Civil Remedy Notice of Insurer Violations
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Filing Number:     688115
Filing Accepted:  4/13/2023
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Complainant
Last/Business Name *  
HEFFELFINGER   First Name   LORI & BOBBY
Street Address * 9358 GULFSTREAM BLVD
City, State Zip * ENGLEWOOD, FL 34224
Email Address * WITHHELD
Complainant Type: * Insured
Insured
Last/Business Name*   HEFFELFINGER   First Name   LORI & BOBBY
Policy # * EDH4071022-03 Claim #* EDI952919
Attorney
Attorney is Applicable
Last Name* MULLINAX First Name * MATTHEW Initial
Street Address* 908 W HORATIO STREET
City, State Zip* TAMPA , FL 33606
Email Address * MATT@MAKRISMULLINAX.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):* BRENDEN COLTER
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
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)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
626.9541(1)(i)(3)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
* 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 perils insured against section. The Loss Payment provision The Loss Settlement Provision. Any provisions of the policy which Edison Insurance Company (EIC) relied upon when adjusting this claim or reaching a coverage decision. Any provisions of the policy which EIC cited in any letters with the insureds.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The insureds purchased, for good and valuable consideration, a policy of insurance from EIC. The insureds paid a premium, and in return EIC agreed to indemnify the insureds for loss or damage to the insureds' home. While that policy was in effect, a covered loss occurred, in the process of Hurricane Ian hitting the state of Florida. The insureds' home suffered significant damage, which the insureds' public adjuster estimated to cost $65,462.32 to repair. The insureds timely reported the damage to EIC but EIC has refused and/or failed to pay the full amount necessary to repair the covered damage, and instead only paid $16,197.95 for the damage to the home and $236.33 for damage to the pool screen. Due to EIC's refusal to adjust the claim properly, the insureds were forced to retain a public adjuster, which creates a new financial obligation that the insureds would not have had, had EIC timely and properly paid the claim. EIC unecessarily delayed the claim, by failing to comply with Florida Statutes that spell out the time frame in which an insurance company should pay or deny a claim. These actions and inactions by EIC are either the result of not having proper procedures in place, or intentional actions designed to thwart an insured from receiving insurance proceeds that are owed. This is a failure to adjust the claim in good faith. To cure, EIC must: accept full coverage, and pay the full amount necessary to restore the damage prior to the expiration of this cure period. The insureds' believe the cost to be the amount of the estimate submitted, $65,462.32.
Comments
User Id Date Added Comment
jbosch@qpwblaw.com 06-09-2023 VIA DFS WEBSITE Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Complainant: Lori & Bobby Heffelfinger Claim No: EDI952919 (“subject claim”) Policy No: EDH4071022-03 (“policy”) Loss Location: 9358 Gulfstream Blvd, Englewood, FL 34224 (“property”) CRN Filing No: 688115 CRN Acceptance Date: 4/13/2023 RE: CIVIL REMEDY NOTICE - DFS FILING NUMBER 688115 Dear Sir or Madam: 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 Lori and Bobby Heffelfinger (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 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. In fact, Edison conducted a thorough investigation in good faith and issued multiple payments 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 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. In fact, Edison conducted a thorough investigation in good faith and issued multiple payments 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 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 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 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)(i): Unfair claim settlement practices 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. In fact, Edison conducted a thorough investigation in good faith and issued multiple payments accordingly. 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 Complainants 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 and blanket references to the policy, 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 October 3, 2022, the Insured reported Hurricane Ian damage that took place on September 29, 2022 advising of damage to the pool enclosure, screen door, and front door. The Insured also reported that windows were leaking and there was water damage to the property. On the same day, 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. By letter dated October 4, 2022, Edison acknowledged the reported claim and advised the Insureds of the name and contact information for the adjuster assigned to the claim. Also, on October 11, the adjuster on the file contacted the Insureds to introduce herself. On October 10, 2022, a field adjuster inspected the property on behalf of Edison and discussed the claim with the insured. On or about October 27, 2022, the Insureds provided an estimate from Blue Sky Roofing for $20,850.59 as well as a $250 invoice for cutting trees. On October 29, 2022, the Insureds provided an estimate for $2500 for the pool cage. After conducting a thorough investigation of the property and reviewing all of the information provided, on November 7, 2022, Edison issued its coverage determination letter stating, “A check in the amount of $16,197.95 for Dwelling, and $236.33 for Screen Enclosure Coverage will be mailed to you.” The letter further states, “Based on our investigation of your claim, and the terms of your policy, we have determined there is no coverage for the screen material of the pool enclosure.” On November 28, 2022, Edison sent the coverage letter to the Insureds again after discussing the claim with the Insureds. Edison received water mitigation documents from Apple Roofing and promptly issued payment of $1,300.00 for same on November 29, 2022. After being advised that the Insureds paid a down payment to Apple Roofing, on December 6, 2022, Edison issued yet another payment for $500 for the previously paid down payment. On January 10, 2023, Edison received a letter of representation from the Insureds’ public adjuster seeking the policy. Accordingly, the requested certified copy of the policy was sent to them on January 16, 2023. On January 16, 2023, the public adjuster emailed again asking for an update on the claim, to which Edison responded on January 19, 2023. On January 24, 2023, the public adjuster asked for an estimate which Edison provided on January 30, 2023. Inexplicably, on January 30, 2023 and January 31, 2023 the public adjuster resent emails previously sent to which Edison had already responded. On February 24, 2023, Edison received photos and an estimate from the public adjuster for $65,462.32. On March 13, 2023, Edison received a sworn proof of loss for $59,320.32 after application of the deductible. The subject Civil Remedy Notice was prematurely filed on April 13, 2023. After conducting another investigation, on or about April 15, 203, Edison issued additional payment with correspondence stating, “A check for Coverage A- Dwelling in the amount of $6,359.63, a check for Coverage A Screen Enclosure in the amount of $6.84, a check for Coverage A- Tree Debris Removal in the amount of $150.00, and a check for Coverage B- Other Structures in the amount of $3,625.37 will be mailed to you.” As you can see, Edison conducted a comprehensive, prompt investigation in good faith, promptly communicated with the Complainants and/or their representative and issued multiple payments as additional information was received. 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 again investigated the loss and issued additional payments. 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 are 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 lists sections that essentially refer 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. Nevertheless, Edison consistently acted in accordance with the terms and conditions 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 CRN accuses Edison of delaying the claim when in reality, the initial coverage determination was provided 35 days after the Insureds reported the claim, well within the 90 days provided by statute. 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. 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. 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 overpaying 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. 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.

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