Civil Remedy Notice of Insurer Violations
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Filing Number:     796845
Filing Accepted:  12/13/2024
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Complainant
Last/Business Name *  
ADAMS   First Name   FRED D. ADAMS III AND PATRICIA Z.
Street Address * 3318 PINE VALLEY DRIVE
City, State Zip * SARASOTA, FL 34239
Email Address * SOJEZA@AOL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   ADAMS   First Name   FRED D. ADAMS III AND PATRICIA Z.
Policy # * HPD026438 Claim #* H010022694
Attorney
Attorney is Applicable
Last Name* ROSS First Name * VANESSA Initial
Street Address* 2501 S. TAMIAMI TRAIL
City, State Zip* SARASOTA , FLORIDA 34239
Email Address * ESERVICE@ROSSLEGALFL.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):* JUSTIN ANDERSON, AND ALL OTHER ADJUSTERS, SUPERVISORS, MANAGEMENT AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unsatisfactory Settlement Offer
Claim Denial
Claim Delay
Unfair Trade Practice
Other : Other: Failure to properly investigate claim and with due regard to the Insured’s interest
* 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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The Insured(s) may not be in possession of a complete copy the applicable policy of insurance, however, the specific policy language relevant to the violations outlined below is contained within INSURER’S policy, Policy No. HPD026438, issued to the Insured including, but is not limited to, the following: Dwelling Property 3 - Special Form (DP 00 03 07 88) COVERAGES This insurance applies to the Described Location, Coverages for which a Limit of Liability is shown and Perils Insured Against for which a Premium is stated. COVERAGE A – Dwelling We cover: 1. the dwelling on the Described Location shown in the Declarations, used principally for dwelling purposes, including structures attached to the dwelling; 2. materials and supplies located on or next to the Described Location used to construct, alter or repair the dwelling or other structures on the Described Location; and 3. if not otherwise covered in this policy, building equipment and outdoor equipment used for the service of and located on the Described Location. This coverage does not apply to land, including land on which the dwelling is located. COVERAGE B – Other Structures We cover other structures on the Described Location, set apart from the dwelling by clear space. This includes structures connected to the dwelling by only a fence, utility line, or similar connection. This coverage does not apply to land, including land on which the other structures are located. *** COVERAGE E – Additional Living Expense If a loss to property described in Coverage A, B or C by a Peril Insured Against under this policy makes the Described Location unfit for its normal use, we cover your: Additional Living Expense, meaning any necessary increase in living expenses incurred by you so that your household can maintain its normal standard of living. Payment will be for the shortest time required to repair or replace the Described Location or, if you permanently relocate, the shortest time required for your household to settle elsewhere. If a civil authority prohibits you from use of the Described Location as a result of direct damage to a neighboring location by a Peril Insured Against in this policy, we cover the Additional Living Expense loss for no more than two weeks. The periods of time referenced above are not limited by the expiration of this policy. *** OTHER COVERAGES 1. Other Structures. You may use up to 10% of the Coverage A limit of liability for loss by a Peril Insured Against to other structures described in Coverage B. Use of this coverage does not reduce the Coverage A limit of liability for the same loss. 2. Debris Removal. We will pay your reasonable expense for the removal of: a. debris of covered property if a Peril Insured Against causes the loss; or b. ash, dust or particles from a volcanic eruption that has caused direct loss to a building or property contained in a building. Debris removal expense is included in the limit of liability applying to the damaged property. *** 6. Reasonable Repairs. In the event that covered property is damaged by an applicable Peril Insured Against, we will pay the reasonable cost incurred by you for necessary measures taken solely to protect against further damage. If the measures taken involve repair to other damaged property, we will pay for those measures only if that property is covered under this policy and the damage to that property is caused by an applicable Peril Insured Against. This coverage: a. does not increase the limit of liability that applies to the covered property; b. does not relieve you of your duties, in case of a loss to covered property, as set forth in Condition 4.b. 8. Trees, Shrubs and Other Plants. We cover trees, shrubs, plants or lawns, on the Described Location for loss caused by the following Perils Insured Against: Fire or lightning, Explosion, Riot or civil commotion, Aircraft, Vehicles not owned or operated by you or a resident of the Described Location or Vandalism or malicious mischief, including damage during a burglary or attempted burglary, but not theft of property. The limit of liability for this coverage will not be more than 5% of the Coverage A limit of liability, or more than $500 for any one tree, shrub or plant. We do not cover property grown for commercial purposes. This coverage is additional insurance. *** 11.Glass or Safety Glazing Material. We cover: a. the breakage of glass or safety glazing material which is part of a covered building, storm door or storm window; and b. damage to covered property by glass or safety glazing material which is part of a building, storm door or storm window. This coverage does not include loss on the Described Location if the dwelling has been vacant for more than 30 consecutive days immediately before the loss. A dwelling being constructed is not considered vacant. Loss for damage to glass will be settled on the basis of replacement with safety glazing materials when required by ordinance or law. This coverage does not increase the limit of liability that applies to the damaged property. *** PERILS INSURED AGAINST COVERAGE A – DWELLING and COVERAGE B – OTHER STRUCTURES We insure against risk of direct loss to property described in Coverages A and B only if that loss is a physical loss to property; however, we do not insure loss: *** SPECIAL PROVISIONS FOR FLORIDA Endorsement (HPCDP3 SP 01 17) AGREEMENT is deleted and replaced by the following: In reliance on the information you have given us, we agree to provide the insurance coverages indicated on the Policy Declarations. In return, you must pay the premium when due and comply with the policy terms and conditions and notify us within 60 days of any change of title, use or occupancy of the Described Location. DEFINITIONS The following definitions are added. “Hurricane loss” means any loss resulting from the peril of Windstorm caused by a hurricane during any period: a. Beginning when a hurricane watch or hurricane warning is issued for any portion of Florida by the National Hurricane Center of the National Weather Service; b. Remaining in effect for as long as hurricane conditions exist anywhere in the state of Florida; and c. Ending 72 hours after any hurricane watch or hurricane warning has been dis- continued for all counties of the state of Florida by the National Hurricane Center of the National Weather Service. “Fungi” means any type or form of fungus, including mold or mildew, and any mycotoxins, spores, scents, or by-products produced or released by fungi. “Vacant” means substantially empty of personal property necessary to sustain normal occupancy. “Unoccupied” means the dwelling is not being inhabited as a residence. “Catastrophic ground cover collapse” means geological activity that results in all of the following. a. The abrupt collapse of the ground cover; b. A depression in the ground cover clearly visible to the naked eye; c. Structural damage to the building, including the foundation; d. The insured structure being condemned and ordered to be vacated by the governmental agency authorized by law to issue such an order for that structure. “Supplemental claim” or “reopened claim” means any additional claim for recovery from us for a loss we previously adjusted pursuant to the initial claim. “Principal building” means the dwelling described in COVERAGES, COVERAGE A – Dwelling of the policy. The “principal building” is also referred to as the covered building. “Structural damage” means a covered building, regardless of the date of its construction, has experienced the following: a. Interior floor displacement or deflection in excess of acceptable variances as defined in ACI 117-90 or the Florida Building Code, which results in settlement related damage to the interior such that the interior building structure or members become unfit for service or represents a safety hazard as defined within the Florida Building Code; b. Foundation displacement or deflection in excess of acceptable variances as defined in ACI 318-95 of the Florida Building code, which results in settlement related damage to the “primary structural members” or “primary structural systems” that prevents those members or systems from supporting the loads and forces they were designed to support to the extent that stresses in those “primary structural members” or “primary structural systems” exceeds one and onethird the nominal strength allowed under the Florida Building Code for new buildings or similar structure, purpose, or location; c. Damage that results in listing, leaning, or buckling of the exterior load bearing walls or other vertical primary structural members to such an extent that a plumb line passing through the center of gravity does not fall inside the middle one-third of base as defined within the Florida Building Code; d. Damage that results in the building, or any portion of the building containing “primary structural members” or “primary structural systems”, being significantly likely to imminently collapse because of movement or instability of the ground within the influence zone of the supporting ground within the sheer plane necessary for the purpose of supporting such building as defined within the Florida Building Code; or e. Damage occurring on or after October 15, 2005, that qualifies as “substantial structural damage” as defined in the Florida Building Code. DEDUCTIBLE Unless otherwise noted in this policy, the following deductible provision applies: Subject to the policy limits that apply, we will pay only that part of the total of all loss payable that exceeds the deductible amount shown in the Declarations. COVERAGES Under COVERAGE A – Dwelling and COVERAGE B – Other Structures: The following is added: Special Limit of Liability Cosmetic and Aesthetic Damage to Floors 1. The total limit of liability for COVERAGE A – Dwelling and COVERAGE B – Other Structures combined is $10,000 per policy term for cosmetic and aesthetic damages to floors. a. Cosmetic or aesthetic damage includes, but is not limited to: (1) Chips; (2) Scratches; (3) Dents; or (4) Any other damage to less than 5% of the total floor surface area and does not prevent typical use of the floor. b. This limit includes the cost of tearing out and replacing any part of the building necessary to repair the damaged flooring. c. This limit does not increase the COVERAGE A – Dwelling and COVERAGE B – Other Structures limits of liability shown on the declarations page. d. This limit does not apply to cosmetic or aesthetic damage to floors caused by a peril named and described under COVERAGE C – Personal Property in PERILS INSURED AGAINST. COVERAGE A – Dwelling Item 1. is deleted and replaced by the following. 1. The dwelling on the Described Location shown in the Declarations, used principally for dwelling purposes, including attached structures and attached wall-to-wall carpeting if damage to the dwelling is caused by a covered loss. COVERAGE C – Personal Property The following is added to Property Not Covered. 8. Your satellite dish, satellite antenna or radio towers and their antenna. This exclusion also applies to all related receiving equipment including receiver mounts, transducers or other receiver parts or installation parts. Television sets are not an excluded item under this exclusion. COVERAGE D – Fair Rental Value is deleted and replaced by the following: COVERAGE D – Fair Rental Value If a loss to property described in Coverage A, B or C by a Peril Insured Against under this policy makes that part of the Described Location rented to others or held for rental by you unfit for its normal use, we cover 80% of its: Fair Rental Value, meaning the fair rental value of that part of the Described Location rented to others or held for rental by you less any expenses that do not continue while that part of the Described Location rented or held for rental is not fit to live in. Payment will be for the shortest time required to repair or replace that part of the Described Location rented or held for rental subject to a maximum time limit of 12 months. If a civil authority prohibits you from use of the Described Location as a result of direct damage to a neighboring location by a Peril Insured Against in this policy, we cover the Fair Rental Value loss for no more than two weeks. The periods of time referenced above are not limited by the expiration of this policy. COVERAGE E – Additional Living Expense is deleted and replaced with the following. COVERAGE E – Additional Living Expense If a loss to property described in Coverage A, B or C by a Peril Insured Against under this policy makes the Described Location unfit for its normal use, we cover 80% of your: Additional Living Expense, meaning any necessary increase in living expenses incurred by you so that your household can maintain its normal standard of living. Payment will be for the shortest time required to repair or replace the Described Location or, if you permanently relocate, the shortest time required for your household to settle elsewhere. In either case, the time period for this coverage is limited to a maximum of 12 months. If a civil authority prohibits you from use of the Described Location as a result of direct damage to a neighboring location by a Peril Insured Against in this policy, we cover the Additional Living Expense loss for no more than two weeks. The periods of time referenced above are not limited by the expiration of this policy. We do not cover loss or expense due to cancellation of a lease or agreement. 1. Other Structures is deleted and replaced by the following. 1. Other Structures is deleted in its entirety. In order for Other Structures to be covered, a limit must be indicated for Coverage B – Other Structures and a premium paid. *** 6. Reasonable Repairs is deleted and replaced by the following: 6. Reasonable Emergency Measures. a. We will pay up to the greater of $3,000 or 1% of your Coverage A limit of liability for the reasonable costs incurred by you for necessary measures taken solely to protect covered property from further damage, when the damage or loss is caused by a Peril Insured Against. b. We will not pay more than the amount in a. above, unless we provide you approval within 48 hours of your request to us to exceed the limit in a. above. In such circumstance, we will pay only up to the additional amount for the measures we authorize. c. If we fail to respond to you within 48 hours of your request to us and the damage or loss is caused by a Peril Insured Against, you may exceed the amount in a. above only up to the cost incurred by you for the reasonable emergency measures necessary to protect the covered property from further damage. d. If however, form DP 03 51 or DP 03 52 is part of your Policy and a covered loss occurs during a “Hurricane” as described in DP 03 51 or DP 03 52, the amount we will pay under this additional coverage is not limited to the amount in a. above. e. A reasonable measure under this Other Coverages, 6. may include a permanent repair when necessary to protect the covered property from further damage or to prevent unwanted entry to the property. To the degree reasonably possible, the damaged property must be retained for us to inspect. f. This coverage does not: (1) Increase the limit of liability that applies to the covered property; (2) Relieve you of your duties, in case of a loss to covered property, as set forth in CONDITIONS 4, Your Duties After Loss; or 3) Pay for property not covered, or for repairs resulting from a peril not covered, or for loss excluded in this policy. *** The following OTHER COVERAGES is added. 12. “Fungi”, Mold, Wet Or Dry Rot, Or Bacteria a. We will pay up to $10,000 for: (1) The total of all loss payable under COVERAGES caused by or resulting directly or indirectly from “fungi”, mold, wet or dry rot, or bacteria; (2) The cost to remove “fungi”, mold, wet or dry rot, or bacteria from property covered under COVERAGES. (3) The cost to tear out and replace any part of the building or other covered property as needed to gain access to the “fungi”, mold, wet or dry rot, or bacteria; and (4) The cost of testing of air or property to confirm the absence, presence or level of “fungi”, mold, wet or dry rot, or bacteria whether performed prior to, during or after removal, repair, restoration or replacement. The cost of such testing will be provided only to the extent that there is a reason to believe that there is the presence of “fungi”, mold, wet or dry rot, or bacteria. b. The coverage described in a. only applies when such loss or costs are a result of PERIL INSURED AGAINST that occurs during the policy period and only if all reasonable means were used to save and preserve the property from further damage at and after the time the PERIL INSURED AGAINST occurred. c. $10,000 is the most we will pay for the total of all loss or costs payable under this OTHER COVERAGES regardless of the: (1) Number of locations insured; or (2) Number of claims made. d. If there is covered loss or damage to covered property, not caused, in whole or in part, by “fungi”, mold, wet or dry rot, or bacteria, loss payment will not be limited by the terms of this OTHER COVERAGES, except to the extent that “fungi”, mold, wet or dry rot, or bacteria causes an increase in the loss. Any such increase in the loss will be subject to the terms of this OTHER COVERAGES. This coverage does not increase the limit of liability applying to the damaged covered property. *** CONDITIONS *** 4. Your Duties After Loss. The sentence “In case of loss to a covered property, you must see that the following are done:” is deleted and replaced by the following: In case of a loss to covered property, we have no duty to provide coverage under this policy if you fail to comply with the following duties. These duties must be performed either by you, an “insured” seeking coverage, or a representative of either Point a. is deleted and replaced by the following: a. Give prompt notice to us or our agent. Except as provided under Other Coverages 6. Reasonable Emergency Measures, there is no coverage for repairs that begin before the earlier of: (1) 72 hours after we are notified of the loss; (2) The time of loss inspection by us; or (3) The time of other approval by us; If you unreasonably deny us access to inspect the loss during the period in a.(1) above, coverage for repairs beyond reasonable emergency measures begins the earlier of when we are given access to inspect the loss or when we fail to appear at a scheduled loss inspection. If the peril of windstorm is provided in this policy; in the case of a windstorm or “hurricane loss”, you must give us notice of the initial claim, “supplemental claim”, or “reopened claim” within three years after the hurricane first made landfall or the windstorm caused the covered damage. For purposes of this section, “supplemental claim” or “reopened claim” means any additional claim for recovery for losses from the same hurricane or windstorm which we have previously adjusted pursuant to the initial claim. 4.b. is deleted and replaced by the following: b. Protect the covered property from further damage. The following must be performed: (1) Take reasonable emergency measures that are necessary to protect the covered property from further damage, as provided under Other Coverages 6. A reasonable emergency measure under 4.b.(1) above may include a permanent repair when necessary to protect the covered property from further damage or to prevent unwanted entry to the property. To the degree reasonably possible, the damaged property must be retained for us to inspect; and (2) Keep an accurate record of repair expenses. 4.c. is deleted in its entirety replaced by the following: c. Prepare an inventory of damaged personal property showing the quantity, description, age, actual cash value and amount of loss. Attach bills, receipts and related documents that establish ownership of the damaged personal property and justify the figures in the inventory. 4.d.(3) is deleted and replaced by the following: (3) You or any “insured” under this policy must submit to examination under oath and recorded statements, which may be videotaped, and which will be at the location insured if requested by us, while not in the presence of any other “insured” and sign the same. The following is added to Paragraph 4.d. Your agents, your representatives, including any public adjusters engaged on your behalf, and anyone insured under this policy, other than an “insured” in (3), must submit to examination under oath and recorded statements, which may be videotaped, and which will be at the location insured if requested by us, while not in the presence of any other “insured” and sign the same. Paragraph 4.f. is added as follows. f. At our request, provide to us or execute an authorization which allows us to obtain on your behalf, records and documentation we deem relevant to the investigation of your loss. Paragraph 4.g. is added as follows. g. To the degree reasonably possible, retain the damaged property. Paragraph 4.h. is added as follows. h. Allow us to inspect, subject to 4.g. above, all damaged property prior to its removal from the “residence premises”. The following is added after point 4.h. The duties above apply regardless of whether you, an “insured” seeking coverage, or a representative of either retains or is assisted by a party who provides legal advice, insurance advice, or expert claim advice, regarding an insurance claim under this policy. *** 11. Suit Against Us is deleted and replaced by the following: 11. Suit Against Us. No action can be brought unless the policy provisions have been complied with and the action is started within 5 years after the date of loss. 13. Loss Payment is deleted and replaced by the following: 13. Loss Payment. We will adjust all losses with you. We will pay you unless some other person is named in the policy or is legally entitled to receive payment. Loss will be payable upon the earliest of the following: a. 20 days after we receive your written proof of loss and reach a written, executed agreement of settlement with you according to the terms of the written agreement; or b. Within 60 days of a written proof of loss: (1) Entry of a final judgment or, in the case of an appeal from such judgment, within 60 days from and after the affirmance of the same by the appellate court; or (2) Written executed mediation settlement with you according to the terms of the written mediation settlement; or c. Within 90 days after we receive notice of an initial claim, “reopened claim” or “supplemental claim” from you, we will pay or deny such claim or a portion of the claim unless the failure to pay such claim or portion of claim is caused by factors beyond our control which reasonably prevent such payment. *** 28. Meetings or Inspections If we need access to an insured or claimant or to the insured property, we will provide you or the claimant 48 hours notice before scheduling a meeting or onsite inspection. You or the claimant may deny access to the property until the notice has been provided. You or the claimant may waive the 48 hour notice requirement. All other provisions of this policy apply. *** CALENDAR YEAR HURRICANE DEDUCTIBLE (PERCENTAGE) WITH SUPPLEMENTAL REPORTING REQUIREMENT – FLORIDA Form No. DP 03 51 05 05 *** A. Loss By Windstorm During A Hurricane With respect to Paragraphs C. and D., coverage for loss caused by the peril of windstorm during a hurricane which occurs anywhere in the state of Florida, includes loss to: 1. The inside of a building; or 2. The property contained in a building caused by: a. Rain; b. Snow; c. Sleet; d. Hail; e. Sand; or f. Dust; If the direct force of the windstorm damages the building, causing an opening in a roof or wall and the rain, snow, sleet, hail, sand or dust enters through this opening. B. Hurricane Described 1. A hurricane means a storm system that has been declared to be a hurricane by the National Hurricane Center of the National Weather Service. 2. A hurricane occurrence: a. Begins at the time a hurricane watch or warning is issued for any part of Florida by the National Hurricane Center of the National Weather Service; and b. Ends 72 hours following the termination of the last hurricane watch or hurricane warning issued for any part of Florida by the National Hurricane Center of the National Weather Service. C. Calendar Year Hurricane Deductible Described A hurricane deductible issued by us or another insurer in our insurer group: 1. Can be exhausted only once during each calendar year; and 2. Applies to loss to Covered Property caused by one or more hurricanes during each calendar year. In determining the amount, if any, that we will pay for loss, we will deduct an amount equal to the percentage, as shown above, of the limit of liability that applies to Coverage A, B, D or E, whichever is greatest, in the policy. A minimum deductible of $500 applies. D. Application of Calendar Year Hurricane Deductible 1. In the event of the first windstorm loss caused by a single hurricane occurrence during a calendar year, we will pay only that part of the total of all loss payable under Coverages that exceeds the calendar year hurricane deductible stated in the Schedule. 2. With respect to a windstorm loss caused by the second, and each subsequent, hurricane occurrence during the same calendar year, we will pay only that part of the total of all loss payable under Coverages that exceeds the greater of: a. The remaining dollar amount of the calendar year hurricane deductible; or b. The deductible that applies to fire that is in effect at the time of the loss. Page 2 of 2 © ISO Properties, Inc., 2005 DP 03 51 05 05 The remaining dollar amount of the calendar year hurricane deductible is determined by subtracting all previous windstorm losses caused by hurricanes during the calendar year from the calendar year hurricane deductible. 3. If: a. Covered property is insured under more than one policy issued by us or another insurer in our insurer group; and b. Different hurricane deductibles apply to the same property under such policies; Then the hurricane deductible applicable under all such policies used to determine the total of all loss payable under Coverages shall be the highest amount stated in any one of the policies. 4. When a renewal policy is issued by us or another insurer in our insurer group, or we issue a policy that replaces one issued by us or another insurer in our insurer group, and the renewal or replacement policy takes effect on a date other than January 1st of a calendar year, the following provisions apply: a. If the renewal or replacement policy provides a lower hurricane deductible than the prior policy and you incurred loss from a hurricane under the prior policy in that same calendar year, the lower hurricane deductible will not take effect until January 1st of the following calendar year. b. If the renewal or replacement policy provides a lower hurricane deductible than the prior policy and you have not yet incurred a loss in that same calendar year, the lower hurricane deductible will take effect on the effective date of the renewal or replacement policy. c. If the renewal or replacement policy provides a higher hurricane deductible than the prior policy, the higher hurricane deductible: (1) Will take effect on the effective date of the renewal or replacement policy; and (2) Shall be used to calculate the remaining dollar amount of the hurricane deductible described in Paragraph 2. 5. We require that you promptly report any windstorm loss caused by a hurricane occurrence that is below the hurricane deductible so that we may consider the amount of such loss when adjusting claims for subsequent hurricane occurrences that occur during the calendar year. E. Loss By Windstorm That Is Not A Declared Hurricane Refer to the policy declarations for the deductible that applies to windstorm loss if the circumstances of the loss described above do not apply. All other provisions of this policy apply. *** PLATINUM PREFERRED SAVINGS PROGRAM Form No. HPCDP3 PPS 12 13P THIS ENDORSEMENT ALLOWS US AT OUR OPTION TO SELECT A QUALIFIED PRE-APPROVED “CONTRACTOR” TO MAKE COVERED REPAIRS TO YOUR DWELLING OR OTHER STRUCTURES. You agree that in the event of a covered loss to your covered dwelling or other structures on the “described location,” other than a hurricane loss or sinkhole loss: We at our option may select a pre-approved “contractor” to repair your damaged property as provided by the policy. If we so elect to repair your covered property, a deductible credit equal to ten percent (10%) of your All Other Perils deductible specified in the Declarations will be applied to reduce your deductible obligation at loss settlement. This credit does not reduce the applicable deductible under the policy. The credit will apply only when the amount of a covered loss exceeds the applicable deductible. You will be responsible for paying the amount of the deductible, (less the deductible credit as applicable), to the pre-approved “contractor”. In addition, the following provisions of the policy and its endorsements where applicable, are changed: DEFINITIONS The following definition is added: “Contractor” means a properly licensed person or company that effectuates the construction, repair or restoration of property. COVERAGES OTHER COVERAGES 6. Reasonable Repairs. in the policy and in the endorsement: Special Provisions for Florida is deleted and replaced by the following: 6. Reasonable Repairs. If a peril causing a loss and related damage are covered and repairs are necessary to protect covered property from further damage, you must notify us before authorizing or commencing repairs so we, at our option, may select a pre-approved “contractor” to make the covered repairs. If you do not so notify us and allow us, at our option, to select pre-approved “contractor” for the covered repairs, our obligation for repairs made to protect the covered property from further damage is limited to the lesser of the following: a. The reasonable cost you incur for necessary repairs made solely to protect the property from further damage; or b. The amount we would have paid to a pre-approved “contractor selected by us for necessary repairs made solely to protect the covered property from further damage. This coverage does not increase the limit of liability that applies to the covered property. This coverage does not relieve you of your duties, in case of a loss to covered property, as set forth in Condition 4.b. CONDITIONS Under 4. Duties After Loss., paragraph b. is deleted and replaced by the following: b. Protect the property from further damage. If repairs to the property are required, or if the services of a “contractor” are required to protect the property from further damage, you must: (1) Notify us before authorizing or commencing the repairs or the services so we, at our option, may select a preapproved “contractor” to make covered repairs or perform the services; and (2) Keep an accurate record of expenses associated with the repairs or the services. If you do not notify us prior to authorizing or commencing the repairs or services and allow us at our option to select a pre-approved “contractor” for the repairs or services, our obligation for the repairs or services is limited to the lesser of the following: (1) The reasonable cost you incur for necessary repairs or for services solely to protect covered property from further damage; or (2) The amount we would have paid to a pre-approved “contractor” selected by us for necessary repairs or for services solely to protect covered property from further damage. The following is added to 4. Your Duties After Loss. g. Our right to repair or replace under the PLATINUM PREFERRED SAVINGS PROGRAM, and our decision to do so, are material parts of this contract and under no circumstances relieves you or us of our mutual duties and obligations under this contract. h. You must permit us to take samples of the damaged and undamaged property for inspection, testing and analysis. i. If we elect to make repairs under this policy, or our pre-approved “contractor” has made repairs to your property pursuant to our PLATINUM PREFERRED SAVINGS PROGRAM, you must notify us in writing if you dispute any part of the repair and: (1) Allow us to re-inspect your property; and (2) Allow us to make any further repairs to be specifically agreed upon with us, in writing. 5. Loss Settlement. The following item 5.c. is added: c. If we elect to repair your covered dwelling or other structures: (1) We will disregard the loss settlement provisions 5.a. and 5.b. above; and (2) We will make payment directly to the vendor designated by us, less the amount of your deductible as reduced by any applicable deductible credit. You will be responsible for paying to the vendor the amount of your deductible less any applicable deductible credit. 8. Mediation or Appraisal. Paragraph 8. Appraisal in the policy and paragraph 8. Mediation or Appraisal in the endorsement: Special Provisions for Florida are deleted and replaced by the following: 8. Mediation or Appraisal a. Mediation. If you and we are engaged in a dispute regarding a claim under this policy, either may demand a mediation of the loss in accordance with the rules established by the Florida Department of Financial Services. The results of the mediation are binding only when both parties agree, in writing, on a settlement and you have not rescinded the settlement within 3 business days after reaching settlement. You may not rescind the settlement after cashing or depositing the settlement check or draft we provide you. We will pay the cost of conducting any mediation conference except when you fail to appear at a conference. That conference will then be rescheduled upon your payment of the costs of that rescheduled conference. b. Appraisal. If you and we fail to agree on the scope of repairs necessary to restore your property to its pre-loss condition, or specifications of materials used in the restoration of your damaged property, either may demand an appraisal of the loss. In this event, each party will chose a competent appraiser within 20 days after receiving a written request from the other. The two appraisers will choose a competent and impartial umpire. If they cannot agree upon an umpire within 15 days, you or we may request that the choice be made by a judge of a court of record in the state where the “residence premises” is located. The appraisers will separately prepare an itemized scope of repair including the specifications of the materials used to restore the property to pre-loss condition. If the appraisers submit a written report of an agreement to us on the scope of repairs to be completed, we will select and authorize a pre-approved “contractor” to complete the repairs in accordance with the agreement. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two and transmitted to us, will authorize our selected pre-approved “contractor” to complete the repairs in accordance with the agreement. You will remain responsible for the payment to the preapproved “contractor” of any applicable deductible, less any credit for participating in the PLATINUM PREFERRED SAVINGS PROGRAM. Each party will: (1) Pay its own appraiser; and (2) Bear the other expenses of the appraisal and umpire equally. Our Option. Paragraph 12. is deleted and replaced by the following: 12. Our Option. a. If we give you written notice within 30 days after we receive your signed, sworn proof of loss, we may repair or replace any part of the damaged property; or b. If your policy is endorsed with the PLATINUM PREFERRED SAVINGS PROGRAM endorsement, we may by engaging our pre-approved “contractor”(s), repair or replace any part of the damaged dwelling and other structures property with like property. c. You must provide access to the property and execute any necessary municipal, county or other governmental documentation or permits for repairs to be undertaken. d. You must execute all work authorizations to allow our pre-approved “contractor”(s) and related parties entry to the property. e. You must otherwise cooperate with repairs to the property. f. You are responsible for payment of the deductible stated in your declaration page, less the deductible credit as applicable, to the pre-approved “contractor”. *** The Declarations Page Loss Payment or Loss Settlement provisions Duties in Event of Loss Policy provisions The insurance policy's definition sections The insurance policy's exclusion of coverage provisions Please advise if there are other applicable policy provisions that are not cited above but would provide coverage to the Insured for the September 28, 2022, windstorm/hurricane force winds loss.
 
* Facts and circumstances giving rise to the violation.
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In Florida, the work of adjusting insurance claims engages the public trust. Heritage Property & Casualty Insurance Company (“INSURER”) has breached the public’s trust by its adjustment of Fred D. Adams III and Patricia Z. Adams (“INSURED”) claim of loss. Heritage Property & Casualty Insurance Company’s mailing address is 1401 N. Westshore Blvd, Tampa, FL 33607. INSURER has failed to create and implement adequate guidelines for the proper investigation and evaluation of claims, claims handling, and for training and supervision of employees resulting in statutory violations as set forth above. INSURER has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the INSURED’S insurance claim for damages. INSURER has failed to promptly settle the INSURED’S insurance claim when the obligation to settle the insurance claim had become reasonably clear. To date, notwithstanding the INSURED’S pleas otherwise, INSURER has continued to refuse to acknowledge its obligation to conduct a proper investigation, and to tender the full amount of insurance monies due and owing its INSURED under the policy. This claim involves the INSURED’S property located at 3318 Pine Valley Drive, Sarasota, FL 34239 which sustained significant damage from wind on or about September 28, 2022. On or about September 28, 2022, Hurricane Ian struck the state of Florida. INSURED was a victim of Hurricane Ian’s destruction and subsequently incurred wind damage to the exterior and interior of their home due to hurricane-force winds, and ensuing damages. INSURED’S insured home suffered extensive hurricane force winds damage to the roof system, allowing water intrusion into the home, causing interior water damage throughout the home. INSURED timely notified INSURER of the damages and opened a claim pursuant to the terms and conditions of the Policy. In response, the INSURER assigned the claim to its representative to adjust and investigate the loss, as well as a field adjuster to inspect the damages. INSURER retained experts from its preferred vendor list, instead of retaining objective experts to provide it with thorough and completely objective opinions and conclusions. This is unfair claims handling practices. INSURED hired Elite Resolutions to assist with their claim and provide an estimate of damages. Elite found damage to the roof, master bedroom, master hallway, master closet, kitchen, living room. Estimate for damages was $114,243.26 ACV. See, Estimate – Elite Resolutions 08.04.24 & Report – roofr attached hereto. INSURER inspected the property however an estimate of damages was never provided to the INSURED as the INSURER denied the claim. INSURED hired DDA Forensics and professional engineer, Manuel Matus, to perform and inspection. The engineer found the roof and interior damages were not the result of windstorm from Hurricane Ian, however the engineer admitted he did inspect damages in the attic as he did not go into the attic. See, Report - DDA Forensics (09.28.22 DOL) 09.17.24 attached hereto. September 25, 2024, INSURER issued correspondence to INSURED denying their damage stating “because the observed condition of your property was due to wear and tear, faulty construction or workmanship, and inadequate maintenance, we are unable to cover the claim.” See, Carrier – Denial 09.25.24 INSURED hired Alvin J. Singleton Inc to replace the roof. The replacement has been performed and the vendor has been paid, yet INSURER has failed to reimburse the INSURED for the $33,600. spent. See, Contract – Alvin J Singleton Roofing & Invoice – Alvin J Singleton Roofing PAID To date, INSURER has failed to tender any insurance benefits. INSURER has admitted that INSURED sustained covered damages as a result of hurricane force winds loss that occurred on or about September 28, 2022., but has denied tendering all owed insurance benefits to INSURED. Pursuant to Florida Statute §626.9541(1)(i)(4), INSURER is required to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after INSURER received notice of the residential property insurance claim, determine the amounts of partial or full benefits, and agree to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5). As INSURER has failed to do so, INSURER has wrongfully denied coverage. Since the beginning of the claim, INSURER has engaged in a pattern of delay, denial, and reckless disregard for INSURED’S rights. The actions of INSURER listed herein have been continuing in nature and given the totality of the circumstances, which includes INSURER’S adjustment, actions and/or omissions post the filing of this CRN. INSURED contend that given the past experience in this matter with INSURER, it is reasonably foreseeable that INSURER’S current actions will extend to its entire conduct in the handing of their claim, including the acts or omissions of INSURER and/or its representatives, until the final resolution of their claim. As such, INSURED contend adequate notice has been given should INSURER’S actions and violations listed herein continue after the expiration of this notice. INSURER has failed and/or refused to settle the claim when it could and should have done so had it acted fairly and honestly towards INSURED and has failed to take into account the information and evidence provided that contradict its decisions. INSURER’S conduct has been reckless and unfair to INSURED and has caused and continues to cause additional damage throughout the property. This is evidenced by the delay in paying the claim and the failure of INSURER to evaluate the claim in total. To date, INSURER has failed and/or refused to provide INSURED with all the necessary insurance benefits due and owing and has not tendered the full amount needed to repair the Property despite knowing that INSURED have sustained covered damages to their insured property. As the INSURER must admit, it is implied within every insurance policy a duty of good faith and fair dealings. In an insurance contract, each party is prevented from interfering with the other’s right to benefit from the contract. The obligations of good faith and fair dealings encompass qualities of decency and humanity inherent in its responsibilities as a fiduciary. INSURER is bound to conduct itself with the utmost good faith for the benefit of INSURED. However, INSURER has failed to comply with the obligations in connection with this claim and has never looked at the claim or the contract for insurance with good faith and fair dealing. Instead, INSURER has looked for ways not to pay the claim in full, or pay the claim at all, and these actions have been to the detriment of INSURED. The adjusters assigned to this claim have a duty to adjust and treat all claims equally. Since the beginning of this claim the representatives on behalf of INSURER have approached this investigation in a manner prejudicial to INSURED. INSURER is using either untrained or improperly trained adjusters in connection with this claim. INSURER should have been adjusting the loss with INSURED but instead, it was looking for ways not to pay the claim at all or pay the claim in full. If the INSURER handles all the claims in the way INSURED’S claim was adjusted, then it is improperly handling all claims. Therefore, demand is hereby made as follows: Estimate $71, 367.26 Less Prior Payments $0 Less Deductible $5,473 TOTAL $65,894.26 The concept of insurance is that the insurer will investigate and grant 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 a specified amount or a determinable benefit upon determinable contingencies. Inherent in that definition is the fact that payment must be made timely and promptly so that the INSURED may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. INSURER has breached this duty. The INSURED was, and still is, forced to expend out of pocket monies to submit her insurance claim, e.g., retaining an attorney and other experts to force INSURER to honor its obligations under the insurance policy and to pay all the insurance proceeds due and owing to them. INSURER has refused and/or failed to tender all the insurance proceeds due and owing to the INSURED. INSURER’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. Furthermore, the INSURED contends that INSURER’s adjusters and/or representatives financially benefit from such wrongful conduct. INSURER has refused and/or failed to comply with The Policy’s cooperation and/or “Loss Payment” provision. Under The Policy, INSURER was to timely tender undisputed insurance benefits to INSURED. INSURER has failed and/or refused to timely tender owed insurance benefits, undisputed or otherwise. This is a breach of The Policy. INSURER has refused and/or failed to cooperate and/or “Adjust the Loss” by cooperating with INSURED during the claims adjustment process in compliance with The Policy’s “Loss Payment” provision. This is a breach of The Policy. This notice is given in order to perfect the right to pursue the civil remedy authorized by Fla. Stat. §624.155. Therefore, to cure the defects outlined in this Civil Remedy Notice, INSURER must: (1) Create and implement adequate guidelines for the proper investigation and evaluation of claims and for the training and supervision of employees, which will avoid future statutory violations as set forth above, and prevent this from occurring in the future; (2) INSURER 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 claims to ensure that the claims handling procedure with regard to these types of losses are adequate to prevent other Insureds from being treated unfairly and wrongfully; (3) INSURER must tender to the INSURED $65,894.26 as set forth above; and, (4) INSURER must act fairly and honestly towards its INSURED and with due regard for her interests in attempting to settle its INSURED’S claim. Or, in the alternative, should INSURER not be in agreement with INSURED’S reasonable demand for payment of their rightfully owed insurance benefits being submitted at this time, INSURED may still be willing to consider and potentially accept a reasonable counter-offer made by INSURER. As such, INSURED hereby request that INSURER now make a reasonable counter-offer before the expiration of the cure period. INSURED still hope that their claim can be resolved amicably. Attachments: 1. Estimate – Elite Resolutions 08.04.24 2. Report – roofr 3. Report - DDA Forensics (09.28.22 DOL) 09.17.24 4. Contract – Alvin J Singleton Roofing 5. Invoice – Alvin J Singleton Roofing PAID 6. Carrier – Denial 09.25.24
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eservice@rosslegalfl.com 03-10-2025 The Insureds, Fred D. Adams III and Patricia Z. Adams, hereby provide notice to the Department of Financial Services and Heritage Property & Casualty Insurance Company and Heritage Property & Casualty Insurance Company, that the issues outlined in Civil Remedy Notice #796845 have been resolved between the parties and Heritage Property & Casualty Insurance Company and Heritage Property & Casualty Insurance Company has cured all allegations listed therein. Accordingly, Fred D. Adams III and Patricia Z. Adams, hereby withdrawals Civil Remedy Notice #796845 filed on 12/13/24.
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: Fred D. Adams III and Patricia Z. Adams Insured: Fred D. Adams III and Patricia Z. Adams Insurer: Heritage Property & Casualty Insurance Company DFS File No.: 796845 Claim No: H010022694 Policy No.: HPD026438 Address: 3318 Pine Valley Dr, Sarasota, FL 34239 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 796845, filed on behalf of Fred D. Adams III and Patricia Z. Adams (“Complainants”). The Department accepted the Notice on December 13, 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 allegedly lists all policy provisions and does not specify which provisions were violated; it indicates several sections of the policy for several types of coverages and conditions, contrary to reference to specific policy provisions that [are] relevant to the violation. Therefore, the Notice failed to provide sufficient notice to Heritage as to 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. 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 HPD026438 for property at 3318 Pine Valley Dr, Sarasota, FL 34239. 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 July 30, 2024, claiming damages from Hurricane Ian on November 28, 2022, Heritage promptly assigned claim number H010022694. An acknowledgment letter with a Bill of Rights was submitted to Complainants on the same day. On the same day the claim was reported, Heritage received a letter of representation from the Complainants’ representatives, Elite Resolutions. The very next day, Heritage replied to the representative, acknowledging the letter of representation and providing the requested documents. In the meantime, Heritage enlisted the services of a field adjuster to coordinate an inspection of the alleged damage caused by the alleged Hurricane. Complainants requested it to occur on August 8, 2024. The on-site inspection documenting the property's exterior and interior conditions occurred as scheduled with the presence of the Complainant and their representatives. The field adjuster noted prior repair to the roof, and interior water stains in the ceiling. On August 13, 2024, Heritage issued a letter including a request for information necessary to investigate the reported claim. In the Request for Information, Heritage asked Complainants, through their representatives, to provide: 1. “An opportunity to obtain your recorded statement. Please provide dates and times that best fit your schedule. 2. Please forward any photos, videos or weather reports pertaining to the weather event on the date of loss.” As an additional step, Heritage requested a reinspection from an independent engineering firm to assess the alleged damage. The Professional Engineer, Manuel Matus of DDA Forensics, conducted the reinspection on August 29, 2024. After the reinspection, Mr. Matus prepared a report with his conclusions. Based on the reinspection and information gathered in his report, Mr. Matus opined that, in summary: - The physical evidence at the residence indicated that there was no storm related damage to the roof from Hurricane Ian on or around the date of loss of September 28, 2022. There were less than tropical storm force winds and the roof covering was not displaced by the direct effects of wind nor were there any impacts, fractures, or storm-created openings from contact with debris or hailstones associated with the weather conditions on or around the reported date of loss. Inspection along the building exterior revealed no evidence of debris or hail stone impact damage to the walls (no scrapes, gouges, or holes in the walls), or to fenestrations (no broken or damaged doors and windows or window screens). There was no storm-related damage to roof appurtenances or to the mechanical equipment. - The localized deterioration noted on several roof fascia sections and soffits resulted from an age-related deterioration of the components, prolonged exposure to the elements and deferred maintenance, as well as water intrusion through inadequate or degraded waterproofing and was not the result of one single accidental or single storm event. - The interior ceiling moisture stains in the residence’s interior were not the result of wind-induced damage to the roof. Although inspection of the attic space above the living room and the kitchen was not possible due to limited attic space constraints, the moisture stains on the living room and the kitchen ceilings coincided with the location of a repaired roof vent, roof penetration in the form of a gooseneck vent, and deteriorated mortar seal as well as replaced concrete tiles (above living room). The roof did not have any missing tiles along the ridge lines, hip lines, eave edged nor rake edges; areas known as high suction zones. Improper repairs on the roof, inadequate detailing, mechanical damage and/or construction defects of the roof covering were observed on the roof. Based on the level of decay, dark hues developed on the wood framing components of the roof observed from within the attic, DDA Forensics estimates that the water intrusion initiated a minimum of several months to years prior to the date of inspection. In addition, given that no storm-created openings were noted on the roof covering, the stains on the interior ceilings were not the direct result of the reported storm event on the DOL. - The moisture stains on the master bedroom and master closet ceilings coincided with the location of repaired flashing around a roof vent as well as repaired ridge tiles. The attic inspection, accessible in that area, revealed dark hues around the roof decking as well as moisture stains. Furthermore, the observed dark hues on the roof decking above the soffit area suggest that the soffit repairs found around the perimeter of the property can be attributed to age-related deterioration, improper construction and/or installation and/or poor workmanship and not the result of a single accidental or single storm event. - There were no uplifted nor displaced tiles that could be attributable to wind. The chipped tiles were attributed to thermal effects. Mechanical damage to tiles was a result of attempts to perform improper repairs on the tiles, feasibly aggravated by foot traffic due to the linear nature of the fractures. Deteriorated and damaged roof vents seals were attributed to construction defects, lack of proper maintenance and/or poor craftmanship. Observations suggest that the damage to the roof tiles was not a result of a storm event. As such, a wind force potent enough to crack/chip a concrete tile would have consequently displaced the chipped tile pieces off the roof. The lack of damage on the roof eaves, rakes and ridge zones indicates the observed instances of damage were not storm- and/or wind induced. - In general, the low-slope roof, covered with roofing membranes, was in good condition consistent with age-related deterioration and weathering of the roof covering, and was observed with no missing, torn, delaminated or de-bonded membrane, nor with any wind-related damage or hailstone impact damage. On September 25, 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 Complainant, which included pertinent facts and insurance policy provisions relating to coverages at issue. The letter explained that because the observed condition of the property was due to wear and tear, faulty construction or workmanship, and inadequate maintenance, Heritage could not cover the claim. The letter further detailed the investigation performed by the field adjuster and the report provided by the engineer with his conclusions. After the letter was issued, a Notice of Intent to Initiate Litigation (“NOI”) was filed on September 25, 2024. Subsequently, Heritage responded to the NOI, maintaining its prior denial of coverage. On December 13, 2024, Ross Legal Group, on behalf of the Complainants, submitted a letter of representation and this Notice, and Vanessa Ross filed a second NOI on behalf of the Complainants. In response, Heritage maintained its prior decision. 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: 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. 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. 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. Failure to properly investigate claim and with due regard to the Insured’s Interest The Notice fails to state instances that Heritage failed “to properly investigate claim and with due regard to the Insured’s Interest”; 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 timely made a coverage determination 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. 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 timely made a coverage determination 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. 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 properly investigated the claim. Further, Heritage has timely made a coverage determination 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. Additionally, Complainants failed to specify the instances where Heritage failed “to adopt and implement standards for the proper investigation of claims” after two inspections were conducted. 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 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)(d): Denying claims without conducting reasonable investigations based upon available information. Response: This allegation is inapplicable to this claim, as Heritage conducted two inspection of the property and requested documents to supplement the claim. As such, Heritage denies the allegations contained herein. Heritage has promptly taken substantial action to investigate Complainant’s claim. As mentioned, Heritage promptly assigned a field adjuster and an engineer to inspect and investigate the claim. Further, in contrast to this allegation, Heritage has timely made a coverage determination of the 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 is an unsupported, sweeping allegation and is 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 regards to the “cure” demanded in the Notice, Complainants indicated that Heritage must: (1) “create and implement adequate guidelines for the proper investigation and evaluation of claims and for the training and supervision of employees, which will avoid future statutory violations as set forth above, and prevent this from occurring in the future; (2) 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 claims to ensure that the claims handling procedure with regard to these types of losses are adequate to prevent other Insureds from being treated unfairly and wrongfully; (3) tender to the INSURED $65,894.26 as set forth above; and, (4) act fairly and honestly towards its insured and with due regard for her interests in attempting to settle its insured’s claim” Although Heritage denied coverage for the claim at issue, it is unclear what specific actions for cure the Complainants are seeking from Heritage. If Heritage pays the specified amount demanded, considering the additional allegations in the cure section, it is unclear if this would be sufficient to cure this Notice. 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