Civil Remedy Notice of Insurer Violations
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Filing Number:     795098
Filing Accepted:  12/3/2024
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Complainant
Last/Business Name *  
GOODWIN   First Name   JOHN AND LISA ANN
Street Address * 11315 PANTHER CREEK COURT
City, State Zip * JACKSONVILE, FL 32221
Email Address * JGBARBABLANCA4@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   GOODWIN   First Name   JOHN AND LISA ANN
Policy # * HO317076 Claim #* H010025308
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):* DARRELL YEAGER
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 08/02/2024, JOHN GOODWIN AND LISA ANN KING-GOODWIN, ("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 & CASUALTY INSURANCE COMPANY ("Insurer"). Prior to the date of loss, Insurer issued a policy of insurance, believed to be policy # HO317076 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 # H010025308. Insurer was fully afforded any and all opportunity to inspect the loss and document the loss. To date, Insurer has paid $00.00 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 11/04/2024,, 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 $ 53,517.00 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
Mmangasarian@serranocagan.com 11-21-2025 Complainant hereby withdraws this Civil Remedy Notice against Heritage Property and Casualty Insurance Company.
ncarlisle@heritagepci.com 01-15-2025 January 15, 2025 VIA ELECTRONIC SUBMISSION Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Complainant: John Goodwin and Lisa Goodwin Insured: John Goodwin and Lisa Goodwin Insurer: Heritage Property & Casualty Insurance Company DFS File No.: 795098 Claim No: H010025308 Policy No.: HOH317076 Address: 11315 Panther Creek Ct., Jacksonville, FL 32221 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 795098, filed on behalf of John Goodwin and Lisa Goodwin (“Complainants”). The Department accepted the Notice on December 3, 2024. While Heritage welcomes the opportunity to respond to the Notice filed concerning this claim, it responds to it specifically denying each and every allegation contained in the Notice. Heritage believes that the 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 as promulgated in Florida Statute §624.155 and Florida Case law. Despite citing the name of one representative from Heritage, the Notice failed to identify the person and persons representing Heritage from the Claims department, which supervisor, management, agents, and adjuster, including following representative and adjusters, and vendors who are most responsible for knowledgeable of the facts giving rise to the allegation in the Notice, as explicitly required. Further, 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 requirement set forth in the statute, this Notice contains overbroad and incorrect allegations, which stem only from the Complainants’ opinions regarding the value of their own claim and, therefore, the Complainants’ opinions regarding Heritage’s adjustment of this claim. Moreover, Florida Statute §624.155(3)(b)(4) requires the Complainant to refer to specific policy language that is relevant to the alleged violation, if any. The Notice is legally insufficient because it failed to provide the correct policy number. Also, it allegedly lists all policy provisions and does not specify which provisions were violated; it indicates that “Entire Section” for all Coverages under the policy, contrary to reference to specific policy provisions that [are] relevant to the violation. Therefore, the Notice failed to provide sufficient notice to Heritage what policy and what policy provision was violated. Additionally, the Notice contains a list of violations that Heritage has allegedly committed but fails to provide an adequate basis in support of those allegations and, on that basis alone, fails to satisfy the basic requirements of an otherwise proper Notice. Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021); Fla. Stat. §§ 624.155 and 626.9541. Lastly, the Notice failed the Insurer’s address, as specifically required. As such, the Notice does not comply with Florida law and is legally insufficient. Notwithstanding the deficiencies, for clarification, Heritage provides a brief history of the claim: Subject to its terms, endorsements, limitations, exclusions, and conditions, the Complainant was issued policy HOH317076 for property at 11315 Panther Creek Ct., Jacksonville, FL 32221. The insurance policy applies to direct physical loss of or damage to covered property at the premises described in the policy's declarations or resulting from any covered cause of loss as described in the policy. Upon receiving the Complainants’ first notice of loss on September 16, 2024, claiming damages from wind on August 2, 2024, Heritage promptly assigned claim number H010025308. An acknowledgment letter with a Bill of Rights was submitted to Complainants on the same day. On September 17, 2024, Heritage issued a Reservation of Rights letter and Request for Information to Complainants’ representative. In the Request for Information, Heritage asked Complainants to provide: 1. “You and your representative to be present and available for all inspections, including answering questions the field adjuster or expert may have during the inspection. 2. An opportunity to obtain your recorded statement. Please provide dates and times that best fit your schedule. 3. Fully completed and executed Sworn Statement in Proof of Loss form. 4. 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 or videos must show the condition of the property and any claimed damage. 5. Submit all repair estimates, inspection reports, documents provided by the restoration or remediation company, including Invoices, dry logs, photos, assignment of benefits, certificates of satisfaction, or direction of payments or invoices obtained by you or on your behalf related to this claim. 6. Copies of supporting documentation for any previous work or maintenance completed in the area of the claimed damage (i.e. roof replacement, solar panels installation, etc.) such as invoices, estimates, pictures, receipts, credit or debit card statements, or canceled checks.” In the meantime, Heritage enlisted the services of a field adjuster to coordinate an inspection of the alleged damage caused by the alleged windstorm. Complainants requested it to occur on September 20, 2024. The on-site inspection documenting the property's exterior and interior conditions occurred as scheduled with the presence of the Complainant Lisa Goodwin. As an additional step, Heritage requested a reinspection from an independent engineering firm to assess the alleged damages. The Professional Engineer, Joshua Rollins of Intertek, conducted the reinspection on October 3, 2024. After the reinspection, Mr. Rollins prepared a report with his conclusions. Based on the reinspection and information gathered in his report, Mr. Rollins opined that, in summary: • The one (1) missing shingle edge tab, one (1) torn/creased shingle, and one (1) torn shingle were the result of mechanical damage during installation, inspections, repairs, and/or maintenance activities (Photographs 11, 12, and 13). The torn/creased shingle was located in the field of the roof w/ several adjacent unsealed shingles. • The front-left corner garage ceiling stains and deterioration were the result of moisture intrusion from long-term and repeated leaks at the dead valley directly above due to improper installation and/or age-related deterioration of the flashing and/or underlayment. Deteriorated sealant repairs were located at the dead valley. No creased or missing shingles were located in the area (Photographs 14 through 17). • The ceiling stains at the center of the garage were the result of moisture intrusion from long-term and repeated leaks through multiple exposed and partially withdrawn fasteners (nail pops) through the top course of shingles adjacent to the wall above the stains. Deteriorated sealant was present at the exposed fasteners. No creased or missing shingles were located in the area (Photographs 18 through 21). • The second-story bedroom closet ceiling stains, as well as the living room ceiling stains below, were the result of moisture intrusion from long-term and repeated leaks at the vent stack penetration above due to age-related deterioration of the vent boot and a raised nail (nail pop) below the vent boot flashing. Newer sheathing was located within the attic space adjacent to the vent penetration. Stains and wood rot were located on the roof sheathing adjacent to the vent penetration, including at the previously repaired sheathing. The boot was cracked and deteriorated, and a nail pop had lifted the vent boot flashing. No creased or missing shingles were located in the area (Photographs 22 through 32). On October 10, 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 Complainants, which included pertinent facts and insurance policy provisions relating to coverages at issue. The letter explained that based on the inspection and the engineer’s opinion, the damage to the roofing system was not from a windstorm, and the interior water damage to the living room, garage and upstairs bedroom was repeated seepage, and, therefore, not covered under the policy. On November 5, 2024, Serrano Cagan & Cagan submitted a letter of representation and requested a copy of the policy and documents associated with the claim. Soon after, Heritage acknowledged the letter of representation and responded to the letter with the documents requested. On December 3, 2024, Serrano Cagan & Cagan, on behalf of the Complainants, filed a Notice of Intent to Initiate Litigation, to which Heritage timely responded, maintaining its decision of prior denial of coverage. On the same day, Complainants’ attorney filed this Notice, to which Heritage is responding. 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 alleges the reasons for the Notice are the following: Claim Denial The Notice fails to state who, how, and when a “claim denial” practice occurred; therefore, it lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. Claim Delay The Notice fails to state who, how, and when a “claim delay” practice occurred; therefore, it lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. The claim was adjusted in a timely manner, following all statutory requirements. Unsatisfactory Settlement Offer The Notice fails to state who, how, and when an “unsatisfactory settlement offer” practice occurred; therefore, it lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. Unfair Trade Practice The Notice fails to state instances of “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. Further, the Notice filed in this matter alleges Heritage 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 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 do not support that a covered loss occurred as described. Therefore, this is an unsupported, sweeping allegation and is without merit. 2. 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. 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 do not support that a covered loss occurred as described. Therefore, this is an unsupported, sweeping allegation and is without merit. 3. 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 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 do not support that a covered loss occurred as described. Additionally, Complainants 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. 626.9541(1)(i)(3)(c): Failing to acknowledge and act promptly upon communications with respect to claims. Response: Heritage denies the allegations contained herein. Accordingly, and as indicated by the facts stated above, Heritage has always promptly acknowledged communications and acted promptly in furtherance of the resolutions of the claim. Further, Heritage has timely made a coverage determination affording coverage for the claim based upon the information and documentation obtained and/or received by Heritage during its investigation of the claim and the subject policy. The Notice does not specifically identify instances where Heritage failed "to acknowledge and act promptly upon communications." Therefore, this is a broad allegation without specific support. 5. 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. Response: Heritage denies the allegations contained herein. Accordingly, and as indicated by the facts stated above, Heritage has always promptly acknowledged communications and acted promptly in furtherance of the resolutions of the claim. Further, Heritage has timely made a coverage determination affording coverage for the claim based upon the information and documentation obtained and/or received by Heritage during its investigation of the claim and the subject policy. The Notice fails to specifically identify instances where Heritage failed “to affirm or deny full or partial coverage of claims” or failed “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.” Therefore, this allegation is unsupported, sweeping allegation, and without merit. 6. 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. Response: Heritage denies the allegations contained herein. Accordingly, and as indicated by the facts stated above, Heritage has conducted a reasonable investigation based on available information and made a coverage determination in reference to Complainants’ claim based upon the information and documentation obtained and/or received by Heritage during its investigation of the claim and the subject policy. The Notice fails to specifically identify instances where Heritage failed “to promptly provide a reasonable explanation in writing to the insured [. . .].” Therefore, this allegation is unsupported, sweeping and without merit. 7. 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). Response: The allegations do not apply to this claim, as the claim is not related to a personal injury. Nonetheless, Heritage denies the allegations contained herein. Accordingly, and as indicated by the facts stated above, Heritage has conducted a reasonable investigation based on available information and made a coverage determination in reference to Complainants’ claim based upon the information and documentation obtained and/or received by Heritage during its investigation of the claim and the subject policy. Therefore, this allegation is unsupported, sweeping allegation and without merit. As detailed by the facts stated above, Heritage Property & Casualty Insurance Company did not violate any of the statutes mentioned above sections. Heritage has diligently and thoroughly investigated the subject claim, followed up with Complainants for documents supporting their claim, and provided a coverage determination. The purpose of the Civil Remedy Notice is to provide the insurer notice of the issue its Complainant have 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. Heritage’s position is that it has complied, in good faith, with these obligations. Furthermore, the Complainants’ Notice seeks cures for the alleged defects. However, the “cures” 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 Complainants. 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 Complainant. In the context of a first-party insurance claim, the contractual amount due to the Complainant 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....” As a result, only the demanded “cures” relating to the payment for covered damages are proper and legal. In short, as in Russo, 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 Complainants have failed to comply with several conditions precedent to bringing a claim under § 624.155. Heritage Property & Casualty Insurance Company 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 Property & Casualty Insurance Company’s response above is based upon the limited information provided in the Notice and the information we have to date. If the Complainants feel that Heritage does not have all the facts, please inform Heritage immediately. In closing, Heritage denies each and every assertion of bad faith in the Notice. And, notwithstanding the foregoing, nothing in this letter should be construed as a waiver or surrender of the policy terms, limitations, exclusions, conditions or agreements, nor should this letter be considered an exhaustive recitation of the deficiencies in the Notice. Heritage reserves the right to supplement its response at a later time. Should the Department have any questions, concerns, or require any additional information regarding this matter, please feel free to contact the undersigned at your convenience. Sincerely, /s/ Priscila Ferreira Priscila Ferreira, Esq. Claims 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