Filing Number: 786036
|
| Filing Accepted: 10/7/2024 |
| Last/Business Name
*
|
|
|
| Street Address
*
|
|
16364 TREASURE POINT DRIVE |
| City, State Zip
*
|
|
WIMAUMA,
FL
33598
|
| Email Address
*
|
|
CAH1809@GMAIL.COM |
| Complainant Type:
*
|
|
Insured |
|
| Last/Business Name* |
|
HILL |
|
First Name |
|
CAITLIN |
| Policy # * |
|
HOH675519 |
|
Claim #* |
|
H104572 |
|
Attorney is Applicable
|
| Last Name* |
MURRAY
First Name *
DAVID
Initial
C
|
| Street Address* |
|
109 N. BRUSH ST., SUITE 350 |
| City, State Zip* |
|
TAMPA
,
FL
33602
|
| Email Address * |
|
SERVICE@MURRAYLAWGROUP.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):*
CLAIM SUPERVISORS, MANAGERS, AGENTS, ADJUSTERS, AND REPRESENTATIVES INCLUDING TRACI BONALI, LONNIE GIBSON, ZACH EDWARDS, TEDRICK ROBINSON, WARWICK GUIDRY, ROBERT HOLMES, & TIM KIERNAN.
|
| Type of Insurance
*
Residential Property & Casualty
|
|
|
| Reason for Notice
*
|
|
|
Cancellation
|
|
|
Non-renewal
|
|
|
Claim Delay
|
|
|
Unsatisfactory Settlement Offer
|
|
|
Unfair Trade Practice
|
|
|
Other
:
Violation of Code of Ethics
|
|
|
Other
:
Litigation Strategy and Behavior
|
|
|
*
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)(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)(g) |
|
Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
|
|
| 626.9541(1)(i)(3)(h) |
|
Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
|
|
| 626.9541(1)(o)(11) |
|
No insurer shall cancel or issue a non-renewal notice on any insurance policy or contract without complying with any applicable cancellation or non-renewal provision required under the Florida Insurance Code.
|
|
| 626.9541(1)(i)(4) |
|
Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
|
|
| 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.
Enter all words or phrases (one at a time) that should be used to filter.
The Insured does not have a certified copy of the Policy despite requesting same from Heritage. Nonetheless, the Insured believes the language relevant to the violations includes the applicable coverages and limits from the Declaration Pages as well as the following policy language:
AGREEMENT is deleted and replaced by the following:
In reliance on the information you have given us, we agree to provide the insurance coverages indicated on the Policy Declarations. In return, you must pay the premium when due, comply with the policy terms and conditions, and notify us within 60 days of any change of title, use or occupancy of the “residence premises.”
10. Loss Payment.
We will adjust all losses with you. We will pay you unless some other person is named in the policy or is legally entitled to receive payment. In the event that any repair services were performed under the Our Option provision, we will pay the retained contractor directly for those services or part or portion of any services the retained contractor performs or provides. For all other claims payments, we will pay you unless some other person is named in the policy or is legally entitled to receive payment.
Loss will be paid upon the earliest of the following:
a. 20 days after we receive your written proof of loss and reach a written, executed agreement of settlement with you according to the terms of the written agreement; or
b. Within 60 days after we receive your proof of loss;
and:
(1) There is an entry of a final judgment or, in the case of an appeal from such judgment, within 60 days from and after the affirmance of the same by the appellate court; or
(2) There is a written executed mediation settlement with us according to the terms of the written mediation settlement; or
(3) There is a filing of an appraisal award with us; or
c. Within 90 days after we receive notice of an initial claim, “reopened claim” or “supplemental claim” from you, we will pay or deny such claim or portion of the claim unless the failure to pay such claim or portion of claim is caused by factors beyond our control which reasonably prevent such payment.
Our failure to comply with this paragraph shall not form the sole basis for an action against us for breach of contract under this policy or for benefits under this policy.
10. Renewal Notification. If we elect to renew this policy, we will let the first named insured know, in writing;
a. Of our decision to renew this policy; and
b. The amount of renewal premium payable to us.
This noticed will be delivered or mailed to the first named insured at the mailing address shown in the Declarations at least 45 days before the expiration date of this policy. Proof of mailing will be sufficient proof of notice.
2. Your Duties After Loss. In case of a loss to covered property, you must see that the following are done:
…
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
(8) Evidence or affidavit that supports a claim under the Credit Card, Fund Transfer Card,
Forgery and Counterfeit Money coverage, stating the amount and cause of loss.
|
| |
*
Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
624.155(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).
69B-220.201(3)(b) An adjuster shall treat all claimants equally.
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)(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)(k) 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.
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.
626.878 An adjuster shall subscribe to the code of ethics specified in the rules of the department. The rules shall implement the provisions of this part and specify the terms and conditions of contracts, including a right to cancel, and require practices necessary to ensure fair dealing, prohibit conflicts of interest, and ensure preservation of the rights of the claimant to participate in the adjustment of claims.
626.9744(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.
626.9744(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.
627.4133(2)(e)(1) An authorized insurer may not cancel or nonrenew a personal residential or commercial residential property insurance policy covering a dwelling or residential property located in this state: a. For a period of 90 days after the dwelling or residential property has been repaired, if such property has been damaged as a result of a hurricane or wind loss that is the subject of the declaration of emergency pursuant to s. 252.36 and the filing of an order by the Commissioner of Insurance Regulation. b. Until the earlier of when the dwelling or residential property has been repaired or 1 year after the insurer issues the final claim payment, if such property was damaged by any covered peril and sub-subparagraph a. does not apply.
627.4133(2)(e)(3) If the insurer elects to nonrenew a policy covering a property that has been damaged, the insurer shall provide at least 90 days’ notice to the insured that the insurer intends to nonrenew the policy 90 days after the dwelling or residential property has been repaired. Nothing in this paragraph shall prevent the insurer from canceling or nonrenewing the policy 90 days after the repairs are complete for the same reasons the insurer would otherwise have canceled or nonrenewed the policy but for the limitations of subparagraph 1.
627.4133(3) Claims on property insurance policies that are the result of an act of God may not be used as a cause for cancellation or nonrenewal, unless the insurer can demonstrate, by claims frequency or otherwise, that the insured has failed to take action reasonably necessary as requested by the insurer to prevent recurrence of damage to the insured property.
627.70131(1)(a) Upon an insurer’s receiving a communication with respect to a claim, the insurer shall, within 7 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. If the acknowledgment is not in writing, a notification indicating acknowledgment shall be made in the insurer’s claim file and dated. A communication made to or by a representative of an insurer with respect to a claim shall constitute communication to or by the insurer.
627.70131(2) Such acknowledgment must be responsive to the communication. If the communication constitutes a notification of a claim, unless the acknowledgment reasonably advises the claimant that the claim appears not to be covered by the insurer, the acknowledgment must provide necessary claim forms, and instructions, including an appropriate telephone number.
627.70131(3) (e) The insurer must send the policyholder a copy of any detailed estimate of the amount of the loss within 7 days after the estimate is generated by an insurer’s adjuster. This paragraph does not require that an insurer create a detailed estimate of the amount of the loss if such estimate is not reasonably necessary as part of the claim investigation.
627.70131(7)(a) Within 60 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer. The insurer shall provide a reasonable explanation in writing 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. If the insurer’s claim payment is less than specified in any insurer’s detailed estimate of the amount of the loss, the insurer must provide a reasonable explanation in writing of the difference to the policyholder. Any payment of an initial or supplemental claim or portion of such claim made 60 days after the insurer receives notice of the claim, or made after the expiration of any additional timeframe provided to pay or deny a claim or a portion of a claim made pursuant to an order of the office finding factors beyond the control of the insurer, whichever is later, bears interest at the rate set forth in s. 55.03. Interest begins to accrue from the date the insurer receives 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 must 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 subsection constitutes a violation of this code. However, failure to comply with this subsection does not form the sole basis for a private cause of action.
The property located at 16364 Treasure Point Drive, Wimauma, Florida was damaged by Hurricane Ian on or about September 28, 2022. The Insured, Caitlin Hill, timely provided notice of the loss to her property insurer, Heritage Property & Casualty Insurance Company (“Heritage”).
Heritage (through Zack Edwards of Tri-Star Claim Solutions) inspected the Insured Property on or about October 15, 2022. Heritage (through Adjuster Tedrick Robinson) emailed the Insured on October 22, 2022 to advise he was the claim adjuster.
More than two weeks passed following the inspection but the Insured did not receive an estimate or update regarding the findings. By email sent November 1, 2022, the Insured emailed Heritage to inquire about the status. Heritage did not respond to the claim communication.
Instead, in a “NONRENEWAL NOTICE” dated November 8, 2022, Heritage advised “We regret to inform you that this policy will not be renewed.” Heritage was wrong to non-renew the Policy when it knew the Insured suffered damage from a windstorm that occurred less than two months earlier—especially when it had not yet issued monies for repairs. When the Insured contacted Heritage to inquire about the Nonrenewal Notice, Heritage advised it would renew her Policy. However, Heritage subsequently canceled the policy in March 2023 based on its position that the Insured never made any payments—but Heritage had never sent payment notices or renewal declarations. The Insured had to pay for (expensive) forced place insurance for a few months due to Heritage’s wrongful non-renewal/cancellation.
More than two months later, on January 17, 2023, Heritage Adjuster Traci Bonali emailed the Insured to advise she was the new adjuster. The Insured responded the following day (January 18, 2023) and provided Heritage with invoices for tree removal, damaged window replacement, and a receipt for a damaged desk. (Heritage had previously been provided with a copy of the roofing contract entered into by the Insured.) Heritage acknowledged receipt of the documents two weeks later by email sent February 1, 2023.
In an email sent February 9, 2023, Heritage provided the insured with its coverage letter and its “revised estimate.” The estimate showed dwelling damages of $15,703.08 (RCV). This estimate significantly undervalued the damages to the Insured Property. Moreover, the “revised” estimate was provided nearly 4 months after the inspection and the Insured was never provided a copy of the original estimate. In its February 9, 2023 letter, Heritage advised it was issuing payment of $8,894.15 ($15,703.08 less the $5,670 deductible). This payment (and the estimate on which it was based) was insufficient to restore the Insured Property to its pre-loss condition. Heritage also failed to pay any amounts owed for damaged personal property even though the Insured had previously submitted documentation for the damaged desk.
By email sent March 15, 2023, the Insured advised the payment was insufficient as follows: “I'd like to talk about either re-opening or doing a supplement to my claim for the cost of window repairs. I was able to deposit the check today for the roof, but nearly all of that amount is for the roof and does not cover what is needed for the windows. Could you please tell me what the best way to proceed is?” More than three weeks passed but Heritage did not acknowledge or respond to this claim communication. The Insured emailed and called Heritage again on April 7, 2023. Heritage again refused to acknowledge or respond to these claim communications.
The Insured was subsequently forced to retain counsel to assist with the claim. On August 7, 2024, the Insured’s counsel submitted his letter of representation. Heritage (through Adjuster Warwick Guidry) responded eleven (11) days later. In its August 18, 2024 letter, Heritage requested the Insured submit claim documentation that had already been provided (such as repair invoices). Heritage also requested a Sworn Statement in Proof of Loss be provided “within 10 days.” Heritage also requested a Personal Property Inventory Form but did not attach the referenced form.
The Insured (through counsel) responded to Heritage on August 20, 2024 to request a copy of the Personal Property Inventory Form. The Insured also requested confirmation regarding the Proof of Loss submission requirement given the Policy provides the Insured has 60-days to submit (not 10 days as stated in 8/18/2024 Heritage’s letter). The Insured followed up again on August 23, 2024 to request the inventory form and for clarification regarding the proof of loss.
By email sent August 25, 2024, Heritage (through Adjuster Guidry) advised “We are requesting that the requested information including the SPOL be provided within 10 days as 10 days is reasonable.” Heritage completely disregarded the Policy’s terms and conditions by requiring the proof of loss to be submitted within 10-days when the Policy clearly provides 60-days. On August 27, 2024, Heritage (through new Adjuster Robert Holmes) contacted the Insured’s counsel to advise she did have 60-days to submit the Proof of Loss.
Over two years have passed since the Insured Property was damaged (and since the claim was reported to Heritage). Heritage has delayed the claim, undervalued the loss, and has refused to issue all amounts owed for the loss and damage to the Insured Property. Throughout the adjustment, Heritage failed to timely respond to claim communications (or to even respond at all), failed to keep the Insured informed of the claim status, failed to timely provide the Insured with information and documentation to which they are entitled (such as the damage estimates), and made misrepresentations to the Insured about the Policy’s terms. The Insured fully complied with Heritage as required under the Policy, and fully cooperated with Heritage in its investigation. Heritage has failed to create and implement adequate guidelines for proper claims investigation, claims evaluation, claims handling, and for training and supervision of employees and independent contractors handling its claims resulting in statutory violations as set forth above.
The concept of insurance is that it is the insurer's granting of timely and prompt indemnity or security against a contingent loss. Fla. Stat. § 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 is made timely and promptly so that insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. Heritage has failed to comply with its duty to indemnify the Insured.
Heritage has refused to provide a proper scope of repairs for the Insured Property and has failed to pay all insurance proceeds owed to the Insured. 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 is wrong.
The actions taken by Heritage in the handling and adjustment of the Insured’s claim were willful, wanton, and in disregard for the rights of its Insured and occur with such a frequency as to indicate a general business practice, and further, are in violation of Florida Statutes § 624.155 and § 626.9541.
Based on the foregoing actions and omissions, Heritage has engaged in wrongful conduct. That wrongful conduct includes, but is not limited to, the following:
1. Improper claim delay.
2. Undervaluing the damages to the Insured Property.
3. Underpaying the damages to the Insured Property.
4. Not conducting a full and fair investigation of the Insured’s claim.
5. Looking for ways to deny recovery to the Insured.
6. Looking for ways to delay recovery to the Insured.
7. Not adjusting the claim and not evaluating the loss properly, promptly, and fairly so that the Insured are fully and promptly indemnified.
8. Failing to implement proper standards for the adjustment and investigation of insurance claims.
9. Not training, supervising, or managing adjusters and independent contractors properly so that prompt and full payments are made, but rather placing the company’s interests before the policyholder’s interests by attempting to deny or minimize payments owed.
10. Establishing severity control initiatives and otherwise establishing a culture of not fully and promptly paying claims following losses.
11. Making misrepresentations to the Insured about the extent of damages at the Insured Property.
12. Making misrepresentations to the Insured about the scope of necessary repairs at the Insured Property.
13. Making misrepresentations to the Insured about the Policy’s requirement for submission of sworn proofs of loss.
14. Failing to acknowledge and/or respond to the Insured’s claim communications.
15. Failing to timely acknowledge and/or respond to the Insured’s claim communications.
16. Failing to provide coverage necessary to restore the Insured Property to its pre-loss condition.
17. Failing to issue any amounts for the Insured’s personal property damages.
18. Failing to timely provide the Insured with a copy of the damage estimate following the field adjuster’s inspection.
19. Failing to provide the Insured with a copy of the original and/or unaltered damage estimate following the field adjuster’s inspection.
20. Improperly sending a Non-Renewal Notice to the Insured on November 8, 2022 (just over a month after the date of loss).
21. Cancelling the policy for non-payment despite never sending renewal documentation and/or payment notices.
Therefore, to cure the defects outlined in this Civil Remedy Notice, Heritage Property & Casualty Insurance Company must:
• Tender an additional payment amount of $6,0000.
• Tender all additional amounts owed under the Policy for the covered loss to the Insured Property.
A copy of this form has been submitted to the FDFS and has been provided to the following parties providing them notice of the filing of the Civil Remedy Notice:
• Heritage Property & Casualty Insurance Company, via DFS filing.
• Heritage Property & Casualty Ins. Co. c/o Adjuster Tim Kiernan (tkiernan@heritagepci.com; Claims@HeritagePCI.com)
• Ms. Caitlin Hill, via email (cah1809@gmslail.com)
|
|
|
*
|
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
|