Filing Number: 797082
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| Filing Accepted: 12/17/2024 |
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PATRICIA J. STADLER, INDIVIDUALLY AND AS PERSONAL REPRESENTATIVE OF THE ESTATE OF GEORGE W. JACKSON
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First Name |
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| Street Address
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26125 FEATHERSOUND DRIVE |
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PUNTA GORDA,
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33955
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| Email Address
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CRUISEN41@GMAIL.COM |
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Insured |
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| Last/Business Name* |
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PATRICIA J. STADLER, INDIVIDUALLY AND AS PERSONAL REPRESENTATIVE OF THE ESTATE OF GEORGE W. JACKSON |
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First Name |
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| Policy # * |
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HOH280498 |
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Claim #* |
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H113292 |
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Attorney is Applicable
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| Last Name* |
PETTINATO
First Name *
DAVID
Initial
J
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| Street Address* |
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1000 W. CASS STREET |
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TAMPA
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FLORIDA
33606
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DPETTINATO@OLDERLUNDYLAW.COM, DJP-PARALEGALS@OLDER |
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| Insurer Type
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 Authorized Insurer
 Unauthorized Insurer
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| Insurer Name |
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| Insurer Name* |
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HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY
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NAIC Company Code 14407 |
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| Name of individual responsible for violation (if any):*
ALISON ZOLLO, URIAH THOMPSON, JOHN SCHABERT, AND ALL OTHER ADJUSTERS, SUPERVISORS, MANAGEMENT AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY INVOLVED IN THE CLAIM.
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| Type of Insurance
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Residential Property & Casualty
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| Reason for Notice
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Claim Denial
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Claim Delay
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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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Other
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Failure to properly investigate claim and with due regard to Insured’s interest
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Other
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Failure to acknowledge and act promptly to communications regarding claim
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Other
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Elderly Insured
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Statutory provision(s) which the insurer allegedly violated.
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| 624.155(1)(b)(1) |
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Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
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| 624.155(1)(b)(3) |
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Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
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| 626.9541(1)(i)(2) |
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A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
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| 626.9541(1)(i)(3)(a) |
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Failing to adopt and implement standards for the proper investigation of claims.
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| 626.9541(1)(i)(3)(b) |
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Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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| 626.9541(1)(i)(3)(c) |
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Failing to acknowledge and act promptly upon communications with respect to claims.
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| 626.9541(1)(i)(3)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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| 626.9541(1)(i)(3)(f) |
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Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement.
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| 626.9541(1)(i)(3)(g) |
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Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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| 626.9541(1)(i)(4) |
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Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees 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).
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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
ADD’L STATUTES VIOLATED
§627.70131(1)(a)
§627.70131(2)
§627.70131(3)(d)
§627.70131(7)(a)
POLICY LANGUAGE
The Insured 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 Heritage Property & Casualty Insurance Company’s Homeowners policy, Policy No. HOH280498, issued to the Insured including, but is not limited to, the following:
Coverage A-Dwelling provisions (HPCH03 09 SP 01 23)
Coverage C-Personal Property provisions (HPCH03 09 SP 01 23)
Coverage D-Loss of Use provisions (HPCH03 09 SP 01 23)
- Additional Living Expenses
Additional Coverages provisions (HPCH03 09 SP 01 23)
- Debris Removal
- Reasonable Repairs
- Glass or Safety Glazing Material
- Ordinance Or Law
Limited Fungi, Wet or Dry Rot, or Bacteria Coverage endorsement
Matching of Undamaged Property-Special Limit of Liability endorsement (HPC MUP 10 22)
The Declarations Page (HPCH03 DEC2 12 21)
Loss Payment or Loss Settlement provisions (HPCH03 09 SP 01 23)
Duties in Event of Loss Policy provisions (HPCH03 09 SP 01 23)
The insurance policy's definition sections (HPCH03 09 SP 01 23)
The insurance policy's exclusion of coverage provisions (HPCH03 09 SP 01 23)
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, Hurricane Ian and/or hurricane force winds loss.
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Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
In Florida, the work of adjusting insurance claims engages the Public Trust. HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY (“HERITAGE”) has breached this duty by its failure or refusal to acknowledge its Insured’s claim of loss.
HERITAGE has failed to create and implement adequate guidelines for proper investigation to evaluate claims handling and for training and supervision of employees resulting in statutory violations as set forth above. HERITAGE has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s insurance claim for damages.
To date, notwithstanding the Insured’s pleas, HERITAGE has continued to refuse to acknowledge its obligation to acknowledge and pay the full amount of its Insured’s claim.
This complaint is made on behalf of the Insured, Patricia J. Stadler, individually and as Personal Representative of the Estate of George W. Jackson (“MS. STADLER”). Further, this complaint is a statement that notice is hereby given in order to perfect the right to pursue the civil remedy authorized and pursuant to Florida Statute §624.155.
In consideration of the premium paid to it by MS. STADLER, HERITAGE issued an Homeowners policy, Policy No. HOH280498 (hereinafter referred to as “the Policy”), to MS. STADLER wherein the insurance policy provided coverage for all losses, including Hurricane Ian and/or hurricane force winds, except those losses which were expressly excluded.
The policy was in full force and effect at the time the damage occurred as a result of Hurricane Ian and/or hurricane force winds, and the ensuing damages as a direct result thereof, to the insured premises located at 26125 Feathersound Drive, Punta Gorda, FL 33955, on or about September 28, 2022.
On or about September 28, 2022, Hurricane Ian, a large and destructive Category 5 storm, struck the state of Florida, becoming the deadliest hurricane to strike the state of Florida in over 80 years. Hurricane Ian was the third-costliest weather disaster on record, causing complete destruction or extensive property damage to the structures, homes, businesses, and roadways in its path. Millions of people were left without power, while many others were entrapped or forced to seek refuge elsewhere. As a result of the extreme damage and loss of life, the name Ian will never be used again for an Atlantic hurricane.
MS. STADLER was a victim of Hurricane Ian’s destruction when her insured home suffered exterior and interior damages due to hurricane-force winds, and ensuing damages, including, but not limited to, extensive wind damage to the roof system, allowing water intrusion into the home, causing interior water damages throughout the home.
MS. STADLER’S insured property sustained damages to the interior and exterior of the home. On the exterior, MS. STADLER’S property sustained damages, including but not limited to, the garage door, patio, stucco, and roofing system.
On the interior, MS. STADLER’S insured property sustained damages, including but not limited to, the insulation, drywall, paint, baseboard, carpet, flooring, etc. in the office, living room/dining room, kitchen, pantry, laundry room, and patio.
MS. STADLER timely notified HERITAGE of the damages and opened a claim pursuant to the terms and conditions of the Policy.
Following the loss, MS. STADLER retained a company to perform post-Hurricane storm debris removal and a stucco company to remove and replace the band on the front bay window of her home. In addition, MS. STADLER also retained Home Services Now to replace ceilings fans in the lanai, the post light, front screen door, and rear screen door.
In response, HERITAGE assigned the claim to its representative to adjust and investigate the loss, as well as a field adjuster to inspect the damages. HERITAGE’S representative visited the insured property and performed a cursory and inadequate investigation of the damaged property.
On or about February 20, 2023, HERITAGE submitted a Denial Letter to MS. STADLER, stating that “the observed condition of [the] property was caused by wind driven rain, but no storm created openings were found”.
Concerned that HERITAGE had no intention to fairly investigate and adjust her claim, MS. STADLER retained the services of an insurance claim professional, Gregory Siviur from CE Resources, LLC. (CE Resources), to assist in submitting her claim to HERITAGE which would adequately and fairly detail all the damages sustained as a result of the loss.
MS. STADLER’S estimate from CE Resources, totaled a loss of $107,951.91 in Dwelling damages (Coverage – A) and $3,077.77 in Loss of Use (Coverage – D). This estimate offers an accurate representation of Dwelling damages and Loss of Use sustained to MS. STADLER’S insured property, as detailed above.
Unable to wait any longer for HERITAGE to issue owed insurance benefits for her claim, during September of 2023, MS. STADLER retained Shawn Grey to paint the exterior of her house.
On September 7, 2023, MS. STADLER submitted a letter to HERITAGE, requesting that her claim be reopened. MS. STADLER received no response to her request.
Again on September 27, 2023, MS. STADLER submitted another letter to HERITAGE, requesting that her claim be reopened. MS. STADLER received no response to her request.
In November of 2023, MS. STADLER retained Roof Leak Detection Company, Inc. (RLDC) to inspect her insured property. RDLC determined that the “windstorm damage observed to the evaluated roofing system are consistent with being a direct physical result of Hurricane Ian” and would require “complete replacement”.
On or about December 1, 2023, HERITAGE advised MS. STADLER that her claim was now moved to a new claims adjuster, Uriah Thompson.
With regards to MS. STADLER’S claim determination process, HERITAGE has misrepresented the extent of damages sustained to her insured property. HERITAGE has also delayed responding in communications with its insured, and as such, has delayed MS. STADLER’S ability to restore her home to pre-loss condition.
To date, MS. STADLER has not received any reinspection requests from HERITAGE.
To date, MS. STADLER has not received any owed insurance benefits from HERITAGE.
To date, HERITAGE has failed to tender any supplemental insurance benefits. HERITAGE has admitted that MS. STADLER sustained covered damages as a result of the Hurricane Ian and/or hurricane force winds loss that occurred on or about September 28, 2022 but has denied tendering all owed insurance benefits to MS. STADLER. Pursuant to Florida Statute §626.9541(1)(i)(4), HERITAGE is required to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 90 days after HERITAGE 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 HERITAGE has failed to do so, HERITAGE has wrongfully denied coverage.
Since the beginning of the claim, HERITAGE has engaged in a pattern of delay, denial, and reckless disregard for MS. STADLER’S rights. The actions of HERITAGE listed herein have been continuing in nature and given the totality of the circumstances, which includes HERITAGE’S adjustment, actions and/or omissions post the filing of this CRN. MS. STADLER contends that given the past experience in this matter with HERITAGE, it is reasonably foreseeable that HERITAGE’S current actions will extend to its entire conduct in the handing of her claim, including the acts or omissions of HERITAGE and/or its representatives, until the final resolution of her claim. As such, MS. STADLER contends adequate notice has been given should HERITAGE’S actions and violations listed herein continue after the expiration of this notice.
HERITAGE has failed and/or refused to settle the claim when it could and should have done so had it acted fairly and honestly towards MS. STADLER, and has failed to take into account the information and evidence provided that contradict its decisions.
Even upon receipt of additional and supporting evidence to the contrary, HERITAGE has continued to stand by its claim denials. As such, MS. STADLER does not anticipate HERITAGE will rescind its denial of her claim.
HERITAGE’S conduct has been reckless and unfair to MS. STADLER, and has caused and continues to cause additional damages throughout the property. This is evidenced by the delay in paying the claim and the failure of HERITAGE to evaluate the claim in total.
To date, HERITAGE has failed and/or refused to provide MS. STADLER with all the insurance benefits due and owing and has not tendered the full amount needed to repair the Property despite knowing that MS. STADLER has sustained covered damages to her insured property.
As HERITAGE 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. HERITAGE is bound to conduct itself with the utmost good faith for the benefit of MS. STADLER. However, HERITAGE 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, HERITAGE has looked for ways not to pay the claim in full, or at all, and these actions have been to the detriment of MS. STADLER.
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 HERITAGE have approached this investigation in a manner prejudicial to MS. STADLER. HERITAGE is using either untrained or improperly trained adjusters in connection with this claim. HERITAGE should have been adjusting the loss with MS. STADLER but instead, it was looking for ways not to pay the claim at all, or pay the claim in full. If HERITAGE handles all the claims in the manner in which MS. STADLER’S claim was adjusted, then it is improperly handling all claims.
HERITAGE has refused and/or failed to comply with The Policy’s cooperation and/or “Loss Payment” provision. Under The Policy, HERITAGE was to timely tender undisputed insurance benefits to MS. STADLER. HERITAGE has failed and/or refused to timely tender owed insurance benefits, undisputed or otherwise. This is a breach of The Policy.
HERITAGE has refused and/or failed to cooperate and/or “Adjust the Loss” by cooperating with MS. STADLER during the claims adjustment process in compliance with The Policy’s “Loss Payment” provision. This is a breach of The Policy.
The concept of insurance is that insurance is the insurer’s granting of timely and prompt indemnity or security against a contingent loss. Florida Statute §624.02 defines “insurance” as a contract whereby one undertakes to indemnify another or pay or allow specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that MS. STADLER may mitigate her damages and to put her back into the position she was in prior to the loss as quickly as possible. HERITAGE has breached this duty.
HERITAGE has refused and/or failed to tender all insurance proceeds to MS. STADLER upon demand. HERITAGE’S refusal and/or failure to settle the insurance claim when under all circumstances it could have and should have done so had it acted fairly and honestly towards MS. STADLER is wrongful conduct. Furthermore, MS. STADLER contends that HERITAGE’S adjusters and/or representatives financially benefit by such wrongful conduct.
It is clear that HERITAGE’S adjusters have also failed to adhere to insurance industry rules and guidelines when adjusting a first party claim. It is also evident that HERITAGE violated the Florida unfair claims practices, the adjuster’s ethical code of conduct, and acted irresponsibly in the handling of its insured’s claims. In this case, MS. STADLER paid a hefty premium for a service, the service is called claims adjusting (I encourage you to read the book titled, “The Claims Environment” written by James J. Markham, Kevin M. Quinley, and Layne S. Thompson-this book is taught in every first year AIC course).
The claim professional must dispense his or her knowledge and skill for the benefit of society. The general public expects claims representatives to pay all legitimate claims promptly and fairly. The claim professional must harness all of his or her knowledge and expertise to accomplish the objectives of the claim function. He or she must also adhere to the highest degree of ethical conduct. In addition to interacting with other insurance personnel and service providers in a professional manner, the claims professional must deal with public’s and regulator’s expectations. Insurance Companies provide such a vital and necessary service to society that the selling and servicing of insurance is imbued with a public trust. James J. Markham, Kevin M. Quinley, Layne S. Thompson, “The Claims Environment”, Insurance Institute of America, 1st ed., 1993.
Accordingly, HERITAGE has a contractual and statutory obligation to investigate all possible bases which might support MS. STADLER’S claim and cannot deny a claim without thoroughly investigating the foundation for its denial or basis for withholding insurance benefits. HERITAGE violated its obligations here.
- HERITAGE has a contractual and statutory obligation to make a perfunctory investigation, not ignoring evidence that would support MS. STADLER’S claim. HERITAGE violated its obligations here.
- HERITAGE has a contractual and statutory obligation not to look the other way when confronted with facts revealing the possibility of coverage and resisting reasonable interpretations of its policy. HERITAGE violated its obligations here.
- HERITAGE has a contractual and statutory obligation not to deny the claim based on standards known to be impermissible or on an interpretation contrary to established law. HERITAGE violated its obligations here.
These actions and violations were either done intentionally or as the result of HERITAGE’S failure to adopt and implement the proper standards of the investigation and adjustment of claims.
Overall, HERITAGE’S investigation of the claim was inadequate and contrary to its obligations under the insurance policy and Florida law.
MS. STADLER has done everything legally requested by HERITAGE to date. To cure the violations set forth in this Civil Remedy Notice, HERITAGE must now agree to acknowledge its duties and obligations under the law in adjusting its insured’s claim, and tender rightfully owed insurance benefits to return MS. STADLER to her pre-loss condition.
Further, to cure the violations set forth in this Civil Remedy Notice, MS. STADLER hereby requests that HERITAGE tender at this time, or prior to the expiration of the statutory cure period, the amount of MS. STADLER’S damage estimate and demand which accurately reflects the true nature and extent of MS. STADLER’S damages. Therefore, HERITAGE should tender $111,979.68 RCV (less any prior payments, depreciation, excess policy limits, and/or deductible) in insurance benefits at this time.
Although MS. STADLER has made a demand for payment in the amount of $111,979.68 RCV (less any prior payments, depreciation, excess policy limits, and/or deductible) and has provided HERITAGE with all the necessary documentation in support thereof, she is still willing to consider and to potentially accept any reasonable counter-offer made by HERITAGE. Therefore, if HERITAGE is not in agreement with MS. STADLER’S reasonable demand for payment of her rightfully owed insurance benefits being submitted at this time, MS. STADLER hereby requests that HERITAGE now make a reasonable counter-offer before the expiration of the cure period. MS. STADLER still hopes that her claim can be resolved amicably.
The concept of insurance is that insurance is the insurer’s granting of timely and prompt indemnity or security against a contingent loss. Florida Statute §624.02 defines “insurance” as a contract whereby one undertakes to indemnify another or pay or allow specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that MS. STADLER may mitigate her damages and to put her back into the position she was in prior to loss as quickly as possible. HERITAGE breached this duty.
This notice is given in order to perfect the right to pursue the civil remedy authorized and pursuant to Florida Statute §624.155, including any and all bad faith/extra contractual, should HERITAGE fail to cure the violations set forth in this Civil Remedy Notice within the given cure period.
While no specific “cure amount” is required for this Civil Remedy Notice to be valid, MS. STADLER will consider the allegations contained herein “cured” if HERITAGE, without any requirement for a release:
(1) Immediately tenders the amount of MS. STADLER damage estimate in the amount of $107,951.91 RCV (less any prior payments, depreciation, excess policy limits, and/or deductible), which accurately reflects the true nature and extent of the damages to the Dwelling / Other Structures;
(2) Immediately tenders the amount of MS. STADLER’S incurred expenses that were submitted $3,077.77 RCV (less any prior payments, depreciation, excess policy limits, and/or deductible);
(3) Agrees to reimburse MS. STADLER for her expenses incurred by having to retain a public adjuster to present her claim; and
(4) Immediately tenders the amount of statutory interest due and owing to MS. STADLER pursuant to Florida Statute §627.70131(5)(a).
(5) Immediately provides MS. STADLER with the documentation HERITAGE has used and/or continues to contend, supports the claim determination made by HERITAGE in the adjustment of MS. STADLER’S claim. Specifically, HERITAGE must provide MS. STADLER with its claim estimate(s), supporting photographs and/or videos, as well as any and all reports of any expert(s) or other individuals retained on behalf of HERITAGE upon which HERITAGE has relied on in reaching and/or further supporting its coverage determination in MS. STADLER’S claim.
MS. STADLER continues to remain open to a fair and reasonable settlement offer from HERITAGE in an effort to avoid additional delay, costs and expenses, and hereby request the same prior to the expiration of the statutory “cure” period. MS. STADLER has provided HERITAGE with all necessary estimates, documentation, etc. in support of the claim. HERITAGE must act fairly and honestly in its response to MS. STADLER’S request for a prompt, fair and reasonable settlement offer and resolution of the claim.
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The submitter hereby states that this notice is given in order to perfect the rights of the
person(s) damaged to pursue civil remedies authorized by Section 624.155, Florida Statutes.
Before submitting a Notice using this system, please verify that all text has been entered
correctly and completely. Once the Notice has been submitted, the text cannot be changed
or deleted.
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DFS-10-363
Rev. 10/14/2008
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