Civil Remedy Notice of Insurer Violations
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Filing Number:     797352
Filing Accepted:  12/18/2024
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Complainant
Last/Business Name *  
SOTO   First Name   JOSE
Street Address * 5701 HAWKPARK BLVD.
City, State Zip * LITHIA, FL 33547
Email Address * CLAY@THEKRFIRM.COM
Complainant Type: * Insured
Insured
Last/Business Name*   SOTO   First Name   JOSE
Policy # * HOH004268 Claim #* H010024145
Attorney
Attorney is Applicable
Last Name* KUHN First Name * CLAYTON Initial
Street Address* 2110 WEST PLATT STREET
City, State Zip* TAMPA , FLORIDA 33606
Email Address * CLAY@THEKRFIRM.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):* ANY AND ALL PERSONS ASSOCIATED WITH THE CLAIMS HANDLING FROM HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unfair Trade Practice
Claim Denial
* 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)(d) Denying claims without conducting reasonable investigations based upon available information.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

THE POLICY LANGUAGE RELEVANT TO THE VIOLATIONS INCLUDES ALL APPLICABLE LOSS PAYMENT AND COVERAGE PROVISIONS OF POLICY NUMBER HOH004268, INCLUDING THE DECLARATIONS PAGE AND ALL ENDORSEMENTS TO THE POLICY, WITH RESPECT TO COVERAGES A, B, C, AND D. ADDITIONALLY, ANY SECTIONS RELIED UPON BY THE INSURER IN ITS DENIAL TO FULLY PAY THE CLAIM, INCLUDING THE DUTIES IN THE EVENT OF LOSS PROVISIONS AND THE POLICY'S EXCLUSION OF COVERAGE PROVISIONS.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Jose Soto (hereinafter “Insured”) is a homeowner insured with an all-risks policy issued by Heritage Property & Casualty Insurance Company (hereinafter “Carrier”). On or about July 18, 2024, Insured’s home located at 5701 Hawkpark Blvd., Lithia, Florida 33547 sustained significant damage as a result of a wind event. Specifically, a windstorm event created multiple openings to the roof of Insured’s property. This resulted in interior water damage to various areas of the interior of Insured’s property including but not limited to, the living room, dining room, kitchen, and garage. The Loss is covered under Insured’s policy issued by Carrier. The Insured mitigated damages by contacting Eco-Pro Restorations SA LLC who performed mold testing and Loss Restorations LLC who performed mitigation services and placed a tarp on the roof of the subject property. All of the relevant documents were provided to Carrier. Insured promptly reported the claim and fully cooperated with all requests for inspections. Carrier assigned Claim No. H010024145 to the loss. The Insured has fully cooperated with Carrier’s investigation of the claim, including providing all requested documentation and complying with all post-loss policy conditions. Specifically, the Insured, with assistance from their public adjuster, submitted an estimate for $66,949.91, which was a fair and reasonable assessment for the repair/replacement of damages. Eco-Pro Restorations SA LLC has an outstanding balance in the amount of $2,650.00 and Loss Restorations LLC has an outstanding balance in the amount of $10,464.20 for their mitigation services and tarp placement. After reporting the claim, Carrier retained an unqualified and biased field adjuster to adjust the loss. This adjuster had a financial incentive to adjust the loss in a manner that would minimize Carrier’s losses. This adjuster performed a mere cursory inspection of the property on August 30, 2024. Instead of adjusting the claim fairly, honestly, in good faith, and with due regard for the Insured’s interests, this adjuster made a conscious effort to ignore evidence of covered losses to the property. Worse still, Carrier failed to retain qualified experts necessary to identify the repairs necessary to restore the property to its pre-loss condition. Despite Insured providing Carrier with a detailed estimate, Carrier failed to pay Insured the amount necessary to repair/replace the damaged property, less the applicable deductible. Instead, Carrier wrongfully denied full coverage for the loss. This has become a common business practice for Carrier. Under the circumstances surrounding this claim, had Carrier acted fairly and honestly toward the Insured and with due regard for the Insured’s interests, Carrier could and should have attempted in good faith to settle this claim. Carrier did not and, instead, dishonestly, and unfairly placed its own interests well ahead of those of the Insured. In doing so, Carrier violated Section 624.155(1)(b)(1), Florida Statutes. Carrier’s use of unqualified and biased adjusters, and failure to retain experts necessary to identify the repairs necessary to restore the property to its pre-loss condition, evidence Carrier’s failure to adopt and implement standards for the proper investigation of claims in violation of Section 626.9541(1)(i)(3)(a), Florida Statutes. Carrier’s use of unqualified and biased adjusters, and failure to retain experts necessary to identify the repairs necessary to restore the property to its pre-loss condition, evidence Carrier’s failure to conduct a reasonable investigation based upon available information. In denying full coverage for this claim without conducting reasonable investigations based upon available information, Carrier has violated Section 626.9541(1)(i)(3)(d), Florida Statutes. By representing to Insured that the Policy does not afford full coverage for this loss, Carrier is misrepresenting pertinent facts and/or insurance policy provisions relating to coverages at issue, in violation of Section 626.9541(1)(i)(3)(b), Florida Statutes. When applying the facts present here to Florida law, it is clear that Carrier is acting in bad faith. 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 based on determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that insureds may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. Carrier has breached this duty by refusing to properly and timely adjust the loss. Moreover, Section 69B-220.201 of the Florida Administrative Code defines Carrier’s adjusters conduct here as an unfair claims settlement practice. Specifically, Section 69B-220.201(3) provides that “[a]n adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured” and that “[a]n adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.” As detailed above, Carrier’s investigation and adjustment of this claim was done in a manner prejudicial to Insured, was incomplete, and lacked truthful and unbiased reports of the facts. Carrier has more than enough information and is still refusing to accept coverage for the Insured’s claim. This continued and repeated reckless claim delay and denial of coverage will result in a significant punitive damage award if a bad faith lawsuit is filed. Carrier can cure the defects outlined in this Civil Remedy Notice and avoid a lawsuit for bad faith by immediately accepting full coverage under the subject insurance policy for this claim and by paying Insured’s estimate of damages $66,949.91, Eco-Pro Restorations SA LLC in the amount of $2,650.00, and Loss Restorations LLC in the amount of $10,464.20, less applicable deductible, which is the reasonable amount of the covered loss pursuant to the policy. A copy of this form has been submitted to the Florida Department of Financial Services who has transmitted the same to the following parties providing them notice of the filing of this Civil Remedy Notice: Heritage Property & Casualty Insurance Company
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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: Jose Soto Insured: Jose Soto Insurer: Heritage Property & Casualty Insurance Company DFS File No.: 797352 Claim No: H010024145 Policy No.: HOH004268 Address: 5701 Hawkpark Blvd, Lithia, FL 33547 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 797352, filed on behalf of Jose Soto (“Complainant”). The Department accepted the Notice on December 18, 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. 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. Moreover, Florida Statute §624.155(3)(b)(4) requires the Complainant to refer to specific policy language that is relevant to the alleged violation, if any. the notice is legally insufficient because it allegedly lists “the violations includes all applicable loss payment and coverage provisions of policy number HOH004268, including the declarations page and all endorsements to the policy, with respect to coverages A, B, C, and D" and does not specify which provisions were violated, contrary to reference to specific policy provisions that [are] relevant to the violation. Therefore, the Notice failed to provide sufficient notice to Heritage as to what policy provision was violated. Heritage further responds that the Notice fails to identify the person or persons representing the insurer who are most responsible for/knowledgeable of the facts giving rise to the allegations in the Notice. Additionally, the Notice contains a list of violations that Heritage has allegedly committed but fails to provide an adequate basis in support of those allegations and, on that basis alone, fails to satisfy the basic requirements of an otherwise proper Notice. Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021); Fla. Stat. §§ 624.155 and 626.9541. Hence, the Notice failed the Insurer’s address, as specifically required. Lastly, the Notice failed to indicate the insured’s e-mail address, as specifically required. As such, the Notice does not comply with Florida law and is legally insufficient. Notwithstanding the deficiencies, for clarification, Heritage provides a brief history of the claim: Subject to its terms, endorsements, limitations, exclusions, and conditions, the Complainant was issued policy HOH004268 for the property at 5701 Hawkpark Blvd, Lithia, FL 33547. The insurance policy applies to direct physical loss of or damage to covered property at the premises described in the policy's declarations or resulting from any covered cause of loss as described in the policy. Upon receiving the Complainant’s representative Trust Public Adjusters' first notice of loss on August 20, 2024, claiming damages from wind damage that occurred on July 18, 2024, Heritage promptly assigned claim number H010024145. An acknowledgment letter with a Bill of Rights was submitted to Complainant on the same day. In the meantime, Heritage enlisted the services of a field adjuster to coordinate an inspection of the alleged damage caused by the alleged wind damage. Complainant’s representative agreed to the inspection to occur on August 30, 2024. The on-site inspection documented the property's exterior and interior conditions in the presence of the Complainant and public adjuster, Nick Morejon. By the time Heritage had a chance to inspect the property, Complainant had contracted with mitigation companies to perform several services, such as tarping for the roof and water mitigation to the interior of the property. Heritage received and acknowledged documents associated with the alleged services. A response advising the companies about the policy cap and limitation for payment for mitigation and remediation services were forwarded in response. Complainant’s representative estimate was also received. In furtherance of the investigation, Heritage retained a Professional Engineer of DDA Forensics to conduct a reinspection. Said inspection was performed on or about October 24, 2024. During the inspection, Professional Engineer Brennen Bourgeois concluded that the (1) the reported wind speeds on the date of loss (DOL) would not have been elevated enough to damage a properly installed shingle roof; (2) Aerial photographs show that the torn and missing shingles were not present on July 26, 2024, which is after the reported date of loss (DOL). The damage that were observed were likely the result of Hurricane Milton; (3) the tear observed in the mesh of the window screen is the result of either flying debris or contact with adjacent vegetation; (4) the staining observed adjacent to the furnace vents is the result of condensation developing around the connection flange from the temperature differential between the air in the ducts and the unconditioned air in the garage; (5) the approximately 125 torn and missing shingle tabs are the result of damage sustained from elevated wind speeds that occurred after the date of loss (DOL). Aerial photographs provide further evidence; (6) approximately seven (7) creased shingles were observed on the various slopes. This damage was likely sustained during the passage of Hurricane Milton, after the reported date of loss (DOL). On November 15, 2024, after conducting a reasonable investigation based on available information to Heritage, and in accordance with its obligations under §627.70131, Fla. Stat., Heritage issued a letter including a written explanation of the coverage decision to Complainant, which included pertinent facts and insurance policy provisions relating to coverages at issue. The letter explained that based on Heritage’s investigation and the policy, on the reported date of loss there was no wind at the property that created the claimed damage. Heritage had been unable to determine the date of loss because the claim was not promptly reported. The date of loss was a material aspect of the claim and Heritage’s inability to determine it has prejudiced the investigation of the claim and ability to make a substantive coverage decision. Therefore, Heritage denied coverage for this claim under the Duties After Loss provision of the policy. On December 18, 2024, Kuhn Raslavich, PA, on behalf of the Complainant, filed a Notice of Intent to Initiate Litigation (“NOI”), and Heritage timely responded, maintaining its prior decision of denial. The very next day, the Complainant’s attorney filed this Notice, to which Heritage is responding. In accordance with Fla. Stat. §624.155, the Civil Remedy Notice requires Complainant, “to indicate all statutory provisions alleged to have been violated.” The Notice alleges the reasons for the Notice are the following: 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. Claim Denial The Notice fails to state who, how, and when a “claim denial” practice occurred; therefore, it lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. Further, the Notice filed in this matter alleges Heritage violated the following statutory provisions: 1. 624.155(1)(b)(1): Not attempting in good faith to settle claims when, under all circumstances, it could and should have done so, had it acted fairly and honestly toward its Complainant and with due regard for his or her interests. Response: Heritage denies the allegations contained herein. Accordingly, and as indicated by the facts stated above, Heritage has at all times acted fairly and honestly. Further, Heritage has timely made a coverage determination based on the information and documentation obtained and/or received by Heritage during its investigation of the claim and the subject policy. Additionally, Complainant failed to specify the instances where Heritage did not attempt “in good faith to settle claims when, under all circumstances, it could and should have done so, had it acted fairly and honestly [. . .]” Therefore, this is an unsupported, sweeping allegation and is without merit. 2. 626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims. Response: Heritage denies the allegations contained herein. Accordingly, and as indicated by the facts stated above, Heritage has always acted fairly and honestly. Further, Heritage has timely made a coverage determination based upon the information and documentation obtained and/or received by Heritage during its investigation of the claim and the subject policy. Additionally, Complainant failed to specify the instances where Heritage failed “to adopt and implement standards for the proper investigation of claims.” Therefore, this is an unsupported, sweeping allegation and is without merit. 3. 626.9541(1)(i)(3)(b): Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. Response: Heritage denies the allegations contained herein. Accordingly, and as indicated by the facts stated above, Heritage has always acted fairly and honestly. Further, Heritage has timely made a coverage determination based upon the information and documentation obtained and/or received by Heritage during its investigation of the claim and the subject policy. Additionally, Complainant failed to specify the instances where Heritage “misrepresented pertinent facts or insurance policy provisions relating to coverages at issue.” Therefore, this is an unsupported, sweeping allegation and is without merit. 4. 626.9541(1)(i)(3)(d): Denying claims without conducting reasonable investigations based upon available information. Response: Heritage denies the allegations contained herein. Heritage has promptly taken substantial action to investigate Complainant’s claim. As mentioned, Heritage promptly assigned a field adjuster and an engineer to inspect and investigate the claim. Further, in contrast to this allegation, Heritage has timely made a coverage determination for the claim based upon the information and documentation obtained and/or received by Heritage during its investigation of the claim and the subject policy. Therefore, this is an unsupported, sweeping allegation and is without merit. As detailed by the facts stated above, Heritage Property & Casualty Insurance Company did not violate any of the statutes mentioned above sections. Heritage has diligently and thoroughly investigated the subject claim, followed up with Complainant for documents supporting their claim, and provided a coverage determination. The purpose of the Civil Remedy Notice is to provide the insurer notice of the issue its Complainants have with the claim and what it is seeking to remedy that issue. However, it is important to note that Insurers are not required to pay any amount demanded by their Complainants to avoid a bad-faith claim. Rousso v. Liberty Surplus Ins. Corp., 2010 U.S. Dist. LEXIS 82328, at *14-15 (S.D. Fla. Aug. 13, 2010). The Florida Supreme Court has held that an insurer's appropriate response to a Civil Remedy Notice filed pursuant to Fla. Stat. 624.155 is “based upon the insurer's good-faith evaluation of what is owed on the insurance contract.” Vest v. Travelers Ins. Co., 753 So. 2d 1270, 1275 (Fla 2000). The Court further stated, “What is owed on the contract is . . . governed by whether all conditions precedent for payment contained within the policy have been met.” Id. For its part, an insurer “must evaluate a claim based upon proof of loss required by the policy and its expertise in advance of a determination by a court or arbitration.” Id. at 1275-76. See also Julien. Heritage’s position is that it has complied, in good faith, with these obligations. Furthermore, the 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 Complainants. Talat also commented that “[i]t naturally follows that for there to be a ‘cure,’ what had to be ‘cured’ is the non-payment of the contractual amount due the Complainant. In the context of a first-party insurance claim, the contractual amount due to the Complainant is the amount owed pursuant to the express terms and conditions of the policy after all of the conditions precedent of the insurance policy in respect to payment are fulfilled....” As a result, only the demanded “cures” relating to the payment for covered damages are proper and legal. One action demanded in the Notice is to “immediately accepting full coverage under the subject insurance policy for this claim and by paying Insured’s estimate of damages $66,949.91, Eco-Pro Restorations SA LLC in the amount of $2,650.00, and Loss Restorations LLC in the amount of $10,464.20, less applicable deductible, which is the reasonable amount of the covered loss pursuant to the policy.” Although Heritage denied coverage for the claim at issue, it is unclear what amount the Complainant is seeking. If Heritage pays an unspecified amount for the repairs associated with the alleged loss it is unclear if this would be sufficient to cure this demand and the effect, if any, on Plaintiff’s lawsuit filed in the Circuit Court in and for Hillsborough County, Florida. In short, as in Russo, the Notice reflects “a shotgun-blast effort to hit a lot of targets with a single salvo. This approach is contrary to the purpose of the statute.” The Notice must reflect a good-faith effort to inform Heritage of how it has fallen short of its obligations under the policy and what it can do to fix its shortcomings. Thus, the Notice is insufficient as a matter of law. Under § 624.155, Heritage is entitled not only to a clear proposed solution, but also more and accurate details about how Heritage fell short of its obligations to provide coverage pursuant to the terms of the insurance agreement. As such, the Notice is deficient, and the Complainant has failed to comply with several conditions precedent to bringing a claim under §624.155. Heritage Property & Casualty Insurance Company believes that the Notice should be rejected and returned by the Department of Financial Services due to its failure to comply with Florida Statute §624.155 and Florida Case law. Moreover, regardless of the rejection, Heritage denies all allegations contained in the Notice and submits there are no violations. While this response is meant to be comprehensive, Heritage Property & Casualty Insurance Company’s response above is based upon the limited information provided in the Notice and the information we have to date. If the Complainant feels that Heritage does not have all the facts, please inform Heritage immediately. In closing, Heritage denies each and every assertion of bad faith in the Notice. And, notwithstanding the foregoing, nothing in this letter should be construed as a waiver or surrender of the policy terms, limitations, exclusions, conditions or agreements, nor should this letter be considered an exhaustive recitation of the deficiencies in the Notice. Heritage reserves the right to supplement its response at a later time. Should the Department have any questions, concerns, or require any additional information regarding this matter, please feel free to contact the undersigned at your convenience. Sincerely, /s/ Priscila Ferreira Priscila Ferreira, Esq. Claims Counsel Heritage Property & Casualty Insurance Co.
Acknowledgement
* The submitter hereby states that this notice is given in order to perfect the rights of the person(s) damaged to pursue civil remedies authorized by Section 624.155, Florida Statutes.

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