Filing Number: 794830
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| Filing Accepted: 12/2/2024 |
| Last/Business Name
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POLANCO
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First Name |
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CARMEN |
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| Street Address
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2366 VICTORIA AVE |
| City, State Zip
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FORT MYERS,
FL
33901
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| Email Address
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LITIGATION@COOKECARBONELL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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POLANCO |
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First Name |
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CARMEN |
| Policy # * |
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HOD305950 |
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Claim #* |
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H109064 |
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Attorney is Applicable
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| Last Name* |
CARBONELL
First Name *
JORGE
Initial
L
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| Street Address* |
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10720 CARIBBEAN BLVD #540 |
| City, State Zip* |
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CUTLER BAY
,
FLORIDA
33189
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| Email Address * |
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LITIGATION@COOKECARBONELL.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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| City, State Zip* |
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,
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NAIC Company Code 14407 |
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| Name of individual responsible for violation (if any):*
CHARLES ISON, FIELD ADJUSTER, WARWICK GUIDRY, CLAIMS EXAMINER, RODNEY FEARS, CLAIMS EXAMINER, AND ANY ADJUSTERS, SUPERVISORS, MANAGEMENT, AND OTHER INDIVIDUALS AND REPRESENTATIVES ASSOCIATED WITH OR RETAINED BY HERITAGE PROPERTY & CASUALTY INSURANCE
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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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Claim Denial
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Claim Delay
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Unsatisfactory Settlement Offer
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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)(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.
Specific policy language relevant to the violation:
Specific policy language that is believed to be relevant to the violations includes, but is not limited to, the following: All provisions of Heritage Property & Casualty Insurance Company’s policy number HOD305950, including but not limited to: Section I – Perils Insured Against: “We insure against risk of direct loss to property…”; “… This includes the cost to tear out and replace any part of a building, or other structure, on the “residence premises”, but only when necessary to repair the system or appliance …”; Section I – Conditions: “We will adjust all losses with you.”; “Covered property losses are settled … at actual cash value at the time of loss …”
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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.
Facts and circumstances giving rise to the violation:
This notice is given in order to perfect the right of the insured, Carmen Polanco, to pursue the civil remedy authorized by Fla. Stat. §624.155 against her insurer, Heritage Property & Casualty Insurance Company (“Heritage”). Heritage has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the claim of loss of its insured. This claim arises from covered damages sustained by the insured from a Hurricane Ian loss and ensuing damage occurring on or about September 28, 2022. On or about that date, the insured property suffered extensive interior and exterior damage as a result of the covered hurricane loss. Heritage was timely notified of the loss, assigned claim number H109064, and investigated the loss. The insured fully cooperated with Heritage during the investigation including inspections by Heritage’s Field Adjuster. Heritage then opened coverage for claim number H109064 and made a partial payment in the amount of $2,281.76. However, said payment was woefully inadequate. Despite repeated pleas and opportunity for Heritage to make a supplemental payment, Heritage has failed and/or refused to fully indemnify the insured for the covered loss.
The actions and claims practices of Heritage with respect to the subject claim rise to the level of bad faith and warrant ethical discipline by DFS. To date, notwithstanding the insured’s pleas otherwise, Heritage has failed and refused to pay all insurance benefits due and owing under the policy and has failed and refused to restore the insured’s property to its pre-loss condition. As a result, the insured was left with no choice but to file a lawsuit against Heritage for its breach of the insurance policy in failing to pay the actual value of the loss.
The facts of this matter are simple. The insured suffered massive damage to her property caused by a covered hurricane loss. Heritage has refused to issue a supplemental payment and/or fully indemnify the insured regarding claim number H109064 for covered hurricane damage which occurred on September 28, 2022. The policy clearly and unambiguously provides coverage for the insured’s loss, which includes the cost of tearing out and replacing any part of the insured’s property when necessary.
To date, Heritage has failed and/or refused to provide the insured with all the insurance benefits due and owing, despite knowing that the insured has sustained covered damage to her insured property. Despite the insured’s repeated pleas, Heritage has not tendered the full amount needed to repair the property or issue adequate payment to the insured under the policy. Implicit within every insurance policy is a duty of good faith and fair dealing. However, Heritage has failed to comply with those obligations in connection with this claim. Instead, Heritage has looked for ways not to pay the claim in full and these actions have been to the detriment of the insured.
Heritage has a contractual obligation to make a thorough investigation, not ignoring evidence that would support the insured’s claim. This is a breach of the policy. Heritage has a contractual obligation not to look the other way when confronted with facts revealing the possibility of coverage and resisting reasonable interpretations of its policy, this is a breach of the policy. The concept of insurance is that insurance is the insurer’s granting of timely and prompt indemnity or security against a contingent loss. Florida Statute § 624.02 defines “insurance” as a contract whereby one undertakes to indemnify another or pay or allow specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that the insured may mitigate her damages and be placed back into the position she was in prior to the loss as quickly as possible. Heritage has breached this duty. Heritage has refused and/or failed to tender all insurance proceeds to the insured upon demand. Heritage’s refusal and/or failure to settle the insurance claim when under all circumstances it could have and should have done so had it acted fairly and honestly towards the Insured is wrongful conduct. Further, the insured contends that Heritage’s adjusters and/or representatives financially benefit by such wrongful conduct. Therefore, to cure the defects outlined in this Civil Remedy Notice, Heritage must: create and implement adequate guidelines for proper investigation and evaluation as to claims handling and for the training and supervision of employees, which will avoid future statutory violations as set forth above, and prevent such violations from occurring in the future. Heritage must create and implement adequate guidelines for the proper investigation and evaluation of these types of claims, and for the training and supervision of employees with regard to these types of claims to ensure Heritage’s claims handling procedures with regard to these types of losses are adequate to prevent other insureds from being treated unfairly and wrongfully. Heritage must act fairly and honestly towards the insured and with due regard for her best interests in attempting to settle the insured’s claim. Heritage must immediately tender all insurance benefits due and owing to the insured under the policy pursuant to the relevant policy provisions provided therein that would reasonably place the insured’s property back to its pre-loss condition, including, but not limited to all interest due and owing under applicable Florida Statutes and all attorney’s fees and costs incurred by the insured because of the bad faith conduct of Heritage. Heritage must pay the insured the fair value of her insurance claim.
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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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