Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 790503

Filing Accepted: 11/6/2024

Print Filing

Complainant

Last/Business Name *

JORDEN

First Name

LAWONDA

Street Address *

209 TAYLOR BAY LN.

City, State Zip *

BRANDON, FL 33510

Email Address *

LAWONDAJORDEN@OUTLOOK.COM

Complainant Type: *

Insured

Last/Business Name*		JORDEN		First Name		LAWONDA
Policy # *		HOH168382		Claim #*		H97772

Attorney

Attorney is Applicable

Last Name*	STAGGS First Name * KYLE Initial B
Street Address*		1715 W. CLEVELAND STREET
City, State Zip*		TAMPA , FLORIDA 33606
Email Address *		COURTDOCS@WILLIAMSPA.COM

Violation

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):* ALL ADJUSTERS, LAURA HERRERA, SUPERVISORS, MANAGEMENT AND INDI-VIDUALS ASSOCIATED WITH OR RETAINED BY HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY IN THIS CLAIM.
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Delay
	Claim Denial
	Unsatisfactory Settlement Offer
	Unfair Trade Practice
	Other : Failure to Properly Investigate Claim and with Due Regard to Insured's Interest
	Other : Failure to Pay the Claim in Full

* 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)(3)(d)		Denying claims without conducting reasonable investigations based upon available information.

* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

RELEVANT POLICY LANGUAGE The specific policy language that is believed to be relevant to the violations includes, but is not limited to, the following: See Subject Policy: Heritage Property & Casualty Insurance Company Policy No.: HOH168382 loss payment provision, policy definitions, and policy exclusions section.

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

Insured's Address: 209 Taylor Bay Ln., Brandon, FL 33510 Insurer’s Address: 1401 N. Westshore Blvd., Tampa, FL 33607 This complaint is made on behalf of Lawonda Jorden (“Insured”) and against Heritage Property & Casualty Insurance Company. In consideration of the premium paid to it by the Insured, Heritage Property & Casualty Insurance Company issued to the Insured an insurance policy, Pol-icy No.: HOH168382 (the “Policy”). On or about September 28, 2022, while the Policy was in full force and effect, the Insured suffered a hurricane loss to the property located at 209 Taylor Bay Ln., Brandon, FL 33510. Heritage Property & Casualty Insurance Company was afforded a complete opportunity to investigate the loss, but conducted a limited and inadequate investigation. As a result of this limited and inadequate investigation, driven by the desire of Heritage Property & Casualty Insurance Company to avoid developing evidence that significant insurance proceeds are owed by it to its Insured, Heritage Property & Casualty Insurance Company did not pay its Insured what the Insured is rightfully entitled to under the insurance policy. In addition to Heritage Property & Casualty Insurance Company improperly investigating the claim, Heritage Property & Casualty Insurance Company improperly interpreted its policy so that it could avoid paying insurance proceeds it owes under the policy. The combination of these acts combined to cause damage to the Insured by way of the Insured having to expend additional resources to collect insurance proceeds that are rightfully owed, loss of use of funds, and the corresponding damage caused by that loss of use of funds, and interest. Therefore, to cure the defects outlined in this Civil Remedy Notice, Heritage Property & Casualty Insurance Company must pay the Insured's claim in full.

Comments

User Id		Date Added		Comment
tracy@williamspa.com		02-19-2025		Both parties were able to come to a resolution and this Civil Remedy Notice is hereby withdrawn.
ncarlisle@heritagepci.com		12-18-2024		December 18, 2024 VIA ELECTRONIC SUBMISSION Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Complainant: Lawonda Jorden Insured: Lawonda Jorden Insurer: Heritage Property & Casualty Insurance Company DFS File No.: 790503 Claim No: H97772 Policy No.: HOH168382 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 790503, filed by or on behalf of Lawonda Jorden (“Insureds and/or Complainants”) and accepted by the department on November 6, 2024. As a preliminary matter, Heritage states that the claim underlying this Notice has been settled between Heritage and the Complainant’s representatives on or about December 13, 2024. The release prepared by Heritage has been forwarded to Complainant’s representative and is currently pending execution. After receiving the release, Heritage will issue payment according to the terms of the settlement agreement. As a condition of the settlement, Complainant is to withdraw CRN 790503 upon receipt of the settlement payment. Notwithstanding the settlement, Heritage responds to it specifically denying each and every allegation contained in the Notice. Heritage believes that the Notice should be rejected and returned by the Department of Financial Services as it fails to comply with the specific information requirements as set forth in Civil Remedy Notice of Insurer Violation document provisions as promulgated in Florida Statute and Florida Case law. More specifically, Florida Statute §624.155(3)(b)(2) requires the Complainant to “describe the facts and circumstances giving rise to the insurer’s violation” to enable the insurer to investigate and resolve the claim. Contrary to the requirement set forth in the statute, this Notice contains overbroad and incorrect allegations, which stem only from the Complainant’s opinions regarding the value of their own claim and, therefore, the Complainant’s opinions regarding Heritage’s adjustment of this claim. Moreover, Florida Statute §624.155(3)(b)(4) requires the Complainant to refer to specific policy language that is relevant to the alleged violation, if any. The Notice is legally insufficient because it allegedly lists policy sections and does not specify which policy provisions were violated Therefore, the Notice failed to provide sufficient notice to Heritage as to what policy provision was violated. Additionally, despite citing the name of one representative from Heritage, the Notice failed to identify the person and persons representing Heritage from the Claims department, which supervisor, management, agents, and adjuster, including the following representative and adjusters, and vendors who are most responsible for knowledgeable of the facts giving rise to the allegation in the Notice, as explicitly required. Further, the Notice contains a list of violations that Heritage has allegedly committed but fails to provide an adequate basis in support of those allegations and, on that basis alone, fails to satisfy the basic requirements of an otherwise proper Notice. Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021); Fla. Stat. §§ 624.155 and 626.9541. Lastly, the Notice failed to inform Heritage whether the Notice had been given to perfect the right to pursue the civil remedy authorized by Florida Statute §624.155 and Florida Case law. As such, the Notice does not comply with Florida law and is legally insufficient. For clarification, Heritage provides a brief history of the claim filed under the policy issued by Complainant: 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 Complainants; wherein, Heritage provided a thorough explanation of the coverage determination. To date, the Complainants have not provided any other information and/or documentation that would alter Heritage’s coverage determination. Nonetheless, Heritage continued its attempts to resolve the claim. In accordance with Fla. Stat. §624.155, the Civil Remedy Notice requires Complainants, “to indicate all statutory provisions alleged to have been violated.” The Notice alleges the reasons for the Notice are the following: Claim Delay The Notice fails to state instances of “claim delay" practice occurred; therefore, it lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. Claim Denial The Notice fails to state who, how, and when a “claim denial” practice occurred; therefore, it lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. Unsatisfactory Settlement Offer The complainant failed to state who, how, and when Heritage provided an “unsatisfactory settlement offer”; therefore, it lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. Unfair Trade Practice The Notice fails to state instances of “unfair trade practice” occurred; therefore, it lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. Failure to properly investigate Claims and with Due Regard to Insured’s interest The Notice fails to state instances of Heritage’s “failure to properly investigate Claims and with Due Regard to Insured’s Interest” occurred; therefore, it lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. Failure to pay the claim in full The Notice fails to state instances of Heritage’s “failure to pay the claim in full” occurred; therefore, it lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. Further, 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 Complainant and with due regard for his or her interests. Response: Heritage denies the allegations contained herein. Accordingly, and as indicated by the facts stated above, Heritage has at all times acted fairly and honestly. Further, Heritage has conducted a reasonable investigation based on available information, made a coverage determination, and settled the claim with Complainants’ representatives. Further, the Notice fails to specifically identify how Heritage failed “to good faith to settle claims.” Therefore, this is an unsupported, sweeping allegation and is without merit. 2. 626.9541(1)(i)(3)(d): Denying claims without conducting reasonable investigations based upon available information. Response: Heritage denies the allegations contained herein. Accordingly, and as indicated by the facts stated above, Heritage has at all times acted fairly and honestly. Further, Heritage has conducted a reasonable investigation based on available information, made a coverage determination, and settled the claim with Complainant’s representatives. Further, the Notice fails to specifically identify instances where Heritage did not conduct “reasonable investigations based upon available information.” Therefore, this is an unsupported, sweeping allegation and is without merit. As detailed by the facts stated above, Heritage Property & Casualty Insurance Company did not violate any of the statutes mentioned above sections. Heritage has diligently and thoroughly investigated the subject claim, followed up with Complainant for documents supporting their claim, provided a coverage determination, and settled the claim with the representatives. The purpose of the Civil Remedy Notice is to provide the insurer notice of the issue its Complainant has with the claim and what it is seeking to remedy that issue. However, it is important to note that Insurers are not required to pay any amount demanded by their Complainants to avoid a bad-faith claim. Rousso v. Liberty Surplus Ins. Corp., 2010 U.S. Dist. LEXIS 82328, at *14-15 (S.D. Fla. Aug. 13, 2010). The Florida Supreme Court has held that an insurer's appropriate response to a Civil Remedy Notice filed pursuant to Fla. Stat. 624.155 is “based upon the insurer's good-faith evaluation of what is owed on the insurance contract.” Vest v. Travelers Ins. Co., 753 So. 2d 1270, 1275 (Fla 2000). The Court further stated, “What is owed on the contract is . . . governed by whether all conditions precedent for payment contained within the policy have been met.” Id. For its part, an insurer “must evaluate a claim based upon proof of loss required by the policy and its expertise in advance of a determination by a court or arbitration.” Id. at 1275-76. See also Julien. Heritage’s position is that it has complied, in good faith, with these obligations. Furthermore, the Complainant’s Notice failed to provide any cure for the alleged defects as required by Florida Case law. Specifically, the case of Talat Enterprises, Inc., v. Aetna Casualty and Surety Co., 753 So.2d 1278, 1281 (Fla. 2000), provides that the scope of what can be “cured” is limited to the alleged non-payment of the contractual amount due the Complainant. Talat also commented that “[i]t naturally follows that for there to be a ‘cure,’ what had to be ‘cured’ is the non-payment of the contractual amount due the Complainant. In the context of a first-party insurance claim, the contractual amount due to the Complainant is the amount owed pursuant to the express terms and conditions of the policy after all of the conditions precedent of the insurance policy in respect to payment are fulfilled....” As a result, only the demanded “cures” relating to the payment for covered damages are proper and legal. The Notice requests that “to cure the defects outlined in this Civil Remedy Notice, Heritage Property & Casualty Insurance Company must pay the Insured's claim in full.” Although the Complainant disputes the amount, it is unclear what amount the Complainant seeks to cure the alleged violations. If Heritage pays an unspecified amount for the repairs of damaged property, it is unclear if this would be sufficient to cure this demand and if there is any effect. In short, similarly to Rousso, the Notice reflects a “shotgun-blast effort to hit a lot of targets with a single salvo. This approach is contrary to the purpose of the statute.” The Notice must reflect a good-faith effort to inform Heritage of how it has fallen short of its obligations under the policy and what it can do to fix its shortcomings. Thus, the Notice is insufficient as a matter of law. Under § 624.155, Heritage is entitled not only to a clear proposed solution, but also more and accurate details about how Heritage fell short of its obligations to provide coverage pursuant to the terms of the insurance agreement. As such, the Notice is deficient, and the Complainants have failed to comply with several conditions precedent to bringing a claim under §624.155. Heritage Property & Casualty Insurance Company believes that the Notice 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. Moreover, regardless of the rejection, Heritage denies all allegations contained in the Notice and submits there are no violations. While this response is meant to be comprehensive, Heritage Property & Casualty Insurance Company’s response above is based upon the limited information provided in the Notice and the information we have to date. If Complainant feels that Heritage does not have all the facts, please inform Heritage immediately. In closing, 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/ Priscila Ferreira Priscila Ferreira, Esq. Claims Counsel Heritage Property & Casualty Insurance Co.

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