Civil Remedy Notice of Insurer Violations
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Filing Number:     796262
Filing Accepted:  12/10/2024
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Complainant
Last/Business Name *  
PARKER   First Name   SUSAN
Street Address * 409 FOX VALLEY DR
City, State Zip * LONGWOOD, FL 32779
Email Address * SCPARKERS@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   PARKER   First Name   SUSAN
Policy # * EDH5017573-02 Claim #* EDI949397
Attorney
Attorney is Applicable
Last Name* KLOTZMAN First Name * SCOTT Initial
Street Address* 2001 TYLER ST, SUITE 5
City, State Zip* HOLLYWOOD , FL 33020
Email Address * PRELIT@SCOTTKLOTZMAN.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):* AND ALL ADJUSTERS, SUPERVISORS, MANAGEMENT AND INDIVIDUALS ASSOCIATED WITH EDISON INSURANCE RELATED TO THIS CLAIM
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
* Statutory provision(s) which the insurer allegedly violated.
 
624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

There are no policy provision specifically at issue or in dispute, the policy provides coverage from Hurricane damage but Edison Insurance as failed to extend coverage for repairs needed for the insured property.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Edson Insurance Company (“Insurer”) issued an insurance policy bearing policy number EDH5017573­02 which insured the property located at 409 Fox Valley Dr, Longwood, FL 32779. The policy was in effect when the property sustained damage on or about September 28, 2022, when it was damaged by Hurricane Ian. Insurer received notice of the claim for property damage resulting from Hurricane Ian, and related damages which occurred on or about September 28, 2022. The damage was reported to Insurer which assigned Claim Number EDI949397to the claim and investigated the claim. On October 25, 2022, Insurer issued a complete denial of the claim. The claim was reopened and the Insurer denied the claim again on October 18, 2024. Insurer failed to retain the experts needed to perform the inspection and needed to address the damage at issue and determine the repairs needed to restore the property. Insurer has been provided with documents establishing that the claim is covered, despite this being apparent from the condition of the property alone. Insurer has failed to extend coverage for payments owed and has refused to attempt to settle the claim with its insureds. Insurer’s delay in issuing payment is causing and will cause the insureds to sustain extra-contractual damages not covered by the property, including loss of use and enjoyment of the property and related damages, costs associated with hiring adjusters and experts, among other damages and these uninsured damages would not have occurred but for the insurer ’s failure to timely issue payments owed. In this claim and as a business practice, insurer fails to retain experts needed to investigate claims, ignores evidence establishing coverage and avoids covered repairs to attempt to avoid issuing payments owed pursuant to the insurance policy. Insurer can cure these violations by attempting to settle the claim in good faith and issuing payment for the remaining contractual damages owed. As Insurer is aware, issuing payment for contractual damages owed will preclude recovery of extra-contractual damages already incurred, and that will be incurred, and the contractual damages should immediately be paid and be paid within 60 days from the date of this notice. Due to applicable Florida Statutes, and the insurance policy’s payment provisions, the payment issued should also include interest. If insurer contends there is somehow more information needed that was not already provided, it should immediately advise the insureds’ attorney what information is needed. Insurer has been provided with information establishing that the claim is covered but has failed to extend coverage for the claim. Insurer’s denial of the claim and refusal to issue payment is a breach of the insurance policy. This notice is being given in order to perfect the right to pursue the civil remedy authorized by this section.
Comments
User Id Date Added Comment
pcole@conroysimberg.com 02-06-2025 We are in receipt of a Civil Remedy Notice of Insurer Violation (“CRN”) filed on behalf of Edison Insurance Company’s Named Insured, Susan Parker, which was accepted by the Department of Financial Services on December 10, 2024, and assigned Filing No. 796262. The CRN revolves around a claim (EDI949397) filed for alleged damage from a windstorm, named Hurricane Ian, that occurred on September 28, 2022 at the Insured’s single-family residence located at 409 Fox Valley Drive, Longwood, Florida 32779. The home was built in 1975 and is comprised of a shingle roof that was installed in 2018. At the time of loss, the Insured’s unit was covered under an HO3 Policy, Policy number EDH5017573-02, issued by Edison Insurance Company (“The Company”). At the outset, it should be stated that the CRN is defective and does not conform with the requirements of filing a CRN as it contains inaccurate factual allegations, lacks the required specificity and does not provide an opportunity for the Company to reasonably respond to the alleged violations contained in the CRN. The CRN merely contains conclusory reasons for the Notice, such as failing to settle claims in good faith, failing to implement standards for the proper investigation, and failing to acknowledge and act promptly upon communications, to name a few. For example, the Notice alleges that the Company violated the following statutory provisions of Florida Statutes §624.155: • §624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all other 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. The CRN fails to identify specific facts as related to the broad and conclusory allegations. Blanket references to policy provisions and statutes without specification deems the Civil Remedy Notice deficient. Julien v. United Property and Casualty Insurance Co., 311 So.3d 875 (Fla. 4th DCA 2021). Notwithstanding, the Company explicitly denies violations of any applicable Florida Statute in the adjustment of the referenced claims. The Company specifically denies that it has not attempted in good faith to settle the Insured’s claim when under all the circumstances it could and should have done so and it denies that it has failed to act fairly and honestly toward its Insured’s interests. Moreover, the Company specifically denies that it refused to properly investigate the claim or refused to tender all insurance proceeds without waiver of its objections, rights and defenses, the Company maintains that it has acted and continues at all times to act in good faith during the investigation and adjustment of the Insured’s claim, and wishes to dispel even the inference of any violation, and reiterates below the reasons which clearly show the proper handling of the Insured’s claim. Additionally, the Civil Remedy Notice demands “cures” for the alleged defects that are improper under Florida case law. In Talat Enter., Inc., v. Aetna Cas. And Sur. Co., 753 So.2d 1278, 1281 (Fla. 2000), the Supreme Court of Florida held that the scope of what can be “cured” is limited to the alleged non-payment of the contractual amount due to an insured. As a result, Edison Insurance Company objects to the CRN as it is defective and should be rejected. In order to understand the deficiencies of this Notice, however, and reserving all objections to the subject CRN, the background of this case is necessary. On September 28, 2022, the insured reported this Hurricane Ian claim as having occurred on September 28, 2022. The insured reported that the roof was leaking in their daughter’s bedroom, garage, and all over the house, although they were unable to see any damage to the roof. It is important to note that from the start, Edison Insurance Company (the “Company”) communicated with its Insured and/or her representatives on a regular basis. In fact, when the claim was reported on September 28, 2022, a first notice of loss letter acknowledging the claim was immediately sent out to the insured by letter dated September 29, 2022 advising the homeowner of her Bill of Rights as an Insured, and her pre-suit mediation opportunities. Further, later in the claim adjustment process, the Insured was advised of those same rights again, so it was very clear that the Insured was informed of what she could do to protect herself under the circumstances should she disagree with the Carrier’s handling and decision. Upon reporting of the loss, the Company assigned the claim to a field adjuster (the “FA”). On October 13, 2022, the FA conducted an inspection of the subject property. The FA carefully assessed and evaluated the claimed damage, which included a thorough inspection of the roof, exterior, and interior of the property. By letter dated October 25, 2022, a coverage determination was issued wherein the Insured was advised that based on the terms of the policy, it had determined there was no coverage for the claim. The Company explained that the policy did not afford coverage for damages related to wind-driven rain. The Company provided the insured with an excerpt detailing the applicable policy language clarifying the Company’s decision. No further communication was received by the Company until October 16, 2024, when a public adjuster (“PA”) from Omega Public Adjusting submitted a letter of representation on behalf of the insured. A certified copy of the policy was provided to the PA on October 30, 2024 as requested. The PA then submitted its estimate on November 12, 2024 in the amount of $132,492.66 Dwelling and $4,809.39 Other Structures. By letter dated October 18, 2024, the Company issued a supplemental coverage determination wherein the insured was advised that based on the terms of the policy it was determined that there was no coverage for the claim. In summary, the Company explained that the supplemental review of the claim revealed common age-related deficiencies that were specifically excluded from coverage under the terms of the policy, such as granule loss, foot traffic, normal age-related wear, and mechanical damage would have occurred over an extended period, indicating an ongoing issue rather than damage caused as a direct result of wind from Hurricane Ian. The Company advised that the policy did not provide coverage for replacement of the roof due to wear and tear, and only provided coverage due to a direct physical loss from a covered peril; therefore, it determined that no coverage applied for the claimed roof damage. The October 18th letter further advised the insured that the policy is specific that there must first be a storm-created opening located to the roof, exterior walls, windows, or doors in order to provide coverage for any ensuing water entry to the interior, and at the time of its loss site inspection, no evidence of any peril created damage causing an opening of the home which would have allowed rainwater to enter the dwelling was observed. The Company again provided the insured with excerpts detailing the applicable policy language clarifying the Company’s decision. By letter dated November 19, 2024, the Company issued an additional coverage determination and again advised that there was no coverage for the claim. The Company advised that it had completed its review of the PA’s estimate, however it rejected the estimate in its entirety and referred the insured to its prior coverage letters dated October 25, 2022 and October 28, 2024, which advised that coverage was not provided for the claim. The Company explained that it was upholding its previous coverage determination and confirmed that no changes to coverage were made based on the estimate submitted by the PA. The insured was advised that the Company had concluded the handling of the claim and closed the claim file. The insured then retained counsel who provided a letter of representation on November 26, 2024. Copies of the previous coverage determinations were provided to counsel on December 2, 2024 as requested. Counsel then filed a Notice of Intent to Initiate Litigation on December 10, 2024 which contained a demand in the amount of $137,302.00. The Company responded to the NOIL by letter dated December 18, 2024. Counsel also filed the Civil Remedy Notice with the Department on behalf of the Insured on December 10, 2024. The Insured’s counsel complains that there is a disagreement as to coverage in this case, among other items. While that might be true, that does not rise to the level of a statutory violation, it is merely a disagreement with the outcome of the loss. Certainly, as is noted above through the chronology of this loss, an appropriate claims handling procedure was in place to give due consideration to the claim. Edison Insurance Company has communicated with its Insured and her representatives as required. Edison Insurance Company has inspected the loss and damages thoroughly and given a thorough assessment of its findings and conclusions made. The fact that Edison Insurance Company was not in agreement with the position of the Insured or her representatives and the estimates prepared on her behalf, does not rise to the level of statutory violations. Certainly, as is noted above through the chronology of this loss, an appropriate claims handling procedure was in place to give due consideration to the claim. As demonstrated above, the Company has, thus far, undertaken a thorough adjustment process and investigation, and the decision that it has made as to what is compensable and what is not has been amply explained to the Insured. The Company has, at all times, acted fairly and promptly toward its Insured and with full regard to her interests, and has complied with its obligations in this claim process. Any further information which may be required is available upon request.
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