Filing Number: 801372
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| Filing Accepted: 1/15/2025 |
| Last/Business Name
*
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ZIEMBA
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First Name |
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LAWRENCE AND LINDA |
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| Street Address
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11942 MAJOR TURNER RUN |
| City, State Zip
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PARRISH,
FL
34219
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| Email Address
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TZALLOUM@ITSABOUTJUSTICE.LAW |
| Complainant Type:
*
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Insured |
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| Last/Business Name* |
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ZIEMBA |
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First Name |
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LAWRENCE AND LINDA |
| Policy # * |
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EDH3501674-01 |
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Claim #* |
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ED1967399 |
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Attorney is Applicable
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| Last Name* |
ZALLOUM
First Name *
TYVEN
Initial
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| Street Address* |
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350 N. LAKE DESTINY RD. |
| City, State Zip* |
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MAITLAND
,
FLORIDA
32751
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| Email Address * |
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TZALLOUM@ITSABOUTJUSTICE.LAW |
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| Insurer Type
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 Authorized Insurer
 Unauthorized Insurer
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| Insurer Name |
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| Insurer Name* |
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EDISON INSURANCE COMPANY
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| Insurer Name* |
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| Street Address* |
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| City, State Zip* |
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,
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NAIC Company Code 12482 |
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| Name of individual responsible for violation (if any):*
REBECCA RUSCH AND DARNELL EVANS
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| Type of Insurance
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Residential Property & Casualty
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| Reason for Notice
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Unfair Trade Practice
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Unsatisfactory Settlement Offer
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Other
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Wrongful Manipulation of Adjuster Estimate
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Statutory provision(s) which the insurer allegedly violated.
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| 624.155(1)(b)(1) |
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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.
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| 624.155(1)(b)(3) |
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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.
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| 626.9541(1)(i)(2) |
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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.
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| 626.9541(1)(i)(3)(a) |
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Failing to adopt and implement standards for the proper investigation of claims.
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| 626.9541(1)(i)(3)(b) |
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Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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| 626.9541(1)(i)(4) |
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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).
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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
A certified copy of the policy is not currently in the possession of Insureds. Based on information and belief, the following policy provisions apply to this Civil Remedy Notice:
Section 1 – Perils Insured Against – Coverage A- Dwelling and Coverage B – Other Structures
Section 1 – Property Coverages – Coverage A - Dwelling and Coverage B – Other Structures
Section 1 – Conditions - Loss Payment
Section 1 – Conditions - Loss Settlement
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Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
On or about October 9, 2024, the Insureds, Lawrence and Linda Ziemba, suffered damage to their home located at 11942 Major Turner Run, Parrish, FL 34219 as a result of Hurricane Milton. Prior to the loss, Edison Insurance Company (“Edison”), had issued a policy of insurance (Policy No.: EDH3501674-01) for the Insureds’ property. Said policy was in full force and effect on date of loss and afforded coverage for damages caused by Hurricanes. Edison was timely notified of the loss by the Insureds and assigned claim number ED1967399. During the course of Edison's investigation, the Insureds made their property available for inspection, provided facts and information about the loss, and complied with Edison's adjustment of the claim. Despite fully cooperating with Edison's investigation, Edison capriciously decided the Insureds’ claim was conveniently just over the Insureds’ deductible even though there was clear evidence that the roof needed to be replaced. Edison knows full well that the roof would be the most expensive items of the Insureds’ home to replace, therefore, it would be unacceptable to extend full coverage for it. Instead, Edison offered to make the bare minimum repairs for the loss evidenced by its estimate indicating the replacement of 75 shingles. It is unfortunately clear that Edison came to its coverage determination by affording the bare minimum in coverage in an effort to try to make the Insureds abandon their claim.
To make matters worse, the independent adjuster that Edison retained to inspect the Insureds’ property, Chris Frazier, advised the Insureds that the roof was damaged beyond repair and that Edison was going to pay for a full roof replacement. Still in doubt that, the Insureds asked Mr. Frazier how he could be so sure that Edison would pay for the entirety of the new roof. In response, Mr. Frazier advised that it is because he makes the decision as to whether or not a roof would be replaced. By reviewing the estimate that Edison provided to the Insureds, it’s clear that it was manipulated and altered from what is likely to be an estimate for a full roof replacement. This is evidenced by the bold-faced typing on every roof-related line item as well at the two notes with asterisks stating “***The Line Items Above are Supplement Items Dated 12/05/2024***”. Edison then fraudulently misrepresented to the Insureds that the estimate for repairs created by Rebecca Rusch, an adjuster who never physically inspected the property, is slightly above the deductible in hopes the Insureds would accept the coverage determination and abandon their claim.
A reasonable person would have thought that Edison learned its lesson after the Washington Post exposed Edison, as well as other insurance companies, for manipulating adjuster’s estimates that were originally estimated to repair credible damage. According to the Washington Post, their investigation of this conduct revealed that more than 100 Hurricane Ian claims had the estimates for repair reduced by 45 to 97 percent. The Post also stated that many other adjusters, just like Mr. Frazier had their estimates to repair credible damage altered. Please see the following link to the Washington Post article.
https://www.washingtonpost.com/climate-environment/2023/03/11/florida-insurance-claims-hurricane-ian/
However, Edison is continuing on its pattern and practice of ripping off paying customers who put their faith into Edison to honor its end of the bargain in order to make a quick buck. The link to the Washington Post article to attached below.
It’s clear that Edison has not acted fairly towards its Insureds. Edison has wrongfully modified the estimates of loss and intentionally misrepresented to the Insureds the actual costs of repairs for this claim in hopes the Insureds would accept the coverage decision and abandon the claim. Edison has also failed to settle and resolve this claim at every point it was able to when all factors were in favor of resolving this dispute.
In order to cure this Civil Remedy Notice, Edison must immediately acknowledge in writing that the roof replacement is warranted, to produce the original estimate before it was altered, and immediately provide payment, along with interest. The written acknowledgment should be tendered to Insureds’ attorney, Tyven S. Zalloum, Esq. at 350 N. Lake Destiny Road, Suite 300, Maitland, FL 32751 and tzalloum@itsaboutjustice.law
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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.
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DFS-10-363
Rev. 10/14/2008
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