Civil Remedy Notice of Insurer Violations
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Filing Number:     805115
Filing Accepted:  2/4/2025
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Complainant
Last/Business Name *  
GARCIA   First Name   CLARA
Street Address * 1090 NW 123RD COURT
City, State Zip * MIAMI, FL 33182
Email Address * CLARAG02@HOTMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   GARCIA   First Name   CLARA
Policy # * HPH091577 Claim #* H010036631
Attorney
Attorney is Applicable
Last Name* STRUBLE First Name * MATTHEW Initial
Street Address* 325 FIFTH AVENUE, SUITE 103
City, State Zip* INDIALANTIC , FLORIDA 32903
Email Address * SERVICE@STRUBLECOHEN.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):* MAUREEN EGAN, AND ANY AND ALL SPECIFIC REPRESENTATIVES AND ADJUSTERS ASSIGNED TO THE SUBJECT CLAIM AND RESPONSIBLE FOR THE VIOLATIONS HEREIN BUT UNKNOWN TO THE INSURED AT THIS TIME
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
* 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.

There are no policy provision specifically at issue or in dispute, the policy provides coverage resulting from water damage but Heritage Property & Casualty Insurance Company has failed to extend coverage for repairs needed for the insured property. The policy provides a loss settlement provision. Additionally, the policy provides an ensuing loss provisions which should have applied despite the cited exclusions.
 
* 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 (“Insurer”) issued an insurance policy bearing policy number HPH091577 with effective dates of coverage from March 11, 2024 to March 11, 2025 , which insured the property located at 1090 NW 123rd Court, Miami, Florida 33182. The policy was in effect when the property sustained damage on or about October 20, 2024, when damage was caused by water. The damage was reported to Insurer which assigned Claim Number H010036631 to the claim and investigated the claim. Insurer denied the claim, misrepresenting that the damages were due to faulty, inadequate maintenance of the A/C and long-term exposure to moisture. However, it was made clear to Insurer the loss was a one-time sudden and accidental event. At the very least, even if insurer's findings are true, the ensuing loss is covered. The estimates obtained by Plaintiff result in a claimed RCV amount of $13,082.36. Thus, the disputed claim amount is $12,582.36, as identified by taking the total RCV amount claimed ($13,082.36) and subtracting the policy’s deductible of $500. The Insured is also at risk of incurring rental loss. On or about January 30, 2025, Insured submitted to Insurer a Sworn proof of Loss for this amount and included the estimate. The Insurer responded and rejected the proof of loss, misrepresenting that the claim number was incorrect (it was not) and that mortgage was incorrect (it was not). Insurer failed to retain the experts needed to perform the inspection and needed to address the damage at issue and determine the repairs needed to restore the property. Insurer has been provided with documents establishing that the claim is covered, despite this being apparent from the condition of the property alone. Insurer has failed to extend coverage for payments owed and has refused to attempt to settle the claim with its insured. Insurer’s delay in issuing payment is causing and will cause the insured to sustain extra-contractual damages not covered by the property, including loss of use and enjoyment of the property and related damages, costs associated with hiring adjusters and experts, among other damages and these uninsured damages would not have occurred but for the insurer ’s failure to timely issue payments owed. In this claim and as a business practice, insurer fails to retain experts needed to investigate claims, ignores evidence establishing coverage and avoids covered repairs to attempt to avoid issuing payments owed pursuant to the insurance policy. Insurer can cure these violations by attempting to settle the claim in good faith and issuing payment for the remaining contractual damages owed. As Insurer is aware, issuing payment for contractual damages owed will preclude recovery of extra-contractual damages already incurred, and that will be incurred, and the contractual damages should immediately be paid and be paid within 60 days from the date of this notice. Due to applicable Florida Statutes, and the insurance policy’s payment provisions, the payment issued should also include interest. If insurer contends there is somehow more information needed that was not already provided, it should immediately advise the insured’s attorney what information is needed. Insurer has been provided with information establishing that the claim is covered but has failed to extend coverage for the claim. Insurer’s denial of the claim and refusal to issue payment is a breach of the insurance policy. This notice is being given in order to perfect the right to pursue the civil remedy authorized by this section.
Comments
User Id Date Added Comment
ncarlisle@heritagepci.com 03-21-2025 March 21, 2025 VIA ELECTRONIC SUBMISSION Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Complainant: Clara Garcia Insured: Clara Garcia Insurer: Heritage Property & Casualty Insurance Company DFS File No.: 805115 Claim No: H010036631 Policy No.: HPH091577 Address: 1090 Nw 123Rd Ct, Miami, FL 33182 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 805115, filed on behalf of Clara Garcia (“Complainant”). The Department accepted the Notice on February 4, 2024. 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, although the Notice identifies one adjuster who handled the claim, ultimately, 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 the 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. Indeed, the Notice indicates that “[t]here are no policy provisions specifically at issue or in dispute.” The Notice is legally insufficient because it does not indicate the specific policy language violated or which specific Section or policy term, and therefore, it failed to specify which provisions were violated. Additionally, the Notice failed to include the Insurer’s address, as specifically required. 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 HPH091577 for the property at 1090 Nw 123Rd Ct, Miami, FL 33182. 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 November 20, 2024, claiming water damage that allegedly occurred on October 20, 2024, Heritage promptly assigned claim number H010036631. An acknowledgment letter with a Bill of Rights was submitted to Complainant on the same day. In the meantime, Heritage enlisted the services of a field adjuster to coordinate an inspection of the alleged damage caused by the alleged storm. Complainant requested it to occur on December 2, 2024. The on-site inspection documents the property's exterior and interior conditions of the property. According to the field adjuster’s report, Complainant’s realtor was present and pointed out the water damage. On January 7, 2025, after conducting a reasonable investigation based on available information to Heritage, and in accordance with its obligations under §627.70131, Fla. Stat., Heritage 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 investigation and the policy, there is no coverage under the policy for loss caused by presence or condensation of humidity, moisture or vapor caused by faulty or inadequate maintenance of the HVAC system. Following it, Heritage received a letter of representation from StrubleCohen advising their representation of Complainant, on or about January 24, 2025. Soon after, Heritage issued an acknowledgment letter in reference to the representation. On February 4, 2024, this Notice was filed, and Heritage timely provides its response. Nonetheless, Heritage’s representative has been attempting to negotiate a resolution of the claim with the Complainant’s attorney. 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: Claim Denial The Notice fails to state who, how, and when a “claim denial” practice occurred; therefore, it lacks the specificity required by Florida Statute 624.155 and thus does not put Heritage on the requisite notice. Claim Delay The Notice fails to state who, how, and when a “claim delay” practice occurred; The coverage determination was issued timely, 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 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. 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 for the claim based on the information and documentation obtained and/or received by Heritage during its investigation of the claim and the subject policy. Additionally, Heritage has made offers for settlement to resolve the claim. 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 at all times acted fairly and honestly. Further, Heritage has timely made a coverage determination for the claim based on 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. 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 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: 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 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 settlement offers. 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 Complainants’ 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 to cure is to attempt “to settle the claim in good faith and issuing payment for the remaining contractual damages owed. As Insurer is aware, issuing payment for contractual damages owed will preclude recovery of extra-contractual damages already incurred, and that will be incurred, and the contractual damages should immediately be paid and be paid within 60 days from the date of this notice. Due to applicable Florida Statutes, and the insurance policy’s payment provisions, the payment issued should also include interest. If insurer contends there is somehow more information needed that was not already provided, it should immediately advise the insured’s attorney what information is needed.” Although Heritage denied coverage for this claim, it is unclear what amount the Complainant is seeking. If Heritage pays an unspecified amount, it is unclear if this would be sufficient to cure this demand. 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