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Independent adjusters’ claims that some Florida insurance companies had tampered with their damage estimates continue to trickle through courthouses and state agencies, with final resolutions far from certain or still months or years in the future.

The latest developments include:

• Allegations by an independent adjuster that the claims-adjusting firm for which he worked in 2022 conspired with Heritage Property & Casualty Insurance Co. to deny or minimize some roof claims.
• A fraud investigations commander for the Florida Department of Financial Services told two adjusters this month that, after almost three years of review, the department has found that no state anti-fraud laws are applicable to the insurers’ alleged actions.
• Tampa-based Heritage asked a Florida court to bar the state Department of Financial Services from releasing trade secrets that may be included in documents requested by a third party in an open records request regarding the investigation.

First, the countersuit by independent adjuster Jordan Lee: Heritage Insurance in April sued Lee in Hillsborough County for defamation after he was interviewed on CBS News’ “60 Minutes” program. Lee alleged in the TV news show that Heritage had altered 42 of his damage estimates in a deceptive manner, keeping his name and license number on the revised reports that were sent to policyholders – without his knowledge.

Lee’s attorney, Joshua Brownlee of the John Tolley law firm, asked the circuit court to dismiss Heritage’s lawsuit, citing a failure to state a claim or show an injury. But the Hillsborough judge denied the motion. Then, on Oct. 7, Lee filed a countersuit, charging that Heritage CEO Ernie Garateix had defamed him by posting a statement in response to the 60 Minutes interview with Lee, a statement that misrepresented the facts while calling Lee “a liar.”

Garateix also claimed Jordan was estimating for damages not covered under the subject policy and had refused to cooperate with Tristar to revise the estimates, Lee’s countersuit argues.

“Heritage wanted revenge on Jordan and set forth a plan to ruin his carrier as a licensed adjuster and financially bankrupt Jordan by statements made to the media and filing a frivolous lawsuit naming Jordan as a defendant,” Lee’s suit maintains.

The countersuit also makes bold claims about how Heritage and Tristar, the Sarasota-based claims handling firm that contracted with Lee, approached roof claims. Heritage discouraged acceptance of roof damage by adopting a policy that ordered adjusters to refrain from walking on tile roofs, Lee’s suit claims. That policy may have been developed to help prevent further damage to tiles, but Lee said it was “contrary to common sense” and prevented adjusters from properly inspecting roofs.

At the same time, a Tristar manager reportedly told Lee in a phone call after Hurricane Ian that Heritage wanted to deny tile roof claims but could not do so with only aerial drone footage, Lee’s countersuit said.

“Mr. Cisco’s instructions were clear enough that the overall intent was to put Heritage in a position to deny tile roof claims regardless of whether the damage was covered under the subject insurance policy,” Lee’s suit reads. The complaint can be seen here.

Tristar representatives did not respond to requests from ¾ÅÉ« to comment about the accusations.

Heritage’s “smear campaign” caused Lee to lose adjusting contracts and significant income, he contends. “When the CEO of a major insurer provides a statement to the media trashing an independent adjusters work product, other insurers listen,” his counterclaim reads.

Back to the allegations made by Lee and other independent adjusters in 2022: At the Florida Association of Public Insurance Adjusters convention in Orlando this month, two adjusters said they had a conversation with Maj. Laquanda Green of the Florida Department of Financial Services’ Division of Investigative Services.

The independent adjusters, Ben Mandell and Mark Vinson, said they had turned hundreds of documents over to the division in late 2022, after going public with their concerns that some carriers were inappropriately altering their damage estimates.

Green told them that the three-year investigation has determined that charges likely cannot be brought against the insurance companies because the insurers may not have violated state fraud laws.

Green and DFS did not respond to inquiries from ¾ÅÉ«. But a prosecutor familiar with the matter said that Green’s conclusions are probably correct.

“The question is, ‘What is in the contract'” between insurance companies and claims firms and adjusters, said James Miller, chief of the Economic Crimes Unit at the State Attorney’s Office in Lee County, a county where hundreds of claims disputes arose after Ian made landfall.

Miller said that if fraud truly exists, it can be prosecuted. But the contracts may give insurers control over adjusters and their work product.

“You can’t really say there’s fraud when the insurance company ultimately owns that adjustment,” Miller told ¾ÅÉ«.

Lee’s lawsuit against Heritage may shed some light on that question. The complaint includes a copy of the independent adjuster agreement with Tristar. The agreement makes it clear that the adjuster is considered an independent contractor. “It is expressly understood and agreed that contractor shall not, under any circumstances be considered an employee of the company,” the agreement reads.

The agreement also notes that “company reserves the right, from time to time, to reassign files from one adjuster to another based on the circumstances.” The TPA has sole discretion to reassign files, it reads. The contract does not mention if that includes reassignment to insurance carriers’ desk adjusters.

Lee never signed a separate contract with Heritage. The contract between Heritage and Tristar was not included in Lee’s lawsuit complaint. The suit also notes that Lee had no control over his compensation, which was subject to Tristar’s and Heritage’s final discretionary review.

The suit contends that, regardless of contractual language, Heritage had influence over Tristar and used that to minimize claims.

“A TPA knew and understood that it had to ensure the independent adjusters were in compliance with Heritage’s claim handling guidelines in order to continue receiving claims from Heritage,” Lee argues. “Heritage used this as leverage to ensure the TPA and adjusters fell in line with its overall goal to deny and/or underpay insurance claims to maximize profits.”