Civil Remedy Notice of Insurer Violations
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Filing Number:     804941
Filing Accepted:  2/4/2025
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Complainant
Last/Business Name *  
PATEL   First Name   ALKESH
Street Address * 3283 SIDERWHEEL DRIVE
City, State Zip * ROCKLEDGE, FL 32955
Email Address * ALPAT169@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   PATEL   First Name   ALKESH
Policy # * HOH634047 Claim #* H86928
Attorney
Attorney is Applicable
Last Name* KRAPF First Name * GRANT Initial W
Street Address* 2790 SUNSET POINT RD
City, State Zip* CLEARWATER , FL 33759
Email Address * GRANT@KRAPFLEGAL.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):* WITHOUT KNOWLEDGE BUT GENERALLY THE CLAIMS DEPARTMENT OF THE INSURER AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, HERITAGE PROPERTY & CASUALTY INSURANCE COMPANY WHO WAS INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unfair Trade Practice
Other : Not treating the policyholders with good faith claims conduct
Other : Looking for ways to deny full recovery to the Insureds
Other : Looking for ways to delay full recovery to the Insureds
Other : Failing to properly investigate the Insureds' loss
Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made,
Other : Failing to provide the Insureds with the full benefits awarded under the contract of insurance in a
Other : Failing to promptly communicate to the Insureds
* 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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

626.9541(1) (2) a material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy. 627.70131(5)(a) failing to make any payment of an initial or supplemental claim or portion of such claim within 90 days after the Insurer receives notice of the claim, or made more than 15 days after there are no longer factors beyond the control of the insurer which reasonably prevented such payment, whichever is later, bears interest. Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Heritage Property & Casualty Insurance Company (the "Insurer") has committed the following in handling the Insureds' claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the policy holders and Claimants; 3) looking for ways to deny benefit payments and otherwise "low ball" or "stone wall" claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) looking for ways to delay benefit payments; 7) shifting the burden of investigating the loss onto the Claimants; 8) making material misrepresentations of the coverages afforded under the insurance policy; and 9) conducting inadequate investigations. The Claimant timely submitted a claim to the Insurer for wind damage sustained to the above-referenced insured property, including the ensuing damage therefrom. Given the scope and nature of the damage, the Insured retained a public adjuster to estimate the covered damage. A copy of their estimate, dated May 4, 2022 detailing $36,306.05 in covered damage due to the Insured was sent to the Insurer but they have failed to substantively respond to the estimate of the damages or the claim itself, only delaying the matter. In delaying the determination of this claim, the Insurer has shifted the burden and cost of investigating and insuring the loss onto the Claimant. The Insurer upon the Claimant's loss had the duty to provide the full benefits under the policy. This includes providing the Claimant with the proper investigation and the funds necessary to return their home to its pre-loss condition. The Insurer is placing its financial interest over the health and safety of the Claimant. Subsequently, the initial Civil Remedy Notice in this matter was filed, and the Insurer took the Examination Under Oath of their Insured, however no coverage decision letter has been received and no decision has been made, only continuing the Insurer's obvious strategy of delay. In short, Insurer is not acting with due regard for the Insureds' interests. In Florida the work of adjusting insurance claims engages the public trust. The Insurer has breached this duty. The Insurer takes advantage of the knowledge imbalance and presents estimates which it knows are inadequate so that it may keep money that otherwise should go to the homeowner. The Insurer has intentionally undervalued the Claimants' loss so that it may render less than the full benefits due under the contract of insurance. The Insurer's actions amount to but are not limited to the following: 1. Claim delay 2. Not treating the policyholders with good faith claims conduct 3. Looking for ways to reduce recovery to the Insureds 4. Looking for ways to deny recovery to the Insureds 5. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insureds 6. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company's interests before the policyholders' interests 7. Placing the financial interest of the insurer over that of the Insureds 8. Failing to pay interest on claim payments that are older than 90 days 9. Shifting the burden of investigating the loss onto the Claimants 10. Treating represented and unrepresented parties differently 11. Requesting a re-inspection only after the Insureds retained a public adjuster 12. Making material misrepresentations of the coverages afforded under the insurance policy 13. Conducting inadequate investigations 14. Failing to provide an estimate that complies with the Florida law Therefore, to cure the defects outlined in this civil remedy notice, the insurer must: (1) Admit full coverage for the Insureds' loss. (2) Tender full benefits owed to Insureds under the insurance contract. (3) Implement policies and procedures to ensure that all estimates and instructions comply with the Florida Statutes. (4) Implement policies and procedures to ensure that all claimants are treated with equal fairness to the investigation of claims. A copy of this form submitted to the FDFS has been sent via certified mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to badfaith@krapflegal.com. Via Electronic Mail: Heritage Property & Casualty Insurance Company P.O. Box 6417 Clearwater, FL 33758 claims@heritagepci.com
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ncarlisle@heritagepci.com 03-26-2025 March 26, 2025 VIA ELECTRONIC SUBMISSION Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Complainant: ALKESH PATEL Insured: ALKESH PATEL Insurer: Heritage Property & Casualty Insurance Company DFS File No.: 804941 Claim No: H86928 Policy No.: HOH634047 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 804941, filed on behalf of Heritage’s insured ALKESH PATEL (“Complainant”). The Notice was accepted by the Department on February 4, 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. The Notice fails to inform Heritage whether it had been given to perfect the right to pursue the civil remedy authorized by Florida Statute §624.155 and Florida Case law. History of Claim For clarification, Heritage provides a brief history of the claim: Subject to its terms, endorsements, limitations, exclusions, and conditions, the Complainant was issued Policy HOH634047 (“Policy”) for the property at 3283 SIDERWHEEL DRIVE, ROCKLEDGE, FL 32955 (“Property”). The Policy of Insurance applies to direct physical loss of or damage to covered property at the premises described in the Declarations of the Policy or resulting from any Covered Cause of Loss as described in the Policy. Heritage sent a licensed adjuster to inspect the insured property, and after its inspection and underlying investigation of the claim, Heritage sent a coverage determination letter to the insured; wherein, Heritage provided a thorough explanation of the coverage determination. Payment was sent under separate cover. Furthermore, Complainants and Heritage settled the claim for an agreeable amount on or about November 22, 2023. As previously stated, Heritage has adjusted the subject claim at all times in accordance with the insurance policy and Florida Statute. To date, Heritage has not received any information that would alter its understanding of the loss or coverage. Alleged Reasons for the Notice In accordance with Fla. Stat. §624.155, the Civil Remedy Notice requires the Complainant, “to indicate all statutory provisions alleged to have been violated.” The Notice alleges the reasons for the Notice are the following: Claim Delay The Notice fails to state instances of “claim delay" 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. Not treating the Insured with good faith claims conduct The Notice fails to state instances of not treating the Insured with good faith claims conduct practice occurred; therefore, it lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. Looking for ways to deny full recovery to the Insured The Notice fails to state instances of looking for ways to deny full recovery to the Insured practice occurred; therefore, it lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. Looking for ways to delay full recovery to the Insured The Notice fails to state instances of looking for ways to delay full recovery to the Insured practice occurred; therefore, it lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. Failing to properly investigate the Insured's loss The Notice fails to state instances of failing to properly investigate the Insured's loss practice occurred; therefore, it lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. Not training, supervising, or managing adjusters properly so that prompt and full payments are made The Notice fails to state instances of not training, supervising, or managing adjusters properly so that prompt and full payments are made practice occurred; therefore, it lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. Failing to promptly communicate to the Insureds The Notice fails to state instances of the alleged failure to respond or act promptly to insured communications practice occurred; therefore, it lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. “Failure to provide the Insured with the full benefits awarded under the contract of insurance in a” The Notice fails to state instances of failure to provide the Insureds with the full benefits under the contract of insurance claim practice occurred; therefore, it lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. Alleged Violations of Statutory Provisions Further, the Notice filed in this matter alleges Heritage violated the following statutory provisions: • §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: The Notice does not provide any specifics by way of who, when and how Heritage committed this violation and therefore fails to comply with the specificity required by Florida Statute §624.155 and thus does not put Heritage on the requisite notice. Accordingly, and as indicated by the facts stated above, Heritage has at all times acted fairly and honestly. Further, Heritage has conducted a reasonable investigation based on available information and made a coverage determination in reference to Complainant’s 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. Regardless, Heritage denies the allegations contained herein. • §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. Response: The Notice does not provide any specifics by way of who, when and how Heritage committed this violation and therefore fails to comply with the specificity required by Florida Statute §624.155 and thus does not put Heritage on the requisite notice. Nowhere in the notice does it state when Heritage paid under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage, nor does it state who did it. Accordingly, and as indicated by the facts stated above, Heritage has at all times promptly settled claims. Further, Heritage has conducted a reasonable investigation based on available information and made a coverage determination in reference to Complainant’s 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. Regardless, Heritage denies the allegations contained herein. • §626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims. Response: The Notice does not provide any specifics by way of who, when and how Heritage committed this violation and therefore fails to comply with the specificity required by Florida Statute §624.155 and thus does not put Heritage on the requisite notice. Nowhere in the notice does it state what the alleged standards for proper investigations are that Heritage failed to adopt or implement, and/or who failed to adopt and implement the standards. Regardless, Heritage denies the allegations contained herein. Accordingly, and as indicated by the facts stated above, Heritage has at all times acted fairly and honestly, upholding and implementing standards for the proper investigation of claims. Further, Heritage has conducted a reasonable investigation based on available information and made a coverage determination in reference to Complainants’ 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. • 626.9541(1)(i)(3)(b): Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. Response: The Notice does not provide any specifics by way of who, when and how Heritage committed this violation and therefore fails to comply with the specificity required. Nowhere in the notice does it state what the pertinent facts or policy provisions which were allegedly misrepresented, and who made the misrepresentations. Furthermore, Florida courts have found that listing nearly all policy provisions on the notice did not satisfy the statute. Fox v. Starr Indem. & Liab. Co., No. 8:16-CV-3254-T-23MAP, 2017 U.S. Dist. LEXIS 65123, 2017 WL 1541294, at *2 (M.D.Fla. Apr. 28, 2017). Regardless, Heritage denies the allegations contained herein. Accordingly, and as indicated by the facts stated above, Heritage has at all times acted fairly and honestly in its representation of pertinent facts and insurance policy provisions relating to coverages at issue. Further, Heritage has conducted a reasonable investigation based on available information and made a coverage determination in reference to Complainants’ 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. • §626.9541(1)(i)(3)(c): Failing to acknowledge and act promptly upon communications with respect to claims. Response: The Notice does not provide any specifics by way of who, when and how Heritage committed this violation and therefore fails to comply with the specificity required by Florida Statute §624.155 and thus does not put Heritage on the requisite notice. Regardless, Heritage denies the allegations contained herein. Accordingly, and as indicated by the facts stated above, Heritage has always promptly acknowledged communications and acted promptly with respect to the claim. Further, Heritage has conducted a reasonable investigation based on available information and made a coverage determination in reference to Complainants’ 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. Request to Reject Notice 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. 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. Moreover, 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. Strict construction of §624.155 demands a specificity level of compliance with the requisite provision of information to the Department and the insurer. See id; See also Marques v. Heritage Property & Cas. Ins. Co., No. 56 2020 CA 000805, 2021 WL 3473940, at 2 (Fla. Cir. Ct. Aug. 02, 2021). As such, the Notice does not comply with Florida law and is legally insufficient. 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. 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). Similarly to Rousso, 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. In closing, 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. Sincerely, /s/ Tamara Schweinsberg Tamara Schweinsberg, Esq. Senior Claims Counsel Heritage Property & Casualty Insurance Co. Civil Remedy Notice of Insurer Violation Response
grant@krapflegal.com 02-04-2025 This Civil Remedy Notice is hereby withdrawn.
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