Civil Remedy Notice of Insurer Violations
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Filing Number:     791756
Filing Accepted:  11/12/2024
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Complainant
Last/Business Name *  
POSTERNAK   First Name   YURIY
Street Address * 54 ERIC DRIVE
City, State Zip * PALM COAST, FL 32164
Email Address * YUPOS911@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   POSTERNAK   First Name   YURIY
Policy # * HOD316627 Claim #* H010022297
Attorney
Attorney is Applicable
Last Name* HAMMACK-BARBER First Name * TAMMY Initial
Street Address* 2300 MAITLAND CENTER PARKWAY STE. 106
City, State Zip* MAITLAND , FLORIDA 32751
Email Address * THAMMACK@SERRANOCAGAN.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):* EDWARD WAITE
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
* 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)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
* 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 – 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. We do not insure, however, for loss: h. Any of the following: (1) Wear and tear, marring, deterioration; (2) inherent vice, latent defect, defect or mechanical breakdown; (3) Smog, rust or other corrosion, “fungi”, mold, wet or dry rot; (6) Settling, shrinking, bulging or expansion, including resultant cracking, or pavement, patios, foundations, walls, floors, roofs or ceiling; We do not insure for loss caused directly or indirectly by any of the following. Such loss is excluded regardless of any other cause or event contributing concurrently or in any sequence to the loss. 2. We do not insure for loss to property described in Coverages A and B caused by any of the following. However, any ensuing loss to property described in Coverages A and B not otherwise excluded or excepted in this policy is covered. c. Faulty, inadequate or defective; (1) Planning, zoning, development, surveying, siting; (2) Design, specifications, workmanship, repair, construction, renovation, remodeling, grading, compaction; (3) Materials used in repair, construction, renovation or remodeling; or (4) Maintenance; of part or all of any property whether on or off 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.

Yuriy Posternak submitted a claim for damage to his home to Heritage Property & Casualty Insurance Company after his home sustained a covered direct physical loss due to a storm. Prior to the loss, Insurer issued a policy of insurance, policy number HOD316627, which afforded coverage for the aforementioned property for losses caused by the covered peril. The policy was in full force and effect when the loss occurred. After sending an adjuster out to inspect, Heritage Property & Casualty Insurance Company acknowledged that they found damage to the roof of the home but claimed that this damage is not covered under the policy, and applied inapplicable exclusions. In doing so it has misrepresented pertinent facts or insurance policy provisions relating to coverages at issue in violation of Fl. Stat. 626.9541(1)(i)(3)(b) and issued in writing a material misrepresentation to the insureds 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 in violation of Fl. Stat. 626.9541(1)(i)(2).Due to this Insured had no choice but to retain legal representation, as the Insurer refused to pay the full amount due and owed to its Insured. Insurer has continually failed to negotiate this claim with Insured’s attorney and/or failed to provide a satisfactory settlement offer to resolve the subject claim. This has severely harmed the Insured's ability to remedy their losses and continue with repairs to the property. The only purpose for Insurer's refusal to negotiate the claim is to increase profits and harm their insured. This is either done intentionally as a pattern and practice of Insurer to deny coverage and harm their insureds, or Insurer has failed to properly train and supervise its adjusters to the harm and detriment of their insured. This pattern and practice is done for only one reason, which again, is to maximize profits and harm their insured. Insurer has violated the following statutory provisions: 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. Insurer can cure its bad faith conduct by: 1) accepting the insured’s claim as compensable, and agreeing to pay the claim in accordance with its loss settlement provision prior to the expiration of the cure period, or 2) reaching an amicable settlement of the pending claim prior to the expiration of the cure period, or 3) tender payment in the amount of $49,431.95 less any applicable deductible and prior payment to the Insured to complete the repairs for the Insured’s property. By doing any one of these three things, the insurer will cure its bad faith in this case, and extinguish any and all of its liability for all bad faith damages which could be sought pursuant to this Civil Remedy Notice.
Comments
User Id Date Added Comment
ncarlisle@heritagepci.com 12-31-2024 December 31, 2024 VIA ELECTRONIC SUBMISSION Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Complainant: YURIY POSTERNAK Insured: YURIY POSTERNAK Insurer: Heritage Property & Casualty Insurance Company DFS File No.: 791756 Claim No: H010022297 Policy No.: HOD316627 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 791756, filed on behalf of Heritage’s insured YURIY POSTERNAK (“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 deny 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. The Notice fails to inform Heritage whether it had been given to perfect the right to pursue the civil remedy authorized by 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 Complainants’ opinions regarding the value of their own claim and, therefore, the Complainants’ 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. 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. As such, the Notice does not comply with Florida law and is legally insufficient. For clarification, Heritage is providing a brief history of the claim: Subject to its terms, endorsements, limitations, exclusions, and conditions, the Complainants were issued Policy HOD316627 (“Policy”) for the property at 54 Eric Drive, Palm Coast, Florida (“Property”). 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 Complainants’ first notice of loss on July 19, 2024, claiming damages that allegedly occurred on April 11, 2024, from wind. Heritage promptly assigned claim number H010022297. On the same day the loss was reported, Heritage issued its acknowledgment letter and Bill of Rights to the Complainants. Moving forward, Heritage’s representative coordinated an inspection of the alleged damage to the Property caused by wind. The Complainant requested the inspection to occur on July 22, 2024, and the on-site inspection documented the exterior condition of the property only, as the insured refused an interior inspection. Licensed Field Adjuster, Laura Rowen, provided an unbiased post-inspection report. In furtherance of its investigation, Heritage assigned a licensed engineer to inspect the property. The inspection took place on July 31, 2024. After conducting a reasonable investigation based upon available information, on September 19, 2024, Heritage advised Complainant that it could not extend coverage under the policy. Heritage promptly provided 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 the claim. In accordance with its obligations under §627.70131, Fla. Stat., a letter including a written explanation of the coverage decision was sent to Complainant on September 19, 2024, which included pertinent facts or insurance policy provisions relating to coverages at issue. On November 12, 2024, Tammy Hammack-Barber, on behalf of the Complainant, filed this Notice, to which Heritage now submits its response. A Notice of Intent to Initiate Litigation was also submitted on October 29, 2024, to which Heritage promptly responded. Nevertheless, on November 13, 2024, a lawsuit was filed by Complainant. In accordance with Fla. Stat. §624.155, the Civil Remedy Notice requires the Complainant, “to indicate all statutory provisions alleged to have been violated.” The Notice alleges the reasons for the Notice are the following: 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. 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 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 do not support a covered loss as demanded by Complainant. 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 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. 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. The CRN fails to specifically identify the “material misrepresentation[s]” allegedly committed by Heritage. This is an unsupported, sweeping allegation and is without merit. 3. 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 at all times acted fairly and honestly. 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 do not support a covered loss as demanded by Complainant. Further, the Notice fails to specifically identify the “misrepresenting facts or insurance policy provision” allegedly committed by Heritage. 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 Complainants for 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 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 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 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. 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 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/ Tamara Schweinsberg Tamara Schweinsberg, Esq. Senior Claims Counsel Heritage Property & Casualty Insurance Co. Civil Remedy Notice of Insurer Violation 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.

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