Civil Remedy Notice of Insurer Violations
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Filing Number:     787370
Filing Accepted:  10/17/2024
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Complainant
Last/Business Name *  
TRIER   First Name   ANNA MARIA AND MARK
Street Address * 16274 CROWN ARBOR WAY
City, State Zip * FORT MYERS, FL 33908
Email Address * CALBERTINI@ITSABOUTJUSTICE.LAW
Complainant Type: * Insured
Insured
Last/Business Name*   TRIER   First Name   ANNA MARIA AND MARK
Policy # * EDH5323182-01 Claim #* EDI951858
Attorney
Attorney is Applicable
Last Name* ALBERTINI First Name * CHRYSTINA Initial M
Street Address* 350 NORTH LAKE DESTINY ROAD
City, State Zip* MAITLAND , FLORIDA 32792
Email Address * CALBERTINI@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):* TRACEY HUNT
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Non-renewal
Unfair Trade Practice
Unsatisfactory Settlement Offer
* 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)(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 following policy provisions are relevant to this civil remedy notice. Section 1 Property Coverages – Coverage A – Dwelling Section 1 Perils Insured Against – Coverage A – Dwelling and Coverage B- Other Structures Section 1- Conditions – 3. Loss Settlement Section 1 – Conditions – 10. 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 September 28,2022, Ana Maria and Mark Trier, (hereinafter “Insureds”) suffered significant damage to their home located at 16274 Crown Arbor Way, Ft. Myers, FL 33908 as a result of hurricane Ian. Prior to the loss, Edison Insurance Company (“Edison”), had issued a policy of insurance (Policy No.: EDH5323182-01) for the Insureds property. Said policy was in full force and effect on date of loss and afforded coverage hurricane damage. Edison was notified of the loss by the Insured and assigned claim number 5930F945R. During the course of Edison’s investigation, the Insureds made the property available for inspection, provided facts and information surrounding the loss, and complied with Edison’s adjustment of the claim. Although, Edison acknowledged the Insured’s property was damaged by Hurricane Ian, Edison capriciously underpaid a majority of the damages claimed, specifically with respect to the roof. Edison came to its coverage determination by ignoring relevant facts and information provided by the Insureds and their contractors that established the damages to the roof and exterior of the residence were unquestionably the result of hurricane damage. Most concerning, Edison and its representatives either underplayed or misrepresented its own findings 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 Insureds. Edison and its representatives have failed to conduct a proper investigation of the loss, misrepresented the scope and cause of damages to the residence, and misapplied exclusions in the policy in order to improperly 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. Most concerning, Edison seems to willfully disregard what it considers to be unfavorable information to avoid payment. As is the case here, it is a pattern and practice for Edison to arbitrarily deny claims without conducting reasonable investigations and instead base its coverage determinations on evidence it knows to be inaccurate or incomplete. Worst of all, Edison has now notified the Insureds that the policy of insurance will not be renewed unless the roof is replaced despite simultaneously underpaying the damages to the roof needs to be replaced during the “adjustment” of the claim. Edison is using the “notice of non-renewal’ as a tactic to try and leverage a low-ball settlement against their Insureds. Edison knows full well that the Insureds are now left between the proverbial “rock and a hard place” – not able to renew their insurance policy with Edison but also unable to obtain an insurance policy from another carrier because of the open unresolved claim that Edison delay in properly adjusting this claim. In order to cure this civil remedy notice, Edison must immediately acknowledge in writing that the damages claimed by the Insureds were primarily caused by Hurricane Ian and that replacement of the roof and any other damages caused by Hurricane Ian are covered by the policy of insurance. The written acknowledgement should be provided to the Insured’s counsel in writing at Chrystina Marie Albertini, at 350 N. Lake Destiny Road, Suite 300, Maitland, FL 32751.
Comments
User Id Date Added Comment
tsalehi@salehiboyer.com 12-03-2024 VIA ELECTRONIC SUBMISSION: civilremedy@myfloridacfo.com Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Re: Complainants: Ana Maria Trier and Mark Trier Policyholders: Ana Maria Trier and Mark Trier Filer: Chrystina M. Albertini, Esq. Claim #: EDI951858 Policy #: EDK5353182-01 Date of Loss: September 28, 2022 CRN filing No.: 787370 CRN filing date: October 17, 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 Chrystina M. Albertini, Esq. on behalf of Ana Maria Trier and Mark Trier (the “Complainants” or “Claimants”). The Parties have reached a settlement within the cure time, and as a result, any allegation contained within the Claimants’ CRN has been resolved. Notwithstanding, Edison has prepared the below response to the Complainants’ claim. 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 obligations 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)(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 denies this allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(a): Failing to adopt and implement . 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)(4): Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer received 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). Edison denies the allegation that it violated the above referenced statute. Edison specifically denies each and every one of the Complainants’ allegations that Edison violated the above referenced statutes. In addition to the allegations specifically denied above, Edison generally denies all allegation presented in this CRN as Edison has not violated any statute or rule. We trust that this response addresses the allegations of insurer violation alleged in the Civil Remedy Notice of Insurer Violations. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Regards, s/ Alex Jung Alex Jung, 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