Civil Remedy Notice of Insurer Violations
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Filing Number:     793118
Filing Accepted:  11/19/2024
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Complainant
Last/Business Name *  
MOATS   First Name   JOHN
Street Address * 4 JUNGLEPLUM COURT WEST
City, State Zip * HOMOSASSA, FL 34446
Email Address * CAROLEANNEMOATS@MSN.COM
Complainant Type: * Insured
Insured
Last/Business Name*   MOATS   First Name   JOHN
Policy # * HOH303790 Claim #* H010018446
Attorney
Attorney is Applicable
Last Name* KRAPF First Name * GRANT Initial W
Street Address* 2790 SUNSET POINT RD
City, State Zip* CLEARWATER , FL 33759
Email Address * GRANT@KRAPFLEGAL.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):* RJ ROOMES, ANITA DYE, ERICKA WOODS, JASON SHELTON, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY WHO WAS INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unfair Trade Practice
Other : Misrepresenting the terms of the insurance policy
Other : Not treating the Insured with good faith claims conduct
Other : Looking for ways to deny full recovery to the Insured
Other : Looking for ways to delay full recovery to the Insured
Other : Failing to properly investigate the Insured's loss
Other : Failing to provide the Insured with the full benefits awarded under the contract of insurance in a
Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made
Other : Not adjusting claims and evaluating loss properly
Other : Shifting the burden of insuring the loss to the Insured
Other : Intentionally misstating the terms, conditions, and benefits of the insurance policy to the insured
Other : Failing to implement proper standards for the adjustment and investigation of claims
* 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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

627.70131 (3)(b) If such investigation involves a physical inspection of the property, the licensed adjuster assigned by the insurer must provide the policyholder with a printed or electronic document containing his or her name and state adjuster license number. An insurer must conduct any such physical inspection within 30 days after its receipt of the proof-of-loss statements. Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language. "It is an accepted principle of law that when parties contract upon a matter which is the subject of statutory regulation, the parties are presumed to have entered into their agreement with reference to such statute, which becomes a part of the contract, unless the contract discloses a contrary intention." Westside EKG Assocs. v. Found. Health, 932 So. 2d 214, 216 (Fla. 4th DCA 2005), aff'd, 944 So. 2d 188 (Fla. 2006).
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Heritage Property & Casualty Insurance Company (the "Insurer") has committed the following in handling the Insured's claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the policyholder and the Insured; 3) looking for ways to deny benefit payments and otherwise "low ball" or "stone wall" claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; 8) denying a claim which it knew or should have known the policy and Florida law provided coverage for; 9) treating represented and unrepresented Insured differently; and 10) misrepresenting the terms of the insurance policy. On or about February 4, 2024, while the subject policy was in full force and effect, the Insured's property was severely damaged by wind and hail. The areas impacted include but are not limited to the shingle and modified bitumen roofing systems, gutters, window screen, and screened lanai. The Insured timely submitted a claim on April 19, 2024, to the Insurer for wind and hail damage and the ensuing damage therefrom. Thereafter, the Insurer assigned claim number H010018446 to the loss and sent a field adjuster to inspect the property on April 24, 2024. The Insurer violated Fla. Stat. 627.70131 (3)(b) by failing to provide the Insured with a printed or electronic document containing the field adjuster's name and state adjuster license number at the inspection. Then in a letter dated June 5, 2024, the Insurer notified the Insured that it was denying coverage for the loss. This coverage decision is incorrect. Denying coverage for the damage was wrongful as the damages are covered under the policy. The Insurer claimed it was prejudiced in its investigation as the Insured allegedly failed to timely report the loss. However, the Insurer failed to retain an engineer to determine the cause of the loss. Additionally, the Insurer only consulted weather data from a single date rather than the entire policy period. The Insurer knows or should know that a denial based on a disputed date of loss is improper when damage did in fact occur from a covered peril within the effective policy period. It is the Insured's duty to report when damage results from a covered peril and that which occurs within the effective policy period. Correspondingly, the Insurer has an obligation to determine whether a covered peril caused the alleged damages within the policy period irrespective of a disputed date of loss. In other words, the Insured has a right to be compensated for the alleged damages and the Insurer has no right to wrongfully deny coverage. Given the denial, the Insured's disagreement with the coverage decision, and the scope and nature of the damage resulting from wind and hail, the Insured retained a public adjuster. After assessing the damage and the true scope of repairs, the public adjuster produced an estimate identifying $47,444.51 in covered damage to the dwelling. The foregoing estimate, photographs, and a letter of representation from the public adjuster were sent to the Insurer. In response, the Insurer then decided to retain a professional engineer to reinspect the property. This demonstrates the Insurer treats unrepresented and represented Insureds differently. Based on the engineer's inspection, the Insurer continued to erroneously deny coverage for the loss. Upon receiving notice of the loss, the Insurer had the duty to provide the full benefits under the policy. This includes providing the Insured with a proper investigation and the funds necessary to return the home to its pre-loss condition. However, when the Insurer conducted its inspections of the insured property, the Insurer's representatives failed to conduct a thorough and adequate investigation, or the representatives intentionally ignored the damage observed and failed to make truthful and unbiased reports of the facts after investigating. As a result, the Insurer breached the policy by failing to fully indemnify the Insured for the covered loss. The Insurer misrepresented the loss and wrongfully denied coverage for the damage sustained to the Insured's property. According to the claims determination letter, the Insurer's engineer observed damage to the property, but attributed the cause of this damage to several causes excluded by the policy. The Insurer knows or should know that when independent perils converge and no single cause can be considered the sole or proximate cause, it is appropriate to apply the concurring cause doctrine. Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016). The concurring cause doctrine states that coverage may exist where an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause. Id. at 698. A covered peril that meets with an uncovered peril may still provide for coverage under a policy when the covered peril triggered the events that eventually led to the loss. Id. at 697. The Insurer intentionally ignored covered damage to deny the reported loss and wrongfully fail to pay the Insured. This is an underhanded attempt to place the financial interests of the Insurer over those of the Insured and to delay and frustrate the Insured's ability to have his claim adjusted promptly to begin restoring his property. There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer's claim file and standards and procedures for the adjustment and investigation of claims. In short, the Insurer is not acting with due regard for the Insured's interests or safety. In Florida the work of adjusting insurance claims engages the public trust. The Insurer has breached this trust and its duty to the Insured. The Insurer and its agents conducted cursory and inadequate investigations and wrongfully denied coverage for a loss that should have been covered under the subject policy. Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer's actions and inactions have continued to frustrate and delay the resolution of the Insured claim. The Insurer's actions amount to but are not limited to the following: 1. Claim denial 2. Claim delay 3. Not treating the Insured with good faith claims conduct 4. Looking for way to reduce recovery to the Insured 5. Looking for ways to deny recovery to the Insured 6. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured 7. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company's interests before the Insured's interests 8. Placing the financial interest of the Insurer over that of the health and safety of the Insured 9. Shifting the burden of investigating onto the Insured 10. Conducting inadequate investigations 11. Treat represented and unrepresented Insured differently 12. Making material misrepresentations Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must: (1). Admit full coverage for the Insured's loss. (2). Tender full benefits owed to the Insured under the insurance contract. A copy of this form submitted to the FDFS has been sent via e-mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to badfaith@krapflegal.com. Via E-mail: Heritage Property & Casualty Insurance Company P.O. Box 6417 Clearwater, FL 33758 claims@heritagepci.com
Comments
User Id Date Added Comment
grant@krapflegal.com 04-14-2025 The details herein have been amicably resolved between the parties; therefore, we withdraw this Civil Remedy Notice. This Civil Remedy Notice is hereby withdrawn.
ncarlisle@heritagepci.com 01-03-2025 January 3, 2025 Delivery Via Certified Mail Florida Department of Insurance Consumer Assistance c/o: Civil Remedy Section Larson Building 200 East Gaines Street Tallahassee, Florida 32399 Delivery Via E-mail and Certified Mail Grant W. Krapf, Esquire Krapf Legal 2790 Sunset Point Road Clearwater, FL 33759 grant@krapflegal.com Complainant : John Moats Insured : Carole Moats Policy Number : HOH303790 Claim Number : H010018446 Date of Loss (as claimed) : February 4, 2024 Loss Location : 4 Jungleplum Ct. W., Homosassa, FL 34446 (Citrus County) DFS Filing Number : 793118 DFS Acceptance Date : November 19, 2024 HERITAGE’S RESPONSE TO CIVIL REMEDY NOTICE 793118 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 793118, filed on behalf of, John Moats (“Complainant”), and accepted by the Department of Financial Services (“DFS”) on November 19, 2024. John Moats is self-identifies as an “Insured” on the Notice but is not listed as a “Named Insured” on the underlying policy. Nevertheless, to ensure that Heritage’s Response to the Notice is comprehensive, Heritage will assume based upon Complainant’s representation in the Notice, for purposes of this Response only, that John Moats is also an “Insured.” Without waiving Heritage’s arguments that the subject 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(s), Carole and John Moats. For clarification and convenience, Heritage is restating the brief history of the claim as provided on the Complainant’s Civil Remedy Notice accepted by the Department on November 19, 2024: Subject to its terms, endorsements, limitations, exclusions, and conditions, Carole Moats was issued Policy HOH303790. 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 Insureds’ first notice of the loss on or about April 19, 2024, more than two (2) months after the purported loss, Heritage promptly assigned claim number H010018446. In the meantime, Heritage enlisted the services of a field adjuster to coordinate with the Complainant an inspection of the alleged damage caused by the alleged hailstorm. Complainant requested it occur on April 24, 2024. The on-site inspection documenting the property's exterior conditions occurred as scheduled in the presence of the Complainant / Insured. Complainant / Insured stated that there was no interior damage related to this alleged loss, and consequently, denied Heritage access to the interior of the Property. On April 28, 2024, Heritage issued its Reservation of Rights and Request for Information Letter since the damages were first reported to Heritage approximately seventy-five (75) days after the purported loss. Therein, it was noted that the reported cause of loss was wind and hail with no interior damage and requested the following: 1. An opportunity to obtain your recorded statement. Please provide dates and times that best fit your schedule. 2. Any and all estimates or invoices for repairs of damage caused by this loss. 3. Any and all inspection reports obtained by or on your behalf related to this claim. 4. Copies of invoices for any and all previous work or maintenance completed on the area of claimed damage (i.e., roof ). 5. All photographs or videos of the of the property showing the condition of the property from 1 year prior to the date of loss to present. Photographs and/or video must show the condition of the property pre-loss and any claimed damage. 6. You to be present and available for any and all inspections, including answering questions the field adjuster or expert may have during the inspection. We have not yet confirmed nor denied through our investigation whether the reported damage is the result of a covered cause of loss or losses to property covered under this policy. The Complainant / Insured failed to respond and provide the requests made in numbers two (2), three (3), four (4), and five (5) above. This is in derogation of the Complainant / Insured’s post loss duties under the policy, which requires the Complainant / Insured to produce records / documents requested by Heritage. On May 9, 2024, Heritage obtained the recorded statement of the Insured Carole Moats. During the recorded statement, it was discovered that the Insured first became aware of the reported damages to her roof after the roofer (presumed to be Linear Roofing given their involvement in the claim at that time) inspected the roof. Again, Complainant / Insured reported that there were no interior damages. The Complainant / Insured disclosed that the roofing company was performing services to other houses in the neighborhood, which provided the opportunity for the roofing company and the Complainant / Insured to meet. On June 5, 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 inspection of the property, the late notice of the claim, and the policy, Heritage was not able to afford coverage for the claim. On or about June 18, 2024, the claim was reopened after Heritage received a Letter of Representation and Florida Public Adjuster Contract from Coastal Claims Services, LLC (“Coastal Claims”) signed by Carole and John Moats on June 17, 2024; the cause of loss listed is “hail.” The public adjuster listed on the contract is Carlos C. Puente (license W720498), but the contract was signed by “Patrick Reginald Ferry” on June 17, 2024. A “corrected” letter of representation and public adjuster contract was later provided with Carlos C. Puente as the signor of the contract with a date listed of June 17, 2024. On June 20, 2024, Heritage sent an e-mail to Coastal Claims requesting Coastal Claims’ theory of liability. No such theory of liability was ever provided by Coastal Claims. On or about June 20, 2024, Coastal Claims provided an Estimate totaling $43,690.90 (RCV and net claim if depreciation is recovered) and $41,718.08 (ACV and net claim). The estimator was Eileen Dalton of Coastal Claims. Shortly after Heritage reopened the claim, Heritage assigned a forensic engineering firm, EFI Global, to conduct a reinspection of the subject property. On August 14, 2024, Jason Shelton, PE of EFI Global conducted the reinspection and subsequently prepared an EFI Roof Assessment Report. In conclusion, Mr. Shelton’s analysis of the available evidence revealed: 1. No hail damage was found to the shingles on this roof. o Based on the lack of collateral damage noted to other items at the property, as well as the size, orientation, and distribution of the damages noted, it is our opinion that the damages to the screens are most consistent with mechanical and/or animal damage to the screen panels. o It should also be noted that repairs were observed to the screen enclosure screen panels. As such, the damages to the screen panel may be an ongoing condition. 2. The granular loss occurring on this roof is the result of normal age-related deterioration and heat-related damages. 3. No wind damage was found to the shingles on this roof. On August 23, 2024, after having received the EFI’s Roof Assessment Report, Heritage issued its Stand on Coverage Determination Letter, maintaining the prior denial since the condition of the subject property was not caused by a covered peril and no coverage was owed under the policy. Heritage further encouraged the Complainant / Insured to submit any documentation or information that has not been submitted to Heritage for consideration. On September 6, 2024, Heritage received a letter of representation from Attorney Grant Krapf of Krapf Legal on behalf of John Moats and Carole Moats. On September 10, 2024, Attorney Grant Krapf of Krapf Legal filed Civil Remedy Notice 782056 on behalf of the Complainant / Insured. On October 28, 2024, Heritage responded to and highlighted the deficiencies associated with Civil Remedy Notice 782056. On October 17, 2024, Attorney Grant Krapf of Krapf Legal filed Notice of Intent to Initiate Litigation 214259 demanding $54,945.00. On October 30, 2024, Heritage responded to Notice of Intent to Initiate Litigation 214259, maintaining its prior denial of coverage. On November 14, 2024, Attorney Grant Krapf of Krapf Legal filed a lawsuit on behalf of Carole and John Moats and against Heritage, alleging Heritage breached the underlying policy of insurance. On November 19, 2024, Attorney Grant Krapf of Krapf Legal filed the instant and second Civil Remedy Notice 793118 on behalf of JOHN MOATS. The allegations contained within Civil Remedy Notice 793118 are largely duplicative of Civil Remedy Notice 782056. Heritage now timely responds and categorically denies all allegations contained therein. On December 5, 2024, Attorney Grant Krapf of Krapf Legal filed a third Civil Remedy Notice in connection with the above-captioned claim on behalf of Carole Moats, to which Heritage timely responded and categorically denied all allegations contained therein. Based on the facts outlined herein, Krapf Legal has engaged and engages in a pattern of wasteful consumption of Florida’s Department of Financial Services’ resources and Heritage’s resources by needlessly filing largely duplicative Civil Remedy Notices on behalf of each Insured and against Heritage. Through said conduct, Krapf Legal intends to either 1) artificially inflate the volume of Civil Remedy Notices filed against the carrier with the intent to harm; and / or 2) confuse the carrier through the filing of multiple largely duplicative Civil Remedy Notices with the intent that the carrier needlessly consumes resources in having to respond to each largely duplicative Civil Remedy Notice. Said conduct evidences a pattern of bad faith on the part of the Insureds / Krapf Legal. 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 filed in this matter alleges Heritage violated the following statutory provisions: 1. Florida Statute §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. Therefore, this is an unsupported, sweeping allegation and is without merit. 2. Florida Statute §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. The Notice further relies on establishing concurring loss doctrine citing Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016), which considers policy language. The representative of Complainant should know, however, that, in Florida, “Parties may contract around the concurrent cause doctrine with an anti-concurrent cause provision.” See Liberty Mut. Fire Ins. Co. v. Martinez, 157 So. 3d 486, 487 n.1 (Fla. 5th DCA 2015); Paulucci v. Liberty Mut. Fire Ins. Co., 190 F. Supp. 2d 1312, 1319-20 (M.D. Fla. 2002); Wallach v. Rosenberg, 527 So. 2d 1386, 1387 (Fla. 3d DCA 1988). “When the insurer explicitly avoids the application of the concurring-cause doctrine with an anti-concurrent cause provision, the plain language of the policy precludes recovery.” See Sec. First Ins. Co. v. Czelusniak, 305 So. 3d 717, 718 (Fla. 3d DCA 2020). The subject policy, which was provided to Complainant’s representative prior to the date of this Notice, and which Complainant fails to consider, states in part, “1. 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.” The representative of the Complainant should know that policy language was considered in Sebo, and in this case, the subject policy language specifically excludes concurring cause doctrine, distinguishing itself from Sebo. As such, this is an unsupported, sweeping allegation and is without merit. 3. Florida Statute §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. Florida Statute §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. The Notice further relies on establishing concurring loss doctrine citing Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016), which considers policy language. The representative of Complainant should know, however, that, in Florida, “Parties may contract around the concurrent cause doctrine with an anti-concurrent cause provision.” See Liberty Mut. Fire Ins. Co. v. Martinez, 157 So. 3d 486, 487 n.1 (Fla. 5th DCA 2015); Paulucci v. Liberty Mut. Fire Ins. Co., 190 F. Supp. 2d 1312, 1319-20 (M.D. Fla. 2002); Wallach v. Rosenberg, 527 So. 2d 1386, 1387 (Fla. 3d DCA 1988). “When the insurer explicitly avoids the application of the concurring-cause doctrine with an anti-concurrent cause provision, the plain language of the policy precludes recovery.” See Sec. First Ins. Co. v. Czelusniak, 305 So. 3d 717, 718 (Fla. 3d DCA 2020). The subject policy, which was provided to Complainant’s representative prior to the date of this Notice, and which Complainant fails to consider, states in part, “1. 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.” The representative of the Complainant should know that policy language was considered in Sebo, and in this case, the subject policy language specifically excludes concurring cause doctrine, distinguishing itself from Sebo. As such, this is an unsupported, sweeping allegation and is without merit. 5. Florida Statute §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, partially covering 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. Complainant references several alleged statutory violations, none of which are correlated to the subject policy language and / or with the few facts / circumstances identified therein. Complainant fails to reference any policy language in derogation of Florida Statute §624.155(3)(b)(4). For this reason alone, the Civil Remedy Notice is deficient. Moreover, as detailed by the facts stated above, Heritage did not violate any of the statutes mentioned above. 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. To date, the Complainant has failed to comply with their post loss duties. 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 v. United Prop. & Cas. Ins. Co., 311 So. 3d 875, (Fla. 4th DCA 2021). It is Heritage’s position that it has complied, in good faith with these obligations. Furthermore, the Civil Remedy Notice contains vague “cures” for the alleged defects. However, the “cures” that are 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 Insureds. 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 insured. In the context of a first-party insurance claim, the contractual amount due to the insured 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 . . . . Talat Enters., 753 So. 2d at 1283. As a result, only the demanded “cures” relating to the payment for covered damages are proper and legal. However, the Civil Remedy Notice fails to specifically state any amount of non-payment of a contractual amount needed to cure the defects stated. The instant Civil Remedy Notice contains a vague “cure” for the alleged defects. Moreover, the “cure” that is sought is improper pursuant to Florida Case law. For those reasons alone, Complainant’s Civil Remedy Notice fails. Furthermore, the Complainant’s Notice fails to explain how the statutory provisions were actually violated, rather the Notice just makes blanket statements that Heritage has failed to sufficiently pay the claim. This proposed solution is the functional equivalent of “pay me everything I've asked for.” 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 WL 7367059, at *14-15 (S.D. Fla. Aug. 13, 2010). In short, as in Rousso, the Notice reflects “a shotgun-blast effort to hit a lot of targets with a single shell. 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 Florida Statute §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 Florida Statute §624.155. Heritage 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’ 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 contends, and the record supports, that the Civil Remedy 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; regardless of the rejection, Heritage denies all allegations contained in the Civil Remedy Notice and submits there are no violations. Please note that Heritage’s response is not exhaustive and does not preclude us from asserting any other valid reason for seeking rejection and return of the Notice. Also, this letter or any act or failure to act on the part of Heritage, its agent or representatives, should not be construed as a waiver of any rights or defenses available to it by contract or at law, as all such rights and defenses are hereby specifically reserved. We trust that this response addresses the allegations alleged in the Civil Remedy Notice. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Sincerely, /s/ Patrick A. Brennan Patrick A. Brennan, Esq. Lead Litigation 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.

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