Civil Remedy Notice of Insurer Violations
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Filing Number:     794580
Filing Accepted:  11/27/2024
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Complainant
Last/Business Name *  
CLARK AND DAI   First Name   JESSE AND YAN
Street Address * 9206 EVERWOOD COURT
City, State Zip * TAMPA, FL 33647
Email Address * CLARKY31685@YAHOO.COM
Complainant Type: * Insured
Insured
Last/Business Name*   CLARK AND DAI   First Name   JESSE AND YAN
Policy # * HOH400586 Claim #* H010011182
Attorney
Attorney is Applicable
Last Name* PARNELL First Name * LINDSEY Initial A
Street Address* 2110 PARK STREET
City, State Zip* JACKSONVILE , FLORIDA 32204
Email Address * LPARNELL@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):* CHRISTOPHER THODE
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
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.
624.155(1)(b)(3) 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.
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
626.9541(1)(i)(3)(e) Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
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.
626.9541(1)(i)(3)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
* 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 – PROPERTY COVERAGE A. Coverage A – Dwelling (Entire Section) B. Coverage B – Other Structures (Entire Section) C. Coverage C – Personal Property (Entire Section) D. Coverage D – Loss of Use (Entire Section).
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

On or about 06/04/2023, JESSE CLARK and YAN DAI, ("Insured"), sustained a covered direct physical loss to Insured's property due to a wind and hailstorm. Insured reported the loss thereafter to HERITAGE PROPERTY AND CASUALTY INSURANCE COMPANY ("Insurer"). Prior to the date of loss, Insurer issued a policy of insurance, believed to be policy # HOH400586 which afforded coverage for the aforementioned property for losses caused by the covered peril. The policy was in full force and effect on the date of loss. The Insured promptly notified Insurer of the loss, who then assigned the loss claim # H010011182. Insurer was fully afforded any and all opportunity to inspect the loss and document the loss. To date, Insurer has paid $1,374.60 to Insured on this claim even after numerous attempts by the Insured to provide documentation of additional damages and compensation owed. Insured had no choice but to retain legal representation on or about 04/17/2024,, 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 insureds. This pattern and practice is done for only one reason, which again, is to maximize profits and harm their insureds. 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; 624.155(1)(b)(3): 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. 626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims. 626.9541(1)(i)(3)(c): Failing to acknowledge and act promptly upon communications with respect to claims; 626.9541(1)(i)(3)(e): Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed; 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. 626.9541(1)(i)(3)(g): Failing to promptly notify the insured of any additional information necessary for the processing of a claim. 626.9541(1)(i)(3)(h): Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. 626.9541(1)(i)(3)(i): Unfair claim settlement practices, and any other applicable statutes to the factual allegations included herein. To remedy and/or cure this CRN, Insurer must immediately tender payment in the amount of $ 64,091.00 less any applicable deductible and prior payment to the Insured to complete the repairs for the Insured property. The payment shall be tendered to the Insured’s attorneys, Serrano Cagan & Cagan at 2110 Park Street, Jacksonville Florida, 32204.
Comments
User Id Date Added Comment
ncarlisle@heritagepci.com 01-16-2025 January 16, 2025 VIA ELECTRONIC SUBMISSION Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Complainant: Jesse and Yan Clark and Dai Insured: Jesse Clark and Yan Dai Insurer: Heritage Property & Casualty Insurance Company DFS File No.: 794580 Claim No: H010011182 Policy No.: HOH400586 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 794580 for claim H01001182, filed by or on behalf of Heritage’s insureds Jesse Clark and Yan Dai, and accepted by the department on November 27, 2024. Without waiving Heritage’s arguments that the subject Civil Remedy Notice is legally insufficient and non-compliant with Florida law. The Notice is legally insufficient as it fails to specify who at Heritage committed the alleged violations, when the alleged violations were committed and fails to give specific facts supporting the alleged violations. Fla. Stat. § 624.155(3)(b)(4) requires the Complainant to set forth with specificity the policy language that is relevant to the violation. The Notice is legally insufficient because it allegedly lists the entire policy and does not specify which policy provisions were violated. In addition, the Notice fails to specifically and correctly quote the policy. The Notice alleges the reasons for the Notice are the following: Unfair Trade Practice The Notice fails to state who, how and when an 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. Unsatisfactory Settlement Offer The Insureds fail to state who, how and when an unsatisfactory settlement offer was made therefore it lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. Claim Denial The Insureds fail to state who, how and when a claim denial was made. In fact it states that Heritage issued payment for the claim. Therefore it lacks a factual basis to support this allegation and lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. The Notice alleges the following violations: 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 The Notice does not provide any specifics by way of who, when and how Heritage committed this violation and therefore fails to comply with the specificity required. 624.155(1)(b)(3) 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 The Notice does not provide any specifics by way of who, when and how Heritage committed this violation and therefore fails to comply with the specificity required. 626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims. The Notice does not provide any specifics by way of who, when and how Heritage committed this violation and therefore fails to comply with the specificity required. Nowhere in the notice does it state what the alleged standards for proper investigations are that Heritage failed to adopt or implement, and who failed to adopt and implement the standards. 626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims. The Notice does not provide any specifics by way of who, when and how Heritage committed this violation and therefore fails to comply with the specificity required. Nowhere in the notice does it state what the pertinent facts as to who failed to acknowledge and act promptly upon communications with respect to claims. 626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information The Insureds fail to state who, how and when a claim denial was made. In fact it states that Heritage issued payment for the claim. Therefore it lacks a factual basis to support this allegation and lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. 626.9541(1)(i)(3)(e) Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed. The Insureds fail to state who, how and when a Heritage failed to affirm or deny full or partial coverage of claims. In fact it states that Heritage issued payment for the claim and provided a written explanation of payment and estimate. Therefore it lacks a factual basis to support this allegation and lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. 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 The Insureds fail to state who, how and when a Heritage failed to promptly provide a reasonable explanation in writing to the insured. In fact it states that Heritage issued payment for the claim and provided a written explanation of payment and estimate. Therefore it lacks a factual basis to support this allegation and lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. 626.9541(1)(i)(3)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b). The Insureds fail to state this rule subsection in its entirety. They also fail to state why this rule is applicable to its homeowner’s insurance claim. Heritage does not waive any of its defenses regarding the Notice including but not limited to any technical and factual deficiencies contained in the Notice. Sincerely, /s/ Robert R. Beard III Robert R. Beard III, Esq. Staff Counsel Heritage Property & Casualty Insurance Co. cc: Lindsey Parnell, Esq., via email; lparnell@serranocagan.com CRN 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