Civil Remedy Notice of Insurer Violations
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Filing Number:     809941
Filing Accepted:  3/6/2025
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Complainant
Last/Business Name *  
IGNACIO   First Name   JOSEPH & SUSAN
Street Address * 3183 SHORELINE DR
City, State Zip * CLEARWATER, FL 33760
Email Address * GIJRAI@YAHOO.COM
Complainant Type: * Insured
Insured
Last/Business Name*   IGNACIO   First Name   JOSEPH & SUSAN
Policy # * HOH360669 Claim #* H010034265
Attorney
Attorney is Applicable
Last Name* KLOTZMAN First Name * SCOTT Initial
Street Address* 9555 SW 175TH TERRACE, SUITE 651
City, State Zip* PALMETTO BAY , FL 33157
Email Address * PRELIT@SCOTTKLOTZMAN.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):* REYNA LOPEZ, ZACHARY LADNER, AND ALL ADJUSTERS, SUPERVISORS, MANAGEMENT AND INDIVIDUALS ASSOCIATED INSURANCE RELATED TO THIS CLAIM
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
* 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.
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.

There are no policy provision specifically at issue or in dispute, the policy provides coverage from Hurricane damage but Insurer has failed to extend coverage for repairs needed for the insured property. SECTION I – PERILS INSURED AGAINST COVERAGE A – DWELLING and COVERAGE B – OTHER STRUCTURES We insure against risk of direct loss to property described in Coverages A and B only if that loss is a physical loss to property. We do not insure, however, for loss: ... 2. Caused by: ... e. Any of the following: (1) Wear and tear, marring, deterioration; (2) Inherent vice, latent defect, mechanical breakdown; ... (6) Settling, shrinking, bulging or expansion, including resultant cracking, of pavements, patios, foundations, walls, floors, roofs or ceilings; ... j. Rain, snow, sleet, sand or dust to the interior of a building unless a covered peril first damages the building causing an opening in a roof or wall and the rain, snow, sleet, sand or dust enters through this opening. ...
 
* 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 HOH360669, which insured the property located at 3183 Shoreline Dr, Clearwater FL 33760. The policy was in effect when the property sustained damage on or about October 9, 2024, when it was damaged by Hurricane Milton. Insurer received prompt notice of the claim for property damage resulting from Hurricane Milton and assigned Claim Number H010034265 to the claim. Insurer sent a field adjuster, Anthony Scott, to inspect the damages on or about November 15, 2024. Mr. Scott prepared an estimate totaling $311.76. His estimate states that “No covered storm related damage observed” to the roof, right elevation, rear elevation, left elevation and interior. Via written correspondence dated November 21, 2024, Insurer advised that no payment was being made as the damages fell below the policy’s deductible. However, 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. It was obvious that the property was damaged by Hurricane Milton, so the Insureds hired a public adjuster to assist with the claim. Insurer retained EFI Global (“EFI”) to determine the cause and origin of the damages to the roof, windows and moisture intrusion. EFI inspected the property on January 10, 2025. In their report, EFI stated “the subject property experienced wind speeds of 100 to 110 mph.” While EFI somehow concluded that the roof tiles were not damaged by Hurricane Milton, EFI did conclude that “[t]here was a metal ridge vent that was lifted in the middle in a manner consistent with being related to wind associated with Hurricane Milton. A review of an April 2022 Google Earth Streetview image noted that the vent was not uplifted at that time.” EFI’s report goes on to discuss that the “debonding of the hip and cap tile/mortar interface observed that was unrelated to a wind event.” EFI concluded that this was an installation deficiency (the roof was installed in 2002). EFI concluded that the (10) cracked field tiles observed that were consistent with damage that occurs due to misalignment and tight installation, foot traffic, and expansion or contraction due to thermal effects. This is considered normal age-related deterioration for a tile roof.” Further, EFI concluded that the “sliding roof tiles that were a result of deficient securement of the tiles during installation and the long-term effects of gravity causing the tiles to slide downwards.” EFI made these conclusions despite the fact that the property experienced wind speeds of 100 to 110 mph from Hurricane Milton. “EFI observed a ceiling stain at the living room associated with rain infiltrating the wind damaged ridge vent above. The ceiling damage was consistent with being the result of a storm created opening.” EFI did not observe any wind damage to the windows at the property. Interestingly, EFI’s report completely omitted any discussion of the large crack in the stucco caused by Hurricane Milton. Via written correspondence date February 26, 2025, Insurer advised that it “received the engineering report and we award in the amount of $1,947.34.” This amount is still far below the policy’s deductible. Interestingly, the letters are almost identical, and Insurer continued to state that there was no wind damage to the roof. Despite EFI concluding that the metal ridge vent was lifted and that there WAS a storm created opening that caused interior damage below the metal ridge vent, Insurer acted in bad faith by failing to provide coverage. Both under deductible letters discuss reported damage to a basement, despite the fact that this property has no basement. 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 insureds. Insurer’s delay in issuing payment is causing and will cause the insureds 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 insureds’ 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 04-23-2025 April 23, 2025 VIA ELECTRONIC SUBMISSION Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Complainant: Joseph & Susan Ignacio Insured: Joseph & Susan Ignacio Insurer: Heritage Property & Casualty Insurance Company DFS File No.: 809941 Claim No: H010034265 Policy No.: HOH360669 Address: 3183 Shoreline Dr., Clearwater, FL 33760 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 809941, filed on behalf of Joseph & Susan Ignacio (“Complainants”). The Department accepted the Notice on March 6, 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. 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 “[t]here are no policy provisions specifically at issue or in dispute…” without specifying which provisions were violated. Therefore, the Notice failed to provide sufficient notice to Heritage of which 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 HOH360669 (“Policy”) for the property at 3183 Shoreline Dr., Clearwater, FL 33760 (“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 22, 2024, claiming damages from Hurricane Milton on October 09, 2024, Heritage promptly assigned the claim number H010034265. 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 November 15, 2024. The on-site inspection documenting the property's interior and exterior conditions occurred as scheduled, with the insured present. Following the inspection, the field adjuster prepared an estimate of damage observed related to Hurricane Milton. On November 19, 2024, in compliance with §627.70131(1)(e), Fla. Stat., Heritage submitted a preliminary field adjuster estimate to Complainants. The letter explained that the preliminary estimate was generated, regardless of whether Heritage had made a coverage decision. The letter further stated that as soon as our investigation was complete, Heritage would provide the insured with a written explanation of the coverage decision. On November 21, 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, the estimated repairs to the dwelling were $311.76. However, because the estimate to repair the property was less than the deductible of $21,108.052, no payment would be forthcoming. The letter further explained that the partial payment would not include repairs for the roof tiles, exterior cracks near the patio area, interior water damage to the living room and bedroom, because based on the investigation, these conditions were caused by excluded causes as stated in the policy. On December 10, 2024, Heritage acknowledged the receipt of the Complainant’s representative documentation, such as the estimate and photographs of the property. Heritage further advised that, as the engineer’s report was received and reviewed, Heritage would discuss the additional coverage determination further. Additionally, Heritage forwarded a copy of the policy shortly after, at the request of Complainant’s representative. Moving forward, and as an additional step and in furtherance of the investigation, EFI Global was retained to perform a reinspection of the property. Randy Ciarlone, P.E., prepared a report based on his inspection. Mr. Ciarlone indicated in his conclusion, based on observations at the property and their subsequent evaluation of the information provided and obtained, it was their professional opinion that: 1. The inspection of the roof found no evidence of wind damage to the roof tiles. 2. There was a metal ridge vent that was lifted in the middle in a manner consistent with being related to wind associated with Hurricane Milton. The ceiling stain at the living room was associated with rain infiltrating the wind damaged ridge vent. 3. EFI did not observe any storm damage to the windows at the property. The moisture infiltration through the rear facing windows was the result of wind driven rain during Hurricane Milton entering through deteriorated, cracked, or missing sealant at the window frame to wall interfaces. In this sense, on February 26, 2025, Heritage issued a second coverage determination letter based on the engineer’s findings, contrary to the allegations stated in this Notice. In the supplemental letter, Heritage opened coverage for the items identified by the engineer as damaged by Hurricane Milton and made payment based on the Public Adjuster’s price listed in the estimate. On March 4, 2025, Heritage received a letter of representation from Complainants’ attorney, Law Offices of Scott Klotzman, P.A. In response to the letter, Heritage acknowledged the representation and submitted the requested documentation to the attorney’s office. On March 6, 2025, Heritage received this Notice, which is being responded to in a timely manner. Further, a Notice of Intent to Initiate Litigation was filed with the Department on March 20, 2025. Shortly after, Heritage responded to the NOI with an offer for settlement, and Heritage’s representative engaged in settlement negotiations 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 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. The claim was covered following the policy and all statutory requirements. 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. 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 an effort to resolve the claim. 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. 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. 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 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. 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 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. 4. 626.9541(1)(i)(3)(d): Denying claims without conducting reasonable investigations based upon available information. Response: Heritage denies the allegations contained herein. Accordingly, and as indicated by the facts stated above, the claim was not denied and a reasonable investigation has been conducted to assess the damages reported by Complainant. 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 identify instances where Heritage failed "to acknowledge and act promptly upon communications." Therefore, this is a broad allegation without specific support. 5. 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 abovementioned statutes. Heritage has diligently and thoroughly investigated the subject claim with an inspection and reinspection, followed up with the Complainants for documents supporting their claim, provided two coverage determinations, 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. 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 afforded coverage for this claim, it is unclear what amount the Complainants are 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 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