Civil Remedy Notice of Insurer Violations
Login

Filing Number:     797206
Filing Accepted:  12/17/2024
         Print Filing
Complainant
Last/Business Name *  
WING   First Name   TYLER
Street Address * 13347 OLD FLORIDA CIRCLE
City, State Zip * HUDSON, FL 34669
Email Address * CFAUNTLEROY@FSATLAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   WING   First Name   TYLER
Policy # * HOH621105 Claim #* H010025770
Attorney
Attorney is Applicable
Last Name* FAUNTLEROY First Name * CHRISTOPHER Initial B
Street Address* 100 S ASHLEY DRIVE, SUITE 600
City, State Zip* TAMPA , FLORIDA 33602
Email Address * CFAUNTLEROY@FSATLAW.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):* RENEE GILMORE AND HERTIGAGE AND TIS ADJUSTERS
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
* Statutory provision(s) which the insurer allegedly violated.
 
624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(e) Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
626.9541(1)(i)(3)(f) Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement.
626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Reference specific policy language that is relevant to violation: COVERAGE A – DWELLING COVERAGE A – Dwelling We cover: 1. The dwelling on the "residence premises" shown in the Declarations, including structures attached to the dwelling; and 2. Materials and supplies located on or next to the "residence premises" used to construct, alter or repair the dwelling or other structures on the "residence premises." This coverage does not apply to land, including land on which the dwelling is located. Loss Settlement 3. Loss Settlement. Paragraphs b.(4) and (5) have been deleted and replaced by the following: (4) We will initially pay at least the actual cash value of the insured loss, less any applicable deductible. We will pay any remaining amount necessary to perform such repairs as work is performed and expenses are incurred. If a total loss of a building or structure insured under this policy occurs, we will pay the replacement cost coverage without reservation or holdback of any depreciation in value, subject to policy limits. Loss Payment 10.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 60 days after we receive your proof of loss and: a. Reach an agreement with you; b. There is an entry of a final judgment; or c. There is a filing of an appraisal award with us. 10. 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. In the event that any repair services were performed under the Our Option provision, we will pay the retained contractor directly for those services or part or portion of any services the retained contractor performs or provides. For all other claims payments, we will pay you unless some other person is named in the policy or is legally entitled to receive payment. Loss will be paid 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 after we receive your proof of loss; and: (1) There is an 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) There is a written executed mediation settlement with us according to the terms of the written mediation settlement; or (3) There is a filing of an appraisal award with us; or c. Within 60 days after we receive notice of an initial claim, “reopened claim” or “supplemental claim” from you, we will pay or deny such claim or 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. Our failure to comply with this paragraph shall not form the sole basis for an action against us for breach of contract under this policy or for benefits under this policy. ***ADDITIONAL STATUTORY PROVISIONS ALLEGED TO HAVE BEEN VIOLATED ARE AS FOLLOWS:*** §624.155(1)(B)(1) Any person may bring a civil action against an insurer when such person is damaged: By the commission of any of the following acts by the insurer: 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 towards its insured and with due regard for her interests; 2. Making claims payments to insures or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made; or 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. §624.155 (5) No punitive damages shall be awarded under this section unless the acts giving rise to the violation occur with such frequency as to indicate a general business practice and these acts are: (a) Willful, wanton, and malicious; (b) In reckless disregard for the rights of any insured; or (c) In reckless disregard for the rights of a beneficiaries under a life insurance contract; (8) The damages recoverable pursuant to this section shall include those damages which are a reasonably foreseeable result of a specified violation of this section by the authorized insurer and may include an award or judgment in an amount that exceeds the policy limits. §627.70131 Insurer’s duty to acknowledge communications regarding claims; investigation (1)(a) Upon an insurer’s receiving a communication with respect to a claim, the insurer shall, within 14 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer which reasonably prevent such acknowledgement. If the acknowledgement is not in writing, a notification indicating acknowledgement shall be made in the insurer’s claim file and dated. A communication made to or by an agent of an insurer with respect to a claim shall constitute communication to or by the insurer. (4) For purposes of this section, the term “insurer” means any residential property insurer. §626.9541(i) Unfair Claim Settlement Practices
 
* 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 in the adjustment of Tyler Wing’s (Wing’s) claim. Heritage has failed to adopt and implement proper standards for investigation, evaluation and adjustment of claims; has failed to properly train, manage, supervise and promote claims adjusters so that policy holder receives good faith, fair, prompt adjustment of claim, service and indemnity; has failed to conduct a full and fair investigation of the claim and has failed to provide full reasons and facts to the claimant for delay of the claim resulting in statutory violations as set forth in this notice. Furthermore, Heritage has engaged in unfair claim delay; has used business or outcome-oriented investigations and experts to determine the outcome of the claim; has wrongfully denied the claim without fully stating reasons and reserving unwritten reasons; has looked for ways to, delay payment and otherwise “stonewall” the claim; and has used improper claims practices to rush the claims process and profit from wrongful claims practices. Wing’s claim results from wind and water damage to the roof and interior of his home from Hurricane Helene that occurred on September 26, 2024, which consequentially resulted in missing and loose shingles throughout the roof, as well as water damage to the interior of the home. In an effort to immediately mitigate the damages to his home, Wing contacted his insurance company, Heritage, to report the damages to his home. As part of their investigation, Heritage assigned a claim number H010025770 and desk adjuster Renee Gilmore (Gilmore) to adjust the loss. As part of the investigation of Wing’s claim, Heritage’s adjuster assigned a field adjuster to inspect the damages to Wing’s home. Subsequently, Heritage sent correspondence on October 2, 2024, in which they partially denied Wing’s claim, stating that they would not provide payment to complete repairs to the flooring or the garage since their inspection revealed that the condition of the flooring and garage was due to wind-driven rain and ground water. Therefore, they issued payment in the amount of $9,683.58 to repair the damages, which is insufficient coverage to return Wing’s property back to pre-loss condition. In view of the foregoing, it is clear and unequivocal that Heritage has failed to provide proper and sufficient compensation to repair the damages caused to Wing’s property. Due to Heritage’s handling of Wing’s claim, Wing chose to retain Fairwinds Construction Services, LLC, to further assess the damages to his home. As such, upon inspection and view of the damages, it was clear that the roof and interior of the property required extensive repair. After the inspection, Fairwinds Construction Services, LLC, provided an estimate for repairs in the amount of $54,683.40, which is the full amount to return Wing’s home back to pre-loss condition. Heritage continues to hold their stance for their claim determination concerning Wing’s loss. Wing complied with all conditions under the policy. Nonetheless, Heritage continues to fail to properly compensate Wing for his loss. The facts of this claim show that for whatever reason, Heritage not only substantially misinterpreted the scope of damages to Wing’s property but failed to conduct a thorough investigation as to the scope of damages to the roof and interior. Upon view of Heritage’s claims handling procedures, it is clear Heritage conducted a limited and quick outcome orientated investigation in the hopes that Wing would make the required repairs with his own money. Wing now must incur costs for assistance to obtain what should have been paid had he been treated fairly and honestly by Heritage. Further, in view of the facts surrounding Wing’s claim it is evident that Heritage has failed to create and implement adequate guidelines for proper investigations to evaluate claims handling for training and supervision of employees in violation of Fla. Stat. §624.155 and §626.9541 statutory regulations, as well as the applicable provisions in the Florida Administrative Code resulting in the statute violations set forth herein. As stated, Heritage has failed and/or refused to thoroughly, accurately and completely investigate the insured’s claim for damages. 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 a specified amount or a determinable benefit upon determinable contingencies. Inherent 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 loss as quickly as possible. Heritage 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 legal counsel, to force Heritage to honor its obligations under the insurance policy to pay all the insurance proceeds due and owing the insured. Furthermore, Heritage has failed to adopt and implement proper standards for investigation, evaluation and adjustment of claims; has failed to properly train, manage, supervise and promote claims adjusters so that policy holder receives good faith, fair, prompt adjustment of claim, service and indemnity; has failed to conduct a full and fair investigation of the claim. Florida Statutes violated by Heritage are as applied to the facts in this matter is as follows: § 626.951 engaging in acts defined as “unfair trade practices” relating to the business of insurance in accordance with the intent of congress as expressed in the act of congress of March 9, 1945 (pub. L. No. 15, 79th congress), by defining, or providing for the determination of, all such practices in this state which constitute unfair methods of competition or unfair or deceptive acts or practices and by prohibiting the trade practices so defined or determined. § 624.155(1)(b)(1) to tender all insurance proceeds monies due and owing the insured or assist the insured in the mitigation of their damages. The insurer breached these statutory duties. Not attempting in good faith to settle claims when, under all circumstance, insurer could have and should have done so, had the insurer acted fairly and honestly toward its insured and with due regard. § 624.155(1)(b)(3) failing to promptly settle claims, when the obligation to settle the 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 investigations of claims. § 626.9541(1)(i)(3)c Failing to acknowledge and to act promptly upon communications with respect to claims. Their actions are willful, wanton and in disregard of the rights of its insured and occur with such a frequency as to indicate a general business practice. Heritage can cure this default by the following: A. Create, adopt and implement adequate standards and/or guidelines for the proper investigation and adjustment of claims. B. Provide sufficient training and supervision of employees and agents to avoid further violations as set forth in the paragraphs above from occurring in the future. C. Tender payment to Wing in the amount of $54,683.40 which is the amount to return Wing’s home back to pre-loss condition. D. Tender prejudgment interest from the date the claim was reported through today. E. Agree to pay Wing’s reasonable attorney’s fees pursuant to Florida Statute §627.428, and the applicable law at the time that the subject claim was filed and all taxable costs.
Comments
User Id Date Added Comment
cfauntleroy@piaflaw.com 02-14-2025 AS OF FEBRUARY 14, 2025 THIS CIVIL REMEDY NOTICE HAS BEEN WITHDRAWN
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: TYLER WING Insured: TYLER WING Insurer: Heritage Property & Casualty Insurance Company DFS File No.: 797206 Claim No: H010025770 Policy No.: HOH621105 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 797206, filed on behalf of Heritage’s insured TYLER WING (“Complainant”). The Notice was accepted by the Department on December 17, 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 HOH621105 (“Policy”) for the property at 13347 Old Florida Cir., Hudson, FL 34669 (“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 September 27, 2024, reporting damages from Hurricane Helene, which occurred on September 26, 2024. Heritage promptly assigned claim number H010025770. On the same day the loss was reported, Heritage issued its acknowledgment letter and Bill of Rights to the Complainant. Moving forward, Heritage’s representative coordinated an inspection of the damage to the Property caused by the alleged windstorm. Complainant requested the inspection to occur on September 28, 2024, and the on-site inspection thoroughly documented the interior and exterior conditions of the property. After conducting a reasonable investigation based upon available information, on October 2, 2024, Heritage advised Complainant that it was extending coverage under the policy. Some of the damage observed was precluded from coverage by the subject policy. Heritage promptly provided a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for partial denial of the claim. In accordance with its obligations under §627.70131, Fla. Stat., a letter including a written explanation of the coverage decision was sent to Complainant on October 2, 2024, which included pertinent facts or insurance policy provisions relating to coverages at issue. Payment was sent on same. On December 17, 2024, Complainant filed this Notice, to which Heritage now submits its response. Heritage is pleased to report that the parties reached an amicable resolution to the claim on January 23, 2025. 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. 2. §624.155(1)(b)(2): Making claims payments to insureds or beneficiaries not accompanied by statement setting forth the coverage under which payments are being made. 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 claims payment was, or who made the payment. On the contrary, Heritage records indicate that it made a payment in this claim to the insured or their beneficiary, within a reasonable amount of time, accompanied by a letter stating the coverage under which payments were made was sent promptly after claim coverage was determined. 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. 3. §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 paid 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 covered loss, under any portion of the insurance policy, so it is unclear how this alleged violation is supported here. 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. 4. §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. 5. §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. 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. 6. §626.9541(1)(i)(3)(e): Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed. Response: The Complainant fails to state who, how and when Heritage failed to affirm or deny full or partial coverage of claims, or as to partial coverage, the dollar amount or extent of coverage or failed to provide a written statement that the claims is being investigated, upon written request of the insured within 30 days after proof-of-loss statements have been completed. Therefore, it lacks a factual basis to support this allegation and lacks the specificity required by Florida Statute §624.155 and thus does not put Heritage on the requisite notice. Regardless, Heritage denies the allegations contained herein. Accordingly, and as indicated by the facts stated above, Heritage has conducted a reasonable investigation based on available information and made a coverage determination in reference to 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. 7. §626.9541(1)(i)(3)(f): Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement. Response: The Notice fails to specifically identify instances where Heritage failed “to promptly provide a reasonable explanation in writing to the insured [. . .]”. Therefore, it lacks a factual basis to support this allegation and lacks the specificity required by Florida Statute §624.155 and thus does not put Heritage on the requisite notice. Regardless, Heritage denies the allegations contained herein. Accordingly, and as indicated by the facts stated above, Heritage has promptly provided a reasonable explanation in writing to Complainant of the basis in the insurance policy, in relation to the facts or applicable law, for the partial denial. 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 allegation is an unsupported, sweeping allegation and without merit. 8. §626.9541(1)(i)(3)(g): Failing to promptly notify the insured of any additional information necessary for the processing of a claim. Response: The Notice does not provide any specifics by way of who, when and how Heritage committed this violation and therefore fails to comply with the specificity required. Nowhere in the Notice does it state the pertinent facts as to who did not promptly notify the insured of any additional information necessary for the processing of a claim and/or when the alleged failure occurred. Therefore, it lacks a factual basis to support this allegation and lacks the specificity required by Florida Statute §624.155 and thus does not put Heritage on the requisite notice. 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. 9. §626.9541(1)(i)(3)(h): Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. Response: The Notice does not provide any specifics by way of who, when and how Heritage committed this violation and therefore fails to comply with the specificity required. Nowhere in the notice does it state what the pertinent facts as to who did not clearly explain the nature of the requested information and the reasons why such information is necessary, nor does it state when or how this instance/s occurred. Therefore, it lacks a factual basis to support this allegation and lacks the specificity required by Florida Statute §624.155 and thus does not put Heritage on the requisite notice. 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 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. 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.

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.




DFS-10-363
Rev. 10/14/2008