Filing Number: 804524
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| Filing Accepted: 1/31/2025 |
| Last/Business Name
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| Street Address
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179 SUNWARD AVE. |
| City, State Zip
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PALM HARBOR,
FL
34684
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| Email Address
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STEVEN@CROSKEYLAW.ORG |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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FARAG |
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First Name |
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REMON |
| Policy # * |
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HOH271798 |
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Claim #* |
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H010023159 |
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Attorney is Applicable
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| Last Name* |
STEVEN
First Name *
CROSKEY
Initial
AT
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| Street Address* |
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1644 BLANDING BLVD. |
| City, State Zip* |
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JACKSONVILLE
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FLORIDA
32210
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| Email Address * |
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STEVEN@CROSKEYLAW.ORG |
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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):*
RENEE GILMORE
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| Type of Insurance
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Residential Property & Casualty
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| Reason for Notice
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Claim Denial
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Claim Delay
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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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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)(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)(g) |
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Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Coverage A – Dwelling: Insurer is required to cover damage incurred by an insured event to the Insured’s dwelling. Insurer is required to cover damage that Insured has claim coverage for.
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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.
On or about August 5, 2024, Claimants suffered loss to their Insured Property as a result of a windstorm. The Claimant reported same loss to the Insurer subsequently thereafter, and the Insurer had the insured Property inspected. The Insurer denied the claim despite Claimant’s roofing company, loss consultant, and engineer indicating that there is clear wind damage to the roof and interior damage from wind driven rain. The Insurer refuses to acknowledge independent engineering reports in order to deny the claim. As a result, Claimant asserts that the Insurer is attempting to undermine the cost of repairs and damage to the Insured Property identified by the Claimant. Moreover, the Insurer is failing or refusing to pay for a replacement of the roof despite the circumstances indicating that more than 25% of the total roof area or roof section of the Property needs to be repaired, replaced or recovered, all within a 12-month period. Claimant asserts that all of these things taken into consideration, along with everything described below, and also each one individually, the Insurer acting in bad faith and not fairly towards the Claimant based off of the circumstances. In Florida, the work of adjusting insurance claims engages the public trust. The Insurer breached this duty in the adjustment of this claim, by failing to apply the insurance policy language to its coverage analysis by, inter alia, unreasonably underpaying a claim with knowledge of higher costs being required to restore the property to its pre-loss condition. Accordingly, the Insurer’s conduct as described herein was inappropriate. Furthermore, by failing to justify any of Insurer’s actions and omissions with policy language, the Insurer is actively misrepresenting a fact material to Insured’s claim, materially misrepresenting the policy, prejudicially investigating the claim, and wrongfully denying and/or limiting coverage based upon these misrepresentations. Specifically, the Insurer knew or had cause to know the amount tendered was insufficient to restore the property to its pre-loss condition; thus the Insurer (1) failed to act in good faith and due diligence to resolve claims; (2) placed the Insurer’s financial interest before that of the Insureds; (3) delayed benefit payments to Insured; (4) unfairly looked for ways to reduce Insured’s recovery; (5) writing to justify their settlement amount; (6) failed to pay the full benefit owed to Insureds; (7) misrepresented the insurance policy provision(s) to the Insured; (8) failed to provide a certified copy of the applicable insurance policy after written request was made as if to further distance the Insured from being able to negotiate this claim with a certified policy in the Insured’s possession; (9) failed to promptly pay the full benefit owed to the Insured; and (10) failed to correct its mistake(s) prior to entry of this civil remedy. These actions and omissions are all inherently deceptive and unfair to any person insured by them. Insurer’s misconduct needlessly increasing the likelihood of continued damage to the Insured Property.
NOTICE: This notice is given in order to perfect the right to pursue the civil remedy authorized by this section. It appears Insurer has a pattern of violating, at the very least, Florida Statute 624.155(1)(b)(1) and also 627.70131(5)(a), 626.9541(1)(i)(3)(c) and 627.70131(1)(a). Undersigned Counsel is aware of numerous other claims where Insurer failed to act in good faith in resolving residential property and casualty insurance claims. Many of these instances are recorded in the Civil Remedy Notice database which indicates these are general business practices for the Insurer.
Insurer’s wrongful conduct and omissions include, but are not limited to those identified above and the following: (1) claim delay; (2) not conducting full and prompt investigation; (3) not treating the Insured with good faith claims conduct; (4) looking for ways to deny, reduce, or delay recovery to Insured; (5) holding back and failing to pay the claim, clearly owed; (6) not adjusting the claim and evaluating the loss property promptly and fairly to provide full and prompt indemnity to the Insured; (7) failing to implement proper standards for the adjustment and investigation of claims; (8) not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company’s interests before the policyholder’s interests; (9) establishing severity control initiatives and otherwise establishing a culture of not fully and promptly paying claims following losses; (10) failing to pay the full amount of the Insured’s damage despite knowing it must do so; (11) ignoring the standard industry practice of including overhead and profit onto a multi-trade claims report while knowing or having cause to know about the claim covering multiple trades. There may be further wrongful conduct which has not been made known to the Insureds. Certain conduct or actions cannot be verified without a review of the Insurer’s claims file and claim guidelines.
Therefore, to cure the defects outlined in this Civil Remedy Notice, Insurer must: (1) admit the misconduct referenced above was incorrect; (2) immediately provide a certified copy of the applicable policy hereto; (3) immediately tender full value of this claim in order to restore the Insured Property to its pre-loss condition; (4) act fairly and honestly towards the Insured, and with due regard for the Insured’s interest in attempting to settle the claim; (5) pay statutory interest on the amount of unpaid contractual damages from the date the claim was reported; (6) cease and desist all present and future bad faith actions with regard to the Insured’s claim. Failure to cure all defects during the 60-day safe harbor period may result in additional extra-contractual damages.
Claimant incorporates by reference as if fully set forth herein the facts asserted in the Complaint, and all Amended Complaint(s), filed in Pinellas County, Florida on January 28, 2025, case no.: 25-000848-CO.
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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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