Civil Remedy Notice of Insurer Violations
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Filing Number:     805687
Filing Accepted:  2/7/2025
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Complainant
Last/Business Name *  
JAMES AVILES & OLGA AVILES   First Name  
Street Address * 1434 DAYSTAR LN.
City, State Zip * DELTONA, FL 32725
Email Address * PAPICHULO0426@HOTMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   JAMES AVILES & OLGA AVILES   First Name  
Policy # * HOH620095 Claim #* H010029729
Attorney
Attorney is Applicable
Last Name* CHAPPEL First Name * ADAM Initial
Street Address* 925 S. FEDERAL HWY
City, State Zip* BOCA RATON , FL 33432
Email Address * ACHAPPEL@KPATTORNEY.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):* ROCHELLE ALLEN
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unfair Trade Practice
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.
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.
626.9541(1)(i)(3)(f) 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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Loss settlement provision
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The carrier was put on notice of the insured’s water damage claim. The carrier initially attempted to low-ball the claim. Subsequently, the insured prepared a loss package in the amount of $187,772.08 needed to restore the property back to its pre-loss condition. Whereas, the carrier wrongfully represented the damages to the insured’s property to be below the policy deductible. The insured has complied with all of the carrier’s requests to date and the carrier has still failed to treat this claim with good faith. This intentional delay with the claim has led to direct prejudice of the insured. About one hundred twenty-five days have passed since the original date of loss. The carrier has still refused to pay the fully covered amount owed under the policy. The carrier is aware of damage sustained by the insured’s property and has not taken any meaningful ensuing action. It is clear that the carrier is not treating the insureds with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insureds; failing to implement proper standards for the adjustment and investigation of claims by its adjusters and placing the company’s interests before the insureds’ interests; refusing to pay the full amount owed to the insureds despite the fact that the carrier has been on notice of the damages and looking for ways to delay full recovery or any recovery to the insureds, when a reasonable carrier in a similar position would have tendered a full payment in accordance with both the policy language and statutory requirements. The carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c) and 626.9541(1)(i)(3)(f), as well as Section I- Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss; and the loss payment provision under Section I- Conditions requiring payment of a claim within 90 days. All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless disregard for the insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $187,772.08, less any prior payments and less any applicable policy deductible; and 2.) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been sent to the carrier. Please do not hesitate to contact the undersigned or Stephanie Pinchao at (561)-892- 9848 if you have any questions or concerns. Sincerely, Adam Chappel Attorney at Law
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: James Aviles and Olga Aviles Insured: James Aviles and Olga Aviles Insurer: Heritage Property & Casualty Insurance Company DFS File No.: 805687 Claim No: H010029729 Policy No.: HOH620095 Address: 1434 Daystar Ln., Deltona, FL 32725 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 805687, filed on behalf of James Aviles and Olga Aviles (“Complainants”). The Department accepted the Notice on February 7, 2025. As a preliminary matter, Heritage 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. Although the Notice indicated Rochelle Allen, the Notice failed to identify the “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 knowledge of the facts giving rise to the allegation in the Notice, as explicitly required. Additionally, Florida Statute §624.155(3)(b)(2) requires the Complainants 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 Complainants’ opinions regarding the value of their claim and, therefore, the Complainants’ 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 Complainants to refer to specific policy language that is relevant to the alleged violation, if any. The Notice is legally insufficient because it indicates that the specific policy provision includes “loss settlement provisions” without specifying which provisions were violated. Therefore, the Notice failed to provide sufficient notice to Heritage what policy provision was violated. Further, the Notice failed to indicate the insurer’s address, as required explicitly by Florida Law. 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 Complainants were issued policy HOH620095 (“Policy”) for the property at 1434 Daystar Ln., Deltona, FL 32725 (“property”). Heritage’s 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 Complainants’ first notice of loss on October 11, 2024, claiming damages from Hurricane Milton on October 09, 2024, Heritage promptly assigned the claim number H010029729. An acknowledgment letter with a Bill of Rights was submitted to Complainants 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 Hurricane. Complainants requested it to occur on October 14, 2024. The on-site inspection documenting the property's interior and exterior conditions occurred as scheduled with the presence of the Complainant James Aviles. On October 22, 2024, 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 Complainants, which included pertinent facts and insurance policy provisions relating to coverages at issue. The letter explained that based on Heritage’s field adjuster inspection estimate repairs to the dwelling of $5,847.78. However, because the amount of the estimate to repair the property was less than the deductible of $12,180.00, no payment will be forthcoming. The letter further explained that the partial payment would not include repairs for the interior damages, as the internal area of the property was damaged due to water intrusion. On October 31, 2024, Heritage received a letter of representation from Complainants’ attorney, Kanner & Pintaluga. In response to the letter, Heritage acknowledged the representation and submitted the requested documentation to the attorney’s office. Additionally, Heritage issued a Request for Information letter, requesting documentation associated with the claim, including estimates, inspection reports, and any documentation associated with repairs or mitigation of damages. On February 7, 2025, Heritage received this Notice, which is timely being responded. Further, a Notice of Intent to Initiate Litigation was filed with the Department on February 11, 2025. Shortly after, Heritage responded to the NOI with an offer for settlement, and Heritage’s representative engaged in settlement negotiation with the Complainants’ representative. In accordance with Fla. Stat. §624.155, the Civil Remedy Notice requires Complainants, “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 who, how, and when a “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. The claim was adjusted in a timely manner, following all statutory requirements. 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. 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. Offers for settlement have been made in efforts to resolve the claim. 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 engaged in settlement negotiations and made offers to Complainants’ representatives. Therefore, this is an unsupported, sweeping allegation and is without merit. 2. 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: 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 engaged in settlement negotiations and made offers to Complainants’ representatives. Therefore, this is an unsupported, sweeping allegation and is without merit. 3. 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. 4. 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, Complainants 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. 5. 626.9541(1)(i)(3)(c): Failing to acknowledge and act promptly upon communications with respect to claims. Response: Heritage denies the allegations contained herein. Accordingly, and as indicated by the facts stated above, Heritage has always promptly acknowledged communications and acted promptly in furtherance of the resolutions of the claim. 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. The Notice does not specifically identify instances where Heritage failed "to acknowledge and act promptly upon communications." Therefore, this is a broad allegation without specific support. 6. 626.9541(1)(i)(3)(f): 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. Response: Heritage denies the allegations contained herein. Accordingly, and as indicated by the facts stated above, Heritage has promptly issued a coverage determination explaining the investigation and policy provisions applicable to the loss. Further, Heritage afforded coverage for covered damages, engaged in settlement negotiations, and made offers for settlement. 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, followed up with the Complainants for documents supporting their claim, provided a coverage determination, engaged in settlement negotiations, and has been making efforts to resolve the claim with the Complainants’ representatives. 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). 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. 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 Complainants have 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 Complainants feel 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 Company.
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