Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 800379

Filing Accepted: 1/10/2025

Print Filing

Complainant

Last/Business Name *

CAGLE

First Name

BENJAMIN AND AMBER

Street Address *

907 OAKWOOD DR.

City, State Zip *

LARGO, FL 33770

Email Address *

BEN@MONSTERADS.COM

Complainant Type: *

Insured

Last/Business Name*		CAGLE		First Name		BENJAMIN AND AMBER
Policy # *		EDH5413249-02		Claim #*		EDI967296

Attorney

Attorney is Applicable

Last Name*	SCHILLING First Name * JEREMY Initial T
Street Address*		1700 NW 64TH ST SUITE 460
City, State Zip*		FORT LAUDERDALE , FLORIDA 33309
Email Address *		AGRONDIN@SCHILLINGSILVERS.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		EDISON INSURANCE COMPANY
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 12482

Name of individual responsible for violation (if any):* EDISON CLAIMS ADJUSTER
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Unsatisfactory Settlement Offer
	Unfair Trade Practice
	Other : Applied Wrong Deductible

* 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)(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.

* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

DEDUCTIBLES All Other Perils Deductible: $2,500 HURRICANE DEDUCTIBLE: 2% of Coverage A = $49,284 A check in the amount of $98,907.73 for Coverage A-Dwelling and $22,584.49 for Coverage C-Contents will be mailed to you. Upon receipt, please review the payment to make sure it corresponds to the enclosed documentation. The policy deductible of $49,284.00 was applied to the loss settlement.

* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

BENJAMIN CAGLE (“Insured”) purchased an Insurance Policy (“Policy”) from EDISON INSURANCE COMPANY (“Edison”), bearing policy EDH5413249-02, for the property located at 907 Oakwood Dr., Largo FL 33770 (“Property.”) On or around October 12, 2024, and during the applicable Policy period, a refrigerator at the Insured’s home caught fire. The flames quickly spread across the property causing significant amount of damage to the Property. The Insured reported a claim under the Policy, which Edison assigned claim number EDI967296 (“Claim”). On or about November 21, 2024, Edison issued a Coverage Determination Letter opening coverage for the claim. Per the coverage letter, the peril is listed as “Wind – Hurricane – Milton.” However, Edison was well-aware the peril was not windstorm from a Hurricane, but rather, from a fire. Based on Edison’s Field Adjuster’s inspection of the Property and corresponding estimate, Edison issued an undisputed payment in the amount of ninety-eight thousand, nine hundred and seven dollars and seventy-three cents ($98,907.73) for Coverage A-Dwelling and twenty-two thousand five hundred eighty-four dollars and forty-nine cents ($25,584.) for Coverage C-Contents. However, Edison Insurance Company incorrectly and intentionally acted in bad faith by applying the “hurricane” deductible of $49,284.00 instead of the “all other perils” deductible, which is $2,500. Thus, Edison should have issued $171,275.73 to the Insured, $46,784.00 more than they previously have issued. Since the issuance of the coverage letter, counsel for the Insured has made repeated attempts for Edison to correct its coverage determination, apply the $2,500.00 deductible, and issue the correct payment. Edison has failed to and refused to do same. It is clear that Edison carried out a subpar investigation of the claim to the detriment of the Insured. Edison saw the discrepancy of the deductible and purposefully applied a higher deductible in order to disadvantage the Insured and issue less insurance proceeds than were due and owing under the Policy. Due to Edison’s gross mismanagement of the claim, the failure to properly investigate the loss and adjust this loss in good faith, the Insured continues to be underpaid on the claim. By stating the above detailed facts, it is clear that Edison has violated the following Florida Statutes: • 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; o Edison failed to act fairly and honestly toward its insured by incorrectly applying the hurricane deductible instead of the appropriate all other perils deductible for fire damage, leading to significant underpayment. • 626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue; o Edison misrepresented pertinent facts or policy provisions by applying the incorrect deductible for the type of loss, thereby depriving the insured of rightful compensation. • 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; o Edison failed to promptly provide a reasonable explanation in writing for the misapplication of the deductible and the resulting underpayment of the claim. Based on the above, it is irrefutable evidence that Edison knowingly and intentionally, performs sub-par investigations into its claim in order to further disadvantage the Insureds. The financial detriment caused to the Insured is a direct result of Edison’s reckless investigation. Upon information and belief, the aforementioned actions complained of, among others, were made by Edison so often as to constitute a general business practice, evidencing a motive to enhance Edison’s profits, and designed to cause a detrimental effect to its policyholders. The above clearly depicts that Edison adjusted this claim in bad faith and that Edison is in direct violation of Unfair Claims Practices, by knowingly underpaying a covered claim. This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should Edison fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, Edison must: Create and implement adequate guidelines for proper investigation and evaluation as to claims handling and for the training and supervision of employees, which will avoid future statutory violations as set forth above, and to avoid this from occurring in the future; Edison must create and implement adequate guidelines for the proper investigation and evaluation of these types of claims, and for the training and supervision of employees with regard to these types of claims to ensure Edison’ claims handling procedures with regard to these types of losses are adequate; Edison must act fairly and honestly towards the Insureds with due regard for their best interests in attempting to settle the claim; Edison must immediately tender all insurance benefits due and owing in the amount of $46,784.00, which represents the difference between the “hurricane” deductible of $49,284.00 and the “all other perils” deductible, which is $2,500.00. The Insured expect Edison to respond to this CRN stating that it does not comply with Florida Statutes and Edison will ignore the specific allegations herein and fail to refute them with any factual basis.

Comments

User Id		Date Added		Comment
pcole@conroysimberg.com		03-11-2025		This matter has settled amicably amongst the parties curing any and all alleged defects or complaints.

Acknowledgement
*	The submitter hereby states that this notice is given in order to perfect the rights of the person(s) damaged to pursue civil remedies authorized by Section 624.155, Florida Statutes. Before submitting a Notice using this system, please verify that all text has been entered correctly and completely. Once the Notice has been submitted, the text cannot be changed or deleted.

DFS-10-363
Rev. 10/14/2008