When Heritage Insurance coverage determined to sue its former impartial adjuster, Jordan Lee, 1 it lit a hearth that may nearly definitely illuminate way over it meant. I wrote in regards to the whistleblower stories that emerged after Hurricane Ian in Whistleblowing Property Adjusters Verify Fraudulent Property Insurer Practices. Impartial adjusters alleged that their authentic estimates had been secretly modified by insurers or their third-party directors earlier than being despatched to policyholders. I famous that these claims raised actual questions on transparency and ethics within the claims-handling course of.
Now, those self same points are shifting from information stories and regulatory testimony to the courtroom.
A Lawsuit That Attracts Its Personal Highlight
When Heritage filed its lawsuit in opposition to Jordan Lee, I used to be stunned. Most insurers which have already weathered a regulatory effective and a few robust headlines relating to claims would like to maneuver on. Apart from these of us deeply fascinated about claims dealing with conduct, the general public and most within the trade produce other issues on their minds. The significance of the difficulty and details are likely to fade. Heritage, nevertheless, selected to go to courtroom. In doing so, it has opened the door to discovery on all the pieces from its Ian claims-handling protocols to its 2024 consent order with the Florida Workplace of Insurance coverage Regulation, which carried a $1 million effective for claims-handling deficiencies.
Lawsuits are like searchlights. When you flip them on, you typically can’t management what will get illuminated.
The counterclaim Lee filed in opposition to Heritage was nearly inevitable. As soon as Heritage went on the offensive with its lawsuit, it was clear Lee would reply by placing the corporate’s practices underneath authorized and public scrutiny yet again.
What the Adjuster Alleges
Lee’s counterclaim tells a narrative that may sound acquainted to anybody following the post-Ian controversies. He says Heritage, by means of its third-party administrator TriStar, imposed procedures that pushed adjusters towards decrease payouts by limiting overhead and revenue, requiring depreciation on roofs, favoring “restore over change” no matter code, and directing discipline adjusters to not stroll tile roofs, relying as an alternative on drone photographs or engineers identified for locating “no harm.”
Maybe most putting, he claims Heritage and TriStar edited his estimates after submission, despatched the revised variations to policyholders along with his identify nonetheless on them, and hid the adjustments from each the adjuster and the insured. He argues that this misrepresented his work and violated Florida’s moral requirements for adjusters.
These are critical allegations, however once more, allegations usually are not proof. They should be confirmed by means of proof, the identical approach Heritage’s proof in opposition to Lee should be confirmed. This lawsuit will now take a look at whether or not these claims by all events will maintain up.
Heritage’s Public Protection
Heritage has pushed again onerous in public statements. Its management says that edits to adjuster estimates had been a part of a normal quality-control course of designed to take away non-covered objects and guarantee constant outcomes. As proof, the corporate has even shared information from a overview of 10,000 Ian claims exhibiting that some revisions elevated funds, some decreased them, and a few had been unchanged.
Heritage additionally factors out that it has since upgraded its techniques to file who edits every estimate, a reform required by the 2024 consent order. In different phrases, Heritage’s place is that these weren’t acts of fraud or retaliation, however somewhat acts of regular oversight that it has realized from previous operational shortcomings.
Anyone operating a corporation of any measurement can definitely admire that processes will not be good, or that sure people throughout the group will not be main others or performing correctly. Intent and motive are sometimes tough to discern with out nice transparency.
Why This Issues Past One Case
Regardless of the consequence, this case has already carried out one thing essential: it’s put a highlight again on post-catastrophe claims dealing with in Florida. Adjuster moral independence, desk enhancing, and insurer transparency usually are not summary points. These points instantly have an effect on how a lot policyholders are paid and the way rapidly they get better. The problems on this case are essential.
As I stated in prior posts, insurers can’t anticipate adjusters to behave as professionals whereas stripping them {of professional} judgment. If an adjuster’s identify seems on a doc, that adjuster has the proper, and arguably the moral responsibility, to make sure the doc displays their very own work. This case will take a look at how the courts view that precept.
It’s value repeating: lawsuits and allegations usually are not proof. The reality comes out by means of proof. However as somebody who’s watched these disputes unfold for many years, I can inform you that Heritage might have reopened a problem most firms would have quietly left behind. The final time a serious insurance coverage firm did one thing like this, a secretive Jewish Attorneys checklist turned public.
So, whether or not the corporate finally prevails or not, the invention course of itself will expose an important deal about how at the very least one insurer dealt with Hurricane Ian claims. In that sense, Heritage’s lawsuit in opposition to its personal adjuster might find yourself serving as an unplanned case research for the whole insurance coverage trade. It’s also a reminder that when whistleblowers communicate honestly, typically the highlight shines brightest on those that struck the match.
Thought For The Day
“It’s error solely, and never fact, that shrinks from inquiry.”
— Thomas Paine
1 Heritage Prop. & Cas. Ins. Co. v. Lee, No. 2025-CA-002113 (Fla. Cir. Ct. – Hillsborough).