Civil Remedy Notice of Insurer Violations
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Filing Number:     786626
Filing Accepted:  10/14/2024
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Complainant
Last/Business Name *  
RYAN   First Name   WILLIAM & SANDRA
Street Address * 10386 CAROLINA WILLOW DRIVE
City, State Zip * FORT MYERS, FL 33913
Email Address * WMPRYAN@AOL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   RYAN   First Name   WILLIAM & SANDRA
Policy # * EDH5363939-00 Claim #* EDI963483
Attorney
Attorney is Applicable
Last Name* KESSLER First Name * JOSEPH Initial
Street Address* 333 SE 2ND AVE, SUITE 2000
City, State Zip* MIAMI , FL 33131
Email Address * JKESSLER@DKLAWFL.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):* CLAIMS DEPARTMENT AND/OR WILL DORSEY
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Claim Denial
* 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.
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

These actions from the carrier as set forth above violate the following Florida Statutes: 626.9541(1)(i)(3)(d), Denying claims without conducting reasonable investigations based upon available information; 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; 626.9541(1)(i)(3)(a), Failing to adopt and implement standards for the proper investigation of claims. The Carrier’s actions set forth above also violated the following policy provisions: 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.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

October 14th, 2024, Sent Via U.S. Mail & Email Edison Insurance Company (Attn: Claims department and/or Will Dorsey) 903 NW 65th St Boca Raton FL, 33487 888-683-7971 csclaims@edisoninsurance.com RE: Insured(s) : William & Sandra Ryan (“insured(s)”) Policy # : EDH5363939-00 Claim # : EDI963483 Property Address : 10386 Carolina Willow Drive, Fort Myers, Fl 33913 Insured(s) Email : WMPRYAN@AOL.COM Dear Edison Insurance Company, (“carrier”): Please find enclosed the civil remedy notice filed for the above referenced claim. As discussed in greater detail in the notice, the carrier has not attempted in good faith to settle the insureds’ claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insureds and with due regard for their interests. The carrier is required to properly investigate and adjust claims and cannot place that burden upon the insureds. The carrier was put on notice of the insureds’ claim that occurred on 09/28/2022. After being put on such notice, the carrier initially sent a representative to inspect the property. It is believed the representative initially sent to the property was unqualified or lacked the necessary training to determine the cause of the damages observed during the inspection. It is also believed that the representative initially sent to the property was unqualified or lacked the necessary training to determine the amount of damages sustained as a result of the loss. It is upon information and belief that the carrier’s initial representative observed widespread wind and water damages from a hurricane to the property. The initial representative was unable to rule out wind and water damages from hurricane Ian as the cause of the damages observed during the inspection of the property. After the cursory inspection of the property, the carrier sent a coverage letter to the insured. The coverage letter provided by the carrier advised the insured there was no coverage for the loss. The policy exclusions/reasons for not extending coverage cited to by the carrier are not supported by the information known to the carrier or the representative that inspected the property at the time the coverage decision was made for the loss. The carrier and its representative lacked necessary information needed to support the incorrect conclusions regarding the cause of the damages to the property. The carrier and its representative relied on a boilerplate exclusion that were not supported by the facts of the loss tin order to deny the claim. It is clear by the language of the carrier’s denial letter that it did not determine what caused the damages observed at the property. The carrier just included various exclusions under the policy. The carrier inspected the property with a representative that was not qualified to determine what caused the damages to the property. After this cursory inspection, the carrier issued its denial letter. The carrier also did not value or evaluate the amount of damages observed to the property. This shows the carrier did not adjust the loss with the insured. The carrier engages in this practice of incorrectly denying claims with such regularity and frequency as to indicate that it is a general business practice of this carrier, in reckless disregard for the rights of the insured. The carrier routinely relies on unsupported conclusions to deny claims based on exclusions under the policy that do not apply to the facts of the loss at the time the carrier issued its coverage decision. The carrier denied the claim without conducting a reasonable investigation and failed to properly adjust the loss. The carrier’s actions have severely delayed the resolution of this claim. Rather than inspecting the property and evaluating the damage in a prudent manner or making any good-faith effort to investigate the claim, the carrier incorrectly denied the claim. This investigation by the carrier is in direct violation of the statutory requirement for carriers to promptly and properly investigate all claims. These actions from the carrier as set forth above violate the following Florida Statutes: 626.9541(1)(i)(3)(d), Denying claims without conducting reasonable investigations based upon available information; 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; 626.9541(1)(i)(3)(a), Failing to adopt and implement standards for the proper investigation of claims. The Carrier’s actions set forth above also violated the following policy provisions: 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. The carrier has mishandled the claim in a classic textbook bad-faith claims handling practice by stonewalling, stalling, and failing to adjust and properly cover the claim by retaining outcome-oriented agents that did not evaluate the loss, coverage, or information objectively. Had the carrier taken the time to properly investigate this claim, reviewed the readily available guidelines, or sent qualified unbiased people out to the property to investigate, the insured would not be in this situation. It is clear that the carrier is not treating the insured with good faith claims conduct; failing to pay a claim clearly owed and acknowledged in writing; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insured; failing to implement proper standards for the adjustment and investigation of claims; not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company’s interests before the insured’s interests; refusing to cover the claim and pay the full amount owed to the insured despite the fact that the damages are covered under the policy; looking for ways to delay full recovery or any recovery to the insured; and refusing to provide coverage for the insured’s loss in a timely manner. The carrier engages in this practice of attempting to delay and deny claims in order to maximize the carrier’s profit margins with such regularity and frequency as to indicate that it is a general business practice of this carrier, in reckless disregard for the rights of the insured. It is clear that the carrier is not treating the insured with good faith claims conduct. 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 $98,138.06; 2.) Pay the Insureds’ attorneys’ fees and costs as they have been forced to retain counsel; 3.) 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 printed out and mailed. Please do not hesitate to contact the undersigned if you have any questions or concerns. Sincerely, Joseph Kessler, Esq. Attorneys at Law
Comments
User Id Date Added Comment
tsalehi@salehiboyer.com 11-25-2024 VIA ELECTRONIC SUBMISSION: civilremedy@myfloridacfo.com Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Re: Complainant: William and Sandra Ryan Policyholders: William and Sandra Ryan Filer: Joseph Kessler, Esq. Claim #: EDI963483 Policy #: EDH5363939-00 Date of Loss: September 28, 2022 CRN Filing No.: 786626 CRN Filing Date: October 14, 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 Dennis Kessler, Esq. on behalf of William and Sandra Ryan (the “Complainants” or “Claimant”). After reviewing the CRN, Edison conducted a thorough review of its handling of the Complainant’s 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 interest. Edison also argues that the CRN utterly fails to describe any of the alleged violations and fails to provide any information such as facts and circumstances which would allow Edison to identify and correct the alleged violations. The Complainant alleges 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. 626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims. Edison denies this allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(d): Denying claims without conducting reasonable investigation based upon available information. 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 Complainants failed to allege specific, actual facts in support of any of their statutory allegations. Next, because the Civil Remedy Notice fails to allege 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 completely devoid of any factual allegations relating to the monetary amount of any claims. 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 glaring deficiency fails 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 first addresses 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 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 any description of the facts and circumstances supporting this contention. Regarding the alleged violation of Section 626.9541(1)(i)(3)(a), Florida Statutes, the CRN’s failure to describe any of the facts or circumstances of the claim precludes Edison from evaluating what error, if any, allegedly occurred during the investigation of the claim. Complainant cannot possibly support the position that Edison failed to adopt and implements standards for the proper investigation of the claim because the CRN provides little to no description of 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. Furthermore, regarding the alleged violation of Section 626.9541(1)(i)(3)(d), Florida Statutes, the CRN does not describe any standards applicable to denying claims without conducting reasonable investigations based upon available information, much less the facts and circumstances giving rise to the contention that Edison denied the subject claim without first conducting a reasonable investigation. Additionally, 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, conclusory, and incorrect allegations with no basis in fact or circumstance. Aside from the fact that the allegations are devoid of sufficient facts, the tenor and inferences of the allegations are wholly without merit and Edison denies each and every one. Additionally, the CRN fails to identify specific policy language relevant to an alleged violation. Blanket references to policy provisions and statutes without specification deems the Civil Remedy Notice deficient. See Julien v. United Property and Casualty Insurance Co., 311 So. 3d 875 (Fla. 4th DCA 2021). The Complainant failed to state any specific policy language or provide the specific facts underlying the basis for alleged policy violations. Instead, the CRN vaguely states “Section 1 – Perils Insured Against; Section 1 – Property Coverage Loss Settlement Provision.” The vague reference in the CRN lacks even minimal specificity. The allegations set forth in the CRN are denied as they are mere conclusory allegations unsupported by facts, devoid of logic and clearly intended solely to tarnish Edison’s name and reputation. Edison, at all times, acted fairly, honestly and in good faith in its dealings with the Complainant. 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 an independent field adjuster who conducted an inspection of the subject property to investigate the Complainant’s claim. As it relates to the facts of the claim, Edison received notice of the subject loss on April 8, 2024, alleged to have occurred more than one year and sixth months earlier, on September 29, 2022. Specifically, it was alleged that the dwelling had sustained damage as a result of Hurricane Ian. On or about April 12, 2024, an independent field adjuster went to the subject property to conduct an inspection on behalf of Edison. After analysis of the subject policy of insurance, and based on the above factual investigation, Edison issued a coverage determination to the Policyholders on or about May 17, 2022, explaining that Edison’s investigation revealed no covered damages pursuant to the terms, conditions, exclusions and limitations of the subject policy. The coverage determination correspondence was in writing, and timely sent to the Insureds. 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. 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, “[i]t 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, Florida Statute § 626.9541, 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