Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 791669

Filing Accepted: 11/12/2024

Print Filing

Complainant

Last/Business Name *

ANDERSON

First Name

TIFFANY

Street Address *

7902 DELAND AVENUE

City, State Zip *

FORT PIERCE, FL 34951

Email Address *

FIRM@FLORIDAINSLAW.COM

Complainant Type: *

Insured

Last/Business Name*		ANDERSON		First Name		TIFFANY
Policy # *		HOH663103		Claim #*		H010022457

Attorney

Attorney is Applicable

Last Name*	CIOCCHETTI First Name * MICHAEL Initial
Street Address*		125 N. RIDGEWOOD AVENUE, SUITE 100
City, State Zip*		DAYTONA BEACH , FLORIDA 32114
Email Address *		FIRM@FLORIDAINSLAW.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):* JAYLA FRAZIER, TIM KIERNAN
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Denial
	Unfair Trade Practice

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

COVERAGE A – Dwelling We cover: 1. The dwelling on the “residence premises” shown in the Declarations, including structures attached to the dwelling; and 2. Materials and supplies located on or next to the “residence premises” used to construct, alter or repair the dwelling or other structures on the “residence premises.”

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

This complaint is made on behalf of the insured, TIFFANY ANDERSON. Further, this complaint is a statement that notice is hereby given in order to perfect the right to pursue the civil remedy pursuant to Florida Statute §624.155. In consideration of the premium paid to it, HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY (“Carrier”), issued a policy, Policy No. HOH663103 (“Policy”), to the Insured where the Policy provided coverage for all losses, except those losses which were expressly excluded, for the property located at 7902 Deland Ave, Fort Pierce, FL 34951 (“Insured Property”). The policy was in full force and effect at the time the damage occurred from a wind & hail storm, and the ensuing damages as a direct result thereof, to the Insured Property, on or about May 19, 2024. Thereafter, the Carrier was timely notified of the Loss. In particular, the Carrier was put on notice of covered direct damages and ensuing damages and of the request that a claim be opened pursuant to the terms and conditions of the Policy. Claim number H010022457 (“Claim”) was assigned to the Loss. The Carrier sent an adjuster to the Insured Property to perform an inspection. The Carrier performed a cursory inspection of the Insured Property and failed to retain unbiased experts necessary to trigger the cause of the Loss and covered repairs necessary to restore the Insured Property to its pre-loss condition. The Carrier deliberately denied the claim. The Carrier knows its aforementioned investigation is insufficient and that it has failed to provide proper payment to restore the property to its pre-loss condition. This inspection placed The Carrier on notice of the severity of the Loss. The Carrier subsequently denied the Insured’s claim and issued no payment for the Loss. Thereafter, the insured sought the assistance of a public adjuster who ensured the proper estimating of the loss and compliance with all Policy conditions. The public adjuster submitted a comprehensive estimate to the Carrier for the full scope of damages to the Insured Property. In addition, a Sworn Statement and Proof of Loss (“SPOL”) was provided, on or about August 30, 2024. The Carrier disregarded this comprehensive estimate and SPOL and, instead, denied the Claim. The Carrier has refused to reassess its denial of benefits and the basis of the denial and has refused to properly adjust and settle the Claim. The Carrier violated the provisions of Florida Statute §624.155(1)(b)(1) by failing to attempt in good faith to resolve this claim when, under all circumstances, it could and should have done so had it acted fairly and honestly toward its insured with a due regard for their interest. When the Carrier was confronted with a comprehensive estimate and verifiable cause of Loss, the Carrier chose to deny the Insured’s valid Claim. The Carrier violated the provisions of Florida Statute §626.9541(1)(i)(2) by materially misrepresenting to the Insured that Policy coverage was unavailable for the Insured’s Claim and Loss to the Insured Property. This misrepresentation was made in an attempt to deny the Insureds’ Claim and escape without paying for the full extent of substantial damage. The Carrier violated the provisions of Florida Statute §626.9541(1)(i)(3)(a) by failing to adopt and implement standards for the proper investigation of claims. When confronted with a comprehensive estimate and verifiable cause of Loss, the Carrier apparently had no system or standards prepared or implemented which would allow it to evaluate the Claim as submitted by its Insured. The Carrier violated the provisions of Florida Statute §626.9541(1)(i)(3)(b) by misrepresenting pertinent facts or Policy provisions relating to the coverage at issue. This has been discussed fully hereinabove. The Carrier violated the provisions of Florida Statute 626.9541(1)(i)(3)(d) by denying the Insured’s Claim without conducting reasonable investigation into the basis for the Claim. The Carrier violated the provisions of Florida Statute 626.9541 (1)(i)(3)(f) by failing to promptly provide a reasonable explanation in writing to the Insured of the basis in the Policy, in relation to the facts or applicable law, for denial of the Claim. The Carrier has refused to properly assess its payment of benefits and the basis of payment and has refused to properly adjust and settle the claim constituting unfair claim settlement practices under Florida Statute §626.9541(1)(i)(3)(i). The Carrier can cure these violations by payment, within 60 days of the date hereof, of all funds contractual owed to the Insured under the terms and conditions of the Policy.

Comments

User Id		Date Added		Comment
taylor@floridainslaw.com		04-16-2025		The Carrier has resolved the Civil Remedy Notice to the satisfaction of the Insured, and the Insured hereby withdraws the instant CRN.
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: Tiffany Anderson Insured: Tiffany Anderson Insurer: Heritage Property & Casualty Insurance Company DFS File No.: 791669 Claim No: H010022457 Policy No.: HOH663103 Address: 7902 Deland Avenue, Fort Pierce, FL 34951 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 791669, filed on behalf of Heritage’s insured Tiffany Anderson (“Complainant”). The Department accepted the Notice on November 12, 2024. While Heritage welcomes the opportunity to respond to the Notice filed concerning this claim, it 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 §624.155 and Florida Case law. 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 does not provide which policy provisions were violated. Therefore, the Notice failed to provide sufficient notice to Heritage as to what policy provision was violated. Moreover, 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. The Notice also contains a duplicate email address for both the Complainant and the Attorney, and as such, the Notice failed to satisfy § 624.155's condition precedent by providing a duplicate email address for both the Complainant and the Attorney. Lastly, the Notice failed to identify the Insurer’s address, as specifically required. As such, the Notice does not comply with Florida law and is legally insufficient. Notwithstanding the deficiencies, for clarification, Heritage provides a brief history of the claim: Subject to its terms, endorsements, limitations, exclusions, and conditions, the Complainant was issued Policy HOH663103 for property located at 7902 Deland Avenue, Fort Pierce, FL 34951. The Policy of Insurance applies to direct physical loss of or damage to covered property at the premises described in the Declarations of the Policy or resulting from any Covered Cause of Loss as described in the Policy. Upon receiving the Complainant’s first notice of loss on July 24, 2024, claiming damages from a wind and/or hail that allegedly occurred on May 19, 2024, Heritage promptly assigned claim number H010022457. On July 25, 2024, Heritage received a letter of representation from the Complainant’s public adjuster, Ask An Adjuster, informing Heritage of the representation and requesting a copy of the policy and information about the claim. Heritage promptly acknowledged the representation and immediately submitted the requested policy copy and a copy of the correspondence sent to Complainant. In the meantime, Heritage enlisted the services of a Field Adjuster to coordinate with Complainant an inspection of the alleged damage caused by the alleged windstorm. Complainant requested it occur on July 30, 2024. The on-site inspection documenting the property's exterior and interior conditions occurred as scheduled with the presence of Complainant’s roofer. Contrary to the allegations in the Notice that Heritage did not conduct a reasonable investigation, Heritage requested a reinspection from an independent engineering firm to assess the alleged damages as an additional step. The Professional Engineer, Manuel A. Matus of DDA Forensics, conducted the reinspection on August 16, 2024. After the reinspection, Mr. Matus prepared a report with his conclusions. Based on the reinspection and information gathered in his report, Mr. Matus opined that: 1. The building envelope, and particularly the roof over the residence, was not affected by wind uplift, impacts from windborne debris, hailstones, or any other effects associated with windstorms and/or hailstorms on or around the date of loss of May 9, 2024. Inspection along the building exterior revealed no evidence of wind-borne debris or hail stone impact damage to the walls (no scrapes, gouges, or holes in the walls), or to fenestration (no broken or damaged doors and windows or window screens). In addition, there was no wind-related damage to roof appurtenances or to mechanical equipment. 2. The localized deterioration noted on the roof covering (both main roof and low slope roof) resulted From an age-related deterioration of the components, prolonged exposure to the elements and deferred maintenance, and water intrusion through inadequate or degraded waterproofing and was not the result of one single accidental or single storm event. 3. In general, the shingles on the roof were in poor condition consistent with age-related deterioration and weathering of the roof covering. The observed loss of granular material and scuffing of the asphalt shingles were consistent with normal wear, aging, weathering, and manufacturing quality of the asphalt shingles. The ridge portion of the roof was observed with no missing or torn shingles. 4. In general, the low-slope roof, covered with roofing membranes, was in a condition consistent with age related deterioration, weathering of the roof covering as well as mechanical damage, and was observed with no missing, torn, delaminated or de-bonded membrane, nor with any wind-related damage or hailstone impact damage. 5. The moisture damage noted on the interior finishes within the bedroom no. 3 were the result of water intrusion through the roof surface due to age-related deterioration, poor/deficient craftmanship during the expansion addition on the rear slope of the residence and/or underlayment above these locations, and not the result of one single storm event or incidental event. The above-described conditions coincided with roof repairs and transitions between two types of roof coverings above (and subsequently repaired), which are roof portions where stress concentration and deterioration of the roof components frequently occur and therefore, susceptible to water intrusion. 6. The repairs found on the roof (above the interior affected area) suggest an effort to correct a detrimental condition of the underlayment resulting from the combined effects of material aging and exposure to environmental elements in addition to cyclic movement of the structure under expected structural loads. This condition predated the date of loss of May 9, 2024. 7. Installation deficiencies, poor workmanship and poor construction practices lead to the failure of the sealant strips on the shingles. The failure occurred several months to years prior to our inspection based on the accumulation of dirt and debris that was observed below the shingle tabs. 8. No wind-creased shingles were observed on the roof. On September 13, 2024, after conducting a reasonable investigation based on available information to Heritage, and in accordance with its obligations under §627.70131, Fla. Stat., Heritage issued a letter including a written explanation of the coverage decision to Complainant, which included pertinent facts and insurance policy provisions relating to coverages at issue. The letter explained that based on the inspections of the property and considering the opinion provided by the Professional Engineer, Mr. Matus, the alleged damages were excluded from coverage under the policy, and therefore, Heritage was unable to cover the claim. On September 26, 2024, Heritage received a request for Mediation through the Department. The parties mediated on October 16, 2024, which resulted in an impasse. On November 12, 2024, Michael Ciocchetti PLLC, on behalf of Tiffany Anderson, filed a Notice of Intent to Initiate Litigation and this Notice, to which Heritage responded in a timely manner. In accordance with Fla. Stat. §624.155, the Civil Remedy Notice requires Complainant, “to indicate all statutory provisions alleged to have been violated.” The Notice alleges the reasons for the Notice are the following: 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. 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. 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 made a coverage determination based upon the information and documentation obtained and/or received by Heritage during its investigation of the claim and the subject policy. The documentation and information received and obtained by Heritage in its investigation of Complainant’s claim does not support that a covered loss occurred as described. 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)(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. 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 made a coverage determination denying the Complainant’s claim based on the information and documentation obtained and/or received by Heritage during its investigation of the claim and the subject policy. The documentation and information received and obtained by Heritage in its investigation does not support that a covered loss occurred as described. The Notice fails to specifically identify the “material misrepresentation[s]” allegedly committed by Heritage. As such, this is an unsupported, sweeping allegation and is without merit. 3. 626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims. Response: Heritage denies the allegations contained herein. Accordingly, and as indicated by the facts stated above, Heritage has always acted fairly and honestly. Further, Heritage has indeed made a coverage determination denying Complainant’s claim based upon the information and documentation obtained and/or received by Heritage during its investigation of the claim and the subject policy. Heritage has always properly investigated Complainant’s claim. Additionally, Complainant failed to specify the instances where Heritage failed “to adopt and implement standards for the proper investigation of claims.” Therefore, this is an unsupported, sweeping allegation and is without merit. 4. 626.9541(1)(i)(3)(b): Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. Response: Heritage denies the allegations contained herein. Accordingly, and as indicated by the facts stated above, Heritage has always acted fairly and honestly. Further, Heritage made a coverage determination denying Complainant’s claim based upon the information and documentation obtained and/or received by Heritage during its investigation of the claim and the subject policy. The documentation and information received and obtained by Heritage in its investigation of Complainant’s claim does not support that a covered loss occurred as described. Additionally, the Notice failed to specifically identify the “misrepresenting facts or insurance policy provision” allegedly committed by Heritage. As such, this is an unsupported, sweeping allegation and is without merit. 5. 626.9541(1)(i)(3)(d): Denying claims without conducting reasonable investigations based upon available information. Response: Heritage denies the allegations contained herein. Heritage has promptly taken substantial action to investigate Complainant’s claim. As mentioned, Heritage promptly assigned a field adjuster and a professional engineer to inspect and investigate the claim. Further, in contrast to this allegation, Heritage has indeed made a coverage determination, denying Complainant’s claim based upon the information and documentation obtained and/or received by Heritage during its investigation of the claim and the subject policy. Heritage has always properly investigated the Complainant’s claim. Therefore, this is an unsupported, sweeping allegation and is without merit. 6. 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. Response: Heritage denies the allegations contained herein. Accordingly, and as indicated by the facts stated above, Heritage has always promptly communicated with Complainant or their representatives. Further, Heritage has conducted a reasonable investigation based on available information and made a coverage determination in reference to Complainant’s claim based upon the information and documentation obtained and/or received by Heritage during its investigation of the claim and the subject policy. The documentation and information received and obtained by Heritage in its investigation of Complainant’s claim do not support a covered loss as demanded by Complainant. The Notice fails to specifically identify instances where Heritage failed “to promptly provide a reasonable explanation in writing to the insured [. . .].” Therefore, this allegation is an unsupported, sweeping allegation and 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 reinspection and documents supporting their claim, and provided a coverage determination. The purpose of the Civil Remedy Notice is to provide the insurer notice of the issue its Complainant have 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 seeks cures for the alleged defects. However, the “cures” sought are improper pursuant to 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 Complainants. 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. One action demanded in the Notice is to “cure this violation by payment, within 60 days of the date hereof, of all funds contractual owed to the Insured under the terms and conditions of the Policy.” Although Heritage denied coverage for the claim at issue, it is unclear what amount the Complainant seeks. If Heritage pays an unspecified amount for the alleged damages, it is unclear if this would be sufficient to cure this demand and the effect, if any, on Complainat’s lawsuit filed in the County Court in and for St Lucie County, Florida. In short, as in Russo, 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 Complainant has 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 the 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