Civil Remedy Notice of Insurer Violations
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Filing Number:     796941
Filing Accepted:  12/16/2024
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Complainant
Last/Business Name *  
LAMPE   First Name   RUSSELL AND JACQUELINE
Street Address * 223 SADDLE RIDGE DR
City, State Zip * DAVENPORT, FL 33896
Email Address * LAMPELIGHTS3@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   LAMPE   First Name   RUSSELL AND JACQUELINE
Policy # * HOH661300 Claim #* H010021140
Attorney
Attorney is Applicable
Last Name* ALTMAN First Name * ALEXIS Initial
Street Address* 925 SOUTH FEDERAL HIGHWAY, 7TH FLOOR
City, State Zip* BOCA RATON , FL - FLORIDA 33432
Email Address * AALTMAN@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):* MARY RANDOM
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unsatisfactory Settlement Offer
Unfair Trade Practice
Claim Delay
* 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.
* 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.

Heritage Property & Casualty Insurance Company (“carrier”) has not attempted in good faith to settle the insureds’ claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insureds and with due regard for their interests. The carrier has done everything possible to delay the claim and refuses to pay the complete covered loss amount due under the policy. Furthermore, the carrier is required to properly investigate and adjust claims and cannot place that burden upon the insureds. This was made clear by the appellate court and the Florida Supreme Court in Allstate Indemnity Co. v. Ruiz, 899 So. 2d 1121 (Fla. 2005) (“The Legislature has clearly chosen to impose on the insurance companies a duty to use good faith and fair dealing in processing and litigating the claims of their insureds…”). The carrier was put on notice of the insureds’ plumbing claim which caused substantial damage to the insureds’ property and contents. Although the insured believed the nightmare was alone the plumbing loss, the nightmare truly began after he reported the loss to Heritage. Heritage sent out United Water Restoration to the insured’s home and they made the loss worst and mold started developing throughout the home. The insured requested all United Restoration’s documents and Heritage in violation of Florida Statute has refused to provide them in an effort to conceal the improper work that was done. This is a very common practice of Heritage to be deceitful to its insureds. The insured got a public adjuster and got mold testing done. The insured has provided all documentation to Heritage and Heritage has refused to not only pay the claim but even respond to the insured or their representative. \\ Pursuant to Florida Statute §624.155(1)(b)(1), Heritage has failed to settle the claim in good faith when it could and should have done so. The Insured reported the Loss and the Property was presented for inspection. The damage to the insured’s home was clearly caused by a covered peril under the Policy, but Heritage intentionally and callously delayed the claim process and failed to fully indemnity the insured. Heritage has not shown a good faith intention to pay what was owed but rather has underpaid the claim for financial gain and profit. Pursuant to Florida Statute 626.9541(1)(i)(3)(c), Heritage has a duty to acknowledge all communications and continues to violate this statute by failing to acknowledge the correspondence from the carrier. A communication made to or by a representative of an insurer with respect to a claim shall constitute communication to or by the insurer. Pursuant to Florida Statute §626.9541(1)(i)(3)(a), Heritage has a duty to adopt and implement standards for the proper investigation of claims. The carrier refused to investigate the claim properly. Florida law mandates that insurers and adjusters do not mislead the Insured. Florida Insurance companies that fail to follow these Florida laws and regulations, designed to protect consumers, do not only breach their duties under the policy of insurance but do so in bad faith. In violation of Florida Statute §626.9541(1)(i)(3)(b), Heritage intentionally misrepresented the available coverage under the policy and has misrepresented that the policy does not provide coverage for the loss. Furthermore, the Insured believes Heritage repeatedly and as a standard business practice engages in this behavior to deprive its Insured of their rightful insurance proceeds when they experience a covered loss. Insured contends Heritage has implemented a claims program and business practices that are tailored to increase its profits at the expense of benefits that are owed to its customers and that other Insured have been refused insurance proceeds due and owing under the policy in the same or similar circumstances, and some have been provided inadequate insurance monies under the same or similar facts or circumstances. This is wrongful conduct and directly violates the purpose of insurance coverage. Heritage’s wrongful conduct and omissions include, but are not limited to: claim delay, not conducting a full and prompt investigation, not treating the policyholder with good faith claims conduct, looking for ways to reduce recovery to Insured; looking for ways to delay full recovery to Insured; holding back and failing to pay portions of claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the Insured; not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company’s interests before the policyholder’s interests; establishing severity control initiatives and otherwise establishing a culture of not fully and promptly paying claims following losses; and failing to pay the full amount of the Insured’s damage despite knowing it must do so. Consequently, these actions have caused undo frustration and financial harm to the Insured. As a direct and proximate result of the poor handling of this Claim by Heritage the Insured sustained extracontractual damages. Due to the bad faith actions of Heritage, Insured was forced to engage the services of the Public Adjuster to attempt to recover the settlement to which they are rightfully entitled. 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 regard 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 $96,463.36less any applicable policy deductible; 2.) Pay all mitigation invoices for emergency services; 3.) Pay all mold; 4.) Pay all damaged contents in the amount of $23,911.62. 5.) 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, Alexis Altman
Comments
User Id Date Added Comment
ncarlisle@heritagepci.com 02-05-2025 February 5, 2025 VIA ELECTRONIC SUBMISSION Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Complainant: RUSSELL AND JACQUELINE LAMPE Insured: RUSSELL AND JACQUELINE LAMPE Insurer: Heritage Property & Casualty Insurance Company DFS File No.: 796941 Claim No: H010021140 Policy No.: HOH661300 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 796941, filed on behalf of Heritage’s insured RUSSELL AND JACQUELINE LAMPE (“Complainant”). The Notice was accepted by the Department on December 16, 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 Complainant was issued Policy HOH661300 (“Policy”) for the property at 223 SADDLE RIDGE DR., DAVENPORT, FL 33896 (“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 Complainant’s first notice of loss on June 24, 2024, reporting damage from a water loss which occurred on June 22, 2024, Heritage promptly assigned claim number H010021140. On the same day the loss was reported, Heritage issued its acknowledgment letter and Bill of Rights to the Complainant. Heritage immediately assigned as a courtesy to its Insured, free of charge, Emergency dry-out and water mitigation to the loss, who arrived on the scene on the evening of June 24, 2024. However, Complaint refused mitigation and dry out services and demanded the restoration company leave the premises and refused to allow the dry-out equipment to remain. On June 27, 2024, three days later, the Insured finally allowed the assigned Emergency restoration company to set up but only allowed the set-up of dry-out machines. Again, Complainant refused Emergency mitigation services. Heritage has no documentation of efforts to mitigate the damage from the Insured, until Heritage’s assigned restoration service was finally allowed access to the property. Heritage’s representative coordinated an inspection of the damage to the Property caused by the water loss. Complainant requested the inspection to occur on June 27, 2024, and the on-site inspection documented the interior and exterior conditions of the property. During the inspection, the Licensed Field Adjuster took photographs and measurements, as well as scoped the damage. The inspection report noted that microbial growth had already begun, and some areas of the loss still had standing water. After dry-out was completed, Heritage reinspected the loss on August 7, 2024. After conducting a reasonable investigation based upon available information, on August 21, 2024, Heritage advised Complainant that it was extending partial coverage under the policy and provided a reasonable explanation 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 August 21, 2024, which included pertinent facts or insurance policy provisions relating to coverages at issue. An undisputed payment was sent on August 25, 2024. On October 24, 2024, Heritage sent a letter to Complaint explaining Additional Living Expenses Coverage (“ALE”) for loss of use, and requested documentation, if any, of such from Complainant. On December 16, 2024, Heritage received 4 images of what appeared to be receipts from Complainant, however, the images couldn’t be opened for review. Heritage has not received any further documentation from Complainant regarding ALE. On October 31, 2024, Heritage received a Letter of Representation from Ask An Adjuster, LLC. (“AAA”). An estimate disputing Heritage’s payment was received on November 26, 2024, which was generated on November 1, 2024, by AAA. On December 16, 2024, Complainant filed this Notice, to which Heritage now submits its response. The claim is currently pending mediation, and Heritage looks forward to resolving the claim with its Insured. 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. 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 an unsatisfactory settlement offer was made therefore it lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. 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 by Florida Statute §624.155 and thus does not put Heritage on the requisite notice. 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 Complainant’s 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 fully covered loss as demanded by Complainant. Therefore, this is an unsupported, sweeping allegation and is without merit. Regardless, Heritage denies the allegations contained herein. 1. §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: 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 by Florida Statute §624.155 and thus does not put Heritage on the requisite notice. Nowhere in the notice does it state when Heritage failed to promptly pay under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage, nor does it state who did it. On the contrary, the documentation and information received do not support a fully covered loss. 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 Complainant’s 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 fully covered loss as demanded by Complainant. Therefore, this is an unsupported, sweeping allegation and is without merit. Regardless, Heritage denies the allegations contained herein. 1. §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 by Florida Statute §624.155 and thus does not put Heritage on the requisite notice. Nowhere in the notice does it state what the alleged standards for proper investigations are that Heritage failed to adopt or implement, and/or 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 fully covered loss as demanded by Complainant. Therefore, this is an unsupported, sweeping allegation and is without merit. 1. §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 by Florida Statute §624.155 and thus does not put Heritage on the requisite notice. Nowhere in the notice does it state what the pertinent facts as to who or when it failed to acknowledge and act promptly upon communications with respect to claims. Furthermore, the Notice fails to give any fact or circumstance of Heritage failing to acknowledge or act promptly upon communications with respect to claims that would give rise to the alleged violations. Regardless, 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 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 and obtained do not support a fully covered loss as demanded by Complainant. Therefore, this is an unsupported, sweeping allegation and is without merit. 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 Complainant’s opinions regarding the value of their own claim and, therefore, the Complainant’s 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 Complainant has 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 Complainant 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 Complainant has 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 Complainant feels 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