Civil Remedy Notice of Insurer Violations
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Filing Number:     792885
Filing Accepted:  11/18/2024
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Complainant
Last/Business Name *  
LACY   First Name   GARRETT AND KERRI
Street Address * 8615 COLONY TRACE DRIVE
City, State Zip * FT. MYERS, FL 33908
Email Address * GARRETTLACY@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   LACY   First Name   GARRETT AND KERRI
Policy # * EDH5344796-01 Claim #* EDI965332
Attorney
Attorney is Applicable
Last Name* MARKER First Name * SHAUN Initial J
Street Address* ONE NORTH CLEMATIS STREET, SUITE 510
City, State Zip* WEST PALM BEACH , FL 33401
Email Address * SMARKER@MERLINLAWGROUP.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):* OFFICERS, SUPERVISORS, AND OR MANAGEMENT OF EDISON INSURANCE COMPANY; INCLUDING ALL CLAIMS REPRESENTATIVES, ADJUSTERS, LOSS CONSULTANTS, ENGINEERS, AND EXPERTS, AND RICK PERICLES.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Claim Denial
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)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
626.9541(1)(i)(3)(e) Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
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.
626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Building coverage provisions; additional coverages; duties in event of loss policy provisions; all terms and conditions of Section I of the insurance policy; the insurance policy's definition section; the insurance policy's exclusion of coverage provisions; loss payment policy provision; loss settlement provision; the declarations page; we will adjust all losses with you.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

In Florida, the work of adjusting insurance claims engages the public trust. Edison Insurance Company, (“Edison”), has breached this duty by its handling of the Insureds, Garrett Lacy and Kerri Lacy’s Claim of Loss (Claim Number EDI965332; D.O.L. 09/28/2022). Edison has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insureds’ insurance claim for damages. On or about September 28, 2022, the Insureds submitted a claim to Edison for damages sustained as a result of Hurricane Ian. We have identified the following instances of bad faith conduct on the part of your company: • Refusing to pay for necessary repairs and attempting to coerce us into accepting a lower settlement amount by failing to properly consider all applicable statutes and building code requirements both at the state and local level. • Purposefully minimizing the value of the claim by using biased estimating software/pricing and low-balling the cost of repairs. Specifically, estimations and repair costs have been purposefully devalued to the benefit of the insurance company despite knowledge that these costs are woefully deficient. • Implementing a claim handling process geared solely to the minimization of roof related damages. Specifically, taking a hardline stance on denial of the claim and denial of a roof replacement regardless of evidence supporting the need for the latter. This scheme is meant solely to benefit the carrier while hindering the insured from obtaining just compensation for the loss. • Failure to perform an adequate and complete inspection of the subject property and/or a complete investigation of all damages attributable to wind from Hurricane Ian, include obvious and apparent damages to the roof related to wind from Hurricane Ian. • Misrepresenting to the Insureds that there was “no covered peril related damage to the exterior” of the property. See correspondence from Edison to Insureds dated 10-10-24. • Misrepresenting to the Insureds that there was “no peril created opening.” See correspondence from Edison to Insureds dated 10-10-24. • Misrepresenting that the roofing system is “failing due to wear, tear and deterioration”, when there was in fact obvious and/or apparent damage to the roof as a result of wind from Hurricane Ian. See correspondence from Edison to Insureds dated 10-10-24. These actions on the part of your company are unacceptable, and are in violation of our insurance policy and the duty of good faith and fair dealing that Edison owes to its policyholders. Based on conduct to date, these practices occur with such frequency as to constitute a general claims handling process/business practice imbedded within the company’s management of Hurricane Ian claims. To date, notwithstanding the Insureds’ pleas otherwise, Edison has continued to refuse to acknowledge its obligation to tender all insurance proceed monies due and owing the Insureds or assist the Insureds in mitigation of the damages. The insurer has failed and refused to acknowledge coverage and restore the Insureds to their pre-loss condition. Edison has sufficient information upon which to evaluate the Insureds’ claim for damages, and certainly has been provided with an independent means by which to determine the amount of loss. The Insureds have otherwise fully complied with the insurer's requests for post-loss compliance. Edison has not properly paid all of the covered damages. These actions by Edison occur with such frequency to indicate a general business practice of the company. The Insureds have complied with the policy of insurance and Florida law, and Edison continues to wrongfully refuse to tender the insurance proceeds that are due and owing the Insureds. The concept of insurance is the granting of timely and prompt indemnity or security against a contingent loss. Florida statute section 624.02 defines "insurance" as a contract whereby one undertakes to indemnify another or pay a specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that the Insureds may be put back into the position they were in prior to the loss as quickly as possible. Edison breached this duty. The Insureds were and still are forced to expend out of pocket monies to submit the insurance claim to force Edison to honor its obligations under the insurance policy to pay all the insurance proceeds due and owing them. Edison has clearly displayed bad faith in its handling, processing, and wrongful delay of this claim. The Insureds merely request that Edison "adjust the loss" with them in accordance with the policy of insurance for which Edison has accepted a premium, and in accordance with Florida law. Edison’s conduct has been reckless and unfair to its Insureds and has caused and continues to cause additional damages. We demand that Edison immediately take steps to rectify the situation and handle this claim in a fair and appropriate manner. This includes providing full and fair compensation for the damages incurred and for any additional costs and expenses incurred as a result of Edison's bad faith conduct, including but not limited to, fees and costs related to the retention of personnel/counsel required to challenge Edison’s improper handling of this claim. [As of this moment, the damages found and evaluated by the insured(s) value at minimum $154,890.09, and we request payment in that sum as a curative measure to the conduct described herein.]
Comments
User Id Date Added Comment
tsalehi@salehiboyer.com 01-14-2025 VIA ELECTRONIC SUBMISSION: civilremedy@myfloridacfo.com Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Re: Complainant: Garrett and Kerri Lacy Policyholder: Garrett and Kerri Lacy Filer: Shaun J. Marker, Esq. Claim #: EDI965332 Policy #: EDH5344796-01 Date of Loss: September 28, 2022 CRN Filing No.: 792885 CRN Filing Date: November 18, 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 Shaun J, Marker, Esq. on behalf of Garrett and Kerri Lacy (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 Complainants 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 on portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage. EDISON denies the allegations 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 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; moreover, this statute has no nexus to the subject claim or the facts at hand. 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)(d): Denying claims without conducting reasonable investigations based upon available information. EDISON denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(e): Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed. 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. 626.9541(1)(i)(3)(g): Failing to promptly notify the insured of any additional information necessary for the processing of a claim. EDISON denies the allegation that it violated the above referenced statute. 626.9541(1)(i)(3)(h): Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. EDISON denies the allegation that it violated the above referenced statute. EDISON specifically denies each and every one of the Complainants’ 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 As a preliminary matter, the CRN must be dismissed because the CRN is defective and fails to comply with the requirements for a property CRN, such as the requirements for specificity with actual and accurate 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 without consideration to the facts of the claim and regardless of whether they are relevant or applicable to the alleged facts contained in the Notice. Because the Civil Remedy Notice failed to allege any specific facts and/or circumstances in support of the 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 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 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 the nature of the underlying claim(s), or the circumstances supporting the conclusion that the unspecified refusal to settle was not in good faith. EDISON investigated the property and issued payment for covered damages on the property. To the extent the CRN suggests that EDISON should tender additional payment on the claim, the CRN fails to provide a sufficient description of the facts and circumstances supporting this contention. As to Section 624.155(1)(b)(3), Florida Statutes, the CRN does not identify any facts to support that EDISON failed to promptly settle a claim under one portion of the policy in order to influence settlement under other portions of the policy. Regarding Section 626.9541(1)(i)(2), Florida Statutes, the CRN fails to describe any instances where a material misrepresentation was made to the Complainants by EDISON, much less any specificity of how EDISON’s investigation was in some way defective which would lead to a material misrepresentation. 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 Complainants, 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. Complainants 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. Regarding the alleged violation of Section 626.9541(1)(i)(3)(b), Florida Statutes,?the CRN fails to describe any "misrepresentation" or false statement relating to the facts of the claim or 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 it relates to Section 626.9541(1)(i)(3)(d), Florida Statutes, the CRN does not describe any instances where EDISON denied the Complainants’ claim without conducting a reasonable investigation based upon available information. As to Section 626.9541(1)(i)(3)(e), Florida Statutes, the CRN does not describe any standards applicable to the purported “claim” advanced by the Complainants, much less the facts and circumstances giving rise to the contention that EDISON failed to affirm or deny full or partial coverage of claims. The Complainants cannot possibly support this contention as EDISON issued a coverage determination which included payment. As it relates to Section 626.9541(1)(i)(3)(f), Florida Statutes, the CRN does not describe any instances where EDISON failed to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy for the coverage determination or offer of a compromise settlement. Regarding Section 626.9541(1)(i)(3)(g), Florida Statutes, the CRN does not describe any instances where EDISON failed to promptly notify the insureds of any additional information necessary for the processing of the claim. Finally, as to 626.9541(1)(i)(3)(h), Florida Statutes, the CRN does not describe any standards applicable to the purported “claim” advanced by the Complainants, much less the facts and circumstances giving rise to the contention that EDISON failed to clearly explain the nature of the requested information and reasons why the information was necessary. 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. Aside from the fact that the allegations are devoid of any specific 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 deem the Civil Remedy Notice deficient. Julien v. United Property and Casualty Insurance Co., (Fla. 4th DCA 2020). The Complainants failed to state the specific policy language relevant to any alleged violation. Thus, the CRN lacks even minimal specificity of policy language to support the allegations. The CRN asserts vague allegations against persons representing EDISON by including “OFFICERS, SUPERVISORS, AND OR MANAGEMENT OF EDISON INSURANCE COMPANY; INCLUDING ALL CLAIMS REPRESENTATIVES, ADJUSTERS, LOSS CONSULTANTS, ENGINEERS, AND EXPERTS, AND RICK PERICLES.” 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 EDISON’s name and reputation. EDISON, at all times, acted fairly, honestly and in good faith in its dealings with the Complainants. EDISON did not 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 Complainants. Finally, EDISON promptly and appropriately communicated with the Complainants 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 Complainants’ 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 September 17, 2024, which was alleged to have occurred on September 28, 2022. Specifically, it was alleged that there were damages to the property from Hurricane Ian. On September 19, 2024, an independent adjuster inspected the subject property on behalf of EDISON. Following the inspection, there were no covered damages found to the property pursuant to the terms and conditions of the Policy and the investigation. In addition to the inspection, to aid its investigation of the claim, EDISON requested information from the Insureds, including documentation to substantiate the reported cause of loss, the date of the reported cause of loss, and the Claimants’ claim for damages. After analysis of the subject Policy, and based on the above factual investigation, EDISON issued a coverage determination by letter dated October 10, 2024, and explained there would be no coverage pursuant to the Policy for the subject claim. Moreover, EDISON’s letter outlined the basis for EDISON’s coverage determination which included there were no covered peril related damage to the exterior of the property and there was no peril created opening found on the roof. Instead, the roof was determined to be failing from wear, tear, and deterioration. The correspondences were in writing and were promptly sent to the Complainants. 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 Complainants about the claim, and provided the Complainants a reasonable explanation for its actions. Clearly, EDISON conducted a an investigation into the subject claim and rendered its coverage decision based on the terms and conditions of the subject policy. Additionally, the CRN contains demanded “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. Mere disagreement as to the amount of coverage does not equate to bad faith. Evidently, this CRN 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 Insured. For the aforementioned reasons, EDISON categorically denies that it has acted with bad faith in connection with this claim. 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/ Tanaz Salehi Tanaz Salehi, 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