Civil Remedy Notice of Insurer Violations
Login

Filing Number:     661828
Filing Accepted:  12/15/2022
         Print Filing
Complainant
Last/Business Name *  
ROBERTS   First Name   GREGORY AND CATHY JOEL
Street Address * 9200 PINE COVE RD,
City, State Zip * ENGLEWOOD, FL 34224
Email Address * CCATBALOU@HOTMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   ROBERTS   First Name   GREGORY AND CATHY JOEL
Policy # * EDH5004210 Claim #* 951302-00
Attorney
Attorney is Applicable
Last Name* KASSEL First Name * MATTHEW Initial
Street Address* 4016 HENDERSON BLVD., SUITE E
City, State Zip* TAMPA , FL 33629-4940
Email Address * MATT@KASSELLAWGROUP.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   EDISON INSURANCE COMPANY
NAIC Company Code 12482
 
Name of individual responsible for violation (if any):* ALL ADJUSTERS AND CLAIMS REPRESENTATIVES WHO HAVE HANDLED THE CLAIMS RELATED TO THIS MATTER.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Unfair Trade Practice
Claim Delay
Other : Failure to investigate claim in consultation with the insured on a timely manner
Other : Failure to keep the insured informed as to the status of claim investigations
Other : Failure to respond or act promptly to insured communications
Other : Failure to act on claim
* 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)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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)(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.

THE POLICY LANGUAGE RELEVANT TO THE VIOLATIONS INCLUDES ALL APPLICABLE POLICY COVERAGES, VALUATION PROVISIONS, AND OTHER TERMS AND CONDITIONS OF THE POLICY. VARIOUS LANGUAGE THROUGHOUT THE POLICY, INCLUDING BUT NOT LIMITED TO PROVISIONS GOVERNING COVERAGE FOR ROOF DAMAGE, WATER DAMAGE, MOLD, HURRICANE DAMAGE, WINDSTORM DAMAGE, HAIL DAMAGE, THE LOSS PAYMENT PROVISION(S), THE PROVISIONS GOVERNING THE DUTIES AND OBLIGATIONS OF THE INSURER; AND COVERAGE A – DWELLING; COVERAGE B – OTHER STRUCTURES; COVERAGE C – PERSONAL PROPERTY; AND COVERAGE D – LOSS OF USE.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

1) FAILURE TO PAY CLAIM IN FULL; 2) FAILURE TO PROMPTLY INVESTIGATE CLAIM; 3) FAILURE TO PROPERLY INVESTIGATE CLAIM; 4) FAILURE TO ADJUST LOSS; 5) FAILURE TO ACT IN DUE DILIGENCE AND GOOD FAITH TO RESOLVE CLAIM; 6) PLACING FINANCIAL INTEREST OF INSURER BEFORE THAT OF POLICY HOLDERS AND CLAIMANTS; 7) FAILURE TO PROPERLY TRAIN, EVALUATE AND MANAGE ADJUSTERS; 8) LOOKING FOR WAYS TO DENY COVERAGE, PAY LESS, DELAY PAYMENT AND OTHERWISE “LOW BALL” OR “STONE WALL” CLAIM; 9) THE REASONS FOR THIS MAY BE ATTRIBUTED TO IMPROPER TRAINING, SUPERVISION, AND/OR MOTIVATION OF ADJUSTERS AND CLAIMS SUPERVISORS. THE INSURER APPEARS TO HAVE FAILED TO ADOPT PROPER STANDARDS OF INVESTIGATION AND ADJUSTMENT OF LOSSES OR IS OTHERWISE NOT IMPLEMENTING THOSE STANDARDS BECAUSE FULL PAYMENT AND PROMPT PAYMENT FOR THE LOSS IS NOT OCCURRING. THE INSURANCE COMPANY ISSUED A POLICY OF INSURANCE TO THE INSURED WHICH PROVIDED COVERAGE FOR CERTAIN LOSSES. DURING THE POLICY PERIOD, ON OR AROUND SEPTEMBER 28, 2022, THE INSURED PROPERTY SUFFERED WINDSTORM DAMAGE WHICH WAS AND IS COVERED BY THE INSURANCE POLICY. THE INSURED PROMPTLY REPORTED THE LOSS TO THE INSURANCE COMPANY AND HAVE COMPLIED WITH ALL CONDITIONS OF THE POLICY. THE INSURANCE COMPANY HAS FAILED AND/OR REFUSED TO PAY THE FULL BENEFITS TO WHICH THE INSUREDS ARE ENTITLED FOR THE LOSS. DUE TO CONCERNS WITH THE DELAY IN THE INVESTIGATION AND THE INSURANCE COMPANY’S FAILURE TO PAY THE FULL AMOUNTS NECESSARY TO RESTORE THE PROPERTY TO ITS PRE-LOSS CONDITION, THE INSURED RETAINED AN EXPERIENCED AND HIGHLY QUALIFIED CONTRACTOR NAMED CYPRESS HILL SERVICES TO PREPARE AN ESTIMATE OF DAMAGE. CYPRESS HILL SERVICES ESTIMATED THE DAMAGE TO THE INSURED’S PROPERTY AT $132,509.21. THE INSURED HAS PROVIDED THE INSURER WITH A SWORN STATEMENT IN PROOF OF LOSS, THE ESTIMATE OF DAMAGE, AND THE AMOUNT OF DAMAGED PROPERTY. THE INSURED HAS MADE AN APPLICATION FOR INSURANCE BENEFITS UNDER THE POLICY BUT THE INSURANCE COMPANY HAS FAILED AND/OR REFUSED TO PAY THE FULL BENEFITS TO WHICH THE INSURED IS ENTITLED FOR THE LOSS. THE INSURANCE COMPANY HAS BREACHED THE POLICY OF INSURANCE BY FAILING TO PAY ALL OF THE BENEFITS DUE UNDER THE POLICY. THE INSURANCE COMPANY HAS FAILED TO SATISFACTORILY SETTLE THIS CLAIM AND HAS DEPRIVED THE INSURED OF A PROPER RESOLUTION OF THIS CLAIM. THE INSURANCE COMPANY HAS FAILED AND/OR REFUSED TO PROPERLY INVESTIGATE THE LOSS AND HAS FAILED AND/OR REFUSED TO TENDER THE PROPER AMOUNT OF INSURANCE BENEFITS DUE AND OWING TO THE INSURED. IN ORDER TO CURE THE CONDUCT GIVING RISE TO THE VIOLATIONS DESCRIBED HEREIN, THE INSURANCE COMPANY MUST COMPLETE THE PROPER EVALUATION OF THE DAMAGES VIA QUALIFIED PROFESSIONALS AND ISSUE PAYMENT FOR ALL THE COVERED DAMAGES. IN ADDITION, THE INSURANCE COMPANY MUST ISSUE PAYMENT TO THE INSURED FOR REASONABLE FEES, COSTS, AND PRE-JUDGMENT INTEREST IF REQUIRED BY THE APPLICABLE FLORIDA STATUTES. AS AN ALTERNATIVE CURE OPTION, THE INSURANCE COMPANY MAY CURE THE ALLEGATIONS GIVING RISE TO THIS NOTICE BY TENDERING A CHECK IN THE AMOUNT OF $132,509.21 LESS THE APPLICABLE DEDUCTIBLE, LESS ANY PRIOR PAYMENT(S), WITHIN THE 60 DAY CURE PERIOD, JOINTLY PAYABLE TO THE INSUREDS AND KASSEL LAW GROUP, PLLC.
Comments
User Id Date Added Comment
jbosch@qpwblaw.com 02-09-2023 VIA DFS WEBSITE Matthew Kassel, Esq. 4016 Henderson Blvd. Suite E Tampa, Florida 33629-4940 matt@kassellawgroup.com Complainant: Gregory Roberts & Cathy Joel (“Complainant[s]” or “Insured[s]”) Claim No: EDI951302 (“Subject claim”) Policy No: EDH5004210-02 (“Policy”) Loss Location: 9200 Pine Cove Rd, Englewood, FL 34224 (“Property”) CRN Filing No: 661828 CRN Acceptance Date: 12/15/2022 RE: CIVIL REMEDY NOTICE - DFS FILING NUMBER 661828 Dear Mr. Kassel: The undersigned counsel represents Edison Insurance Company (“Edison”) in regard to the alleged dispute as to the subject claim number listed above involving an alleged windstorm with a date of loss of on or about September 29, 2022, made under the Policy of insurance Edison issued to the Insureds listed above. This correspondence constitutes Edison Insurance Company’s response to the Civil Remedy Notice of Insurer Violations (“Notice” or “CRN”) you filed on behalf of Gregory Roberts & Cathy Joel (referenced herein as “Insureds” or “Complainants”) regarding the claim listed above. Edison believes that the Civil Remedy Notice should be rejected and returned by the Department of Financial Services as it is substantively defective and objectionable for the reasons stated herein, and, without waiving objections, as it completely misstates the facts surrounding this claim. ALLEGED STATUTORY VIOLATIONS 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. Edison specifically denies the Complainants’ allegation that it has violated the above referenced statute. Edison did not violate these provisions. The CRN does not include any facts to support this allegation. Edison conducted a thorough investigation in good faith and issued payment accordingly. 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. Edison specifically denies the Complainants’ allegation that it has violated the above referenced statute. Edison did not violate these provisions. The CRN does not include any facts to support this allegation. Edison conducted a thorough investigation in good faith and issued payment accordingly. 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. Edison specifically denies the Complainants’ allegation that it has violated the above referenced statute. The CRN does not include any facts to support this allegation. Edison did not make any misrepresentations regarding this claim or the policy. 626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims. Edison specifically denies the Complainants’ allegation that it has violated the above referenced statute. The CRN does not include any facts to support this allegation. Edison did not fail 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. Edison specifically denies the Complainants’ allegation that it has violated the above referenced statute. The CRN does not include any facts to support this allegation. Edison did not make any misrepresentations regarding this claim or the policy. 626.9541(1)(i)(3)(c): Failing to acknowledge and act promptly upon communications with respect to claims. Edison specifically denies the Complainants’ allegation that it has violated the above referenced statute. The CRN does not include any facts to support this allegation. Edison consistently and promptly communicated with the Insureds and their representatives via phone, email and formal correspondence. 626.9541(1)(i)(3)(d): Denying claims without conducting reasonable investigations based upon available information. Edison specifically denies the Complainants’ allegation that it has violated the above referenced statute. The CRN does not include any facts to support this allegation. Edison conducted a thorough, complete, comprehensive investigation and issued payment in good faith. 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. Edison specifically denies the Complainants’ allegation that it has violated the above referenced statute. The CRN does not include any facts to support this allegation. Edison issued payment and consistently sent detailed correspondence as outlined below. 626.9541(1)(i)(4): Failing to pay undisputed amounts of partial or full benefits owed under first party property insurance policies within 90 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 an act of God, prevented by the impossibility of performance, or due to actions by the insured or claimant that constitute fraud, lack of cooperation, or intentional misrepresentation regarding the claim for which benefits are owed. Edison specifically denies the Complainants’ allegation that it has violated the above referenced statute. The CRN does not include any facts to support this allegation. Edison issued payment within the 90 day period to do so and consistently sent detailed correspondence as outlined below. In addition to the allegations specifically denied above, Edison generally denies all allegations presented in this CRN, as Edison has not violated any statute, Code or Rule. SPECIFICITY REQUIREMENTS Florida Statute requires that a CRN state the facts and circumstances giving rise to the alleged violations with specificity sufficient to allow an insurer to “cure” the alleged violations within the sixty-day statutory period. See Fla. Stat. § 624. 155(3)(b)(2). See also Lane v. Westfield Ins. Co., 862 So. 2d 774, 777 (Fla. 5th DCA 2003), Talat Enterprises, Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). However, here, the CRN is deficient and defective in that it fails to state with sufficient specificity the necessary facts in support of the Insureds’ contentions, including but not limited to, those that would be necessary for Edison to “cure” the alleged violations. Further, the subject CRN provides what appears to be several boilerplate and conclusory statements, which fail to describe any accurate facts constituting violations of the statutes cited therein. Thus, because the allegations in the CRN are incomplete and incorrect, they fail to provide actual notice of the specific allegations and the actions that Edison could undertake to cure any alleged violations. 316, Inc. v. Maryland Cas. Co., 625 F. Supp. 2d 1187, 1193 (N. D. Fla. 2008). Blanket references to policy provisions and statutes without specification deems the Civil Remedy Notice deficient. Julien v. United Property and Casualty Insurance Co., (Fla. 4th DCA 2020). For the reasons set forth herein, Edison hereby objects to the subject CRN and states it does not intend to waive, ratify or otherwise accept the deficiencies in the CRN, and reserves the right to contest the legal adequacy of the CRN hereinafter as appropriate. As to the content of the CRN here, it is important to note that said CRN is a nullity and should be rejected because the CRN fails to comply with the specific requirements mandated by Florida Statutes §624.155. Specifically, Fla. Stat. § 624.155(3)(b)(2) requires the Complainant to set forth with specificity, sufficient factual allegations to state a prima facie case of an insurer violation, so as to put the insurer on notice and be afforded the opportunity to cure the deficiency. However, the Insureds failed to do so in the subject CRN and instead only included conclusory statements, which lack even minimal specificity and/or lack the underlying factual basis to support them. The Insureds’ failure to describe any actual facts or circumstances to support the alleged statutory violations in the CRN precludes Edison from evaluating what error, if any, allegedly occurred during the claim process. Furthermore, contrary to the requirement to “describe the facts and circumstances giving rise to the insurer’s violation as you understand them at this time,” the purpose of which is “to enable the insurer to investigate and resolve [the] claim,” the CRN itself only provides unsupported and incorrect allegations with no basis in fact or circumstances. Consequently, the CRN lacks the requisite minimal specificity and Edison is unable to determine what specifically the Complainants are claiming was done by or on behalf of Edison that constitutes the bad faith alleged. Due to the absence of specific and accurate information regarding the alleged acts or omissions by Edison which allegedly give rise to any violation of the Civil Remedy Statute, Edison is limited in its ability to set forth specific facts to address and/or refute these unsubstantiated assertions. Notwithstanding, Edison explicitly denies violations of any applicable Florida Statute in the adjustment of the Subject claim and realleges and re-asserts its specific denials to the alleged violations in the subject CRN as set forth above. In addition, Edison denies that it has conducted the practices listed under the “reasons for notice” portion of the Notice. Accordingly, without waiver of its objections, rights and defenses, Edison maintains that it has acted and continues at all times to act in good faith during the investigation and adjustment of the Insureds’ claim. Further, Edison wishes to dispel even the inference of any statutory violation and reiterates below the various reasons which clearly show the proper handling of the Subject claim by Edison. Moreover, as stated in Demase v. State Farm Florida Insurance Company (Fla. 5th DCA November 14, 2022), and as a condition precedent to bringing a first-party bad faith case, an insured must provide timely notice of the alleged violation to the authorized insurer and to the DFS. The Insureds have failed to provide such timely notice to Edison. BACKGROUND FACTS Aside from the fact that the allegations contained in the subject CRN lack specific facts, the tenor and inferences of statutory violations are wholly without merit, and Edison denies each and every one. Below are some of the relevant facts regarding the Subject claim that the Insureds failed to include in the CRN. On September 30, 2022, the Insured Gregory Roberts reported damage to his property that took place on the day before, September 29, 2022. He stated there were many fallen trees and damage to the roof, fence, screen, and carport as well as water damage in the bedroom. On the same day, September 30, 2022, Edison immediately sent correspondence acknowledging receipt of the claim. This correspondence included the Florida homeowner claim bill of rights as well as information on mediation and claims handling. On the next day, October 1, 2022, Edison sent correspondence providing the name and contact information for the adjuster assigned to the claim. On October 12, 2022, the field adjuster inspected the subject property on behalf of Edison and observed damage to the property. Accordingly, on October 31, 2022, Edison issued a coverage determination letter stating, “A check in the amount of Coverage A Dwelling $1,529.73 will be mailed to you. A check for Coverage A Dwelling Screened Enclosures $1,532.82 and Coverage B Other Structures $9,094.00 will also be mailed to you.” The letter further explains, “We are denying the portion of your claim that is related to any damages related to the window in the downstairs bedroom. There is not a storm created opening. The damages related to the window is from wind driven rain and wind driven rain is an exclusion in the policy.” Over a month later, the subject Civil Remedy Notice was filed on December 15, 2022. Also on December 15, 2022, Edison received correspondence from Insureds’ counsel’s office attaching a letter, an executed sworn proof of loss for $132,509.21 and an estimate from Cypress Hill Services for the same amount. Please note, this was the first time any estimate was provided to Edison. On December 21, 2022, the supervising adjuster called and sent correspondence to counsel advising that in response to the newly provided estimate, Edison will reinspect the property. The adjuster also provided the name and contact information for the field adjuster. The correspondence also outlines the next steps in the investigation. On December 23, 2022, the supervising adjuster sent correspondence to counsel asking for more information about items in the Cypress Hill estimate regarding solar panels. On January 9, 2022, Edison sent correspondence to counsel stating, “We are accepting the Sworn Statement in Proof of Loss as being in compliance with the policy conditions concerning the filing of a Sworn Statement in Proof of Loss. We expressly reject any and all statements contained in the Sworn Statement in Proof of Loss with reference to the amount of loss, and we expressly reserve all of the rights and defenses which Edison Insurance Company possesses under its Policy Number EDH5004210-02. On January 10, 2023, the supervising adjuster sent detailed correspondence to counsel seeking specific information regarding the claim including pertinent photos and documents. On January 18, 2023, Edison sent a reservation of rights letter explaining, “We have reopened the claim and require time to investigate the Supplement Claim. While the investigation of your claim is ongoing, we would like to take this opportunity to inform you of your responsibilities under the policy. There is also a question whether coverage under your policy applies to this loss. Under the policy conditions we need to further investigate this matter to provide a timely response. The nature of the coverage question that exists is whether you have complied with your duties after a loss as noted in Section I – Conditions of your policy.” Then, on January 21, 2023, counsel filed a Property Insurance Notice of Intent to Initiate Litigation stating their presuit demand is $143,609.00 along with the same Cypress Hill estimate. On January 26, 2023, Edison sent correspondence in response to the Notice of Intent to Initiate Litigation stating, “Please be aware that Edison Insurance Company maintains your Notice of Intent to Initiate Litigation is premature pursuant to Florida Statute 627.70152, because Edison Insurance Company has not yet made a coverage determination of your Supplemental Claim under Florida Statute 627.70131. As such, Edison Insurance Company respectfully requests that your Notice of Intent to Initiate Litigation be withdrawn at this time.” It further explains, “Edison Insurance Company was placed on notice that you are claiming additional damages relating to the above-referenced claim and the claim was re-opened on December 21, 2022 preceding your Notice of Intent to Initiate Litigation. As part of the supplement a re-inspection was requested but date has not been completed. Accordingly, Edison Insurance Company requires time to investigate this newly reported Supplemental Claim and will advise you of Edison Insurance Company’s coverage determination of your Supplemental Claim in accordance with Florida Statute 627.70131.” On January 26, 2023, the supervising adjuster sent correspondence to counsel providing the name and contact information for the new field adjuster assigned to the claim. The email also requests and outlines other information needed to fully investigate the claim. Please note this information has not been provided to Edison to date. On February 3, 2023, the field adjuster conducted a reinspection of the subject property along with the public adjuster. Thus, Edison is conducting its investigation of the supplemental portion of the claim in good faith but the Insureds are acting in bad faith by not providing required and necessary information despite. INACCURACY OF ALLEGATIONS IN THE SUBJECT CRN The case specific facts related to Edison’s handling of the Subject claim provided above implicitly address many of the vague allegations contained within the Insureds’ CRN and further establish that Edison undertook a thorough investigation in accordance with applicable statutory requirements and professional standards of care. It is important to note that the Insureds have not provided any factual support for any of the above allegations. Instead, the facts support that Edison promptly contacted the Insureds, inspected the claim shortly after it was reported, and issued a coverage determination and payment based on a thorough investigation. When additional information was provided in the form of the adjuster estimate, Edison inspected the loss and made many attempts to obtain additional information. The circumstances support that Edison conducted a good faith, thorough, prompt investigation with the information provided. It is the Insureds via their counsel who are acting in bad faith. The Insureds accuse Edison of misrepresenting pertinent facts and delaying the claim without any basis. The reality is that the Insureds failed to comply with Edison’s request for additional information. Insureds’ counsel is alleging bad faith in a scenario where Edison conducted a comprehensive, prompt investigation in good faith. Also, the Notice fails to set forth any specific policy language alleged to have been violated. Instead, the notice essentially refers to the entire policy. It is this failure to identify the specific policy provision that is allegedly relevant to the alleged violations that prevents Edison from addressing any issues regarding the policy. Edison consistently acted in accordance with the terms and condition outlined in the policy. Furthermore, contrary to the requirement to “describe the facts and circumstances giving rise to the insurer’s violation as you understand them at this time”, the purpose of which is “to enable the insurer to investigate and resolve [the] claim”, the Civil Remedy Notice itself only provides completely false allegations with no basis in fact or circumstances. For example, the Civil Remedy Notice repeatedly states Edison failed to issue payment but conveniently left out the payments issued on October 31, 2022. The CRN accuses Edison of delaying the claim when in reality, the initial coverage determination was provided within a month of reporting the claim and Insureds have still failed to provide requested documentation and information. Thus, the Insureds are delaying the supplemental portion of the claim. Furthermore, the tenor and inferences of the allegations are without merit, and Edison denies each and every one. Some of the relevant facts that Insureds’ counsel failed to include in the notice have been set out above. In their Notice, the Insureds make multiple blanket statements that appear to just be copied and pasted and not based on any facts. Specifically, the Insureds’ Notice makes 9 allegations of what Edison failed to do but does not include any facts to support these allegations. Edison did not fail to pay the claim in full, has not failed to promptly investigate the claim, did not fail to properly investigate the claim, did not fail to adjust the loss, and did not fail to act in due diligence and good faith to resolve the claim. Edison did not place its financial interest before that of policy holders and claimants and did not fail to properly train, evaluate, and manage adjusters. Edison has not looked for ways to deny coverage, pay less, delay payment, and otherwise “low ball” or “stonewall” the claim. Edison properly trains, supervises and motivates adjusters and claim supervisors. Edison has not failed to adopt proper standards of investigation and adjustment of losses or is otherwise not implementing same. As clearly set forth above and contrary to the allegations set forth in the Notice, Edison’s investigation and adjusting of its Insureds’ claim was prompt, thorough, and complete. Furthermore, the Insureds have included absolutely no facts or evidence to support any claims in the Notice. All of these baseless claims support Edison’s position that the claim was properly adjusted, and the Insureds do not actually have any concrete facts to support a bad faith allegation. Mere disagreement as to the amount of coverage does not equate to bad faith. The Civil Remedy Notice does not show how Edison has failed to comply with the statutory provisions alleged to have been violated. Evidently, this Civil Remedy Notice was filed in bad faith, as it is being used as an improper mechanism designed solely for the purpose of intimidating Edison into potentially over paying the Insureds. For the aforementioned reasons, Edison categorically denies that it has acted with bad faith in connection with this claim. CONCLUSION The purpose of a CRN is to provide the insurer an opportunity to “cure” the alleged wrongdoing. Talat Enterprises, Inc. v. Aetna Casualty and Surety Co. , 753 So. 2d 1278 (Fla. 2000). However, the CRN here does not serve this purpose because it does not provide any means as to how Edison can “cure” the alleged defects. This failure to provide a proper opportunity to cure renders the CRN improper. Longpoint Condominium Associations v. Allstate Insurance Co. , 2005 WL 131580 (N. D. Fla. June 2, 2005). Moreover, the method for curing the violations alleged in a civil remedy notice are not determined by the insured. In Talat Enterprises, Inc. v. Aetna Casualty and Surety Co. , 753 So. 2d 1278 (Fla. 2000), the Florida Supreme Court accepted and quoted the reasoning of the court below in its opinion which stated in relevant part, as follows: Section 624. 155 does not impose on an insurer the obligation to pay whatever the insured demands. . . . Section 624. 155(2)(d) would have no effect or purpose under such an interpretation. The law does not support such an expansive and illogical reading of Fla. Stat. Ann. §624. 155(2)(d). . . . To cure an alleged violation and to avoid a civil action, an insurer must pay the claim . . . before the sixty days expire. Talat, 753 So2d at 1282 citing Talat Enterprises Inc. v. Aetna Cas. & Sur. Co., 952 F. Supp. 773, 777-778 (M. D. Fla. 1996). Here, Edison properly adjusted the Subject claim as it investigated the loss within the statutory time frame and the Insureds have not produced the requested, necessary information to support their positions that they are entitled to any additional damages. Edison denies all of the allegations contained in the subject CRN, which is defective and improper, as Edison has not violated any of the subject statutes. Edison further states that the accusations made against it in the subject CRN are patently false. In closing, Edison first believes that the Civil Remedy 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. Due to the lack of any factual and circumstantial basis to support the allegations therein, Edison respectfully requests, through this response, that the DFS return and reject the CRN for lack of specificity pursuant to Florida Statutes. Regardless of the rejection, Edison denies all allegations contained in the Civil Remedy Notice and submits there are no violations. While Edison’s response herein is meant to address the allegations in the Insureds’ Notice, it is based upon the limited information provided in the Civil Remedy Notice and the information presented to date. If the Insureds feel that Edison is not in possession of all the facts, please inform the undersigned immediately. Please note that Edison’s response is not necessarily exhaustive and does not preclude Edison or anyone on Edison’s behalf from asserting any other valid reason for seeking rejection and return of the Civil Remedy Notice. Also, this letter or any act or failure to act on the part of Edison or any agent or representative of Edison should not be construed as a waiver of any rights or defenses available to it by contract or at law, as all such rights and defenses are hereby specifically reserved. On behalf of Edison, we trust that this response addresses the allegations in the Civil Remedy Notice of Insurer Violation. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Very Truly Yours, QUINTAIROS, PRIETO, WOOD & BOYER, P.A.
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.

Before submitting a Notice using this system, please verify that all text has been entered correctly and completely. Once the Notice has been submitted, the text cannot be changed or deleted.




DFS-10-363
Rev. 10/14/2008