Civil Remedy Notice of Insurer Violations
Login

Filing Number:     788977
Filing Accepted:  10/28/2024
         Print Filing
Complainant
Last/Business Name *  
DENIQUE C. REDDIE   First Name  
Street Address * 1141 ELMONT ST. NW
City, State Zip * PALM BAY, FL 32907
Email Address * DEN.REDDIE@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   DENIQUE C. REDDIE   First Name  
Policy # * HOH256360 Claim #* H125853
Attorney
Attorney is Applicable
Last Name* GONZALEZ First Name * ANTHONY Initial
Street Address* 925 S. FEDERAL HWY
City, State Zip* BOCA RATON , FL 33432
Email Address * AGONZALEZ@KPATTORNEY.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):* NICK COUGHLIN
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unfair Trade Practice
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)(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)(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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

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

The carrier was put on notice of the insured’s windstorm event claim. The carrier initially attempted to low-ball the claim. Subsequently, the insured prepared a loss package in the amount of $49,743.80 needed to restore the property back to its pre-loss condition. Whereas, the carrier furnished a wrongful estimate and, having withheld the deductible, offered a deficient payment in the amount of $5,739.66 only, leaving a remainder in the amount of $44,004.14 to be paid in order to cure the breach, less any applicable policy deductible. The insured has complied with all of the carrier’s requests to date and the carrier has still failed to treat this claim with good faith. This intentional delay with the claim has led to direct prejudice of the insured. About five hundred forty-five days have passed since the original date of loss. The carrier has still refused to pay the fully covered amount owed under the policy. The carrier is aware of damage sustained by the insured’s property and has not taken any meaningful ensuing action. Additionally, the carrier has refused to cooperate or communicate with the undersigned counsel for the insured despite being presented with a letter of representation. This method of stonewalling is patently bad faith conduct and claims handling intended to prejudice and harm the insured who awaits benefits from the carrier at her own peril due to the carrier’s repeated, calculated, and contumacious disregard of both the law, policy, and good faith claims handling. It is clear that the carrier is not treating the insured with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insured; failing to implement proper standards for the adjustment and investigation of claims by its adjusters and placing the company’s interests before the insured’s interests; refusing to pay the full amount owed to the insured despite the fact that the carrier has been on notice of the damages and looking for ways to delay full recovery or any recovery to the insured, when a reasonable carrier in a similar position would have tendered a full payment in accordance with both the policy language and statutory requirements. The carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c) and 626.9541(1)(i)(3)(f), as well as Section I- Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss; and the loss payment provision under Section I- Conditions requiring payment of a claim within 90 days. All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless disregard for the insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $49,743.80, less any prior payments and less any applicable policy deductible; and 2.) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been sent to the carrier. Please do not hesitate to contact the undersigned at agonzalez@kpattorney.com or Kimberly Morales at (561)-892-9915 if you have any questions or concerns. Sincerely, Anthony Gonzalez Attorney at Law
Comments
User Id Date Added Comment
ncarlisle@heritagepci.com 12-16-2024 December 16, 2024 VIA ELECTRONIC SUBMISSION Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Complainant: Denique C. Reddie Insured: Denique C. Reddie Insurer: Heritage Property & Casualty Insurance Company DFS File No.: 788977 Claim No: H125853 Policy No.: HOH256360 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 788977, filed on behalf of Heritage’s insured Denique C. Reddie (“Complainant”). The Notice was accepted by the Department on October 28, 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. Heritage sent a licensed adjuster to inspect the insured property, and after its inspection and underlying investigation of the claim, Heritage sent correspondence, including a payment explanation letter to the insured; wherein, Heritage provided a thorough explanation of the coverage determination. To date, the Complainant has not provided any other information and/or documentation which would alter Heritage’s coverage determination. In the Notice, the Complainant generally alleges that Heritage engaged in bad faith conduct. However, sufficient information/documentation has not been provided to support these boilerplate allegations. The Complainant also alleges that Heritage has refused to communicate with it, however, that is not accurate as the undersigned has attempted to discuss this issue with the Complainant’s counsel. The parties were in the process of settlement discussions and this Notice seems unwarranted and unnecessary. Nevertheless, Heritage remains ready and willing to continue these discussions in furtherance of reaching an amicable resolution. 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
Acknowledgement
* The submitter hereby states that this notice is given in order to perfect the rights of the person(s) damaged to pursue civil remedies authorized by Section 624.155, Florida Statutes.

Before submitting a Notice using this system, please verify that all text has been entered correctly and completely. Once the Notice has been submitted, the text cannot be changed or deleted.




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