Civil Remedy Notice of Insurer Violations
Login

Filing Number:     786975
Filing Accepted:  10/15/2024
         Print Filing
Complainant
Last/Business Name *  
PETER BORTNICK   First Name   POA FOR PETER AND ELIZABETH BORTNICK
Street Address * 4761 SW HAMMOCK CREEK DRIVE
City, State Zip * PALM CITY, FL 34990
Email Address * LONELYPINESHUNT@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   PETER BORTNICK   First Name   POA FOR PETER AND ELIZABETH BORTNICK
Policy # * EDH4028001-06 Claim #* EDI961613
Attorney
Attorney is Applicable
Last Name* MCLESTER First Name * MINDY Initial
Street Address* 350 NORTH LAKE DESTINY ROAD
City, State Zip* MAITLAND , FLORIDA 32751
Email Address * MMCLESTER@ITSABOUTJUSTICE.LAW
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   EDISON INSURANCE COMPANY
NAIC Company Code 12482
 
Name of individual responsible for violation (if any):* ANY ADJUSTER, MANAGER, OR INDIVIDUAL INVOLVED IN THE HANDLING OF THE SUBJECT CLAIM ON BEHALF OF THE INSURANCE CARRIER.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
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)(d) Denying claims without conducting reasonable investigations based upon available information.
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.

A certified copy of the policy is not in the possession of the Insureds, but has been requested from the insurance carrier. Based on information and belief, the following policy provisions are relevant to this civil remedy notice.: Section 1 – Coverage A – Perils Insured Against Section 1- Conditions – Loss Settlement Section 1 – Conditions - Loss Payment
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

On or about April 26, 2023, the Insureds, Peter Bortnick POA for Peter and Elizabeth Bortnick, suffered significant damage to their home located 4761 SW Hammock Creek Drive, Palm City, FL 34990-7933 as a result of a severe hailstorm. Prior to the loss, Edison Insurance Company (“Edison”), had issued a policy of insurance (Policy No.: EDH4028001-06) for the Insured’s property. Said policy was in full force and effect on date of loss and afforded coverage for wind and hail damage. Edison was notified of the loss by the Insured and assigned claim number EDI961613. During the course of Edison’ investigation, the Insured made the property available for inspection, provided facts and information surrounding the loss, and complied with Edison’ adjustment of the claim. Despite fully cooperating with Edison’ investigation, Edison capriciously denied coverage for the Insured’s insurance claim even though there was clear evidence of wind and hail damage to the roof. Edison came to its coverage determination by ignoring relevant facts and information provided by the Insured and his contractors that established the damages were unquestionably the result of wind and hail. Most concerning, Edison and its representatives either underplayed or misrepresented the findings from its own inspections in order to avoid having to tender payment on a claim that it knows should be covered pursuant to the terms of the policy. It is clear that Edison has not acted honestly or fairly towards its Insured. Edison and its representatives have failed to conduct a proper investigation of the loss, misrepresented the scope and cause of damages at the residence, and misapplied exclusions in the policy in order to deny coverage for the Insured’s claim. It has become a general business practice of Edison to not implement proper claims handling procedures, to hire consultants that routinely ignore or intentionally misidentify relevant evidence, and to not settle claims in good faith when under all circumstances it should have. As is the case here, it is a pattern and practice for Edison to arbitrarily deny claims without conducting reasonable investigations based upon information and evidence available to it. In order to cure this civil remedy notice, Edison must immediately acknowledge in writing that the roof, interior, and exterior damages claimed by the Insureds were caused by wind and hail and immediately tender the full payment owed to the Insureds for damage to covered property in the amount of $144,771.73 less the applicable deductible. The written acknowledgement should be provided to the Insured’s counsel in writing at Mindy McLester, Esq. at 350 N. Lake Destiny Road, Suite 300, Maitland, FL 32751.
Comments
User Id Date Added Comment
joseph@becklawpa.com 11-08-2024 Department of Financial Services Civil Remedy Section 200 East Gaines Street Tallahassee, FL 32399-0322 Re: Civil Remedy Notice of Insurer Violation Complainant : POA for Peter and Elizabeth Bortnick, Peter Bortnick Insureds : Peter and Elizabeth Bortnick Policy Number : EDH4028001-06 Claim No. : EDI961613 DFS File Number: 786975 Acceptance Date: October 15, 2024 Insurer : Edison Insurance Company To Whom It May Concern: Please be advised that we represent Edison Insurance Company (“Edison”) in the above-referenced matter. Kindly consider this to be Edison’s report to the Department on the disposition of the alleged violations. Edison maintains that it has not been in any violation of the law and that the Civil Remedy Notice of Insurer Violation (“CRN”) filed by the purported Power of Attorney for Peter and Elizabeth Bortnick, Peter Bortnick (“Complainant”) on behalf of Peter and Elizabeth Bortnick (“Insureds”), is defective on its face and fails to comply with the specificity requirements under Florida Statute 624.155 and Form DFS-10-363. As such, Edison objects to the Department’s acceptance of the above-referenced CRN. By way of background, this matter involves claimed roof damage that allegedly occurred on April 26, 2023 yet was first reported to Edison on October 22, 2023. Upon untimely notice of the alleged loss, a licensed field adjuster inspected the property on or about November 8, 2023 on Edison’s behalf. As a result of the inspection, Edison found no evidence of any covered peril related damage to the property’s exterior, and that the roofing system exhibited wear and tear, deterioration, mechanical damage, and prior repairs. Further, there were no visible signs of water intrusion to the interior of the property. In addition, and contrary to the allegations contained in the Notice, the Insureds failed to provide any documentation or information identifying wind and/or hail related damage as the cause of the damage alleged in the subject claim. As such, after a thorough inspection and investigation, Edison denied coverage pursuant to the terms, conditions, definitions, limitations and exclusions of the subject Insurance Policy, and informed the Insureds of the same. As is evident from the aforementioned, the allegations contained in the Notice are without merit. Nonetheless on June 18, 2024, the Complainant, through legal counsel, filed a breach of contract lawsuit against Edison. The Complainant subsequently, on October 15, 2024, filed a CRN against Edison, which is a pre-requisite to a bad faith lawsuit under Florida Statute 624.155. This CRN alleges that Edison engaged in “Claim Denial, Claim Delay, Unsatisfactory Settlement Offer, and Unfair Trade Practice.” Additionally, the CRN alleges that Edison has violated Florida Administrative Codes and Statutes. On the face, this CRN merely contains accusations without any factual specificity to support them. Edison contends that the Notice filed by the Complainant is deficient as a matter of law as it fails to comply with Fla. Stat. §624.155. See 316, Inc. v. Maryland Cas. Ins. Co., 526 F. Supp. 2d 1187 (N.D. Fla. 2008); Rousso v. Liberty Surplus Ins. Corp., 2010 WL 7367059, (S. D. Fla. 2010); Heritage Corp. of South Fla. v. Nat’l Union Fire Ins. Co. of Pittsburgh, P.A., 580 F. Supp. 2d 1294 (S.D. Fla. 2008); Talat Enterprises, Inc. v. Aetna Cas. & Surety Co., 753 So. 2d 1278 (Fla. 2000). Pursuant to § 624.155(3)(b), Fla. Stat., the Notice “shall state with specificity” the following information: 1. The statutory provision, including the specific language, which the authorized insurer allegedly violated; 2. the facts and circumstances giving rise to the violation; 3. the name of any individual involved in the violation; 4. reference to specific policy language that is relevant to the violation, if any. . . .; 5. a statement that the notice is given in order to perfect the right to pursue the civil remedy authorized by this section. In addition to the criteria cited above, the Florida legislature created “Form DFS-10-363”, which is a Civil Remedy Notice form that lays out an additional fifteen (15) requirements: 1. Complainant’s Name; 2. Complainant’s Address; 3. Complainant’s email address; 4. Complainant type (Insured or otherwise) 5. Insured’s Name; 6. Insurance Policy Number; 7. Insurance Claim Number; 8. Attorney’s Name; 9. Attorney’s Address; 10. Attorney’s email Address; 11. Type of Insurer (authorized or otherwise) 12. Name of Insurer; 13. Address of Insurer; 14. Type of Insurance (Commercial Property & casualty or otherwise); and 15. Reason for Notice. Similar to the five (5) criteria specifically listed in Fla. Stat. § 624.155, the fifteen (15) additional items required by the Department of Financial Services must be correctly stated with specificity in order to satisfy a condition precedent to bringing an action under Fla. Stat. § 624.155. See, Pin-Pon Corp. v. Landmark Am. Ins. Co., 20-CV-14013, 2020 WL 3038576, at * 3-4 (holding that the plaintiff’s Civil Remedy Notice was deficient as a matter of law because the email address listed for the Complainant was the attorney’s email address); Mathurin v. State Farm Mut. Auto Ins, Co., 285 F. Supp. 3d 1311 (M.D. Fla. 2018) (holding that the correct policy number, one of the above listed requirements promulgated by the Florida Department of Financial Services, must be on a Civil Remedy Notice for it to be valid because Fla. Stat. § 624.155 requires a Civil Remedy Notice to have the information required by the Florida Department of Financial Services). To put it simply, a CRN is defective as a matter of law if any of the twenty (20) mandatory items cited above are missing or otherwise incorrect. As already mentioned, Edison maintains the CRN filed by the Complainant is defective on its face as it fails to meet the requirements of Form DFS-10-363 and Fla. Stat. § 624.155 on several grounds. First and foremost, the Notice fails to properly identify the Insureds pertinent to the subject Insurance Policy, but rather lists the purported Power of Attorney, which renders the Notice invalid as a matter of law. Second, with respect to the requirement to identify the person or persons representing the insurer most responsible for or knowledgeable of the facts giving rise to the allegations. The Notice makes no reference to any individual and in fact merely cites to absolutely “any adjuster, manager, or individual”. Edison is left to guess the individual(s) who are most responsible and/or knowledgeable of the facts giving rise to the allegations in the Notice. In order to comply with the requirements of Fla. Stat. § 624.155, the Complainant must name the individual(s) involved with specificity to allow Edison to properly investigate the allegations. The Notice, as filed, lacks the requisite specificity as provided in Fla. Stat. § 624.155. Thus, the Notice is insufficient as a matter of law. Third, with respect to the statutory requirement to set forth with specificity the “facts and circumstances giving rise to the violation,” the Notice fails to allege any specific conduct on the part of Edison that would actually violate any policy provision or statute. The Notice contains conjecture and supposition as opposed to any facts supporting the conclusory allegations. A written notice which is vague and “shotgun” in nature or is written in general terms fails to satisfy the specificity requirement of the statute. See Heritage Corp. of South Fla., 580 F. Supp. 2d at 1300; 316, Inc., 625 F. Supp. 2d at 1193; see also Rousso, 2010 WL 7367059 at *3-6; Valenti v. Unum Life Ins. Co. of America, 2006 WL 1627276 (M.D. Fla. 2006). The CRN filed by Complainant merely contains boilerplate broad language used routinely in a litany of other filings. In fact, the Complainant’s legal counsel incredibly has filed approximately 27 CRNs against various carriers in October 2024 alone. These CRNs largely include the same generic language, many use the same sentences throughout, and include largely the same allegations. With regards to the CRN, it contains the same generic improper and legally insufficient allegations that are contained within every CRN filed by the Complainant’s legal counsel. Moreover, the Complainant should not be able to simply file the same lengthy generic CRN without containing the requisite specificity. The purpose of a CRN is to place the carrier on notice of specific violations so that they can be corrected during the statutory “cure” period. This CRN fails to meet this requirement and as such, should not be able to proceed on such a defective and improper CRN that contains nothing but accusations and conclusions without any specificity to the purported statutory violations. The CRN alleges that the carrier has, among others, “ignoring relevant facts and information” and “underplayed or misrepresented the findings from its own inspections in order to avoid having to tender payment”. These allegations as stated are improper, factually incorrect, do not comply with the specificity requirements set forth in Florida Statute 624.155, and are unfairly vague to put the carrier on notice of any alleged violations. As stated (and contradictory to the allegations in the Notice), upon the Insureds untimely report of the subject claim, Edison conducted an inspection of the property. As a result of the thorough inspection, Edison observed no covered storm damage to the worn and deteriorated roofing system. As such, Edison denied the claim pursuant to the terms and conditions of the Policy. To date, the Insureds have not submitted any documentation contrary to Edison’s determination or observations. As such, Edison maintains that it acted fairly and honestly to make a proper determination in light of all the information known and provided., and the Complainant has failed to provide factual specificity to its allegations whatsoever. The CRN further alleges that by way of this conduct, Edison is in violation of Florida Statutes §§ 624.155 and §§ 626.9541. On its face, this is nothing more than a recitation of alleged statutory violations, without providing any specificity as to the facts of the alleged claim of how Edison allegedly made “material misrepresentations” or “failed to adopt and implement standards for the proper investigation”, for example, and thus, is statutorily deficient. Edison asserts that it has acted in compliance with the terms and conditions of the insurance policy, and all enumerated Florida Statutes and administrative code(s). Forth, the Notice fails to satisfy Fla. Stat. § 624.155(3)(b)(4) in that it fails to reference specific policy language relevant to the alleged violation with any degree of specificity. In particular, the Notice cites to certain vast portions of the policy at issue without specifically delineating what specific subsection was violated. The Complainant also fail to provide factual specificity for any purported violations of the policy at issue, thereby preventing Edison from responding in regard to what policy language is relevant to the alleged bad faith violation(s). As such, the Notice is insufficient as a matter of law to satisfy the specificity requirement of Fla. Stat. § 624.155(3)(b)(4). Finally, the Notice fails with respect to its requirement to specify how Edison may “cure” the alleged violations. The CRN demands Edison (1) immediately acknowledge in writing that the roof, interior, and exterior damages claimed by the Insureds were caused by wind and hail; and (2) immediately tender the full payment…$144,771.73 less the applicable deductible. The purpose of a Civil Remedy Notice is to provide a carrier with one last opportunity to “cure” the alleged violations. In this instance, the only real “cure” that the Notice is seeking is full payment of a random sum unilaterally determined by the Complainant, notwithstanding Edison’s right to investigate and adjust the loss. The Notice further seeks an admission of liability, notwithstanding Edison’s right for due process and to defend itself in the breach of contract lawsuit filed in advance of the CRN. In addition, the Notice seeks remedies that are “extra-contractual”. A demand for a cure is properly limited to the four corners of the policy and thus the extra-contractual demands render the Notice insufficient on its face. In fact, the Florida Supreme Court has recognized that a Civil Remedy Notice is invalid if the curative action demands more than the payment of contractual benefits under the insurer’s policy. See, Talat Enterprises, Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). Subsequent to Talat, Florida courts, and federal courts applying Florida law, reaffirmed the rule articulated in Talat. See, Do v. Geico Gen. Ins. Co., 1:17-CV-23041-JLK, 2019 WL 331295, at *1 (S.D. Fla. Jan. 25, 2019) (finding that a plaintiff’s Civil Remedy Notice was invalid as a matter of law because the curative actions demanded did not concern payment of contractual benefits owned under the insurer’s policy). Based on the information outlined above, Edison maintains that each and every allegation of the CRN is incorrect, and this the CRN should be dismissed. Edison requests that the DFS re-consider its acceptance of the above-referenced CRN and further requests that the DFS provide Edison a list of the guidelines and requirements utilized by the DFS in determining to accept this defective CRN. As outlined above, Edison maintains that it has not acted in bad faith in handling the Insureds’ claim, has not been in violation of any law, and has properly fulfilled its obligations to the pursuant to the terms, conditions, exclusions, and exemptions of the Policy regarding coverage for the claimed loss. The subject policy of insurance, governing statutes, and case law only permit submission of a claim and payment for covered losses. While an insurance company is required to settle claims that should be settled, it is not required to settle claims that are legitimately contested. Florida law continually affirms the principle that an insurer has the right to investigate claims presented for payment. An insurance company is expressly afforded an opportunity to evaluate its rights and liabilities. The alleged statutory violations and factual allegations set forth in the Notice are devoid and without merit. Edison further maintains that the CRN, as filed, is defective on its face as it fails to meet the specificity requirements of Florida Statute 624.155. Should the Department require additional information, please do not hesitate to contact us. Sincerely, ASHLEY JOSEPH, ESQ.
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