Civil Remedy Notice of Insurer Violations
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Filing Number:     804040
Filing Accepted:  1/29/2025
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Complainant
Last/Business Name *  
ESPERANCE   First Name   SAINVIL
Street Address * 4486 35TH AVENUE
City, State Zip * VERO BEACH, FL 32967
Email Address * CLAY@THEKRFIRM.COM
Complainant Type: * Insured
Insured
Last/Business Name*   ESPERANCE   First Name   SAINVIL
Policy # * HPH063358 Claim #* H010035321
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 *
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)(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 HPH063358, 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.

Sainvil Esperance (hereinafter “Insured”) is a homeowner insured with an all-risks policy issued by Heritage Property & Casualty Insurance Company (hereinafter “Carrier”). On or about October 9, 2024, Insured’s home located at 4486 35th Avenue, Vero Beach, Florida 32967 sustained significant damage as a result of a windstorm event. Specifically, Hurricane Milton 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, entrance, living room, guest bathroom, and guest bedroom. The Loss is covered under Insured’s policy issued by Carrier. The Insured mitigated damages by contacting Florida Water and Mold Restoration who performed mitigation services on 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. H010035321 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 $103,547.11, which was a fair and reasonable assessment for the repair/replacement of damages. Florida Water and Mold Restoration has an outstanding balance in the amount of $8,954.90 for their mitigation services. 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. 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 gave Insured a lowball estimate that failed to encompass all covered damages. The carrier only offered to pay $0.00, after applicable deductible $3,773.00, a gross underpayment for all the damage associated with this claim. 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 $103,547.11, and Florida Water and Mold Restoration in the amount of $8,954.90, less applicable deductible and prior payments, 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
Comments
User Id Date Added Comment
ncarlisle@heritagepci.com 03-07-2025 March 7, 2025 VIA ELECTRONIC SUBMISSION Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Complainant: Sainvil Esperance Insured: Sainvil Esperance Insurer: Heritage Property & Casualty Insurance Company DFS File No.: 804040 Claim No: H010035321 Policy No.: HPH063358 Address: 4486 35th Ave., Vero Beach, FL 32967 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 804040, filed on behalf of Sainvil Esperance (“Complainant”). The Department accepted the Notice on January 29, 2025. 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. First, the Notice failed to identify all the person and persons representing Heritage from the Claims department, which supervisor, management, agents, and adjuster, including following representative and adjusters, and vendors who are most responsible for knowledgeable of the facts giving rise to the allegation in the Notice, as explicitly required. Additionally, 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. 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. 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 does not indicate the policy language violated or which specific Section or policy term. Therefore, the Notice failed to provide sufficient notice to Heritage regarding the provision allegedly violated. Additionally, the Notice failed the Insurer’s address, as specifically required. Still, the Notice failed to adequately provide the insured’s e-mail address. 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 HPH063358 for the property at 4486 35th Ave, Vero Beach, FL 32967. 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 first notice of loss on October 31, 2024, claiming damages from Hurricane Milton on October 09, 2024, Heritage promptly assigned claim number H010035321. An acknowledgment letter with a Bill of Rights was submitted to Complainant on the same day. On November 20, 2024, Heritage also received a Letter of Representation from Complainant’s Public Adjuster, Five Star Claims Adjusting. In the meantime, Heritage enlisted the services of a field adjuster to coordinate an inspection of the alleged damage caused by the alleged Hurricane. Complainant requested it to occur on November 20, 2024. The on-site inspection documents the property's exterior and interior conditions of the property. Complainant was present for the inspection. On December 4, 2024, after conducting a reasonable investigation based on available information to Heritage, and in accordance with its obligations under §627.70131, Fla. Stat., Heritage timely 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 field adjuster inspection, the estimated cost of the covered repairs was $1,727.51, below the policy deductible of $3,772.00. And because the estimate to repair the property was less than the deductible, no payment would be forthcoming. Moving forward, Heritage received additional documents from Complainant’s public adjuster and mitigation documents. On January 29, 2025, A Notice of Intent to Initiate Litigation (“NOI”) was also filed. In Response, Heritage submitted an offer for settlement. On the same day, Kuhn Raslavich, P.A., on behalf of the Complainant, filed this Notice with the Department, to which Heritage provided a response. 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: Unsatisfactory Settlement Offer The Notice fails to state who, how, and when an “unsatisfactory settlement offer” 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. 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 affording coverage 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. Additionally, Heritage responded to the NOI by providing an offer for settlement. 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 affording coverage 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. Additionally, Complainants 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 affording coverage 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. Additionally, Complainant failed to specifically identify the “misrepresenting facts or insurance policy provision” allegedly committed by Heritage. As such, 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: This allegation is inapplicable to this claim, as coverage for covered damages was afforded. As such, 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 to inspect and investigate the claim. Further, in contrast to this allegation, Heritage has timely made a coverage determination affording coverage 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, provided a coverage determination, and made offers for settlement of the claim. 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 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 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. 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 $103,547.11, and Florida Water and Mold Restoration in the amount of $8,954.90, less applicable deductible and prior payments, which is the reasonable amount of the covered loss pursuant to the policy.” Although Heritage opened coverage for the claim at issue, it is unclear what amount the Complainant seeks. If Heritage pays an unspecified amount as a supplemental payment, it is unclear if this would be sufficient to cure this demand and the resolution of the lawsuit filed in the circuit court of Indian River County. 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