny the Insureds the benefit of the bargain after they have satisfied all of their obligations is morally and ethically reprehensible, and reeks of Unfair Trade Practice. Insurer is putting its profits ahead of its contractual and statutory obligations. In Florida the work of adjusting insurance claims engages the public trust. The Insurer has failed to create and implement adequate guidelines for proper investigation to evaluate claims handling and for training and supervision of employees. The Insurer has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insureds’ insurance claim and damages. Therefore, the Insurer breached its statutory and ethical duties, and has put profits ahead of the duties it owed to its Insureds when they most needed the insurance coverage they had paid for. Florida Statute § 624.02 defines “insurance” as a contract where one undertakes to indemnify another or pay or allow specified amounts, or determinable benefit, upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly. This timely and prompt payment allows the insured to mitigate their damages and place them back to the position they were in prior to the loss, as quickly as possible. The Insurer breached this duty. The Insurer has refused and failed to tender all insurance proceeds to the Insureds upon demand. The Insurer’s refusal and/or failure to settle the insurance claim when it, under all circumstances, should have done so, is wrongful conduct. The Insurer is failing to promptly settle the Insureds’ claim as it is required to do so by contract, in order to influence settlements. To cure the defects outlined in this civil remedy notice, the Insurer must (1) immediately, and under no circumstances no later than sixty days from the date of this civil remedy notice, tender all insurance monies due and owing to the Insured under the Policy, specifically $ $93,773.24 under Coverages A and B pursuant to the public adjuster’s repair estimate and submitted invoices, less applicable deductible and prior payments; (2) tender all insurance monies due and owing to the Insureds for Mitigation/Remediation services incurred as a result of the Claim; (3) ensure that payment made would be adequate to place the Insureds and their Property back in the pre-loss condition; and (4) reimburse the Insureds’ attorneys’ fees and costs, since the Insureds were forced to hire legal counsel in order to receive adequate payment. Should the Insurer fail to comply with the demands set forth in this civil remedy notice, the Insurer must prepare to pay the full cost of its failure to rightfully indemnify the Insureds, including all future damages that come about as a result of the Insurer’s failure to comply with the demands set forth in this civil remedy notice. This Notice is giving in order to perfect the right to pursue the civil remedy authorized by section 624.155(3)(b), Florida Statutes.
Comments
User Id Date Added Comment
ncarlisle@heritagepci.com 11-15-2024 November 15, 2024 VIA ELECTRONIC SUBMISSION Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Complainant: Daniel and Victoria Schaefer Insured: Daniel and Victoria Schaefer Insurer: Heritage Property & Casualty Insurance Company DFS File No.: 785880 Claim No: H103287 Policy No.: HPH014002 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 785880, filed on behalf of Heritage’s insured Daniel and Victoria Schaefer (“Complainant”). The Notice was accepted by the Department on October 4, 2024. The subject Notice fails to comply with §624.155, Florida Statute, which provides that a Civil Remedy Notice must state with specificity the facts giving rise to the alleged violations and the policy language relevant to the violation, if any. Here, the Complainant did not substantially comply with the specificity standard, and this is more than a mere technical defect. As a result, the Complainant has failed to satisfy the requirement that it identify the specific policy provision relevant to Heritage’s alleged violation and/or the specific facts and circumstances giving rise to the violation and/or the names of any individuals involved in the alleged violations. See Fla. Stat. § 624.155(3)(b). Strict construction of Fla. Stat. § 624.155 demands a specificity level of compliance with the requisite provision of information to the Department and the insurer. See e.g. Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021). However, here, the Notice fails to meet the stringent standards that are required by Florida Law. Id. Instead, the Notice merely contains a list of violations which Heritage has allegedly committed but the Notice fails to provide an adequate basis in support of those allegations and on that basis alone, the Notice fails to satisfy the basic requirements of an otherwise proper Civil Remedy Notice. See Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875; Fla. Stat. §§ 624.155 and 626.9541. Furthermore, and without waiving Heritage’s arguments that the 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. The Notice contains a list of violations which are alleged to have been committed by Heritage. However, none of the listed violations/allegations have occurred and Heritage categorically denies any claims that it has violated the obligations and duties set forth under §624.155 and §626.9541, Fla. Stat., as well as any and all other statutes/regulations/codes/rules raised in the Notice. Furthermore, the Complainant has failed to produce any substantive information and/or documentation to support any of the allegations set forth in the Notice; and as such, the Notice is legally insufficient. Moreover, recently, the parties entered into a settlement agreement and this Notice was withdrawn. As such, this issue is moot. Accordingly, Heritage has handled the claim in accordance with the insurance policy, Florida law, and all statutory and regulatory requirements. Therefore, Heritage denies each and every assertion of bad faith in the Notice. And, notwithstanding the foregoing, nothing in this letter should be construed as a waiver or surrender of the policy terms, limitations, exclusions, conditions or agreements, nor should this letter be considered an exhaustive recitation of the deficiencies in the Notice. Heritage reserves the right to supplement its response at a later time. Should the Department have any questions, concerns, or require any additional information regarding this matter, please feel free to contact the undersigned at your convenience. Sincerely, /s/ Benndrick C. Watson Benndrick C. Watson, Esq. Claims Counsel Heritage Property & Casualty Insurance Co. CRN Response
mdaniels@thedaniels-lawgroup.com 10-24-2024 This CRN is hereby withdrawn.
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