Civil Remedy Notice of Insurer Violations
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Filing Number:     792332
Filing Accepted:  11/14/2024
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Complainant
Last/Business Name *  
SUNSET VILLAS PHASE III CONDOMINIUM ASSOCIATION INC C/O HERRERA LAW FIRM PA   First Name  
Street Address * 9485 SUNSET DRIVE STE A230
City, State Zip * MIAMI, FL 33173
Email Address * JTHERRERA@HERRERALAWFIRM.COM
Complainant Type: * Insured
Insured
Last/Business Name*   SUNSET VILLAS PHASE III CONDOMINIUM ASSOCIATION INC   First Name  
Policy # * HCP002817-1 Claim #* H2978
Attorney
Attorney is Applicable
Last Name* HERRERA First Name * JOSE-TRELLES Initial
Street Address* 9485 SUNSET DRIVE SUITE A230
City, State Zip* MIAMI , FLORIDA 33173
Email Address * JTHERRERA@HERRERALAWFIRM.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):* HERITAGE INSURANCE
Type of Insurance * Commercial Property & Casualty   
Reason for Notice *
Unfair Trade Practice
Claim Delay
Unsatisfactory Settlement Offer
Other : Failure to adjust claim in a timely manner
* 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)(a) Failing to adopt and implement standards for the proper investigation of claims.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

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

On September 10, 2017, Hurricane Irma delivered a devastating blow to South Florida. Hurricane Irma caused considerable and costly damage to properties throughout South Florida. Sunset Villas was not spared from Irma’s wrath. The residents of the Sunset Villas property paid excessive premiums to Heritage Insurance with the expectation that Heritage Insurance will pay the claims they agreed to pay per the Policy. Here for over 5 years, Heritage Insurance has dragged their feet and made no reasonable efforts to indemnify Sunset Villas for their loss despite acknowledging that the claims made by Sunset Villas were covered by the Policy. Sunset Villas is a condominium association organized under Chapter 718 Florida Statutes. Sunset Villas suffered extensive damage as a result of Hurricane Irma, which made landfall on or about September 10, 2017. Prior to Hurricane Irma, Heritage Insurance issued a policy of insurance to Sunset Villas bearing Policy Number HCP002817-1 (the “Policy”) for coverage of Sunset Villas’ property as further defined in the Policy. On or about October of 2017 Sunset Villas reported losses suffered as a result of Hurricane Irma to Heritage Insurance. On January 26, 2018, Heritage Insurance submitted to Sunset Villas its coverage determination, acknowledging that there was coverage for the damage sustained in connection with Hurricane Irma. The coverage determination specifically included the roofs contrary to Heritage Insurance’s argument. The coverage determination dated January 26, 2018, expressly stated that it was not to be construed as a settlement. In the January 26, 2018, Heritage Insurance determined that Sunset Villas’s loss was the type of loss covered by the Policy and that the amount of the loss was $20,580.99, thereby admitting coverage for same. However, this amount was below the applicable deductible and no payment was issued. Sunset Villas disputed Heritage’s estimate of damages and retained the services of an adjuster. On March 27, 2019, a supplemental claim was submitted to Heritage Insurance, which included the additional losses. The adjuster determined that the correct amount of the loss was over six million dollars. Together with the supplemental claim, Sunset Villas demanded appraisal, as was their contractual right, pursuant to the terms and explicit provisions of the Policy. Sunset Villas fully cooperated with Heritage Insurance allowing them to inspect the property and providing documentation that was requested by Heritage Insurance. It should be noted that in addition to the Sworn Proof of Loss, Sunset Villas provided extensive photographs, including photographs of the roof, documenting the damages being claimed. During the latter part of 2019, Sunset Villas communicated with Heritage Insurance to coordinate additional inspections to no avail. Contrary to the representations of Heritage Insurance, Sunset Villas complied with its post-loss obligations which are found within the four corners of the insurance policy. To date, Heritage Insurance has failed to adjust the claim or make a final determination as to the Supplemental Claim submitted on March 27, 2019. To be clear it has been five years and to date Heritage Insurance has not adjusted or made a coverage determination on the claim. Further, since 2019 Sunset Villas has submitted additional evidence of covered losses with evidence to Heritage Insurance which all are part of the covered claim. To date, Heritage Insurance has failed to adjust the claim and make any determination notwithstanding the fact that Sunset Villas has fully cooperated with Heritage Insurance’s investigation and has continuously submitted additional information related to losses covered under the subject Policy. The conduct by Heritage Insurance described above constitute clear violations of: 624.155(1)(b)(1), Fla. Stat. - 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)(i), Fla. Stat. – unfair claim settlement practices.
Comments
User Id Date Added Comment
jrubinton@rubintonlaw.com 01-13-2025 January 13, 2025 VIA Certified Mail: 9407111898765457399757 Florida Department of Financial Services Consumer Assistance, c/o: Civil Remedy Section Larson Building 200 East Gaines Street Tallahassee, Florida 32399-0322 VIA Certified Mail:9407111898765457399924 E-mail Correspondence: jtherrera@herreralawfirm.com Sunset Villas Phase III Condominium Association, Inc. 9845 Sunset Drive, Suite A230 Miami, Florida 33173 Re: CIVIL REMEDY NOTICE OF INSURER VIOLATIONS Claimant: Sunset Villas Phase III Condominium Association, Inc. Policy Number : HCP002817-1 Claim Number : H2978 Date of Loss (as claimed) : September 10, 2017 Loss Location : 4705 NW 7TH St., Miami, FL 33126 DFS Filing Number : 792332 Date of DFS Acceptance : November 14, 2024 Dear Sunset Villas Phase III Condominium Association, Inc. and Department of Financial Services, Our firm represents Heritage Property & Casualty Insurance Company (“Heritage”) regarding the claim presented by Sunset Villas Phase III Condominium Association, Inc. (“Complainant”) for alleged damages sustained to the subject property on or about September 10, 2017. We are in receipt of a Civil Remedy Notice of Insurer Violation (“CRN”), accepted on November 14, 2024, as submitted to the Florida Department of Financial Services. This shall serve as Heritage’s response to the CRN. While Heritage welcomes the opportunity to respond to this Civil Remedy Notice of Insurer Violation and specifically denies each and every allegation contained in the Civil Remedy Notice filed in relation to this claim, Heritage believes that the Civil Remedy 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 in Florida Statute §624.155 and Florida Case law. Furthermore, 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 statute, the Notice filed by Complainant contains allegations that are not only overbroad and vague but are also inaccurate. Moreover, Complainant’s allegations stem only from Complainant’s opinions regarding the adjustment of this claim. Additionally, the tenor and inferences of the allegations in the Notice are wholly without merit and Heritage denies each and every one. Below are some of the facts regarding the claim that were not included in the CRN. Subject to its terms, limitations, exclusions and conditions, Heritage insured the Complainant under a Commercial Property Condominium Association Policy of Insurance bearing Policy No. HCP002817-1. The Policy of Insurance applies to direct physical loss of or damage to Covered Property at the premises described in the Declarations of said Policy, caused by or resulting from any Covered Cause of Loss as described in said Policy. The Policy insures the properties located at 4705-4805 NW 7th St., Miami, FL 33126. On or about September 27, 2017, Complainant filed a claim for damages allegedly caused by Hurricane Irma on September 10, 2017. Upon reporting of the claim, there was no specific scope included of what damages were being claimed. Heritage proceeded to investigate the claim and assigned an independent adjuster, Kevin Luker, to inspect the property on its behalf. Based on its investigation and the inspection conducted, Heritage issued a coverage determination on January 26, 2018. Heritage informed the insured that there was coverage for the loss but that the damages did not exceed the applicable Hurricane Deductible. Heritage did not hear back from the Complainant or its representatives until May 3, 2018, when it received a copy of the estimate prepared by Complainant’s Public Adjuster, National Claims Adjusters. Complainant’s first estimate claimed $6,505,774.85 in damages to the structures of all buildings covered by the Policy. Importantly, the first estimate did not claim any damage to the roofs of the property as a result of the storm. Complainant’s first estimate was also the basis for the Sworn Statement of Proof of Loss executed by the Complainant’s attorney, Robert Rodriguez, on March 28, 2019. Complainant further demanded appraisal on March 27, 2019. In response, Heritage requested documents from the Complainant’s counsel, including engineer reports, expert reports, photographs, and board meeting minutes. Notwithstanding Heritage’s request for documents done pursuant to the terms of the Policy, Complainant filed suit on June 17, 2019. Thereafter, the parties proceeded to conduct discovery in the matter and prepare the case for trial. However, on May 2023, after the expiration of the statute of limitations for filing of supplemental, reopened, or new claims, Complainant submitted a new estimate claiming an additional $3,495,647.36 in damages to the roofs. Complainant also sought to compel appraisal via a Motion to Compel Appraisal filed with the Court. After an evidentiary hearing on Complainant’s Motion, the Court denied without prejudice the Complainant’s Motion and instructed Heritage to issue adjust and issue a coverage determination on the supplemental claim submitted to Heritage prior to the filing of the lawsuit. In an effort to comply with the Court’s order regarding Plaintiff’s first supplemental claim, Heritage relied upon the investigation and inspections conducted by Intertek from January 29 to 31, 2020. Intertek’s inspection was limited to the scope claimed by Complainant at the time of its inspection, which was based on Complainant’s first estimate of damages submitted to Heritage. Based upon Intertek’s findings and investigation, Heritage has now issued a new Coverage Determination on January 6, 2025. Contrary to Complainant’s allegations, Heritage had in fact issued a coverage determination before the filing of the suit. In regards to its first supplemental claim, submitted to Heritage supported by the estimate and the Sworn Statement in Proof of Loss, Heritage requested further documents to aid in its investigation and Complainant filed suit before it could complete its investigation. Contrary to Complainant’s allegations, Heritage has properly investigated the claim, assigned an independent adjuster, and experts to inspect the property on several occasions. The expert came to a conclusion regarding the cause and origin of the damages and the cost to bring the property back to its pre-loss condition. Furthermore, Heritage has provided an explanation for all of its coverage determinations, including four separate letters explaining the basis for its determinations and payments issued thus far. Finally, as for Complainant’s claim for damages to the roofs, the same was submitted untimely in violation of Florida Statutes. Complainant’s allegations set forth in its Civil Remedy Notice stem from its own opinion regarding Heritage’s handling of the Claim. Heritage always acted in good faith in its handling of this claim. Heritage has acted at all times in accordance with its rights and duties under the subject Policy of Insurance and under Florida Law. Finally, as stated above, Heritage always retained all of its rights and defenses available under the Policy of Insurance and under Florida Law. Under Florida Law, a Civil Remedy Notice requires the Complainant, “pursuant to section 624.155, F.S., to indicate all statutory provisions alleged to have been violated.” The notice filed in this matter alleges Heritage Property & Casualty Insurance Company 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 insured and with due regard for his or her interests. Response: Heritage denies the allegations contained herein. As indicated by the facts stated above, Heritage has at all times acted fairly and honestly toward the Complainant. 2. 626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims. Response: The Complainant fails to describe any facts and/or circumstances regarding the failure to adopt and implement standards for the proper investigation of claims. This is an unsupported, sweeping allegation and is without merit. Heritage has completed a thorough investigation of the reported claim and issued two coverage determinations. As detailed by the facts stated above, Heritage did not violate any of the aforementioned statute sections. Heritage has properly investigated the subject claim and provided a detailed explanation with regards to coverage for same. The purpose of the Civil Remedy Notice is to provide the insurer notice of the issue its insured 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 insureds 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. Heritage has complied, in good-faith, with these obligations. In short, 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. In closing, Heritage first believes that the CRN 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 CRN and submits there are no violations. While this response is meant to be comprehensive, Heritage’s response above is based upon the limited information provided in the CRN and the information we have to date. If the Complainant feels that we are not in possession of all the facts, please inform us immediately. Please note that Heritage’s response is not necessarily exhaustive and does not preclude us from asserting any other valid reason for seeking rejection and return of the CRN. Also, this letter or any act or failure to act on the part of Heritage or any agent or representative of Heritage or at law as all such rights and defenses are hereby specifically reserved. We trust that this response addresses the allegations of insurer violation alleged in the Civil Remedy Notice of Insurer Violation. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Very truly yours, Jesus R. Goatache Jesus R. Goatache, Esq. Rubinton Simms, P.A. 3440 Hollywood Boulevard, Suite 460 Hollywood, Florida 33021 T- (954) 251-5500 F- (954) 251-5501 www.RubintonLaw.com JRG
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