Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 799674

Filing Accepted: 1/7/2025

Print Filing

Complainant

Last/Business Name *

BELLO

First Name

GREGORY AND CINDY

Street Address *

8303 ESTERO BOULEVARD

City, State Zip *

FORT MYERS BEACH, FL 33931

Email Address *

BELLONAPLES@COMCAST.NET

Complainant Type: *

Insured

Last/Business Name*		BELLO		First Name		GREGORY AND CINDY
Policy # *		HCPC-DP3-418143		Claim #*		926112

Attorney

Attorney is Applicable

Last Name*	AVERSANO First Name * JONATHAN Initial B
Street Address*		490 SAWGRASS CORPORATE PARKWAY, SUITE 110
City, State Zip*		SUNRISE , FLORIDA 33325
Email Address *		JON@GFT.LAW

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		HOMEOWNERS CHOICE PROPERTY & CASUALTY INSURANCE COMPANY, INC.
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 12944

Name of individual responsible for violation (if any):* ANTHONY PIFERRER, BRIAN BREWER, JOHN KNIGHT, RYAN GISSAL, P.E., BRITTANY ABERCROMBIE AND ALL OTHER ADJUSTERS, SUPERVISORS, MANAGEMENT AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY HOMEOWNERS CHOICE PROPERTY & CASUALTY INSURANCE COMPANY INVOLVED IN T
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Denial
	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.
	624.155(1)(b)(3)		Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
	626.9541(1)(i)(3)(a)		Failing to adopt and implement standards for the proper investigation of claims.
	626.9541(1)(i)(3)(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)(d)		Denying claims without conducting reasonable investigations based upon available information.
	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)(j)		Altering or amending an insurance adjuster’s report without: (I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and (II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or (III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change;

* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Not all the violations identified herein are directly associated with the policy terms and conditions. Many violations identified herein are associated with the insurance company’s misconduct and failure to abide by the proper Florida statutory and Florida administrative code guidelines for the administration of claims. Nevertheless, specific policy language that is relevant to the violations set forth herein includes, but is not limited to, the following sections of the insurance policy in this case: COVERAGES Coverage A – Dwelling We cover: 1. The dwelling on the Described Location shown in the Declarations, used principally for dwelling purposes, including structures attached to the dwelling; 2. Materials and supplies located on or next to the Described Location used to construct, alter or repair the dwelling or other structures on the Described Location; and 3. If not otherwise covered in this policy, building equipment and outdoor equipment used for the service of and located on the Described Location. Coverage C – Personal Property We cover personal property, usual to the occupancy as a dwelling and owned or used by you or members of your family residing with you while it is on the Described Location. At your request, we will cover personal property owned by a guest or servant while the property is on the Described Location. Coverage E – Additional Living Expense If a loss to property described in Coverage A, B or C by a Peril Insured Against under this policy makes the Described Location unfit for its normal use, we cover your: Additional Living Expense, meaning any necessary increase in living expenses incurred by you so that your household can maintain its normal standard of living. Payment will be for the shortest time required to repair or replace the Described Location, or if you permanently relocate, the shortest time required for your household to settle elsewhere. If a civil authority prohibits you from use of the Described Location as a result of direct damage to a neighboring location by a Peril Insured Against in this policy, we cover the Additional Living Expense loss for no more than two weeks. The periods of time referenced above are not limited by the expiration of the policy. We do not cover loss or expense due to cancellation of a lease or agreement. PERILS INSURED AGAINST COVERAGE A – DWELLING and COVERAGE B – OTHER STRUCTURES We insure against risk of direct loss to the property described in Coverages A and B only if that loss is a physical loss to property; however, we do not insure loss:

* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Gregory and Cindy Bello (the “Insureds”) purchased an insurance policy (“Policy”) from Homeowners Choice Property & Casualty Insurance Company (“HCI”) with effective dates of coverage from October 17, 2021, through October 17, 2022, and Policy Number HCPC-DP3-418143, to insure their home located at 8303 Estero Boulevard, Fort Myers Beach, FL 33931 (the “Property”). On or about September 28, 2022, the Property sustained substantial damage due to Hurricane Ian. This direct and ensuing damage to the Property included damage to the roof, which allowed water to enter the Property through the roof and damage the trusses, insulation, sheathing ceilings and molding inside the Property. Hereinafter, this windstorm damage to the Dwelling, coupled with the personal property damage and the covered corresponding financial loss (arising from the inability to use the windstorm damaged property) shall be referred to as the “Loss”. The Insureds promptly reported the Loss to HCI and the Insureds did what they could to mitigate the damages. On October 3, 2022, HCI acknowledged receipt of the claim and assigned claim number 926112 (“Claim”) to the Loss. HCI assigned handling of the claim to its in-house adjuster Anthony Piferrer and outside contracted adjusting team, including an independent field adjuster from Griston Claims Services, Brian Brewer, to inspect and evaluate the windstorm damage. At some point in October or early November 2022, Mr. Brewer inspected the Property along with Mr. Bello. Mr. Brewer agreed that there was significant damage to the roof and the systems below the roof, but the Insureds never heard from Mr. Brewer again. Instead, the Insureds received a letter on November 18, 2022, that another adjuster from Griston Claims, John Knight, would be inspecting the Property. Thereafter, on or about November 20, 2022, John Knight inspected the Loss, prepared an estimate and submitted a report to HCI for payment of the Claim. The Insureds also had the Loss inspected and damage valuation prepared – which was submitted to HCI for review and payment of the Claim. On or about October 27, 2022, an engineer from IFG Independent Forensics Group, Ryan Gissal, P.E. inspected the Loss on behalf of HCI without anyone present for the Insureds. On or about December 20, 2022, HCI sent a letter, damage estimate and lowball payment of $26,124.76 for the Claim, which represented a fraction of the Actual Cash Value truly owed to the Insureds. The letter stated “[o]ur payment to you does not necessarily constitute full and final settlement of this claim. Please notify us of any additional loss or damage to the property and ensure that necessary repairs are made to protect the property from further damage.” Consequently, on or about January 17, 2022, the Insureds’ notified HCI that the estimate was woefully inaccurate and provided additional support for HCI to pay the appropriate amount of the Claim, including a damaged personal property inventory and support for additional living expenses incurred to date. When HCI refused to pay the Insureds anything further, the Insureds, had no choice but to retain legal counsel to resolve the disputed Claim. And in turn, the Insureds agreed to pay the attorney’s fees and costs related to the legal services, and pursuit of their insurance benefits owed under the Policy. On or about February 23, 2023, HCI sent correspondence to counsel for the Insureds requesting various documents and in response, the Insureds’ counsel provided all requested documents, including an estimate for all the wind-related damage to the Property. For two months, HCI failed to respond, so the Insureds had no choice but to file a Notice of Intent to Litigate and eventually file a lawsuit against HCI based on HCI’s breach of the policy for failure to pay the appropriate amount of benefits owed. In fact, HCI never provided any explanation as to why it failed to pay the Insureds for their damaged personal property and months of rent incurred by the Insureds because the insured Property was uninhabitable due to the windstorm damage from Ian. Ultimately, Lee County determined that the Property was uninhabitable and was a total loss. There was nothing for the Insureds to mitigate and they were forced to demolish the entire Property. To date, HCI has failed and/or refused to pay for the correct amount owed for the Loss, and refused to adequately compensate the Insureds for the covered damages in this case. Moreover, HCI took action to lessen and/or avoid its liability to the Insureds in this case, frustrate its Insureds and thwart a fair and equitable resolution of the Claim. HCI knowingly and intentionally refused to acknowledge the full extent of the Loss and in turn, pay what it knew or should have known was owed. Without question, the actions that followed HCI’s receipt of Mr. Brewer’s initial report were made with the goal of underpaying, delaying and frustrating the insurance claim process. HCI has violated Florida Statute § 624.155(1)(b)(1), by continuously not attempting in good faith to settle these claims when it should have done so if it had acted fairly and honestly towards its Insureds. It has also violated Florida Statute § 624.155(1)(b)(3), by failing to promptly settle these obviously covered claims to influence settlement in its favor. HCI knew or should have had reason to know the extent of damages, but still provided an under-inclusive scope of repair, and wholly disregarded and/or underpaid numerous components of the Loss. Rather than work out the dispute, HCI curiously refused to reconsider its erroneous position or send out an unbiased engineer and/or general contractor to perform a property causal analysis and more detailed claim determination. HCI violated Fla. Statute § 626.9541(1)(l)(2) by making material misrepresentations to the Insureds for the purpose and with the intent to settle these claims on less favorable terms than those provided and contemplated by the Policy. HCI misrepresented the facts related to the cause of the windstorm damage and the correct scope of the damages owed under the Policy. Evidence of the cause and nature of the damages was presented to HCI, along with facts regarding the full scope of repair and proper payment due. Instead, HCI turned a blind eye to the Policy’s terms and refused to acknowledge its Insureds’ requests to pay what was truly owed. In doing so, HCI misrepresented the terms of the Policy as it relates to its obligations to the Insureds. HCI has also violated Florida Statute §§ 626.9542(1)(i)(3)(a), 626.9542(1)(i)(3)(b), 626.9542(1)(i)(3)(c), 626.9542(1)(i)(3)(d), 626.9542(1)(i)(3)(e), 626.9542(1)(i)(3)(f), 626.9542(1)(i)(3)(g) and 626.9542(1)(i)(3)(j) for the reasons stated below. HCI failed to adopt and implement standards for the proper investigations of claims. HCI and their representatives are willfully blind and grossly underqualified to handle the loss sustained. In addition to the conduct described above, HCI missed obvious damage, and sought to avoid payment for same, for what was obviously a covered loss. It is also believed, upon information and belief, that HCI knowingly manipulated the damage estimate that it was provided by Mr. Brewer or disregarded it altogher and then lowballed the Insureds – a clear violation of § 626.9542(1)(i)(3)(j). Moreover, HCI should have assigned an unbiased engineer to properly evaluate the cause, nature and extent of the damages. It failed to do so. In addition, to being placed on notice as to the blatantly mistaken estimates of the scope of the damage for the Claim, it refused to take corrective action that could have avoided escalation, and instead chose to punish the Insureds with delays. This misconduct forced the Insureds to file suit, which could have been avoided if HCI would have simply treated its customer, the Insureds, honestly and in accordance with the property guidelines for the handling of claims. HCI may not deny claims without conducting reasonable investigations based on available information – a violation of § 626.9542(1)(i)(3)(d). Here, HCI breached this duty, time and again by failing and refusing to pay what it knew or should have known was owed, by disregarding its own field adjusters findings, by failing to send out an unbiased engineer to investigate, by refusing to reconsider its estimate of damages and incorrect scope of work and by failing to even acknowledge the Insureds’ claims for damage to personal property and loss of use. HCI’s manipulative and outcome oriented determinative manner of investigating property damage claims fell well below the industry standard for claims handling in this case. Further, upon information and belief, this is not the only time that HCI has acted in the aforementioned improper manner – which is textbook bad-faith claims handling practices. HCI violated § 626.9542(1)(i)(3)(c) and § 626.9542(1)(i)(3)(e) when it failed to engage in any meaningful communications regarding the Claim. Throughout the adjustment of the Claim to the present, HCI has time and again failed to adequately respond to simple issues brought to its attention regarding the Claim that include, but are not limited to, the correct scope of the damage, the corresponding cost of repairs and the Insureds’ damages to personal property and loss of use. Pursuant to Florida Statute § 626.9542(1)(i)(3)(f), HCI has a duty to provide a reasonable explanation in writing to the Insureds, of the basis of the Insurance policy, in relation to the applicable facts or law for a denial of a claim or offer of settlement. HCI breached this duty by and through the conduct described herein that includes its delays, failure to provide any meaningful communication on a timely basis, failure to review documents and materials sent, failure to assign an unbiased engineer, refusing to reconsider its faulty lowball estimate and scope and refusal to provide meaningful explanations for its positions. Pursuant to Florida Statute § 626.9542(1)(i)(3)(g), HCI has a duty to promptly notify the Insureds of any additional information necessary to process the claim. HCI breached this duty by avoiding answering questions or providing substantive information when necessary. The undeniable truth is that HCI and its personnel knowingly kept pushing a false narrative of the Loss. In clear violations of the Policy and the reasonable standard for claims handling practices. It is these actions, among others as described herein, that constitute a breach of Florida Statute § 626.9542(1)(i)(3)(h) as well. Furthermore, as a general “bad faith” business practice, HCI knowingly employs individuals to evaluate and “revaluate” property damage claims who manipulate the facts and work to low-ball claims. Thereafter, once the consumer or representative of the consumer complains about the undervaluation of the claim to HCI’s claim representative, HCI hires outcome-oriented experts to reinforce the initial low-ball claim valuation rather than hiring experts to provide it with a true analysis of what the scope and cause of damage is. This “bad faith” business practice is commonly found in windstorm damage claims. HCI all too often engages individuals who turn a blind eye to the true amount owed, delay settlement, and ultimately work to increase HCI bottom line through bad-faith claims handling practices. This is evidenced in the significant number of cases that are low-balled and the insured must fight to obtain what HCI knew or should have known was owed from the start. This is particularly problematic because all of these claim representatives and outside consultants hired by HCI, time and gain, do not report the fact that windstorm was also a cause and contributed to the loss – instead incorrectly blaming the entire damage on an excluded cause of loss in order to escape liability. HCI expects this result from its engineers, contractors, adjusters and other consultants it engages to protect its interest no matter the cost. This can often be found when HCI attempts to avoid the concurrent cause doctrine followed in Florida that would afford coverage to numerous claimants, despite the fact that non-covered causes (such as wear and tear) may also be present. Again, evidence of this can be found in the thousands of reports HCI received from its experts, finding no windstorm damage to a roof, and then in a subsequent mediation, appraisal, litigation or trial the finder of fact determines that wind damage did in fact exist, the loss was covered and HCI pays. Incredibly, HCI keeps hiring the same outcome-oriented group of adjusters and consultants – all laser focused on providing HCI results that lessen or eliminate its legal responsibility to its insured – primarily by misrepresenting the true facts and circumstances in these windstorm cases. How many times does it have to take for HCI to realize the advisors, adjusters and experts HCI is hiring are getting it wrong again and again? HCI could have stopped using these outcome-oriented individuals, particularly after discovering the flaws in their work thousands of times. HCI has created a sophisticated litigation machine designed to make it very difficult for consumers and ultimately plaintiff attorneys to prosecute first-party property damage claims against it. This practice continues to be a textbook “bad faith” business practice for HCI to have designed such a claims handling framework that from day one sets up a series of traps and landmines to be used in litigation down the road. It should also be noted that HCI approaches most, if not all, of its Florida claims from the start expecting to be sued by its policyholders down the road. How and why? Because it knows that it routinely lowballs and underpays its claims. And because its “bad faith” claims handling leads to so much litigation, HCI set up a sophisticated claims handling structure coupled with an army of in-house litigation adjusters that defend the tens of thousands of improper denials and/or lowball claims valuations. HCI has done all of this instead of simply spending the premiums it charged policyholders on quality unbiased adjusters and experts and paying legitimate claims made against it. In other words, HCI decided long ago to spend millions on defensive claims handling and litigation defense costs rather than paying policyholders what it should have from the beginning – all done to increase its bottom line. This Claim is a classic example of HCI’s bad faith conduct. This bad faith conduct must be stopped and should be punished to protect Florida’s consumers. For the foregoing reasons, HCI is in direct violation of Florida Statutes identified herein and as referenced above. Furthermore, and upon information and belief, the aforementioned actions complained of, among others, were made by HCI so often as to constitute a general business practice, evidencing a motive to enhance HCI profits and designed to cause a detrimental effect to its policy holder. HCI was aware that the Insureds’ damages were covered and took advantage of its Insureds in an attempt to force them into a disadvantaged position, which HCI hoped would force the Insureds to abandon the coverage they were contractually entitled to under the Policy. This is general business practice that had resulted in harm to countless other consumers in Florida. This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should HCI fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, HCI must in addition to obviously stopping the bad faith conduct in this case, immediately tender to the Insureds the amount that remains owed to them under the specific terms and conditions of the Policy.

Comments

User Id		Date Added		Comment
Legal@hcpci.com		03-07-2025		This is Homeowners Choice Property & Casualty Insurance Company’s (“HCPCI”) response to the Civil Remedy Notice of Insurer Violations (“CRN”) filed on behalf of Gregory and Cindy Bello (“Insured”). After reviewing the CRN, HCPCI conducted a thorough review of the subject claim (“Claim”) and confirmed it handled the Claim properly. Ultimately, all issues regarding the Claim, including all issues raised in the CRN, have been resolved via a full and final settlement agreement (“settlement”). Pursuant to the settlement, the Insured signed a full, final and valid release that addresses all claims for bad faith in relation to the Claim. This response to the CRN in no way impairs or otherwise alters the full and final settlement of the Claim. Subject to the foregoing, HCPCI denies it committed a violation of any Florida statute prior to the settlement or at any time as alleged in the CRN. HCPCI also notes the CRN is deficient as, for instance, it fails to cite relevant statutory provisions along with supporting, specific insurance contract language and facts. Ultimately, as referenced above, HCPCI settled all issues regarding the Claim, including any and all issues raised in the CRN, as set forth in the release. Finally, upon request by the Department of Financial Services, HCPCI will provide to the Department of Financial Services detailed correspondence HCPCI provided to the Insured regarding HCPCI’s obligations for the Claim under the insurance contract and the facts of the Claim.

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