Civil Remedy Notice of Insurer Violations
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Filing Number:     796504
Filing Accepted:  12/11/2024
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Complainant
Last/Business Name *  
MINNIE HOWELL   First Name  
Street Address * 38842 OLD SPARKMAN RD
City, State Zip * DADE CITY, FL 33525
Email Address * MCKINNEYTR5@YAHOO.COM
Complainant Type: * Insured
Insured
Last/Business Name*   MINNIE HOWELL   First Name  
Policy # * HPH234075 Claim #* H010031578
Attorney
Attorney is Applicable
Last Name* ATTIA ESQ. First Name * JEREMY Initial
Street Address* 925 S. FEDERAL HWY
City, State Zip* BOCA RATON , FL 33432
Email Address * JATTIA@KPATTORNEY.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):* ICYLIN THOMAS
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unfair Trade Practice
Unsatisfactory Settlement Offer
* 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)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
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.
* 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
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The carrier was put on notice of the insured’s windstorm damage claim. The carrier initially attempted to low-ball the claim. Subsequently, the insured prepared a loss package in the amount of $49,628.70 needed to restore the property back to its pre-loss condition. Whereas, the carrier wrongfully represented the damages to the insured’s property to be below the policy deductible. The insured has complied with all of the carrier’s requests to date and the carrier has still failed to treat this claim with good faith. This intentional delay with the claim has led to direct prejudice of the insured. About seventy-five days have passed since the original date of loss. The carrier has still refused to pay the fully covered amount owed under the policy. The carrier is aware of damage sustained by the insured’s property and has not taken any meaningful ensuing action. It is clear that the carrier is not treating the insured with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insured; failing to implement proper standards for the adjustment and investigation of claims by its adjusters and placing the company’s interests before the insured’s interests; refusing to pay the full amount owed to the insured despite the fact that the carrier has been on notice of the damages and looking for ways to delay full recovery or any recovery to the insured, when a reasonable carrier in a similar position would have tendered a full payment in accordance with both the policy language and statutory requirements. The carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c) and 626.9541(1)(i)(3)(f), as well as Section I- Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss; and the loss payment provision under Section I- Conditions requiring payment of a claim within 90 days. All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless disregard for the insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $49,628.70, less any prior payments and less any applicable policy deductible; and 2.) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been sent to the carrier. Please do not hesitate to contact the undersigned or Stephanie Alexandre at (561)-892- 9925 if you have any questions or concerns. Sincerely, Jeremy Attia Esq. Attorney at Law
Comments
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ncarlisle@heritagepci.com 01-30-2025 January 30, 2025 VIA ELECTRONIC SUBMISSION Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Complainant: MINNIE HOWELL Insured: MINNIE HOWELL Insurer: Heritage Property & Casualty Insurance Company DFS File No.: 796504 Claim No: H010031578 Policy No.: HPH234075 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 796504, filed on behalf of Heritage’s insured MINNIE HOWELL (“Complainant”). The Notice was accepted by the Department on December 11, 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. The Notice fails to inform Heritage whether it had been given to perfect the right to pursue the civil remedy authorized by Florida Statute §624.155 and Florida Case law. History of Claim For clarification, Heritage is providing a brief history of the claim: Subject to its terms, endorsements, limitations, exclusions, and conditions, the Complainants were issued Policy HPH234075 (“Policy”) for the property at 38842 OLD SPARKMAN RD., DADE CITY, FL 33525 (“Property”). 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 Complainants’ first notice of loss on October 14, 2024, claiming damages from a windstorm that allegedly occurred on October 9, 2024, Heritage promptly assigned claim number H010031578. On the same day the loss was reported, Heritage issued its acknowledgment letter and Bill of Rights to the Complainants. Moving forward, Heritage’s representative coordinated an inspection of the damage to the Property caused by the alleged windstorm. The on-site inspection documented the interior and exterior conditions of the property After conducting a reasonable investigation based upon available information, on November 12, 2024, Heritage advised Complainant that it had extended coverage under the policy. The damage caused was precluded from coverage by the subject policy. Heritage promptly provided a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for partial denial of the claim. In accordance with its obligations under §627.70131, Fla. Stat., a letter including a written explanation of the coverage decision was sent to Complainant on November 12, 2024, which included pertinent facts or insurance policy provisions relating to coverages at issue. Because the damage did not surpass the applicable deductible, no payment was sent. On December 11, 2024, Complainants filed this Notice, to which Heritage now submits its response. As previously stated, Heritage has adjusted the subject claim at all times in accordance with the insurance policy and Florida Statute. To date, Heritage has not received any information that would alter its understanding of the loss or coverage. Additionally, Heritage is pleased to inform that the parties resolved the claim amicably on January 30, 2025. 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. Heritage’s position is that it has complied, in good faith, with these obligations. Alleged Reasons for the Notice In accordance with Fla. Stat. §624.155, the Civil Remedy Notice requires the Complainant, “to indicate all statutory provisions alleged to have been violated.” The Notice alleges the reasons for the Notice are the following: Claim Delay The Notice fails to state instances of “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. 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. Unsatisfactory Settlement Offer The Insureds fail to state who, how and when instances of unsatisfactory settlement offer occurred therefore it lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. Alleged Violations of Statutory Provisions 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:. 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. Regardless, 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 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 documentation and information received do not support a covered loss as demanded by Complainants. Therefore, this is an unsupported, sweeping allegation and is without merit. Regardless, Heritage denies the allegations contained herein. 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: Accordingly, and as indicated by the facts stated above, Heritage has promptly provided a reasonable explanation in writing to Complainants of the basis in the insurance policy, in relation to the facts or applicable law, for the denial. Further, 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 documentation and information received do not support a covered loss as demanded by Complainants. The Notice fails to specifically identify instances where Heritage failed 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.” Therefore, this allegation is an unsupported, sweeping allegation and without merit. Regardless, Heritage denies the allegations contained herein. 3. 626.9541(1)(i)(3)(b): Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. Response: 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 are for representing pertinent facts or insurance policy provisions relating to coverages at issue with respect to claims which Heritage failed to adopt or implement, and who failed to adopt and implement the standards. Accordingly, and as indicated by the facts stated above, Heritage has at all times acted fairly and honestly. Further, 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 documentation and information received do not support a covered loss as demanded by Complainants. Heritage has always represented pertinent facts or insurance policy provisions relating to coverages at issue with respect to claims. Therefore, this is an unsupported, sweeping allegation and is without merit. Regardless, Heritage denies the allegations contained herein. 4. 626.9541(1)(i)(3)(c): Failing to acknowledge and act promptly upon communications with respect to claims. Response: 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 acknowledgment and actions taken with regard to prompt communications with respect to claims which Heritage failed to adopt or implement, and who failed to adopt and implement the standards. Regardless, 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 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 documentation and information received do not support a covered loss as demanded by Complainants. Heritage has always promptly acknowledged and acted prompt upon communications with respect to claims. Therefore, this is an unsupported, sweeping allegation and is without merit. 5. 626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims. Response: 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. Regardless, 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 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 documentation and information received do not support a covered loss as demanded by Complainants. Additionally, the Notice fails to specifically identify how Heritage fails “to adopt and implement standards for the proper investigation of claims.” Heritage has always properly investigated the claims. Therefore, this is an unsupported, sweeping allegation and is 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: 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 promptly providing 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 with respect to claims which Heritage failed to adopt or implement, and who failed to adopt and implement the standards. Accordingly, and as indicated by the facts stated above, Heritage has promptly provided a reasonable explanation in writing to Complainants of the basis in the insurance policy, in relation to the facts or applicable law, for the denial. Further, 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 documentation and information received do not support a covered loss as demanded by Complainants. Therefore, this allegation is an unsupported, sweeping allegation and without merit. Regardless, Heritage denies the allegations contained herein. Request to Reject Notice 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. 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. Moreover, 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. Strict construction of §624.155 demands a specificity level of compliance with the requisite provision of information to the Department and the insurer. See id; See also Marques v. Heritage Property & Cas. Ins. Co., No. 56 2020 CA 000805, 2021 WL 3473940, at 2 (Fla. Cir. Ct. Aug. 02, 2021). As such, the Notice does not comply with Florida law and is legally insufficient. The purpose of the Civil Remedy Notice is to provide the insurer notice of the issue its Complainants 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). I Furthermore, the Complainant’s 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 Complainant. 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, similarly to Rousso, 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. In closing, 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. Sincerely, /s/ Tamara Schweinsberg Tamara Schweinsberg, Esq. Senior Claims Counsel Heritage Property & Casualty Insurance Co. Civil Remedy Notice of Insurer Violation 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