Civil Remedy Notice of Insurer Violations
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Filing Number:     802929
Filing Accepted:  1/22/2025
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Complainant
Last/Business Name *  
CHAMBERS   First Name   JOSEPH
Street Address * 14636 BEAUFORT CIR
City, State Zip * NAPLES, FL 34119
Email Address * WEHRMAN@ITSABOUTJUSTICE.LAW
Complainant Type: * Insured
Insured
Last/Business Name*   CHAMBERS   First Name   JOSEPH
Policy # * EDH4077701-06 Claim #* EDI967787
Attorney
Attorney is Applicable
Last Name* EHRMAN First Name * WESTON Initial
Street Address* 350 NORTH LAKE DESTINY ROAD
City, State Zip* MAITLAND , FLORIDA 32751
Email Address * WEHRMAN@ITSABOUTJUSTICE.LAW
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   EDISON INSURANCE COMPANY
NAIC Company Code 12482
 
Name of individual responsible for violation (if any):* AMY MUTTWILL , WARREN HARBIN, GARY WIDICH
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unsatisfactory Settlement Offer
Unfair Trade Practice
Other : Lowballing
Other : misrepresentation
* 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)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

We insure for direct physical loss. With respect to this endorsement, the provisions of the policy apply unless modified by the endorsement. The following is added in Form EDI HO 03 – HOMEOWNERS 3 SPECIAL FORM – SECTION I – PROPERTY COVERAGES under A. Coverage A – Dwelling and B. Coverage B – Other Structures and EDI HO 06 – HOMEOWNERS 6 – UNIT-OWNERS FORM under Coverage A – Dwelling: Special Limit of Liability Matching Of Undamaged Property We will only initially pay the actual cash value of damage to covered property that is directly and physically damaged by the reported loss, less any applicable deductible. We will pay any remaining amounts necessary to perform such repairs as work is performed and expenses are incurred. If, after work is performed and expenses are incurred, it is determined that the covered property that was directly and physically damaged by the reported loss cannot be repaired or replaced to match the adjoining undamaged property, then we will repair or replace adjoining undamaged property. In determining the extent of the repairs or replacement of adjoining undamaged property, we will consider, subject to the limit provided in this endorsement: 1. The cost of repairing or replacing the undamaged portions of the property; and 2. The degree of uniformity that can be achieved without such cost; and 3. The remaining useful life of the undamaged portion; and 4. Other relevant factors. The total limit of liability for Coverages A and B (Coverage A in Form EDI HO 06) is 1% of the Coverage A limit of liability for repairs or replacements of all undamaged parts of the building or its components to match repairs or replacements made to damage as a result of a covered loss. This limitation does not increase the Coverage A or Coverage B limits of liability shown on the Declarations page, nor does it apply to damage otherwise limited or excluded. All other policy provisions apply.
 
* Facts and circumstances giving rise to the violation.
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Joseph Chambers (hereinafter “the insured”) is insured under a homeowner all risk insurance policy EDH4077701-06 issued by Edison Insurance Company (hereinafter “Edison” or “the insurer”). On or about October 9, 2024, while the subject policy was in full force and effect, Joseph Chambers suffered a sudden and accidental loss at the property due to Hurricane Milton. The loss caused damage to the insureds roof and Edison acknowledged a peril created opening by affording coverage for interior damages at the property. The insured reported the claim to EDISON. Edison issued claim number EDI 967787 to the loss and sent its adjuster to inspect the property. The insured allowed an inspection and fully cooperated with the investigation of the claim. Edison afforded coverage for replacement of 378 roofing tiles in its adjustment of the claim and improperly applied its 1% matching cap for the replacement of the estimated 10,602 remaining tiles in order to preclude paying its insured for replacement of his roof. By asserting this 1% matching cap, Edison is to consider In determining the extent of the repairs or replacement of adjoining undamaged property, we will consider, subject to the limit provided in this endorsement: 1. The cost of repairing or replacing the undamaged portions of the property; and 2. The degree of uniformity that can be achieved without such cost; and3. The remaining useful life of the undamaged portion; and 4. Other relevant factors. By acknowledging payment for interior damages, Edison has acknowledged that there is a peril created opening at the insured property. EITHER the adjuster(s) on this claim VIOLATED THE ADJUSTER CODE OF ETHICS by undertaking the adjustment of a claim that they were not competent or knowledgeable to the components of a roofing system OR Edison was intentionally cheating the insured out of coverage for a roof replacement in violation of F.S. 626.9541. How specifically? The Estimate allegedly created by Warren Harbin acknowledges replacement for the tiles and for the interior damages BUT FAILS to account for the secondary water barrier that would need to be addressed. Edison, knowing that it would have to pay for the replacement of the roof if it addressed the approximately 20 year old secondary water barrier as it is unrepairable and does not comply with the current building code. Despite stating it will consider the factors listed above, it is clear that Edison has ignored the fact that there is a discontinued tile on the roof. Edison has also ignored the ordinace and law coverage which the insured paid additionally for as the Home Owner Association does not permit mismatched tiles. Edison has ignored the remaining usefull life of the undamaged portion as the tile roof and ( more importantly the underlayement) is at the end of its useful life. The other relevant factor that Edison looked at was profit maximation and stock price by underpaying claims. By it is undisputed that Edison did not pay the actual cash value of the loss as required by Florida Statute Section 627.7011 and the policy. This failure to pay the actual cash value of the loss is a result of the bad faith business practice of Edison and will subject Edison to Punitive Damages. This is an egregious unfair claims practice. Edison is 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 refuses to treat its insured fairly and honestly and with due regard for the Insureds’ interest. This claim lowballing, and mis application of the 1% matching cap is part of a general business practice. This conduct can be cured by accepting coverage and paying all covered damages related to the loss at the property in the amount of the $78,282 (minus any prior payment and deductible) plus interest. All attorney fees and costs must also be paid. All expert reports, photographs and video tapes relied on by the insurance carrier must be provided to the insured and their contractor. All documents and statements provided by the insureds must be provided to the insured’s attorney. This notice is given in order to perfect the insureds’ right to pursue the civil remedy authorized by Fla. Stat. §624.155. To cure this bad faith, Edison must do the following: 1. Pay for the replacement of the insured’s roof 2. Edison must pay $78,282 (minus any prior payment and deductible) plus interest from the date of loss
Comments
User Id Date Added Comment
alessandra.m.dominguez@gmail.com 02-18-2025 VIA ELECTRONIC SUBMISSION: civilremedy@myfloridacfo.com Florida Department of Insurance Civil Remedy Section 200 East Gaines Street Tallahassee, Florida 32399 Complainant: Joseph Chambers (“Complainant[s]” or “Insured[s]”) Claim No: EDI967787 (“Subject Claim”) Policy No: EDH4077701-06 (“Policy”) Loss Location: 14636 Beaufort Cir. Naples, FL 34119(“Property”) CRN Filing No: 802929 CRN Acceptance Date: 01/22/2025 Dear Sir or Madam: The undersigned counsel represents Edison Insurance Company (“Edison”) regarding the alleged dispute in connection with claim number EDI967787, involving a Hurricane Milton claim with a date of loss of October 9, 2024, and made under the policy of insurance EDH4077701-06. Please accept this correspondence as Edison’s response to the Civil Remedy Notice of Insurer Violations (“CRN”) filed with the Department of Financial Services (“DFS”) by attorney Weston Ehrman, Esq. on behalf of the Complainant, Joseph Chambers, and accepted for filing by the DFS on January 22, 2025 (CRN filing number 802929). The Complainant has alleged violations of various statutory provisions in CRN filing number 802929 dated January 22, 2025. Specifically, the Complainant alleges violations of the following statutory provisions: ALLEGED STATUTORY VIOLATIONS 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 specifically denies the Complainants’ allegation that it has violated the above referenced statute. 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 settlement under other portions of the insurance policy coverage. Edison specifically denies the Complainants’ allegation that it has violated the above referenced statute. 626.9541(1)(i)(2): A material misrepresentation made to an insured or any to the person having an interest in the proceeds payable under such a 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 contemplate by, such contract or policy. Edison specifically denies the Complainants’ allegation that it has violated the above referenced statute. 626.9541(1)(i)(3)(a): Failing to adopt and implement standards for the proper investigation of claims. Edison specifically denies the Complainants’ allegation that it has violated the above referenced statute. 626.9541(1)(i)(3)(b): Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. Edison specifically denies the Complainants’ allegation that it has violated the above referenced statute. 626.9541(1)(i)(3)(h): Failing pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b). Edison specifically denies the Complainants’ allegation that it has violated the above referenced statute. In addition to the allegations specifically denied above, Edison generally denies all allegations presented in this CRN, as Edison has not violated any statute, Code or Rule. SPECIFICITY REQUIREMENTS Florida Statute requires that a CRN state the facts and circumstances giving rise to the alleged violations with specificity sufficient to allow an insurer to “cure” the alleged violations within the sixty-day statutory period. See Fla. Stat. § 624. 155(3)(b)(2). See also Lane v. Westfield Ins. Co., 862 So. 2d 774, 777 (Fla. 5th DCA 2003), Talat Enterprises, Inc. v. Aetna Cas. & Sur. Co., 753 So. 2d 1278, 1283 (Fla. 2000). However, here, the CRN is deficient and defective in that it fails to state with sufficient specificity the necessary facts in support of the Insureds’ contentions, including but not limited to, those that would be necessary for Edison to “cure” the alleged violations. Further, the subject CRN provides what appears to be several boilerplate and conclusory statements, which fail to describe any accurate facts constituting violations of the statutes cited therein. Thus, because the allegations in the CRN are incomplete and incorrect, they fail to provide actual notice of the specific allegations and the actions that Edison could undertake to cure any alleged violations. 316, Inc. v. Maryland Cas. Co., 625 F. Supp. 2d 1187, 1193 (N. D. Fla. 2008). Blanket references to policy provisions and statutes without specification deems the Civil Remedy Notice deficient. Julien v. United Property and Casualty Insurance Co., (Fla. 4th DCA 2020). For the reasons set forth herein, Edison hereby objects to the subject CRN and states it does not intend to waive, ratify or otherwise accept the deficiencies in the CRN, and reserves the right to contest the legal adequacy of the CRN hereinafter as appropriate. As to the content of the CRN here, it is important to note that said CRN is a nullity and should be rejected because the CRN fails to comply with the specific requirements mandated by Florida Statutes §624.155. Specifically, Fla. Stat. § 624.155(3)(b)(2) requires the Complainant to set forth with specificity, sufficient factual allegations to state a prima facie case of an insurer violation, so as to put the insurer on notice and be afforded the opportunity to cure the deficiency. However, the Insured failed to do so in the subject CRN and instead only included conclusory statements, which lack even minimal specificity and/or lack the underlying factual basis to support them. The Insureds’ failure to describe any actual facts or circumstances to support the alleged statutory violations in the CRN precludes Edison from evaluating what error, if any, allegedly occurred during the claim process. 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 and incorrect allegations with no basis in fact or circumstances. Consequently, the CRN lacks the requisite minimal specificity and Edison is unable to determine what specifically the Complainants are claiming was done by or on behalf of Edison that constitutes the bad faith alleged. Due to the absence of specific and accurate information regarding the alleged acts or omissions by Edison which allegedly give rise to any violation of the Civil Remedy Statute, Edison is limited in its ability to set forth specific facts to address and/or refute these unsubstantiated assertions. Notwithstanding, Edison explicitly denies violations of any applicable Florida Statute in the adjustment of the Subject Claim and realleges and re-asserts its specific denials to the alleged violations in the subject CRN as set forth above, including but not limited to its specific denials of the allegations that it has not attempted in good faith to settle the Insureds’ claim and that it failed to acknowledge and act promptly upon communications related to the Subject Claim. Moreover, Edison specifically denies that it denied the Subject Claim without conducting a reasonable investigation, that it failed to implement standards for the proper investigation of claims, and that it misrepresented pertinent facts relating to coverages at issue. Accordingly, without waiver of its objections, rights and defenses, Edison maintains that it has acted and continues at all times to act in good faith during the investigation and adjustment of the Insureds’ claim. Further, Edison wishes to dispel even the inference of any statutory violation and reiterates below the various reasons which clearly show the proper handling of the Subject Claim by Edison. Moreover, as stated in Demase v. State Farm Florida Insurance Company (Fla. 5th DCA November 14, 2022), as a condition precedent to bringing a first-party bad faith case, an insured must provide timely notice of the alleged violation to the authorized insurer and to the DFS. BACKGROUND FACTS Aside from the fact that the allegations contained in the subject CRN lack specific facts, the tenor and inferences of statutory violations are wholly without merit and Edison denies each and every one. Below are some of the relevant facts regarding the Subject Claim that the Insureds failed to include in the CRN. Specifically, Edison promptly assigned claim number EDI967787 to the subject claim upon receiving first notice of loss of same on October 16, 2024. On the very next day, Edison sent the insured an e-mail acknowledging the claim, informing the insured of who the adjuster was and providing the adjuster’s contact information, as well as informing that the adjuster would be in touch with him within the next 24-48 hours to set an inspection. On October 29, 2024, Edison sent the insured a Reservation of Rights Letter informing them of their responsibilities under the policy. Upon receiving notice of the claim, Edison retained an adjuster to inspect and evaluate the Insured’s property and reported damages. On November 14, 2024, the Field Adjuster, inspected the property on the carriers behalf. On December 5, 2024, Edison issued a coverage determination letter to the insureds making payment in the amount of $5,297.48 for the replacement cost value of Coverage A-Dwelling portion of the estimate and $10,602.00 for the Matching of Undamaged Property portion of the estimate. As well, the correspondence stated that the policy deductible of $21,204.00 was applied to the loss settlement. Moreover, Edison stated that coverage for the screened enclosure portion of the claim was not afforded due to screen material not being included in the screen enclosure endorsement portion of the policy. The pertinent estimate, statement of loss and policy language for screened enclosure was included with the coverage determination letter. On January 22, 2025, this Civil Remedy Notice was incorrectly filed. Edison respectfully denies any wrongdoing in the adjustment and handling of the Subject Claim and denies any and all allegations that it committed any acts or violated any Florida statutes. Instead, Edison acted quickly and responsibly, in good faith and in accordance with the terms and provisions of the applicable policy of insurance as well as with F.S. § 624.155 and § 626.9541 and its sub-parts. Contrary to the allegations that Edison violated various statutes in the CRN, at all times Edison has acted in good faith with respect to every aspect of its investigation of the claim and has also acted fairly and honestly toward its Insureds and with due regard for their interests. Insofar as Edison denies the accusations made in the subject CRN, to the extent Edison can identify that which needs to be “cured” and/or “remedied,” through the course of this response, such matters are “cured” or “remedied.” As you can see, Edison conducted a good faith comprehensive and prompt investigation of this claim. Edison consistently and promptly communicated with the Insured and its representatives and its inspection of the property. Edison made a coverage determination and informed the Insured based on the inspection and investigation of the claim. INACCURACY OF ALLEGATIONS IN THE SUBJECT CRN The case specific facts related to Edison’s handling of the Subject Claim provided above implicitly address many of the vague allegations contained within the Insured’s CRN and further establish that Edison undertook a thorough investigation in accordance with applicable statutory requirements and professional standards of care. As such, Edison respectfully denies any wrongdoing in the adjustment and handling of the Subject Claim and denies any and all allegations that it committed any acts or violated any Florida statutes or other laws. With the aforementioned facts established, coupled with the Insured’s failure to provide specific facts relating to the Subject Claim to support or justify the alleged violations in the CRN, said CRN is baseless and without merit. In light of the Insured’s failure to comply with the requirements of the Civil Remedy Notice Statute, Edison is unable to fully address the Insured’s allegations in the Subject CRN. Quite plainly, at all times Edison has acted quickly and responsibly, in good faith and in accordance with the terms and provisions of the applicable policy of insurance as well as with F. S. § 624. 155 and § 626. 9541 and its sub-parts. Further, Edison completed its investigation and provided a coverage decision within the statutory time frame, effectively rendering all allegations set forth in the Insured’s CRN moot and unfounded. The Complainant’s CRN presumes to prescribe how Edison can cure the alleged violations in the CRN. In the context of a first-party insurance claim, the contractual amount due to the insured is the amount owed pursuant to the express terms and conditions of the policy after all of the conditions precedent of the insurance policy in respect to payment are fulfilled....” As a result, only the demanded “cures” relating to the payment for covered damages are proper and legal. See Talat Enterprises, Inc. v. Aetna Casualty and Surety Co. , 753 So. 2d 1278 (Fla. 2000). Further, the purpose of a CRN is to provide the insurer an opportunity to “cure” the alleged wrongdoing. Talat Enterprises, Inc. v. Aetna Casualty and Surety Co. , 753 So. 2d 1278 (Fla. 2000). Here, the CRN here does not serve this purpose because it does not provide a proper means whereby Edison can “cure” the alleged defects, short of paying additional benefits which are not due and owing for the Subject Claim. This failure to provide a proper opportunity to cure renders the CRN improper. Longpoint Condominium Associations v. Allstate Insurance Co. , 2005 WL 131580 (N. D. Fla. June 2, 2005). Moreover, the method for curing the violations alleged in a civil remedy notice are not determined by the insured. In Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So. 2d 1278 (Fla. 2000), the Florida Supreme Court accepted and quoted the reasoning of the court below in its opinion which stated in relevant part, as follows: Section 624. 155 does not impose on an insurer the obligation to pay whatever the insured demands. . . . Section 624. 155(2)(d) would have no effect or purpose under such an interpretation. The law does not support such an expansive and illogical reading of Fla. Stat. Ann. §624. 155(2)(d). . . . To cure an alleged violation and to avoid a civil action, an insurer must pay the claim . . . before the sixty days expire. Talat Enterprises. v. Aetna Cas. & Sur. Co., 952 F. Supp. 773, 777-778 (M. D. Fla. 1996). ] Here, Edison properly adjusted the Subject Claim and timley investigated same. Further, the Insureds have not produced any evidence that they are entitled to any payments. As such, Edison denies all of the allegations contained in the subject CRN, which is defective and improper, as Edison has not violated any statutes. CONCLUSION The purpose of a CRN is to provide the insurer an opportunity to “cure” the alleged wrongdoing. Talat Enterprises, Inc. v. Aetna Casualty and Surety Co. , 753 So. 2d 1278 (Fla. 2000). However, the CRN here does not serve this purpose because it does not provide any means as to how Edison can “cure” the alleged defects. This failure to provide a proper opportunity to cure renders the CRN improper. Longpoint Condominium Associations v. Allstate Insurance Co. , 2005 WL 131580 (N. D. Fla. June 2, 2005). Moreover, the method for curing the violations alleged in a civil remedy notice are not determined by the insured. In Talat Enterprises, Inc. v. Aetna Casualty and Surety Co. , 753 So. 2d 1278 (Fla. 2000), the Florida Supreme Court accepted and quoted the reasoning of the court below in its opinion which stated in relevant part, as follows: Section 624. 155 does not impose on an insurer the obligation to pay whatever the insured demands. . . . Section 624. 155(2)(d) would have no effect or purpose under such an interpretation. The law does not support such an expansive and illogical reading of Fla. Stat. Ann. §624. 155(2)(d). . . . To cure an alleged violation and to avoid a civil action, an insurer must pay the claim . . . before the sixty days expire. Talat, 753 So2d at 1282 citing Talat Enterprises Inc. v. Aetna Cas. & Sur. Co., 952 F. Supp. 773, 777-778 (M. D. Fla. 1996). Based on the foregoing, Edison respectfully denies any wrongdoing in the adjustment and handling of the Subject Claim and further denies any and all allegations that it violated any statutes. Instead, Edison acted quickly and responsibly and in accordance with the terms and provisions of the applicable policy of insurance as well as with F.S. §624.155 and §626.9541 and its sub-parts. Contrary to the allegations that Edison violated various statutes in the CRN, at all times Edison has acted in good faith with respect to every aspect of its investigation of the Subject Claim and has also acted fairly and honestly toward its Insured and with due regard for her interests. Insofar as Edison denies the accusations made in the subject CRN, to the extent Edison can identify that which needs to be “cured” and/or “remedied,” through the course of this response, such matters are “cured” or “remedied.” In closing, Edison believes that the CRN should be rejected and returned by the DFS due to its failure to comply with Florida Statute §624.155 and Florida Case law. Due to the lack of any factual and circumstantial basis to support the allegations therein, Edison respectfully requests, through this response, that the DFS return and reject the CRN for lack of specificity pursuant to Florida Statutes. Regardless of the rejection, Edison denies all allegations contained in the subject CRN and submits that there are no statutory violations. While the foregoing response by Edison is meant to be comprehensive, it is based upon the limited information provided in the CRN and the information in Edison’s possession to date. If the Complainants feel that Edison is not in possession of all the relevant facts, please inform the undersigneded immediately. Please also note that this response is not necessarily exhaustive and does not preclude Edison from asserting any other valid reason for seeking rejection and return of the CRN. Also, neither this response or any act or failure to act on the part of Edison, or any agent or representative of Edison, 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. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Very truly yours, QUINTAIROS, PRIETO, WOOD & BOYER, P. A. /s/ Jose Bosch, Esq. Alessandra D. Diaz, Esq. on behalf of 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