Civil Remedy Notice of Insurer Violations
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Filing Number:     785211
Filing Accepted:  10/1/2024
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Complainant
Last/Business Name *  
SANTI AVERSANO AND MARY ANN AVERSANO   First Name  
Street Address * 12531 ALLENDALE CIR
City, State Zip * FORT MYERS, FL 33912
Email Address * SANTIAVERSANO27@COMCAST.NET
Complainant Type: * Insured
Insured
Last/Business Name*   SANTI AVERSANO AND MARY ANN AVERSANO   First Name  
Policy # * EDH4059764-04 Claim #* EDI964959
Attorney
Attorney is Applicable
Last Name* MONTAZER First Name * ARDALAN Initial
Street Address* 925 FEDERAL HWY
City, State Zip* BOCA RATON , FL 33432
Email Address * AMONTAZER@KPATTORNEY.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):* DANIEL RIVERA
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
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)(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)(f) Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Loss settlement provision
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The carrier was immediately put on notice of the insureds’ Hurricane Ian claim. Subsequently, the insureds prepared a loss package in the amount of $129,309.86 needed to restore the property back to its pre-loss condition. Whereas, the carrier has failed to prudently inspect the insureds’ property, come to a fair coverage determination and promptly pay the claim. The carrier improperly determined that the loss was not covered under the policy and wrongfully denied the claim. In turn, the insureds have complied with all of the carrier’s requests to date and the carrier has still failed to treat this claim with good faith. This intentional delay with the claim has led to direct prejudice of the insureds. About seven hundred forty-five days have passed since the original date of loss. The carrier has still refused to pay the fully covered amount owed under the policy. The carrier is aware of the damage sustained by the insured’s property and has not taken any meaningful ensuing action. It is clear that the carrier is not treating the insureds with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insureds; failing to implement proper standards for the adjustment and investigation of claims by its adjusters and placing the company’s interests before the insureds’ interests; refusing to pay the full amount owed to the insureds despite the fact that the carrier has been on notice of the damages and looking for ways to delay full recovery or any recovery to the insureds, when a reasonable carrier in a similar position would have tendered a full payment in accordance with both the policy language and statutory requirements. The carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c) and 626.9541(1)(i)(3)(f), as well as Section I- Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss; and the loss payment provision under Section I- Conditions requiring payment of a claim within 90 days. All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless disregard for the insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $129,309.86, less any prior payments and less any applicable policy deductible; and 2.) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been sent to the carrier. Please do not hesitate to contact the undersigned or Eva Hernandez at (561)-892-2035 if you have any questions or concerns. Sincerely, Ardalan Montazer Attorney at Law
Comments
User Id Date Added Comment
tsalehi@salehiboyer.com 11-18-2024 Re: Complainants: Santi Aversano and Mary Ann Aversano Policyholders: Santi Aversano and Mary Ann Aversano Filer: Ardalan Montazer, Esq. Claim #: EDI964959 Policy #: EDH4059764-04 Date of Loss: September 28, 2022 CRN Filing No.: 785211 CRN Filing Date: October 1, 2024 To Whom It May Concern at The Department of Financial Services: With this correspondence, EDISON INSURANCE COMPANY (“EDISON”) responds to the Civil Remedy Notice of Insurer Violations (“CRN”) filed by Ardalan Montazer, Esq., on behalf of Santi Aversano and Mary Ann Aversano (the “Complainants” or “Claimants”). After reviewing the CRN, EDISON conducted a thorough review of its handling of the Complainants’ claim. EDISON denies that it has violated any of the statutes referenced in the CRN. At all times, EDISON has acted in good faith, fairly and honestly toward the Complainant and with due regard for their interests. EDISON also argues that the CRN fails to adequately describe the alleged violations and fails to provide sufficient information such as facts and circumstances which would allow EDISON to correct the alleged violations. The Complainants allege violations of the following statutory provisions: 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 denies the allegation that it violated the above referenced statute. 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 denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims. EDISON denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(b): Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. EDISON denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(c): Failing to acknowledge and act promptly upon communications with respect to claims. EDISON denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(f): Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement. EDISON denies the allegation that it violated the above referenced statute. EDISON specifically denies each and every one of the Complainant’s allegations that it violated any of the above referenced statutes. In addition to the allegations specifically denied above, EDISON generally denies all allegations presented in this CRN as EDISON has not violated any statute or rule. CRN MUST BE DISMISSED The CRN must be dismissed first and foremost because the Complainant failed to allege any specific, actual facts in support of any of their statutory allegations. Next, the CRN requires that the Complainant “pursuant to section 624.155, F.S., please indicate all statutory provisions alleged to have been violated.” The CRN filed in this matter includes almost every statutory provision that could be claimed against an insurance company, regardless of whether they are relevant or applicable to the alleged facts contained in the Notice. Because the Civil Remedy Notice fails to allege any specific facts and/or circumstances in support of its allegations, EDISON is unable to properly respond; as such, the CRN should be rejected and returned. The CRN is wholly devoid of any factual allegations relating to the monetary amount of any claims, or any reference to communications (or lack thereof) possibly giving rise to any alleged violation. See Rousso v. Liberty Surplus Ins. Corp., No. 10-cv-20554, 2010 WL 7367059, at *4 (S.D. Fla. Aug. 13, 2010) (“In this case, the Plaintiffs do not explain how or identify which claims or suits the Defendant responded to in a manner that was contrary to good faith, unfair, or dishonest. This vagueness continues in the Plaintiffs' claim that the Defendant failed to respond to repeated pleas for assistance.”). These glaring deficiencies fail to apprise EDISON of the nature of any purported violation and cannot satisfy the statutory standard of “pleading the facts and circumstances” giving rise to the violation with specificity. The CRN also fails to set forth the applicable policy language or the policy provisions that have been violated. The CRN first identifies Section 624.155(1)(b)(1), Florida Statutes, which addresses an insurer’s refusal to attempt to settle in good faith. The CRN, however, does not specify when any settlement opportunity or proposal existed, the details of the settlement proposal, the nature of the underlying claim(s), or the circumstances supporting the conclusion that the unspecified refusal to settle was not in good faith. To the extent the CRN suggests that EDISON should tender payment due on the claim, the CRN fails to provide a sufficient description of the facts and circumstances supporting this contention. As to 624.155(1)(b)(3), Florida Statutes, the CRN does not describe how EDISON failed to promptly settle the claim, and the Complainant cannot possibly support this contention as EDISON issued a coverage determination in accordance with the terms and conditions of the subject policy of insurance. As to Section 626.9541(1)(i)(3)(a), Florida Statutes, the CRN does not describe any standards applicable to the investigation of the purported “claim” advanced by the Complainant, much less the facts and circumstances giving rise to the contention that EDISON failed to adopt or implement such standards. The general defects specified above again apply with particularity here because the CRN’s failure to describe the facts or circumstances of the claim precludes EDISON from evaluating what error, if any, allegedly occurred during the claim process. Complainant cannot possibly support the position that the claim was denied improperly because the CRN provides no description of the applicable policy provisions, the facts or circumstances of EDISON’s investigation, the disposition of the claim, or the facts and circumstances indicating EDISON’s investigation was in some way defective. As to Section 626.9541(1)(i)(3)(b), Florida Statutes, the Purported Notice fails to describe any "misrepresentation" or false statement relating to the facts of the claim or coverages at issue, much less the facts and circumstances giving rise to the contention that EDISON misrepresented pertinent facts or insurance policy provisions relating to coverages at issue. As to Section 626.9541(1)(i)(3)(c), Florida Statutes, the CRN does not describe any standards applicable to the purported “claim” advanced by the Complainant, much less the facts and circumstances giving rise to the contention that EDISON failed to acknowledge and act promptly upon communications with respect to claim. As to Section 626.9541(1)(i)(3)(f), Florida Statutes, the CRN does not describe any failure to promptly provide an explanation in writing of the basis in the insurance policy. Complainant cannot possibly support this contention as EDISON issued a coverage determination in accordance with the terms and conditions of the subject policy of insurance. 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 circumstance. The tenor and inferences of the allegations are wholly without merit and EDISON denies each and every one. The allegations set forth in the CRN are denied as they are mere conclusory allegations unsupported by facts, devoid of logic and intended solely to tarnish FLORIDA PENINSULA’s name and reputation. EDISON, at all times, acted fairly, honestly and in good faith in its dealings with the Complainant. EDISON did not engage in unfair settlement practices nor did EDISON fail to promptly settle the claim or attempt to settle the claim in order to influence settlement under a different portion of the policy. EDISON at no time misrepresented any pertinent facts or insurance policy provisions. EDISON conducted a reasonable and prudent investigation of the claim and acted upon all communications from the Complainant. Finally, EDISON promptly and appropriately communicated with the Complainant and provided explanations for the actions and decisions that were made. EDISON retained a field adjuster and conducted an inspection of the subject property to investigate the Complainant’s claim. Thereafter, EDISON made a coverage decision. As it relates to the facts of the claim, EDISON received notice of the subject loss on or about August 16, 2024, alleged to have occurred on September 28, 2022. Specifically, the Complainants Public Adjuster reported wind damage to the property caused by Hurricane Ian. On August 21, 2024, an independent adjuster inspected the subject property on behalf of EDISON and observed the reported damages related to the alleged loss. After analysis of the subject Policy, and based on the above factual investigation, EDISON issued a coverage determination on August 28, 2024 pursuant to the terms and conditions of the subject policy of insurance. Moreover, EDISON’s letter outlined the basis for the coverage determination based on policy provisions and exclusions. The correspondence was in writing, promptly sent to the Complainants, and explained that there was no coverage for the reported claim. The above demonstrates quite clearly that EDISON acted in good faith, acted fairly and honestly, acknowledged and acted promptly upon receipt of the claim, attempted to determine coverage for the claim pursuant to the terms of the policy, took reasonable steps to investigate the claim, communicated reasonably with the Complainant about the claim, and provided the Complainant a reasonable explanation for each of its actions. Clearly, EDISON conducted a comprehensive investigation into the subject claim and rendered its coverage decision based on the terms and conditions of the subject policy. Additionally, the CRN contains “cures” for the alleged defects; however, the listed “cures” are improper pursuant to Florida case law, specifically the case of Talat Enterprises, Inc., v. Aetna Casualty and Surety Co., 753 So.2d 1278, 1281 (Fla. 2000). The Talat case provides that the scope of what can be "cured" is limited to the alleged non-payment of the contractual amount due to the insureds. Talat also commented that, "It naturally follows that for there to be a "cure," what had to be "cured" is the non-payment of the contractual amount due the insured. In the context of a first-party insurance claim, the contractual amount due the insured is the amount owed pursuant to the express terms and conditions of the policy after all of the conditions precedent of the insurance policy in respect to payment are fulfilled....” As a result, only a demanded “cure” relating to the specific amount needed to repair covered damages is proper and legal – any remaining “cures” are improper remedies and contrary to Florida law. In closing, EDISON first believes that the CRN 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, and regardless of the rejection, EDISON denies all allegations contained in the CRN and submits that there are no violations. While this response is meant to be comprehensive, EDISON based the above-mentioned statements upon the limited information provided in the CRN and the information EDISON has been provided to date. If the Complainant feels that EDISON is not in possession of all the facts, please provide such additional information as soon as possible. Please note that EDISON’s response is not necessarily exhaustive and does not preclude the assertion of other valid reasons for seeking rejection and return of the CRN. Also, nothing in this letter, or any act or failure to act on the part of EDISON or any agent or representative of EDISON should 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. We trust that this response addresses the allegations of insurer violation alleged in the CRN. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Regards, /s/ Donald Lavigne Donald Lavigne, Esquire On behalf of Edison Insurance Company
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