Heritage Property & Casualty: the denial record

Per the attached (2) estimates as outlined by Storm Force Roofing, a supplemental check in the amount of $590,574.51 will be sent under separate cover.

THE ESTIMATED COST OF REPAIRS TO THE INSURED PROPERTY CURRENTLY STANDS AT APPROXIMATELY $ 8,638,026.43.

The Insured's total damage is estimated by Strategic Claims Consultants at $5,584,523.87 ACV / $5,693,298.15 RCV.

On or about May 3rd, 2023 Insurer respond to the notice and provided Association a Statement of Loss, Loss Letter, and Building estimates in a letter for an amount of $4,193,153 before considering recoverable, non-recoverable, and deductible amounts.

The Policy provides coverage on a replacement cost basis, subject to a 3% hurricane deductible, with a limit of liability in the amount of $770,000 for each building identified as Location # 1- Structure # 1-3, 7-8, 12, 13, and 16-18; and $376,000 for each building identified as Location # 1- Struct

Our email included supporting claim documentation for several necessary incurred mitigation and clean up expenses totaling $138,950.33, along with GlobalPro's estimate totaling $3,045,606.

Specifically, the Association through its adjuster has submitted a detailed damage analysis and photos establishing damage in the amount of $1,832,803.26 ACV/ $2,062,162.29 RCV and Heritage refused to tender payment beyond the initial payment of $29,515.15.

As is set forth hereafter, among other wrongs, considering the vicissitudes experienced by the Insured, this carrier has failed and refused to thoroughly, accurately, and completely investigate, evaluate, and adjust the Insured's insurance claims for damages in good faith.

James' damage estimate of $1,131,064.66, plus interest, less the applicable deductible.

On December 2, 2022, HERITAGE, through its adjuster, [name redacted] notified the INSURED that the independent field adjuster had estimated the damages at just $4,366.67, which fell below the INSURED's hurricane deductible.

On October 10, 2024, the insured sent correspondence to HERITAGE enclosing the Sworn Statement in Proof of Loss, the supporting SCG report outlining the cause, scope, and cost of the loss and other supporting documents, the Notice of Intent to Initiate Litigation, and requested HERITAGE to reconside

Having conducted thorough investigations and analysis, Premier prepared an estimate of costs to repair the damaged property in the amount of RCV $192,114.91.

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.

The Insured and Insured's representative provided the Insurance Company with all claim-related documents including an estimate to repair covered damages in the amount of $135,885.13 and other supporting documentation and/or information.

The carrier only offered to pay $0.00, after applicable deductible of $12,421.00, a gross underpayment for all the damage associated with this claim.

Therefore, demand is hereby made as follows: Estimate $71, 367.26 Less Prior Payments $0 Less Deductible $5,473 TOTAL $65,894.26 The concept of insurance is that the insurer will investigate and grant timely and prompt indemnity or security against a contingent loss.

Therefore, HERITAGE should tender $111,979.68 RCV (less any prior payments, depreciation, excess policy limits, and/or deductible) in insurance benefits at this time.

After assessing the damage and the true scope of repairs, the roofing contractor prepared an estimate identifying $106,938.92 in covered damage to the roof alone.

Specifically, the Insured, with assistance from their public adjuster, submitted an estimate for $103,547.11, which was a fair and reasonable assessment for the repair/replacement of damages.

Heritage Property & Casualty Insurance Company ("carrier") has not attempted in good faith to settle the insureds' claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insureds and with due regard for their interests.

The Insurer inspected the Property and prepared a woefully deficient initial estimate that failed to address the full scope of damages and repairs necessary to return the Property to its pre-loss condition.

Therefore, demand is hereby made as follows: Estimate $87,476.80 Less Deductible $5,711.00 TOTAL $81,765.80.

Subsequently, the insureds prepared a loss package in the amount of $60,721.93 needed to restore the property back to its pre-loss condition.

Specifically, the Insured, with assistance from their public adjuster, submitted an estimate for $66,949.91, which was a fair and reasonable assessment for the repair/replacement of damages.

Moreover, COASTAL determined that at least $65,715.25 worth of repairs would be required to return the property to its pre-loss condition as a result of the windstorm loss.

To remedy and/or cure this CRN, Insurer must immediately tender payment in the amount of $ 64,091.00 less any applicable deductible and prior payment to the Insured to complete the repairs for the Insured property.

After sending an estimator to the insured's property, Heritage sent a letter that the insureds were only entitled to a roof repair and estimated the damages at $62,907.88.

Subsequently, Heritage sent correspondence on October 2, 2024, in which they partially denied [name redacted] 's claim, stating that they would not provide payment to complete repairs to the flooring or the garage since their inspection revealed that the condition of the flooring and garage was due

To remedy and/or cure this CRN, Insurer must immediately tender payment in the amount of $ 53,517.00 less any applicable deductible and prior payment to the Insured to complete the repairs for the Insured property.

Whereas, the carrier furnished a wrongful estimate and, having withheld the deductible, offered a deficient payment in the amount of $5,739.66 only, leaving a remainder in the amount of $44,004.14 to be paid in order to cure the breach, less any applicable policy deductible.

Whereas, the carrier wrongfully represented the damages to the insured's property to be below the policy deductible.

After sending an adjuster out to inspect, Heritage Property & Casualty Insurance Company acknowledged that they found damage to the roof of the home but claimed that this damage is not covered under the policy, and applied inapplicable exclusions.

After assessing the damage and the true scope of repairs, the public adjuster produced an estimate identifying $47,444.51 in covered damage to the dwelling.

A copy of their estimate, dated May 4, 2022 detailing $36,306.05 in covered damage due to the Insured was sent to the Insurer but they have failed to substantively respond to the estimate of the damages or the claim itself, only delaying the matter.

To cure the defects outlined in this Civil Remedy Notice, Carrier must: (1) Immediately tender all insurance proceeds due and owing to the Insured that are fairly owed to them under the insurance policy that would reasonably place them back to a pre-loss condition pursuant to the estimate of damages

In its February 9, 2023 letter, Heritage advised it was issuing payment of $8,894.15 ($15,703.08 less the $5,670 deductible).

The estimates obtained by Plaintiff result in a claimed RCV amount of $13,082.36.

Therefore, demand is hereby made as follows: Estimate $12,353.66 Less Prior Payments $0 Less Deductible $2,500 TOTAL $9,853.66 The concept of insurance is that the insurer will investigate and grant timely and prompt indemnity or security against a contingent loss.

Despite knowing this, [name redacted] extended a meager $3,793.32 after deductible for repairs to Insured's [name redacted] .

(2) TENDER INSURANCE PROCEEDS IN AN AMOUNT TOTALING AT LEAST $200,000.00; AND (3) PAY STATUTORY INTEREST FROM THE DATE OF THE LOSS.

In consideration of the premium paid to it by the Insured, Heritage Property & Casualty Insurance Company issued to the Insured an insurance policy, Pol-icy No.: HOH168382 (the "Policy").

The Carrier performed a cursory inspection of the Insured Property and failed to retain unbiased experts necessary to trigger the cause of the Loss and covered repairs necessary to restore the Insured Property to its pre-loss condition.

It is clear by the language of the carrier's denial letter that it did not determine what caused the damages observed at the property.

HERITAGE PROPERTY AND CASUALTY INSURANCE COMPANY HAS BEEN GIVEN COMPLETE ACCESS TO THE INSURED PROPERTY, HAS NOTICE OF THE CONDITION OF THE PROPERTY THROUGH THEIR OWN INSPECTION AND PHOTOGRAPHS.

The Insurer refuses to acknowledge independent engineering reports in order to deny the claim.

Heritage has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured's insurance claim for damages.

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.

As is the case here, it is a pattern and practice for [name redacted] to arbitrarily deny claims without conducting reasonable investigations and instead base its coverage determinations on evidence it knows to be inaccurate or incomplete.

Additionally, the Insureds submitted their own estimate of damages; however, the Insurer has failed to acknowledge coverage for the full extent of damages.

As of this moment, the damages found and evaluated by the insured(s) value at minimum $4,500,000.00 in damages, attorney fees, costs and interest.

To date, [name redacted] has failed to adjust the claim or make a final determination as to the Supplemental Claim submitted on March 27, 2019.

Currently, litigation is still pending against both [name redacted] Property and Casualty Insurance Company has failed to: respond to notices sent, provide requested copies of the insured coverage policy and failed to defend the insured as required by the policy.

Heritage has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured's insurance claim for damages.