Filing Number: 803656
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| Filing Accepted: 1/27/2025 |
| Last/Business Name
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PINEBROOK WOODS HOMEOWNERS ASSOCIATION, INC.
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First Name |
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| Street Address
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13004-13272 TALL PINE CIRCLE |
| City, State Zip
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FORT MYERS,
FL
33907
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| Email Address
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ALFONSOJ.DASILVA@GMAIL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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PINEBROOK WOODS HOMEOWNERS ASSOCIATION, INC. |
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First Name |
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| Policy # * |
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HCP000372-7 |
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Claim #* |
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H102467 |
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Attorney is Applicable
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| Last Name* |
BOYD
First Name *
CALSIE
Initial
M
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| Street Address* |
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3001 17TH STREET |
| City, State Zip* |
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METAIRIE
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LOUISIANA
70002
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| Email Address * |
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CBOYD@HSTALAW.COM |
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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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| Insurer Name* |
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| Street Address* |
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| City, State Zip* |
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,
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NAIC Company Code 14407 |
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| Name of individual responsible for violation (if any):*
MICAH TOMPKINS
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| Type of Insurance
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Commercial Property & Casualty
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| Reason for Notice
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Unsatisfactory Settlement Offer
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Claim Delay
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Unfair Trade Practice
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Claim Denial
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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)(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)(e) |
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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.
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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)(h) |
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Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
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| 626.9541(1)(i)(3)(i) |
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Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
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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.
VARIOUS LANGUAGE THROUGHOUT THE POLICY, INCLUDING BUT NOT LIMITED TO PROVISIONS GOVERNING COVERAGE FOR ROOF DAMAGE, WATER DAMAGE, WINDSTORM DAMAGE, THE LOSS PAYMENT PROVISION(S), THE PROVISIONS GOVERNING THE DUTIES AND OBLIGATIONS OF THE INSURER; AND COMMERCIAL PROPERTY COVERAGE PART; BUILDING AND PERSONAL PROPERTY COVERAGE FORM; CAUSES OF LOSS – SPECIAL FORM; COMMERCIAL PROPERTY CONDITIONS; PROPERTY ENHANCEMENT ENDORSEMENT LIMITED ORDINANCE OR LAW – EXTENSION OF COVERAGE; ROOF/ACTUAL CASH VALUE ENDORSEMENT. HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY HURRICANE DEDUCTIBLE.
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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 HAS BREACHED THIS DUTY THROUGH ITS HANDLING OF THE CLAIM. THE INSURER HAS FAILED TO EVALUATE CLAIMS HANDLING AND TRAINING AND SUPERVISION OF ITS EMPLOYEES AND REPRESENTATIVES RESULTING IN STATUTORY VIOLATIONS AS SET FORTH WITHIN THIS CRN:
1) FAILURE TO PAY CLAIM IN FULL; 2) FAILURE TO PROMPTLY INVESTIGATE CLAIM; 3) FAILURE TO PROPERLY INVESTIGATE CLAIM; 4) FAILURE TO ADJUST LOSS; 5) FAILURE TO ACT IN DUE DILIGENCE AND GOOD FAITH TO RESOLVE CLAIM; 6) PLACING FINANCIAL INTEREST OF INSURER BEFORE THAT OF POLICY HOLDERS AND CLAIMANTS; 7) FAILURE TO PROPERLY TRAIN, EVALUATE AND MANAGE ADJUSTERS; 8) LOOKING FOR WAYS TO DENY COVERAGE, PAY LESS, DELAY PAYMENT AND OTHERWISE “LOW BALL” OR “STONE WALL” CLAIM; 9) THE REASONS FOR THIS MAY BE ATTRIBUTED TO IMPROPER TRAINING, SUPERVISION, AND/OR MOTIVATION OF ADJUSTERS AND CLAIMS SUPERVISORS. THE INSURER APPEARS TO HAVE FAILED TO ADOPT THE PROPER STANDARDS OF INVESTIGATION AND ADJUSTMENT OF LOSSES OR IS OTHERWISE NOT IMPLEMENTING THOSE STANDARDS BECAUSE FULL PAYMENT AND PROMPT PAYMENT FOR THE LOSS IS NOT OCCURRING.
THIS COMPLAINT IS MADE ON THE BEHALF OF THE NAMED INSURED, PINEBROOK WOODS HOMEOWNERS ASSOCIATION, INC. IN CONSIDERATION OF THE PREMIUMS PAID TO THE INSURANCE COMPANY, HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY, A POLICY OF INSURANCE WAS ISSUED TO PINEBROOK WOODS HOMEOWNERS ASSOCIATION, INC., WHICH PROVIDED COVERAGE FOR CERTAIN LOSSES-INCLUDING WIND DAMAGE ASSOCIATED WITH HURRICANE IAN. DURING THE POLICY PERIOD, HURRICANE IAN CAUSED CONSIDERABLE DAMAGE TO THE INSURED'S PROPERTY AND OTHER STRUCTURES. THE INSURED PROPERTY SUFFERED DAMAGE WHICH WAS AND IS COVERED BY THE TERMS AND CONDITIONS OF THE INSURANCE POLICY. THE LOSS WAS SUDDEN AND ACCIDENTAL, AND THEREFORE A COVERED PERIL UNDER THE POLICY. PINEBROOK WOODS HOMEOWNERS ASSOCIATION, INC. PROMPTLY REPORTED THE LOSS TO THE INSURANCE COMPANY AND HAS COMPLIED WITH ALL THE CONDITIONS OF THE POLICY.
AFTER AN INSUFFICIENT INVESTIGATION AND THE PREPARATION OF A LACK LUSTER ESTIMATE, THE INSURANCE COMPANY UNDERVALUED AND UNDERPAID THE DAMAGES TO THE INSURED PROPERTY BY DETERMINING THAT THE DAMAGES RELATING TO THE CLAIM CONTAINED ITEMS UNRELATED TO HURRICANE IAN DAMAGE AND THAT PINEBROOK WOODS HOMEOWNERS ASSOCIATION, INC.’S ROOFS HAD DAMAGES THAT COULD BE REPAIRED RATHER THAN REPLACING THE ROOFS.
DUE TO CONCERNS WITH THE DELAY IN THE INVESTIGATION AND THE INSURANCE COMPANY’S UNDERVALUE AND UNDERPAYMENT OF THE CLAIM, THE INSURED RETAINED AN EXPERIENCED AND HIGHLY QUALIFIED PUBLIC ADJUSTER-DAY ADJUSTING-TO PREPARE AN ESTIMATE OF DAMAGE. AFTER THE CLAIM COULD NOT BE RESOLVED PRIOR TO FOLLOWING SUIT, INSURED FILED SUIT AGAINST THE INSURER. THE INSURED HIRED AN EXPERT TO EVALUATE THE DAMAGE AND ALSO PREPARE AN ESTIMATE AND SUPPORTING REPORT. THE ESTIMATED COST OF REPAIRS TO THE INSURED PROPERTY CURRENTLY STANDS AT APPROXIMATELY $ 8,638,026.43.
THE INSURED HAS PROVIDED THE INSURER WITH DOCUMENTATION SUPPORTING THE MITIGATION OF THEIR DAMAGES ASSOCIATED WITH THEIR CLAIM FROM. THE INSURED HAS MADE AN APPLICATION FOR INSURANCE BENEFITS UNDER THE POLICY BUT THE INSURANCE COMPANY HAS FAILED AND/OR REFUSED TO PAY THE FULL BENEFITS TO WHICH THE INSURED IS ENTITLED FOR THE LOSS. THE INSURANCE COMPANY HAS BREACHED THE POLICY OF INSURANCE BY FAILING TO PAY ALL OF THE BENEFITS DUE UNDER THE POLICY. THE INSURANCE COMPANY HAS FAILED TO SATISFACTORILY SETTLE THIS CLAIM AND HAS DEPRIVED THE INSURED OF A PROPER RESOLUTION OF THIS CLAIM. THE INSURANCE COMPANY HAS FAILED AND/OR REFUSED TO PROPERLY INVESTIGATE THE LOSS AND HAS FAILED AND/OR REFUSED TO TENDER THE PROPER AMOUNT OF INSURANCE BENEFITS DUE AND OWING TO THE INSURED.
IN ORDER TO CURE THE CONDUCT GIVING RISE TO THE VIOLATIONS DESCRIBED HEREIN, THE INSURANCE COMPANY MUST COMPLETE A PROPER EVALUATION OF THE DAMAGES VIA QUALIFIED PROFESSIONALS AND IMMEDIATELY ISSUE PAYMENT FOR ALL THE COVERED DAMAGES PRESENTED BY THE INSURED AND THE INSURED’S REPRESENTATIVES. IN ADDITION, THE INSURANCE COMPANY MUST ISSUE PAYMENT TO THE INSURED FOR REASONABLE FEES, COSTS, AND PRE-JUDGMENT INTEREST IF REQUIRED BY THE APPLICABLE FLORIDA STATUTES. AS AN ALTERNATIVE CURE OPTION, THE INSURANCE COMPANY MAY CURE THE ALLEGATIONS GIVING RISE TO THIS NOTICE BY TENDERING A CHECK IN THE AMOUNT OF $8,638,026.43, LESS THE APPLICABLE DEDUCTIBLE AND PRIOR PAYMENTS, WITHIN THE 60-DAY CURE PERIOD, JOINTLY PAYABLE TO “HAIR SHUNNARAH TRIAL ATTORNEYS, DAY ADJUSTING AND PINEBROOK WOODS HOMEOWNERS ASSOCIATION, INC.”
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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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