Filing Number: 793252
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| Filing Accepted: 11/19/2024 |
| Last/Business Name
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WILLOW BROOK AT PARKER LAKES
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First Name |
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| Street Address
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9301 ALAMANDER CT |
| City, State Zip
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FORT MYERS,
FL
33919
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| Email Address
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MEYER.DOUGLAS73@GMAIL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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ILLOW BROOK AT PARKER LAKES |
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First Name |
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| Policy # * |
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H112425 |
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Claim #* |
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HCP008334 |
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Attorney is Applicable
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| Last Name* |
ALTMAN
First Name *
ALEXIS
Initial
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| Street Address* |
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925 SOUTH FEDERAL HIGHWAY, 7TH FLOOR |
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BOCA RATON
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FL
33432
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| Email Address * |
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AALTMAN@KPATTORNEY.COM |
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| Insurer Type
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Authorized Insurer
Unauthorized Insurer
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| Insurer Name |
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| Insurer Name* |
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HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY
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| Insurer Name* |
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| Street Address* |
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,
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NAIC Company Code 14407 |
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| Name of individual responsible for violation (if any):*
TROY WILLIAMS
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| Type of Insurance
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Residential Property & Casualty
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| Reason for Notice
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Unsatisfactory Settlement Offer
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Claim Delay
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Unfair Trade Practice
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Statutory provision(s) which the insurer allegedly violated.
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| 624.155(1)(b)(1) |
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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.
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| 624.155(1)(b)(3) |
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Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
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| 626.9541(1)(i)(3)(a) |
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Failing to adopt and implement standards for the proper investigation of claims.
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| 626.9541(1)(i)(3)(b) |
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Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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| 626.9541(1)(i)(3)(c) |
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Failing to acknowledge and act promptly upon communications with respect to claims.
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| 626.9541(1)(i)(3)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Loss settlement provision
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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 (“carrier”) has not attempted, in good faith, to settle the insured’s claim when under all the circumstances it could have and should have done so had it acted fairly and honestly toward its insured and with due regard for their interests. In fact, the carrier has intentionally under-valued the scope the insureds’ claim in an effort to maximize its profits, thereby preventing the insured from being able to restore his home to its pre-loss conditions. American Integrity has engaged in these actions, despite the clear and unequivocal burden discussed in Allstate Indemnity Co. v. Ruiz, 899 So. 2d 1121 (Fla. 2005), wherein the Florida Supreme Court held, “The Legislature has clearly chosen to impose on the insurance companies a duty to use good faith and fair dealing in processing and litigating the claims of their insureds.”
This claim arises from a Hurricane Ian which wreaked havoc and decimation in the State of Florida. The Insured Property’s roofs were hit by unprecedented 150 MPH winds. After Ian, Heritage began sending out estimators and instructing the estimators to not include words such as wind damage in their photographs or estimate. Brave estimators have come forward and advised the insureds that the payment was not based upon their estimate, but an adjusted estimate from Heritage’s claims team. Heritage has continued this scheme and was hit with a million dollar fine as well as National attention from 60 minutes. This claim is no different. After sending an estimator to the insured’s property, Heritage sent a letter that the insureds were only entitled to a roof repair and estimated the damages at $62,907.88. Based on Heritage’s actions, it cannot be said that this is the actual estimate written by the field adjuster and most likely it is not. Upon review of the carrier estimate and settlement letter, it was noted that the claim was improperly scoped, grossly underpaid, and is insufficient to properly indemnify Insured’s loss.
Heritage and its representative have failed at every step of the process. Heritage has failed to adjust and settle the claim in good faith, in accordance with the insurance contract and Florida Statutes. Heritage continues to conduct its investigation in a manner prejudicial to the insured, failing to complete a thorough and truthful investigation of the claim. To date, Heritage has failed to fairly pay Insured for the damages they are owed.
Pursuant to Florida Statute §624.155(1)(b)(1), Heritage has failed to settle the claim in good faith when it could and should have done so. The Insured reported the Loss as soon as they were aware of the damage and the Property was presented for inspection. The damage to the Insured’ property was clearly caused by a covered peril under the Policy, but Heritage intentionally turned a blind eye to the damage, low-balled the Claim, and callously delayed the claim process. Heritage has not shown a good faith intention to pay what was owed but rather has underpaid the claim for financial gain and profit.
Pursuant to Florida Statute §626.9541(1)(i)(3)(a), Heritage has a duty to adopt and implement standards for the proper investigation of claims. Adjuster Troy Williams displayed a lack of knowledge, improper training, and/or intent to underpay the claim by signing a letter stating that the insureds were only entitled to a roof repair. Mr. Williams displayed a further lack of knowledge of (or an intentional choice to ignore) Florida Statute relating to settlement of the claim. She should be aware that the roof is unrepairable. Thus, the Insured is entitled to replacement of the roof. Insured believes and asserts that Heritage refuses to implement standards for proper investigation of claims for purely financial reasons.
Florida law mandates that insurers and adjusters do not mislead the Insured by misrepresenting pertinent facts or insurance policy provisions relating to coverages. Florida Insurance companies that fail to follow these Florida laws and regulations, designed to protect consumers, do not only breach their duties under the policy of insurance but do so in bad faith. In violation of Florida Statute §626.9541(1)(i)(3)(b), Heritage intentionally misrepresented the available coverage under the policy. Mr. Williams ignored Insured’s right to roof replacement based on matching as mandated by Florida Statute 626.9744 for Claim Settlement Practices.
This notice is provided in order to perfect a right to pursue the civil remedy authorized by Florida Statute §624.155. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must:
1) Pay all amounts due and owing to the insured in the amount of $2,233,995.00, minus any applicable deductibles, for indemnity benefits;
2) Pay the insured’s attorneys’ fees and costs as they have been forced to retain counsel to litigate the loss; and
3) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made.
Should you have any questions please do not hesitate to contact me at 561-892-9988. We appreciate your attention to this matter.
Alexis E. Altman, Esq.
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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.
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DFS-10-363
Rev. 10/14/2008
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