Civil Remedy Notice of Insurer Violations
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Filing Number:     813815
Filing Accepted:  3/31/2025
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Complainant
Last/Business Name *  
SALVADOR   First Name   CARLOS AND LILLIAN
Street Address * 12515 SWGRASS OAK STREET
City, State Zip * ORLANDO, FL 32824
Email Address * WITHELD
Complainant Type: * Insured
Insured
Last/Business Name*   SALVADOR   First Name   CARLOS AND LILLIAN
Policy # * HOH338866 Claim #* H010029620
Attorney
Attorney is Applicable
Last Name* GUTIERREZ First Name * DANIEL Initial
Street Address* 924 DELANEY AVENUE
City, State Zip* ORLANDO , FLORIDA 32806
Email Address * SERVICE@DGPALAW.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):* UNKNOWN
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Claim Denial
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.
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)(e) Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
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.
626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
626.9541(1)(i)(4) Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Heritage Property & Casualty Insurance Company has failed to respond to requests for the coverage determination correspondence and the insurance policy. However, the Insured’s policy is an All-Risk policy and does not exclude coverage for the hurricane damages to the property.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

On or about October 9, 2024, the home of Carlos and Lillian Salvador (hereinafter referred to as the “Insured”) was damaged by Hurricane Milton. The Insureds reported the damages to their homeowners’ insurance company, Heritage Property & Casualty Insurance Company (hereinafter referred to as the “Insurer”). The Insurer sent an adjuster to inspect the damages. Additionally, the Insureds submitted their own estimate of damages; however, the Insurer has failed to acknowledge coverage for the full extent of damages. Further, they have failed to issue payment adequate for the Insureds to complete the repairs necessary. The Insured was concerned that the Insurer did not properly consider the extent of the damages, so the Insureds retained an attorney. The attorney sent correspondence on or about February 21, 2025 to the Insurer requesting a complete copy of the policy, including the declarations page, as well as any documentation supporting or explaining the Insurer’s coverage decision in the claim. A follow-up request was sent to the Insurer on or about March 11, 2025. However, as of the date of this filing, the Insurer has not responded to the request for information. 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, failing to promptly and fairly to provide full and prompt indemnity to the Insureds; failing to acknowledge and act promptly upon communications with respect to claims; failing to provide the facts relied on for the denial of the claim as well as the policy language being relied on and placing the company’s interests before the Insureds’ interests, when a reasonable carrier in a similar position would have provided coverage. Specifically, the Insurer routinely ignores requests from attorneys for information related to claims decisions to make it more difficult for their claims decision to be questioned and further pursued. 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 insured’s 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.) Respond to the request for information from the Insureds’ attorney; 2.) Acknowledge coverage for full extent of the claim as outlined by the Insureds’ public adjuster; and 3.) Pay the statutory interest on the amount of unpaid damages from the date the loss was reported to the date payment is finally made. A copy of this form has been submitted to the FDFS and has been printed out and mailed to the following parties providing them notice of the filing of the Civil Remedy Notice: Heritage Property & Casualty Insurance Company 1401 N Westshore Blvd., Tampa, Florida 33607 Certified Return Receipt #9589 0710 5270 1009 7574 42
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ncarlisle@heritagepci.com 05-20-2025 VIA ELECTRONIC SUBMISSION Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Complainant: Carlos and Lillian Salvador Insured: Carlos and Lillian Salvador Insurer: Heritage Property & Casualty Insurance Company DFS File No.: 813815 Claim No: H010029620 Policy No.: HOH338866 Address: 12515 Sawgrass Oak Street., Orlando, FL 32824 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 813815, filed on behalf of Heritage’s insureds Carlos and Lillian Salvador (“Complainant”). The Department accepted the Notice on March 31, 2025. While Heritage welcomes the opportunity to respond to the Notice filed concerning this claim, it responds to it specifically denying each and every allegation contained in the Notice. Heritage believes that the Notice should be rejected and returned by the Department of Financial Services as it fails to comply with the specific information requirements as set forth in Civil Remedy Notice of Insurer Violation document provisions as promulgated in Florida Statute §624.155 and Florida Case law. 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 his own claim and, therefore, the Complainant’s opinions regarding Heritage’s adjustment of this claim. 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. Moreover, the Notice contains a list of violations that Heritage has allegedly committed but fails to provide an adequate basis in support of those allegations and, on that basis alone, fails to satisfy the basic requirements of an otherwise proper Notice. Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875 (Fla. 4th DCA 2021); Fla. Stat. §§ 624.155 and 626.9541. For clarification, Heritage provides a brief history of the claim: Subject to its terms, endorsements, limitations, exclusions, and conditions, the Complainant was issued Policy HOH338866 for property located at 12515 Sawgrass Oak Street., Orlando, FL 32824. The Policy of Insurance applies to direct physical loss of or damage to covered property at the premises described in the Declarations of the Policy or resulting from any Covered Cause of Loss as described in the Policy. Upon receiving the Complainant’s first notice of loss on October 18, 2024, claiming damages from Hurricane Milton that allegedly occurred on October 9, 2024, Heritage promptly assigned claim number H010029620. In the meantime, Heritage enlisted the services of a Field Adjuster to coordinate with the Complainant an inspection of the alleged damage caused by the hurricane. The inspection documenting the property's exterior and interior conditions occurred on November 11, 2024. On November 19, 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 Complainant, which included pertinent facts and insurance policy provisions relating to coverages at issue. The letter explained that the FA observed roof damage and coverage was opened for the observed damage. The field adjuster’s estimate was $1,021.74, which fell below the Insured’s $9,353.00 Hurricane deductible, which meant no payment would be forthcoming. On February 21, 2025, Heritage received a letter of representation from Daniel Gutierrez P.A., informing Heritage of the representation and requesting a copy of the policy and information about the claim. Heritage promptly acknowledged the representation on February 26, 2025. In the same correspondence, Heritage requested certain documentation from the Insureds’ to support their disputed price and scope of the damage. On March 11, 2025, Daniel Gutierrez P.A. requested additional documentation from Heritage. On March 16, 2025, Heritage sent the requested documents, the Policy, the Coverage Determination Letter and the Field Adjuster’s Estimate. Heritage again requested supporting documentation for further review and consideration. To date no documents have been received. 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 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 made a coverage determination based upon the information and documentation obtained and/or received by Heritage during its investigation of the claim and the subject policy. Heritage investigated the claim and based on the documentation and information received afforded coverage for the reported damage. 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. The insured reported the loss on October 18, 2024, claiming damages from Hurricane Milton that allegedly occurred on October 9, 2024. On November 11, 2024 the Field Adjuster conducted an on-site inspection documenting the property's exterior and interior conditions. On November 19, 2024, 30 days after the reporting of the claim, a coverage determination letter was sent advising the insureds Heritage opened coverage for the covered damage. Therefore, this is an unsupported, sweeping allegation and is without merit. 3. 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. 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 made a coverage determination opening coverage for the Complainant’s claimed damages based on the information and documentation obtained and/or received by Heritage during its investigation of the claim and the subject policy. The Notice fails to specifically identify the “material misrepresentation[s]” allegedly committed by Heritage. As such, this is an unsupported, sweeping allegation and is without merit. 4. 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 indeed made a coverage determination denying Complainant’s claim based upon the information and documentation obtained and/or received by Heritage during its investigation of the claim and the subject policy. Heritage has always properly investigated Complainant’s claim. Additionally, Complainant 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. 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 promptly responded to requests. The Complaint states that the Policy was not sent despite multiple requests which are not supported by the facts. The Policy, the Coverage Determination Letter, and Estimate were sent less than five days after the request. 6. 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 opened coverage for the claim. Heritage has diligently and thoroughly investigated the subject claim, followed up with Complainant for reinspection and documents supporting their claim, and provided a coverage determination. 7. 626.9541(1)(i)(3)(e): Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed. Response: Heritage denies the allegations contained herein. As of the date of the filing of this Notice, there has been no proof of loss statement received by Heritage. The insured reported the loss on October 18, 2024, but no Estimate or Proof of Loss was ever sent to Heritage. Coverage for the loss was opened and the Coverage Determination Letter was sent to the Insured on November 19, 2024. Therefore, this is an unsupported, sweeping allegation and is without merit. 8. 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. The insured reported the loss on October 18, 2024, claiming damages from Hurricane Milton that allegedly occurred on October 9, 2024. On November 11, 2024 the Field Adjuster conducted an on-site inspection documenting the property's exterior and interior conditions. On November 19, 2024, 30 days after the reporting of the claim, a coverage determination letter was sent advising the insureds Heritage opened coverage for the covered damage. The letter advised the insured that because the field adjuster’s estimate was $1,021.74 and fell below the Insured’s $9,353.00 Hurricane deductible, it meant no payment would be forthcoming. Therefore, this is an unsupported, sweeping allegation and is without merit. 9. 626.9541(1)(i)(3)(g): Failing to promptly notify the insured of any additional information necessary for the processing of a claim. Response: Heritage denies the allegations contained herein. The November 19, 2024 coverage determination letter stated that if you disagree with Heritage’s valuation of the damage, please notify us and submit a copy of your contractor’s estimate of repair, showing the scope and pricing of their plan of repair. On February 26, 2024, Heritage again asked the Insureds to please submit any information you have that may assist Heritage in its investigation of this claim. After no response, another email was sent on March 16, 2024, asking for any information you have that may assist Heritage in its investigation of this claim. Nothing was received. Therefore, this is an unsupported, sweeping allegation and is without merit. 10. 626.9541(1)(i)(3)(h): Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. Response: Heritage denies the allegations contained herein. The November 19, 2024 coverage determination letter stated that if you disagree with Heritage’s valuation of the damage, please notify us and submit a copy of your contractor’s estimate of repair, showing the scope and pricing of their plan of repair. On February 26, 2024, Heritage again asked the Insureds to please submit any information you have that may assist Heritage in its investigation of this claim. After no response, another email was sent on March 16, 2024, asking for any information you have that may assist Heritage in its investigation of this claim. Nothing was received. Heritage opened coverage for the loss and provided a copy of the Field Adjsuter’s Estimate for the cost to repair the damage. As of the date of the Notice, no documents have been received to show that there is a dispute of the price and scope of the damage. Therefore, this is an unsupported, sweeping allegation and is without merit. 11. 626.9541(1)(i)(4): Failing to pay undisputed amounts of partial or full benefits owed under firstparty property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5). Response: Heritage denies the allegations contained herein. The insured reported the loss on October 18, 2024, claiming damages from Hurricane Milton that allegedly occurred on October 9, 2024. On November 11, 2024, the Field Adjuster conducted an on-site inspection documenting the property's exterior and interior conditions. On November 19, 2024, 30 days after the reporting of the claim, a coverage determination letter was sent advising the insureds Heritage opened coverage for the covered damage. The letter advised the insured that because the field adjuster’s estimate was $1,021.74 and fell below the Insured’s $9,353.00 Hurricane deductible, it meant no payment would be forthcoming. Therefore, this is an unsupported, sweeping allegation and is without merit. The purpose of the Civil Remedy Notice is to provide the insurer notice of the issue its Complainant 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 Complainant’s Notice seeks cures for the alleged defects. However, the “cures” sought are improper pursuant to Florida Case law. Specifically, the case of Talat Enterprises, Inc., v. Aetna Casualty and Surety Co., 753 So.2d 1278, 1281 (Fla. 2000), provides that the scope of what can be “cured” is limited to the alleged non-payment of the contractual amount due the Complainants. 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 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/ Matthew Leon Matthew Leon, 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