Civil Remedy Notice of Insurer Violations
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Filing Number:     801747
Filing Accepted:  1/17/2025
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Complainant
Last/Business Name *  
BRACY   First Name   THOMAS AND CHERYLE
Street Address * 23126 LINDALE AVENUE
City, State Zip * PORT CHARLOTTE, FL 33954
Email Address * SMERILLO@FALONILAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   BRACY   First Name   THOMAS AND CHERYLE
Policy # * EDH4062303-04 Claim #* EDI955150
Attorney
Attorney is Applicable
Last Name* KIMMEL First Name * GINA Initial
Street Address* 20 N. ORANGE AVE STE 1600
City, State Zip* ORLANDO , FLORIDA 32801
Email Address * SMERILLO@FORTHEPEOPLE.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):* JOY DANIELS AND PATRICK MAHONEY
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unfair Trade Practice
Unsatisfactory Settlement Offer
* 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)(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 – PERILS INSURED AGAINST COVERAGE A – DWELLING and COVERAGE B – OTHER STRUCTURES 1. We insure for sudden and accidental direct loss to property described in Coverages A and B only if that loss is a physical loss to covered property.
 
* 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 September 28, 2022, Insured, Thomas M. Bracy and Cheryle L. Bracy’s (“Insured”) home belonging to Complainant was damaged during the policy period as a result of Hurricane Ian. Insured filed a claim to her Insurer, Edison Insurance Company (“Insurer”). Despite having extensive knowledge of the foregoing information, Insurer has failed to adjust the claim in a manner favorable to the Insured, despite having the opportunity to inspect the damaged property and there being sufficient evidence of damage. This systematic underpayment and/or denial of claims is believed to be a business practice of this insured. Insurer investigated the claim, inspected the property, and rendered an erroneous claims decision. As a result of Insurer’s insufficient payment, Insured provided Insurer with notice to re-open and/or supplement the claim and a copy of an itemized supporting estimate of damages and photographs. Insured also advised of its amenability to attend a pre-suit DFS Mediation. Accordingly, Insured filed a Notice of Intent to Initiate Litigation based upon a supporting estimate of damage. In response, Insurer relayed a settlement offer which amounted to less than what is necessary to restore the property its pre-loss condition. Bad faith discovery will likely reveal that it is a business practice of Insurer to treat insureds who are unrepresented at the time of making a claim, or through the initial claim adjustment process, unfairly. Those insureds regularly receive a calculated denial of the claim and/or low ball offers until after counsel is retained on the insured’s behalf. Further, Bad faith discovery will also likely reveal Insurer has a team of individuals it pays to conduct inspections and prepare reports and estimates that attempt to deny claims, and limit or minimize coverage for the insured’s loss. Insurer’s reliance on these estimates and reports benefits the Insurer as they are biased by not addressing the full scope or cost of the loss and the appropriate coverage. To cure this violation, insurer should agree, in writing, to completely bring the property to its pre-loss condition pursuant to the damage estimate attached to the insureds’ Notice of Intent to Litigate filed on May 23, 2024, subject to the terms and conditions of the policy of insurance and applicable Florida law. As a result, if the Insurer pays the damages alleged herein, any further claims for additional insurance proceeds will be submitted to the Insurer pursuant to the policy's loss settlement provision. This payment is exclusive of Insured’s claims for statutory attorney fees, costs, and interest pursuant to Florida law. This matter and Insurer’s business practices with respect to loss adjustment and claims handling should be investigated further by the Office of the Insurance Consumer Advocate.
Comments
User Id Date Added Comment
Tom@zinoberdiana.com 03-04-2025 March 4, 2025 Via Electronic Posting to the DFS Website Department of Financial Services Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399-6322 Re: Insureds: Thomas Bracy and Cheryle Bracy Insurer: Edison Insurance Company Filing No.: 801747 Claim No.: EDI955150 Policy No.: EDH4062303-04 Date of Loss: 09/28/2022 Property: 23126 Lindale Ave., Port Charlotte, FL 33954 Dear Sir or Madam: This correspondence shall serve as a formal response on behalf of Edison Insurance Company, (hereinafter “Edison”) to the Civil Remedy Notice of Insurer Violation (hereinafter “Notice”) filed by the Insureds, Thomas Bracy and Cheryle Bracy (hereinafter “Insureds” and/or “Plaintiffs”), that was accepted by the Department of Financial Services (hereinafter “Department”) on January 17, 2025. The Department’s Filing Number is 801747. I. The Notice fails to satisfy the requirements of Florida law and should be rejected. As to the content of the Notice, it is important to note that the Notice fails to comply with the specific requirements mandated by Florida Statutes §624.155. As such, the Notice should be rendered null and void, and should be rejected by the Department. Specifically, the Notice fails to comply with Florida Statute 624.155(3)(b)(4), Florida Statutes, which requires that the Notice state, with specificity, the specific policy language that is deemed to be violated. Rather than complying with this requirement, the Notice refers to the Perils Insureds Against provision, without providing any context to how virtually the entire policy was violated. Instead, the Notice includes a lengthy commentary on unsupported, conclusory accusations, unqualified opinion, legal conclusions, conjecture, and inaccurate statements of facts casted in the light most favorable to the Insureds and their representatives. Finally, it is of primary importance to Edison that it is provided an opportunity to respond to the concerns of its policyholders which it routinely does as a matter of course. Instead, the Notice in this matter provides nothing more than general statements regarding statutes and rules applicable to the investigation of insurance claims and unsupported, conclusory, allegations of fact that purportedly support the incorrect notion that Edison adjusted the Insureds’ claim in bad faith. The deficiencies in this Notice preclude Edison from providing an adequate response as provided for in Section 624.155, Florida Statutes. Therefore, Edison requests that the Department reject the Notice as a result of the deficiencies noted hereinabove. II. Despite the deficiencies, Edison denies all allegations contained in the Notice. Notwithstanding the deficiencies in the Notice, Edison denies it committed the acts or violated the statutes cited in the Notice. Edison hereby denies each and every allegation contained in the Notice, either explicitly or implicitly, and denies any wrongdoing in the handling of this matter. Edison has acted fairly and with due diligence throughout the entire investigation and handling of this claim. To the extent that this reply does not fully address and respond to the allegations set forth by the Notice, such deficiency is the direct result of the lack of specificity and the overall vague nature of the allegations therein. Edison denies each and every allegation contained in the Civil Remedy Notice and responds to them individually as follows: The Insureds lists two (2) reasons for submitting the Notice which are: 1) Unfair Trade Practice; and 2) Unsatisfactory Settlement Offer. As indicated in detail below, the Notice fails to establish or set forth any specific facts that would support the allegation asserted in support of the perceived violations. Specifically, Edison responds as follows: Unfair Trade Practice: This allegation is wholly without basis in law or fact and is therefore denied. Counsel for Plaintiffs should immediately withdraw this allegation from the Notice as it cannot be established by any credible evidence. Edison has always implemented standards for investigating and adjusting claims commensurate with the requirements of Florida Statutes, and it will continue to do so. At all times material to this claim, Edison acted in good faith towards its insureds, as it does on every claim. Unsatisfactory Settlement Offer: This allegation is wholly without basis in law or fact and is therefore denied. Counsel for Plaintiffs should immediately withdraw this allegation from the Notice as it cannot be established by any credible evidence. Edison acted fairly, honestly, and promptly towards the Insured and with due regard for their interests. Edison engaged in a thorough investigation of the subject claim, tendering coverage in accordance with the Policy, and continuing to adjust the claim together with the Insured. Alleged Statutory Violations The Complainant lists six (6) statutory provisions which have allegedly been violated by Edison. In response, Edison denies each of the allegations of statutory violation as all are wholly without merit, and responds as follows: • §624.155(1)(b)(1): Denied. At all times material to this claim, Edison acted fairly and honestly towards the Insured and with due regard for their interests. Edison engaged in a thorough investigation of the subject claim. At no time has Edison acted dishonestly or unfairly toward the Insured and/or their representatives. All actions have been performed in good faith for the purpose of moving the claim towards a just and equitable resolution. • §624.155(1)(b)(3): Denied. At all times material to this claim, Edison acted fairly, honestly, and promptly towards the Insured and with due regard for their interests. Edison engaged in a thorough investigation of the subject claim. At no time has Edison acted dishonestly or unfairly toward the Insured and/or their representatives. All actions have been performed in good faith for the purpose of moving the claim towards a just and equitable resolution. • §626.9541(1)(i)(2): Denied. Insured should immediately withdraw this allegation from the Notice as it cannot be established by any credible evidence. At all times material to this claim, Edison acted fairly and honestly towards the Insured and with due regard for their interests. Edison has not made any misrepresentations to the insured or anyone else with regarding to this claim. All actions have been performed in good faith and for the purpose of moving the claim towards a just and equitable resolution. Absolutely no facts or circumstances supporting this allegation have been provided by Insured in the Civil Remedy Notice. • §626.9541(1)(i)(3)(a): Denied. Insured should immediately withdraw this allegation from the Notice as it cannot be established by any credible evidence. Edison has always implemented standards for investigating and adjusting claims commensurate with the requirements of Florida Statutes, and it will continue to do so. All actions have been performed in good faith and for the purpose of moving the claim towards a just and equitable resolution. Absolutely no facts or circumstances supporting this allegation have been provided by Insured in the Civil Remedy Notice. • §626.9541(1)(i)(3)(b): Denied. Insured should immediately withdraw this allegation from the Notice as it cannot be established by any credible evidence. At all times material to this claim, Edison acted fairly and honestly towards the Insured and with due regard for their interests. Edison has not made any misrepresentations to the insured or anyone else with regarding to this claim. All actions have been performed in good faith and for the purpose of moving the claim towards a just and equitable resolution. Absolutely no facts or circumstances supporting this allegation have been provided by Insured in the Civil Remedy Notice. • §626.9541(1)(i)(4): Denied. Insured should immediately withdraw this allegation from the Notice as it cannot be established by any credible evidence. Edison engaged in a prompt and thorough investigation of the subject claim, providing a timely and detailed claim determination and properly communicating with the Insured, well within the time allowed by Florida Statutes and set forth in detail below. Absolutely no facts or circumstances supporting this allegation have been provided by Insured in the Civil Remedy Notice. Alleged Violations of Policy of Insurance The Notice requires the Complainant to reference the specific policy language that is relevant to the violation. Rather than complying with this requirement, counsel for Plaintiffs have asserted that Edison has breached the Perils Insured Against section of the Policy in its entirety. The Notice also fails to provide any context as to how virtually the entire policy was violated. Nonetheless, Edison states with confidence that it acted promptly, fairly, and in good faith towards the Insureds at all times material to the adjustment and investigation of this claim. Edison denies violating any provision or duty set forth in the policy or statute. Alleged Factual and Circumstantial Support for the Notice The Notice requires the Complainant to “describe the facts and circumstances giving rise to the insurer’s violation as you understand them at this time.” In part, the Notice incorporates vague, unsubstantiated, irrelevant, and inflammatory allegations which purportedly give rise to the violation. Therefore, these portions of the Notice should be dismissed for failure to properly complete the form pursuant to Florida Statute §624.155, as the alleged violations are without basis in law or fact. The allegations set forth are so vague, boilerplate, and non-specific that they fail to allow a reasonable response. Nevertheless, Edison asserts that all actions taken have been made entirely in good faith and for the purposes of fair, just and timely disposition of this matter. The facts of this matter are clear, and these are they: Edison provided homeowners insurance coverage to the Insureds, Thomas Bracy and Cheryle Bracy (“Insureds”), for a property located at 23126 Lindale Ave., Port Charlotte, FL 33954 (the “Insureds’ Property”) under the terms of policy number EDH4062303-04 (the “Policy”). Contrary to Complainants’ assertions within its Notice, the carrier did not make a “calculated denial” of the claim or “low ball” offers. In fact, upon receipt of the claim on October 12, 2022, Edison immediately and diligently investigated the Claim which included, but was not limited to, multiple physical inspections of the Insureds’ Property by multiple licensed professionals to determine the causation, scope and extent of damage being claimed. Specifically, an inspection by a licensed field adjuster took place on October 27, 2022. As a result, Edison provided a detailed coverage determination on December 18, 2022 based on the findings of the inspection and coverage under the Policy, tendering coverage and payment for the observed damages. Edison continued to adjust the claim with the Insureds, reviewing additional documentation as it was submitted, and provided a supplemental coverage determination on April 17, 2023 tendering additional coverage. Edison provided additional supplemental coverage determination letters on July 20, 2023 and October 16, 2023 explaining in detail the reasons that no additional coverage was available. Specifically, the inspection and continued investigation and adjustment revealed damage that was specifically excluded from coverage by the subject Policy of insurance, like age-related deterioration, wear and tear, and mechanical damage. In addition to thoroughly investigating the claim, Edison promptly communicated with the Insureds and its representatives throughout its adjustment of the claim, as well. Based on the facts presented in detail above, Edison wholly denies the Insureds’ allegations contained within the Notice, and in support thereof asserts that it acted in accordance with Florida law, its policy of insurance, and in good faith toward the Insureds and their representatives, as well as other Edison policyholders. III. Demands to Cure Defects Finally, the Notice requests that in order to cure the alleged violations, Edison should agree, in writing, to completely bring the property to its pre-loss condition pursuant to the damage estimate attached to the insureds’ Notice of Intent to Litigate filed on May 23, 2024. The Notice fails to include any dollar amount to allow Edison to determine what the Complainant contends would bring the property to its pre-loss condition. Notwithstanding, after a diligent investigation, Edison has concluded that the claim does not qualify for coverage under the terms of the Policy. Edison is not able to tender coverage in excess of what is provided by the Policy. IV. Conclusion In closing, Edison first believes that the Civil Remedy Notice does not comply with section 624.155, Florida Statutes, and should therefore be rejected and returned by the Department of Financial Services due to its failure to comply with § 624.155, Fla. Stat., and Florida case law. Regardless of the lack of compliance, Edison denies all allegations contained in the Civil Remedy Notice and submits there are no violations. Edison denies all of the allegations contained in the Civil Remedy Notice and note that the Notice is riddled with inaccuracies. Due to the lack of any reliable or authoritative basis in fact or circumstances to support such allegations, we request, through this response, that the Department of Financial Services return the Notice for lack of specificity in accordance with Florida Statutes. While this response is meant to be comprehensive, Edison’s response above is based upon the limited information provided in the Civil Remedy Notice and the information we have to date. If the Insureds feel that we are not in possession of all the facts, please inform us immediately. Please note that Edison’s response is not necessarily exhaustive and does not preclude us from asserting any other valid reason for lack of compliance with F.S. § 624.155. Also, this letter, or any act or failure to act on the part of Edison or any agent or representative of Edison should not be construed as a waiver of any rights or defenses, including but not limited to proper notice and service by the Insureds, 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 Civil Remedy Notice of Insurer Violation. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Best regards, ZINOBER, DIANA, & MONTEVERDE, P.A. Megan R. Michalski, Esquire MMichalski@zinoberdiana.com CC: Gina Kimmel, Esquire 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