Civil Remedy Notice of Insurer Violations
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Filing Number:     795401
Filing Accepted:  12/4/2024
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Complainant
Last/Business Name *  
WATTERSON   First Name   BRETT & SUSAN
Street Address * 201 SPORTSMAN ROAD
City, State Zip * ROTONDA WEST, FL 33947
Email Address * C/O RNIPPS@WOOLSEYMORCOM.COM
Complainant Type: * Insured
Insured
Last/Business Name*   WATTERSON   First Name   BRETT & SUSAN
Policy # * EDH4056829-04 Claim #* EDI951861
Attorney
Attorney is Applicable
Last Name* NIPPS First Name * ROBERT Initial L
Street Address* 203 FORT WADE RD., SUITE 260
City, State Zip* PONTE VEDRA , FLORIDA 32081
Email Address * RNIPPS@WOOLSEYMORCOM.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):* LEROY MARTINEZ / ADJUSTER LICENSE #W269013
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unfair Trade Practice
Other : Unfair Claim Settlement Practices
Other : Unreasonable Investigation
Other : Failure to act on claim
Other : Failure to conduct a reasonable investigation based on available information
Other : Failure to maintain proper complaint handling procedures
Other : Misrepresenting the insurance policy provisions to the insured
Other : Misrepresenting Florida statutory provisions to the insured
Other : Misrepresenting facts to the insured
Other : Failure to acknowledge and act promptly upon communications with respect to claims
Other : Denying claims without conducting reasonable investigations based upon available information
* 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.
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.

SECTION I – PROPERTY COVERAGE Coverage A - Dwelling Protects against covered loss to your dwelling and structures attached to your dwelling. It also protects against covered loss to building materials located on your residence, which are being used in connection with your residence premises. This coverage does not apply to land, including land on which the dwelling is located. ******* PERILS INSURED AGAINST Coverage A – Dwelling and Coverage B – Other Structures This policy insures under Coverages "A" and "B" unless not covered or excluded from coverage as described elsewhere in the policy. There are some perils not covered under Coverage "A" … ******** ADDITIONAL COVERAGES These additional coverages include limitations and may not completely protect you against loss: • Debris Removal • Reasonable Repairs • Trees, Shrubs and Other Plants • Fire Department Service Charge • Property Removed • Credit Card, Fund Transfer Card, Forgery and Counterfeit Money • Loss Assessment • Collapse • Glass or Safety Glazing Material • Landlords Furnishings • "Fungi," Wet or Dry Rot, Yeast or Bacteria • Law and Ordinance ******** Also refer to: Coverage A provision, coverage B provision, coverage C provision, coverage D provision, all additional coverages provisions, all coverages provided by endorsement or rider, the declarations page, loss payment or settlement provision, duties in event of loss policy provision, all terms and conditions of section I of the insurance policy, the insurance policy definitions section, the insurance policy‘s exclusion of coverage provisions, all insurance policy provisions that provide coverage to the insured property, and all policy provisions.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Additional Statutes Violated: 624.155(1)(a)(1) – violating 626.9541(1)(i) 626.9541(1)(a)(1) -- misrepresenting the terms of an insurance policy. 626.9541(1)(i) -- unfair claim settlement practices. Facts of the case: Edison Insurance Company (“EIC”) has committed the following in handling the insured’s claim: 1) failure to pay benefits owed; 2) failure to act in due diligence and good faith to resolve claims; 3) placing the financial interest of the insurer before that of the policy holder and claimant; 4) failure to properly train, evaluate, and manage adjusters retained to represent the policies and procedures of EIC; 5) looking for ways to delay benefit payments and otherwise “low ball” or “stone wall” claims; 6) looking for ways to deny the insured’s claim; 7) looking for ways to reduce recovery to the insured; 8) failure to perform a reasonable investigation; 9) misrepresenting Florida statutory provisions to its insured; 10) misrepresenting insurance policy provisions to the insured; 11) EIC has failed and refused to acknowledge coverage and promptly pay the benefits due and owed to the insured; 12) the reasons for this may be attributed to improper training, supervision, and/or motivation of outside adjusters and claims supervisors to promptly and fairly adjust and pay full benefits available to the insured. The insurer may have failed to adopt proper standards of Investigation and adjustment of losses or is otherwise not implementing those standards because a proper investigation and full and prompt payment for the loss is not occurring. In Florida, the work of adjusting insurance claims engages the public trust. EIC has breached this duty by its adjustment of the insured’s claim of loss. EIC has failed to create and implement adequate guidelines for proper investigation to evaluate claims handling and for training and supervision of employees resulting in violations as set forth above. EIC has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the insured’s insurance claim for damages. Despite the insured’s timely notification to EIC of the insurance claim, EIC has failed and refused to acknowledge the covered loss and pay all amounts due and owing to the insured under the policy of insurance. EIC has failed to promptly settle the insured’s insurance claim, when the obligation to settle the claim had become reasonably clear, under one portion of the insurance, in order to influence settlements under other portions of the insurance policy coverage. Despite the insured’s pleas otherwise, EIC has failed and refused to acknowledge its obligation to tender all insurance proceed monies due and owing the insured or assist the insured in mitigation of the damages. In exchange for a premium paid by the insured, EIC issued the subject insurance policy which provided coverage for the insured property from March 1, 2022 to March 1, 2023, for “sudden and accidental direct loss to property described in COVERAGE A - Dwelling and COVERAGE B- Other Structures only if that loss is a physical loss to covered property.” As such, the subject all-risk Policy contains coverage for all direct physical losses to the insured property unless the loss is specifically and unambiguously excluded from coverage by the Policy. On or about September 28, 2022, the insured property suffered a windstorm/hurricane loss, and the insured immediately submitted a claim to EIC for property damage, i.e., storm, wind, rain, and water intrusion damage throughout the insured property. Hence, the insured suffered a substantial loss regarding the real property and continue to suffer such loss. Having suffered such substantial damage, the insured promptly notified EIC of the loss in an effort to mitigate the current damage and prevent the exacerbation of any additional losses. The desired result did not follow. EIC since being presented the Insured’s claim has misrepresented policy provisions to avoid paying the insured what they are owed under the policy. Ultimately, EIC has failed and refused to properly settle the insured’s claim in good faith. The insured has requested that EIC conduct an investigation, admit coverage, and pay damages; EIC has failed and refused to do so. In short, EIC has failed to handle its insured’s claim in good faith in violation of Fla. Stat. 624.155(1)(b)(1), 624.155(1)(b)(3), and 626.9541(1)(i). Based upon EIC’s investigation and property inspection EIC has denied the claim and in fact "closed" the claim. In regard to insurance contracts, a specific refusal to pay a claim is the breach which triggers the cause of action. Allstate Ins. Co. v. Kaklamanos, 843 So. 2d 885, 892 (Fla. 2003); Donovan v. EIC Fire and Cas. Co., 574 So. 2d 285, 286 (Fla. 2nd DCA 1991) (finding that a breach of contract takes place at the moment the insurance company refuses to pay a claim). Therefore, EIC breached the Policy. Moreover, EIC’s argued exclusions and/or limitations to coverage are devoid of anti-concurrent causation language. Thus, “coverage may exist where an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause.” Sebo v. Am. Home Assurance Co., Inc., 208 So. 3d 694, 699 (Fla. 2016). In addition, under the Policy, any ensuing loss to property not excluded or excepted in this policy is covered. Hence, there are a myriad of coverages under the Policy that would provide coverage for the loss. Nevertheless, EIC failed and refused to acknowledge the covered loss and pay all amounts due and owing for the loss. Therefore, EIC breached the Policy. Questioning the propriety of EIC’s coverage denial, and given the extensive nature of the physical damage, the insured retained a loss consultant, River City Claims (RCC), to perform an investigation and damage evaluation in accordance with industry standards and Florida law. Based on its investigation, RCC determined that a windstorm/hurricane did in fact cause damage throughout the exterior of the insured property (particularly the roof warranting its replacement), including openings, which allowed wind and rain to intrude into the interior causing additional damages. Moreover, RCC determined that at least $144,309.22 worth of repairs would be required to return the property to its pre-loss condition as a result of the windstorm/hurricane loss, consisting of exterior and interior damage. Nevertheless, EIC failed and refused to acknowledge the covered loss and pay all amounts due and owing under the Policy. Therefore, EIC breached the Policy. Thereafter, the insured sent correspondence to EIC enclosing the RCC report outlining the cause, scope, and cost of the loss along with other supporting documents and requested EIC to reconsider its coverage denial. Nevertheless, EIC failed to acknowledge the covered loss and pay all amounts due and owing under the Policy. Therefore, EIC breached the Policy. The insured has submitted to EIC an appropriate Sworn Statement in Proof of Loss, the supporting RCC report outlining the cause, scope, and cost of the loss along with the Contents & Additional Dwelling ledger and other supporting documents, the Notice of Intent to Initiate Litigation, and requested EIC to reconsider its coverage denial. To date, EIC has failed and refused to acknowledge the covered loss and pay all amounts due and owing under the Policy. Therefore, EIC breached the Policy. As such, EIC’S coverage denial is a blatant misrepresentation of the available coverages under the Policy in direct violation of Fla. Stats. 626.9541(1)(a)(1), 626.9541(1)(i)(3)(b), 626.9541(1)(a)(1), and 626.9541(1)(i)(2) and is nothing more than a mere pretext to wrongfully deny and delay this claim. As a result, EIC has materially misrepresented the coverages under the subject policy to the insured for the purpose and with the intent of effecting settlement of the insured’s claim on less favorable terms than those provided in, and contemplated by, the subject policy in direct violation of Fla. Stat. § 626.9541(1)(i)(2). Further, EIC is in violation of Florida statutes §§ 626.9541(1)(a)(1), 626.9541(1)(i)(3)(b), and 626.9541(1)(a)(1) by misrepresenting pertinent facts and insurance policy provisions relating to coverages at issue; and also in violation of Fla. Stat. 626.9541(1)(i)(3)(d) by denying the insured’s claim without conducting a reasonable investigation based upon available information. In summary, the insured’s loss is clearly covered by the terms of the policy of insurance with EIC. However, EIC chose to deny coverage for the insured’s loss. Despite clear evidence that the damage was covered and caused by a covered peril, the claim was denied. To date, EIC continues to deny the insured and its insured full indemnity for the claim. While EIC refuses to honor this claim, a jury in Charlotte County will likely do what EIC has refused; exercise the benefit of doubt in favor of the insured in finding full coverage for this loss. Indeed, the insured will undoubtedly meet the burden of proof at trial, under the EIC all-risk policy, to show that, while EIC provided insurance coverage, damage occurred to the insured property. See Jones v. Federated Nat'l Ins. Co., 235 So. 3d 936, 942 (Fla. 4th DCA 2018). With the data presented within EIC’s investigation and RCC’s investigation, EIC’s burden to demonstrate by the greater weight of the evidence that all the physical damage to the insured property was caused solely by excluded perils under the policy and not in combination with a covered peril has not and cannot be met. See Sebo v. Am. Home Assurance Co., Inc., 208 So. 3d 694 (Fla. 2016). Despite clear indicators of covered damage, EIC nevertheless inexplicably denied the insured’s claim. As of today, EIC has failed and refused to inform the insured of his/her rights under the policy of insurance and Florida statutes, has improperly delayed the insured’s claim, has wrongfully denied the insured’s claim, and has failed and refused to adequately indemnify the insured for the loss and defiantly continues to do so. Indeed, from the time of receiving the claim, EIC has purposely and maliciously delayed in adjusting the subject claim in an effort to either avoid paying the claim altogether or, at the very least, avoid paying the full extent of the loss. Notably, under Florida law, “[t]he filing of a lawsuit does not extinguish the insurer’s obligations under the policy to adjust and pay the claim.” Tristar Lodging, Inc. V. Arch Specialty Ins. Co., 434 F. Supp. 2d 1286, 1289 (M.D. Fla. 2006). To date, the insured has made a good faith effort to comply with all of the requirements under the subject policy of insurance, and it is only fair that EIC do the same. Yet, that is not the case. The insured feels that the insured property is a valuable asset, and, by continuously delaying the proper handling of this claim, EIC is putting the insured property at risk. As a responsible property owner, the insured purchased insurance to protect the property, paid all of the premiums, and has kept up to date with the responsibilities under the policy. Yet, when the insured needed to rely on the insurance because of this unforeseen loss, EIC turned its back and delayed and wrongfully denied coverage that the insured is rightfully owed. Ultimately, EIC has failed and refused to properly investigate the loss. The insured has requested that EIC admit coverage and pay damages, EIC has failed and refused to do so, and continues to refuse to fully indemnify the insured for the loss and pay the amounts necessary to properly repair the insured’s property, despite knowing it is required to do so. In short, EIC has failed to handle its insured’s claim in good faith. In Florida, the work of adjusting insurance claims engages the public trust; EIC has breached this duty by its insufficient adjustment of the insured’s claim. EIC has failed to create and implement adequate guidelines for proper investigation to evaluate claims handling and for training and supervision of employees resulting in statutory violations set forth above. EIC has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the insured’s insurance claim for damages. Florida statute § 624.02 defines insurance as a contract whereby one undertakes to indemnify another or pay or allow 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 insured may mitigate their damages to put them back into the position they were prior to loss as quickly as possible. EIC breached this duty. The actions taken by EIC in the handling / adjustment of the insured’s claim were willful, wanton, and with complete disregard for the rights of its insured and occur with such a frequency as to indicate a general business practice and are in violation of Fla. Stat. 624.155 and 626.9541. EIC’S actions amount to but are not limited to the following: 1. Claim delay 2. Wrongful claim denial 3. Unfair trade practice 4. Unfair claim settlement practices 5. Unreasonable investigation 6. Failure to act on claim 7. Failure to conduct a reasonable investigation based on available information 8. Failure to maintain proper complaint handling procedures 9. Misrepresenting the insurance policy provisions to the insured 10. Misrepresenting Florida statutory provisions to the insured 11. Misrepresenting facts to the insured 12. Failure to acknowledge and act promptly upon communications with respect to claims 13. Denying claims without conducting reasonable investigations based upon available information 14. 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. 15. 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. 16. Failing to promptly notify the insured of any additional information necessary for the processing of a claim. 17. Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. 18. Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 90 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 an act of God, prevented by the impossibility of performance, or due to actions by the insured or claimant that constitute fraud, lack of cooperation, or intentional misrepresentation regarding the claim for which benefits are owed. Therefore, to cure the defects outlined in this civil remedy notice, EIC must: (1): Admit full coverage for the insured’s loss; and (2): Tender all insurance monies due and owing to the insured for the loss under the subject Policy. A copy of this form submitted to the FDFS has been emailed and/or uploaded and also printed out and mailed to the following parties providing them notice of the filing of this civil remedy notice: Edison Insurance Company P.O. Box 21957 Lehigh Valley, PA 18002-1957claimsmail@aiiflorida.com 866-568-8922 csclaims@edisoninsurance.com
Comments
User Id Date Added Comment
rnipps@woolseymorcom.com 10-13-2025 Withdrawn
tsalehi@salehiboyer.com 01-01-2025 VIA ELECTRONIC SUBMISSION: civilremedy@myfloridacfo.com Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Re: Complainants: Brett & Susan Watterson Policyholders: Brett & Susan Watterson Filer: Robert L. Nipps, Esq. Claim #: EDI951861 Policy #: EDH4056829-04 Date of Loss: September 28, 2022 CRN Filing No.: 795401 CRN Filing Date: 12/4/2024 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 Raymond Powers Esq. on behalf of Janice and James Sudol. (the “Complainants” or “Claimants”). After reviewing the CRN, Edison Insurance Company 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 Insurance Company Insurance Company 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 actually describe the alleged violations and fails to provide any information such as facts and circumstances which would allow Edison Insurance Company Insurance to 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. 624.155(1)(b)(3): 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 reference 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 reference 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; moreover, this statute has no nexus to the subject claim or the facts at hand. 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 status 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 communication 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 (a)(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 the 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. 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). 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 Insurance Company 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 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 numerous statutory provisions that could be claimed against an insurance company, regardless of whether they are relevant or applicable to the allegations contained in the Notice. Because the CRN fails to allege specific facts and/or circumstances in support of its allegations, Edison Insurance Company 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 Insurance Company 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 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 Insurance Company 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 624.155(1)(b)(3) the complainant provides no specific facts that would suggest that the obligation to settle was, is, or has become clear to the insurance carrier at any point. In fact, the CRN mentions the aforementioned statute twice and in essence, only states that it was violated as a blanket allegation and presents no detailed instances of how the section was allegedly violated; it is suspected that these types of CRN’s are filed as a matter of course and have no real merit. Regarding Section 626.9541(1)(i)(2), the CRN is absolutely devoid of any facts that would suggest a material misrepresentation of any kind. The complaints mention that the denial of the claim was a blatant misrepresentation of the available coverage under the policy but provides no texture to the conclusory statement nor factual support which boils down to an unsupported self-serving opinion that happens to be diametrically that of the carrier. In reference to 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 Insurance Company from evaluating what error, if any, allegedly occurred during the investigation of the claim. Complainant cannot possibly support the position that Edison Insurance Company 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. As to Section 626.9541(1)(i)(3)(b), Florida Statutes, the CRN provides only conclusory and unsupported allegations of Edison’s “misrepresentation” or false statements relating to the facts of the claim or coverage at issue. Because the CRN fails to describe any of facts or circumstances of the claim with any particularity, Edison Insurance Company is precluded from evaluating what error, if any, allegedly occurred during the claim process. Next, as to Section 626.9541(1)(i)(3)(c), the CRN suggests that Edison Insurance Company failed to acknowledge and act promptly upon communication with respect to claims. This is wholly false, and Edison Insurance Company vehemently denies these allegations, especially since this claim was reported to Edison on September 5, 2024, just shy of two (2) years after the alleged date of loss of September 28, 2022. If there is any failure to acknowledge and act promptly, it was on the part of the insureds. As to Section 626.9541(1)(i)(3)(d), The CRN suggests that Edison Insurance Company denies claims without conducting reasonable investigations based on available information. This is false as Edison makes coverage determinations based on the totality of documentation and information available to it during the investigation of the claim. As to Section 626.9541(1)(i)(3)(e), Edison vehemently denies the allegation set forth by the Complainants that it violated this statute. Moreover, regarding Section 626.9541(1)(i)(3)(f), Edison denies the allegation set forth by the Complainants that there was a failure to 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. Also, a detailed coverage determination explaining Edison’s position based on the Policy and the Florida Building Code was sent to the Insureds pursuant to applicable Florida Law. Next, regarding 626.9541(1)(i)(3)(g), the allegations stating that Edison failed to promptly notify the insured of any additional information necessary for the processing of the claim is complete fails as the coverage determination letter that was sent to the insureds not only set forth a detailed explanation of Edison’s position, but also invited the insureds to contact Edison should there be question or concerns regarding the handling of the claim and/or the insureds believed there were facts or information that was not considered. Regarding Section 626.9541(a)(i)(3)(h) and 626.9541(a)(i)(4), Edison denies the allegations set forth in Complainants CRN. 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, conclusory, 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 Insurance Company 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 clearly intended solely to tarnish Edison’s name and reputation. Edison Insurance Company, at all times, acted fairly, honestly and in good faith in its dealings with the Complainant. Edison Insurance Company at no time misrepresented any pertinent facts or insurance policy provisions. Edison Insurance Company conducted a reasonable and prudent investigation of the claim and acted upon all communications from the Complainant. Finally, Edison Insurance Company promptly and appropriately communicated with the Complainant and provided explanations for the actions and decisions that were made. As it relates to the facts of the claim, Edison Insurance Company received notice of the subject loss from the Insureds on or about October 1, 2022, alleged to have occurred on September 28, 2022. On October 3, 2022, Edison made contact with the named insured(s) notifying them that an adjuster would be contacting them to schedule an inspection of their property within 48-72 hours. On October 6, 2022, the Insureds’ property was inspected. On December 14, 2022, Edison sent the Insureds a coverage determination letter with a payment in the amount of $2,518.61. It was not until February 4, 2024, that Edison Insurance Company received a letter of representation from River City Claims notifying it that Complainants/Insureds were represented by a public adjusting company. On March 20, 2023, Edison made a supplemental coverage determination with a payment in the amount of $6,378.59 which provided a detailed explanation of coverage, and an excerpt detailing the applicable policy language clarifying Edison’s decision, followed by a detailed estimate of coverage. On or about May 13, 2024, Edison requested the Insureds provide an executed Sworn Statement in Proof of Loss (SPOL). On May 20, 2024, in response to Edison’s request for a SPOL, it received a signed SPOL in the amount of $138,097.22, which was rejected. The Insureds were notified that the claim number within this SPOL was incorrect. Also on May 20, 2024, Edison sent correspondence to the Insureds stating that it had completed the investigation and evaluation of the claim and that it was determined based on the review of the documentation it was provided that the damage to the roof was within the current repairability standards as set forth by the Florida building codes. Said correspondence also provided a detailed explanation of Edison’s position, which also informed the Insureds that if they had further information to provide that they could do so. On November 21, 2024, Edison received yet another SPOL in the amount of $144,309.22 which was also rejected as the mortgage holder was not listed, the limits within said SPOL did not match the Policy, and the Proof of Loss was made out to American Integrity Insurance Company of Florida. Regarding the Complainants’ allegation that a coverage determination was not made within sixty (60) days, Edison did not have to make a coverage determination within sixty (60) days as this requirement was not in effect at the time of the reporting of the claim. The claim was reported to Edison on or about October 1, 2022. Edison made a coverage determination which resulted in a detailed explanation of how the Policy, facts and findings were applied to the investigation of the claim. Said coverage determination was pursuant to Fla. Statute 627.70131(7)(a) which states in relevant part the following: Within 90 days after an insurer received notice of an initial, reopened, or supplemental property insurance claim form a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer which reasonably prevent such payment. The sixty (60) day coverage determination for property insurance in Florida did not go into effect until December 16, 2022. Edison made every effort to promptly communicate with the insureds. Edison Insurance Company also denies any allegation that it violated any Florida statues or any other applicable law as it diligently investigated the claim and thoroughly informed the insureds and/or their representation of the above facts regarding its claim decision. However, the insured proceeded with the filing of this civil remedy notice (CRN), which appeared to have been filed as a matter of course and not based on the merits of the claim investigation. The above demonstrates quite clearly that Edison Insurance Company 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 Insurance Company investigated the subject claim and rendered its coverage decision based on the terms and conditions of the subject policy. In closing, Edison Insurance Company 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 Insurance Company denies all allegations contained in the CRN and submits that there are no violations. While this response is meant to be comprehensive, Edison Insurance Company based the above-mentioned statements upon the limited information provided in the CRN and the information Edison Insurance Company has been provided to date. If the Complainant feels that Edison Insurance Company is not in possession of all the facts, please provide such additional information as soon as possible. Please note that Edison Insurance Company’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 Insurance Company or any agent or representative of Edison Insurance Company 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/ Lanzce A. Francis Lanzce A. Francis, Esquire On behalf of Edison Insurance Company
kcmc1014@gmail.com 12-04-2024 Filer inadvertently added an email that is not associated with Insurer at the bottom of this form regarding the form been emailed/uploaded, etc. The email address of claimsmail@aiiflorida.com is incorrect. The bottom paragraph of this Notice is Amended to read: A copy of this form submitted to the FDFS has been emailed and/or uploaded and also printed out and mailed to the following parties providing them notice of the filing of this civil remedy notice: Edison Insurance Company P.O. Box 21957 Lehigh Valley, PA 18002-1957 866-568-8922 csclaims@edisoninsurance.com
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