Civil Remedy Notice of Insurer Violations
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Filing Number:     804952
Filing Accepted:  2/4/2025
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Complainant
Last/Business Name *  
DIVITA   First Name   TIMOTHY
Street Address * 3279 ROYAL PALM DRIVE
City, State Zip * NORTH PORT, FL 34288
Email Address * MARILYNDIVITA@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   DIVITA   First Name   MARILYN
Policy # * HOD301579 Claim #* H100872
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):* CHANTAY COX, 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 Insured with good faith claims conduct
Other : Looking for ways to deny full recovery to the Insured
Other : Looking for ways to delay full recovery to the Insured
Other : Failing to properly investigate the Insured's loss
Other : Failing to provide the Insured with the full benefits awarded under the contract of insurance in a t
Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made
Other : Not adjusting claims and evaluating loss properly
Other : Shifting the burden of insuring the loss to the Insured
Other : Failing to implement proper standards for the adjustment and investigation of claims
Other : Making material misrepresentations
* 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)(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.
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
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)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

627.444(2)(a) Notwithstanding any other law, an insurer shall provide to an insured within 15 calendar days after an individual or entity designated by the insurer receives the insured's written request, either: A loss run statement. 627.4137(1)(e) - Each insurer which does or may provide liability insurance coverage to pay all or a portion of any claim which might be made shall provide, within 30 days of the written request of the Insured, a statement, under oath, of a corporate officer or the insurer's claims manager or superintendent setting forth the following information with regard to each known policy of insurance, including excess or umbrella insurance: a copy of the policy. 627.70131 (1)(a) - upon the Insurer receiving a communication with respect to a claim, the insurer shall, within 14 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer which reasonably prevent such acknowledgement. If the acknowledgement is not in writing, a notification indicating acknowledgement shall be made in the insurer's claim file and dated. A communication made to or by an agent of an insurer with respect to a claim shall constitute communication to or by the insurer. As used in this subsection, "agent" means any person to whom an insurer has granted authority or responsibility to receive or make such communications with respect to claims on behalf of the insurer. This subsection shall not apply to Insureds represented by counsel beyond those communications necessary to provide forms and instructions. 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 Insured's claim: 1) failing to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the Insured; 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) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; 8) failing to provide an estimate that complies with the Florida Building Codes; 9) shifting the burden of investigating the loss onto the Insureds; 10) failing to acknowledge and act promptly upon communications with respect to claims; 11) failing to respond to or acknowledge correspondence within statutory time period (14 days); 12) failing to provide a loss run statement; and 13) making material misrepresentations. On or about September 28, 2022, while the subject policy was in full force and effect, the insured property suffered a loss caused by Hurricane Ian. The areas impacted include but are not limited to the roofing system, foyer, living room, kitchen, closets, bedrooms, master bedroom, master bathroom, master closet, laundry room, laundry closet, garage, and patio. The Insured timely submitted a claim to the Insurer for damages caused by Hurricane Ian and the ensuing damage therefrom. Thereafter, the Insurer assigned claim number H100872 to the loss and sent a field adjuster to inspect the property on October 7, 2022. Subsequently, in a coverage determination letter dated April 21, 2023, the Insurer notified the Insured that it was extending coverage for the loss. However, the Insurer wrongfully determined that it would only require $24,780.32 to restore the insured property to its pre-loss condition, resulting in a $16,421.32 net payment to the Insured. The Insurer's lowball estimate is that of a classic under scope and under value of the claim. Given the vastly underestimated cost of repairs and the scope and nature of the damage, the Insured retained a roofing contractor. After assessing the damage and the true scope of repairs, the roofing contractor prepared an estimate identifying $106,938.92 in covered damage to the roof alone. The foregoing estimate, photographs, and a letter of representation from the public adjuster were sent to the Insurer who subsequently retained an engineer to conduct an additional inspection. The Insurer then sent a subsequent coverage determination letter, dated July 19, 2023, in which it notified the Insured that it was standing on its previous coverage decision. The Insurer misrepresented the loss and issued a wrongful partial denial. The Insurer somehow found "4 cap tiles and 1 field tile were displaced by wind pressure " and determined the roof could be spot repaired. The Insurer denied coverage for the remaining damage sustained to the roof based on the rationale that the damage was a result of " foot traffic and manual manipulation." Although the Insurer and Insured are in dispute about how the damage was sustained, the Insurer knows or should know that when independent perils converge and no single cause can be considered the sole or proximate cause, it is appropriate to apply the concurring cause doctrine. Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016). The concurring cause doctrine states that coverage may exist where an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause. Id. at 698. A covered peril that meets with an uncovered peril may still provide for coverage under a policy when the covered peril triggered the events that eventually led to the loss. Id. At 697 Upon receiving notice of the loss, the Insurer had the duty to provide the full benefits under the policy. This includes providing the Insured with a proper investigation and the funds necessary to return the home to its pre-loss condition. However, when the Insurer conducted its inspection of the insured property, the Insurer's adjuster failed to conduct a thorough and adequate investigation, or the adjuster intentionally ignored the damage observed and failed to make truthful and unbiased reports of the facts after investigating. As a result, the Insurer breached the policy by failing to fully indemnify the Insured for the covered loss. Despite the obvious water damage, the Insurer did not feel it was necessary to inspect the Insured's home for mold. A mold inspection test can be purchased online from Amazon for around $46 before tax. This mold test only takes five minutes to assess whether or not the property has mold-particulates. However, the Insurer would much rather risk the health of the Insured in order to save some time and a money. In short, when it comes to mold, the Insurer accepts premiums but does not accept the responsibility of inspecting for mold. This is further evidence that the Insurer is placing its financial interest over the health and safety of the Insured. Not surprisingly, the Insurer continued to delay and frustrate the Insured's ability to have this claim adjusted promptly by failing to timely provide the Insured with the policy after it was requested. The Insured, through their representatives, first requested the policy on or about April 24, 2023, then again on May 2, 2023, May 8, 2023, May 12, 2023, May 18, 2023, May 24, 2023, May 30, 2023, June 5, 2023, June 9, 2023, and June 14, 2023. The policy was not received within 30 days of the first written request. Each Insurer which does or may provide liability insurance coverage to pay all or a portion of any claim which might be made shall provide, within 30 days of the written request of the Insured, a statement, under oath, of a corporate officer or the insurer's claims manager or superintendent, a copy of the policy. Fla. Stat. 627.4137(1)(e). Insurers have a duty to settle claims in good faith when, under all the circumstances, they could and should have done so, had they acted fairly and honestly toward its insureds and with due regard for their interests. This is to say, this Insurer has failed and/or refused to promptly acknowledge the Insured's communication in an attempt to frustrate and delay the resolution of this claim. In addition, this shows that Insurer has failed to acknowledge the receipt of communications within fourteen (14) days in violation of Florida Statute 627.70131(1)(a). Upon an Insurer's receiving a communication with respect to a claim, the Insurer shall, within 14 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the Insurer which reasonably prevents such acknowledgement. Furthermore, the Insurer and its agents failed to comply with Fla. Stat. 627.444 by not providing the Insured and the Insured's representatives with a loss run statement. On April 24, 2023, the Insured's legal counsel provided the Insurer with a letter of representation. Within the letter, legal counsel requested a copy of a loss run statement. The Insurer and its agents have not acknowledged the request for a loss run statement nor has a loss run statement been provided. Upon an Insurer receiving a written request for a loss run statement, the Insurer is required, within fifteen (15) calendar days, to provide either a loss run statement or information on how to obtain a loss run statement at no charge through a consumer reporting agency. There has been no response within fifteen (15) calendar days of the Insured's written request and the Insurer has not provided information on how to obtain a loss run statement at no charge through a consumer reporting agency. This Insurer has breached its duty to settle claims in good faith when, under all the circumstances, it could and should have done so. The Insurer and its agents have not acted fairly and honestly toward the Insured and the Insured's representative and have moreover failed or refused to promptly acknowledge the Insured's communications in an attempt to frustrate and delay the resolution of the Insured's claim. Moreover, upon information and belief, the Insurer wrongfully under-scoped for the Insured's roof because it knows or should have known that the Insured needs a new roof in order to comply with the Florida Building Code. Rather than paying for a roof replacement consistent with all laws and ordinances, the Insurer contends the roof is repairable, which is not true. All repairs to the roofing system must be done in accordance with applicable Florida Building Codes which require all repairs be done consistent with the manufacturer's specifications and warranties which this Insurer clearly did not account for. The conduct outlined above is done within the Insurer's routine course of the business. There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer's claim file and standards and procedures for the adjustment and investigation of claims. In short, the Insurer is not acting with due regard for the Insured's interests or safety. In Florida the work of adjusting insurance claims engages the public trust. The Insurer has breached this trust and its duty to the Insured. The Insurer and its agents conducted cursory and inadequate investigations and wrongfully determined that it would only require $24,780.32 to restore the insured property to its pre-loss condition. Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer's actions and inactions have continued to frustrate and delay the resolution of the Insured claim. The Insurer's actions amount to but are not limited to the following: 1. Claim delay 2. Not treating the Insured with good faith claims conduct 3. Looking for way to reduce recovery to the Insured 4. Looking for ways to deny recovery to the Insured 5. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured 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 Insured's' interests 7. Placing the financial interest of the Insurer over that of the health and safety of the Insured 8. Failing to provide an estimate that complies with the Florida Building Codes 9. Shifting the burden of investigating onto the Insured 10. Conducting inadequate investigations 11. Requesting a re-inspection despite no changes to the above-referenced insured property 12. Treat represented and unrepresented Insured differently 13. Failing to provide a loss run statement 14. Making material misrepresentations Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must: (1). Admit full coverage for the Insured's loss. (2). Tender full benefits owed to the Insured under the insurance contract. A copy of this form submitted to the FDFS has been sent via e-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 E-mail: Heritage Property & Casualty Insurance Company P. O. Box 6417 Clearwater, FL 33758 claims@heritagepci.com
Comments
User Id Date Added Comment
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: Timothy Divita and Marilyn Divita Insured: Timothy Divita and Marilyn Divita Insurer: Heritage Property & Casualty Insurance Company DFS File No.: 804952 Claim No: H100872 Policy No.: HOD301579 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 804952 for claim H100872, filed by or on behalf of Heritage’s insureds Timothy Divita and Marilyn Divita, and accepted by the department on February 4, 2025. Without waiving Heritage’s arguments that the subject Civil Remedy Notice is legally insufficient and non-compliant with Florida law, the Notice is legally insufficient as it fails to specify who at Heritage committed the alleged violations, when the alleged violations were committed and fails to give specific facts supporting the alleged violations. Fla. Stat. § 624.155(3)(b)(4) requires the Complainant to set forth with specificity the policy language that is relevant to the violation. The Notice is legally insufficient because it allegedly lists the entire policy and does not specify which policy provisions were violated. In addition, the Notice fails to specifically and correctly quote the policy. The Notice alleges the reasons for the Notice are the following: Unfair Trade Practice The Notice fails to state who, how and when an 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. Unsatisfactory Settlement Offer The Insureds fail to state who, how and when an unsatisfactory settlement offer was made therefore it lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. Claim Delay The Insureds fail to state who, how and when a claim delay was done. In fact it states that Heritage issued payment for the claim. Therefore it lacks a factual basis to support this allegation and lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. The Notice alleges the following violations: 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 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. 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 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. 626.9541(1)(i)(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. 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. 626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims. 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 alleged standards for proper investigations are that Heritage failed to adopt or implement, and who failed to adopt and implement the standards. 626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims. 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 as to who failed 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 The Insureds fail to state who, how and when a claim denial was made. In fact it states that Heritage issued payment for the claim. Therefore it lacks a factual basis to support this allegation and lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. 626.9541(1)(i)(3)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b). The Insureds fail to state why this rule is applicable to its homeowner’s insurance claim. 627.444(2)(a) Notwithstanding any other law, an insurer shall provide to an insured within 15 calendar days after an individual or entity designated by the insurer receives the insured's written request, either: A loss run statement The Insureds fail to state the entirety of 627.442(2)(a) and why this rule is applicable to its homeowner’s insurance claim. The Insureds also fail to state how or when a loss run statement was requested or any alleged specific facts. 627.4137(1)(e) Each insurer which does or may provide liability insurance coverage to pay all or a portion of any claim which might be made shall provide, within 30 days of the written request of the Insured, a statement, under oath, of a corporate officer or the insurer's claims manager or superintendent setting forth the following information with regard to each known policy of insurance, including excess or umbrella insurance: a copy of the policy. 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. The Insureds also don’t state why this is applicable to it’s homeowner’s insurance claim. 627.70131(1)(a) upon the Insurer receiving a communication with respect to a claim, the insurer shall, within 14 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer which reasonably prevent such acknowledgement. If the acknowledgement is not in writing, a notification indicating acknowledgement shall be made in the insurer's claim file and dated. A communication made to or by an agent of an insurer with respect to a claim shall constitute communication to or by the insurer. As used in this subsection, "agent" means any person to whom an insurer has granted authority or responsibility to receive or make such communications with respect to claims on behalf of the insurer. This subsection shall not apply to Insureds represented by counsel beyond those communications necessary to provide forms and instructions. 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. Heritage does not waive any of its defenses regarding the Notice including but not limited to any technical and factual deficiencies contained in the Notice. Sincerely, /s/ Robert R. Beard III Robert R. Beard III, Esq. Staff Counsel Heritage Property & Casualty Insurance Co. cc: Grant Krapf, Esq., via email; grant@krapflegal.com CRN Response
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