Filing Number: 804495
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| Filing Accepted: 1/30/2025 |
| Last/Business Name
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MOISTURE RID, INC.
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First Name |
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| Street Address
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C/O PEDRAZA LAW, P.A. 200 S ANDREW AVE, SUITE 504 |
| City, State Zip
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FT. LAUDERDALE,
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33301
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| Email Address
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MPEDRAZA@PEDRAZALAW.NET |
| Complainant Type:
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Third Party |
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| Last/Business Name* |
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MARSHALL |
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First Name |
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GLENDA |
| Policy # * |
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EDH4019679-01 |
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Claim #* |
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EDI936374 |
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Attorney is Applicable
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| Last Name* |
PEDRAZA
First Name *
MALCOLM
Initial
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| Street Address* |
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PEDRAZA LAW, P.A., 200 S ANDREWS AVE, SUITE 504 |
| City, State Zip* |
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FT. LAUDERDALE
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FLORIDA
33301
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| Email Address * |
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MPEDRAZA@PEDRAZALAW.NET |
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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):*
DONNELL LYNCH
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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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Claim Denial
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Claim Delay
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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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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)(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)(3)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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| 626.9541(1)(i)(3)(f) |
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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.
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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.
Florida Admin Code:
69B-220.201(3)(b) An adjuster shall treat all claimants equally.
69B-220.201(3)(b)2. An adjuster shall adjust all claims strictly in accordance with the insurance contract.
69B-220.201(3)(c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured.
69B-220.201(3)(e) An adjuster shall handle every adjustment and settlement with honesty and integrity, and allow a fair adjustment or settlement to all parties without any remuneration to himself except that to which he is legally entitled.
69B-220.201(3)(m) An adjuster shall not knowingly fail to advise a claimant of the claimant’s claim rights in accordance with the terms and conditions of the contract and of the applicable laws of this state. An adjuster shall exercise care not to engage in the unlicensed practice of law as prescribed by the Florida Bar.
69B-220.201(3)(o) An adjuster shall not undertake the adjustment of any claim concerning which the adjuster is not currently competent and knowledgeable as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster’s current expertise.
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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.
Complainant, MOISTURE RID, INC. is an assignee of EDISON INSURANCE COMPANY’s (“EIC”) insured, GLENDA MARSHALL, who submitted a homeowner’s insurance claim for benefits pursuant to a sudden and accidental loss and/or damages that occurred on September 10, 2017 and performed tarping services to mitigate those ensuing damages associated with direct physical loss to the insured property which resulted in water entering into the property through the roofing system damages which remained latent until manifesting in observable form and otherwise unknown consequential losses (“Loss”) for which the complainant performed reasonable, necessary and otherwise emergency mitigation services to protect the party from further damage. Complainant provided tarping services in exchange for the referenced partial assignment of the insured’s policy benefits. The Loss caused substantial, direct and consequential damages, due to EDISON INSURANCE COMPANY’s general business practice of willful, wanton, immoral, deceptive and bad faith claim handling policies, procedures, guidelines, protocol, adjusting, investigating, drawing valuations and issuing payment for claims has caused the Complainant to suffer further harm and extra-contractual damages which have accrued, and will continue to accrue. The stated misconduct by EDISON INSURANCE COMPANY is collectively referred to as “Bad Faith,” and the specific factual and/or legal considerations in relation thereto are further outlined below for their consideration in accordance with Fla. Stat. Sec. 624.155 and the cited legal authorities associated therewith.
EDISON INSURANCE COMPANY has unlawfully, immorally, unfairly, deceptively and/or in bad faith pursuant to the above-stated legal authorities that govern the insurance policy (“Policy”), adopted and implemented a general business practice of misconstruing the Policy for their own financial gain by way of delay, denial and ultimately defending against the claim and thereby not attempting in good faith to settle assignee’s claim when under all circumstances it should have done so had it acted fairly and honestly toward the insured and assignee with due regard for their interests, instead of own self-interest.
EDISON INSURANCE COMPANY knows that it has a duty to duly and promptly investigate, adjust, and pay claims in strict accordance and application with the Policy. That said, and by maintaining these unjust means for denying assignments, reducing the service charges thereto, they have willfully, wantonly, contumaciously and/or recklessly disregarded the rights of the Complainant as further outlined below.
1. EDISON INSURANCE COMPANY adjusts, investigates and issues payment on thousands of water loss claims per year, including those caused by Hurricane Irma, and notwithstanding its specialized knowledge and fiduciary duty to its insureds, it has failed to institute the necessary policies, procedures, guidelines, protocol, personnel and contingencies in relation to fully, promptly and equitably indemnifying its insureds who sustain a loss and damages due to a water loss that can in days create various health hazards for its insureds.
2. If not acting with a reckless disregard for the interests of its insureds and their assignees, EDISON INSURANCE COMPANYknows (“knows” as used herein includes knowledge that would have existed if not acting with a reckless disregard for the truth) that water damages are of a nature that a thorough, nuanced and specialized investigation/adjustment of the claim needs to be promptly performed by qualified and prepared personnel to protect its insureds, satisfy its fiduciary duties and otherwise not engage in the Bad Faith claim handling practices at issue. That said, to the detriment of its insureds and their assignees and to maximize its financial interests, EDISON INSURANCE COMPANY disregards the obvious and known obligations by way of the Bad Faith general business practices that are further delineated, described and specified as follows:
(a.) Not developing, maintaining and/or instituting policies, procedures, protocol or guidelines to determine whether adjusters/personnel/vendors utilized to protect its insureds were even qualified and trained to duly assess the scope, cause and/or value of the loss;
(b.) By way of the cited legal authorities and considerations, EDISON INSURANCE COMPANY knows that in order to duly adjust, investigate and issue payment for a water loss it needs to retain vendors that: are licensed and qualified to perform necessary mold assessments, and then institute a mold remediation protocol in order to develop the necessary predicate for establishing the true scope and value of the loss; are certified and qualified to perform necessary moisture assessments, and then institute a reasonable moisture remediation protocol to develop the necessary predicate to determine the true cause, scope and value of the loss; licensed and qualified to adjust the scope, cause and/or value of the loss per reliable principles and methods, and only after, have the necessary underlying considerations of the reasonable and necessary moisture and/or mold remediation protocols are considered; etc.;
(c.) Although EDISON INSURANCE COMPANY will arbitrarily and without fixed protocol hire experts to establish a lack of coverage as it relates to a specific claim in which they determine coverage may be in dispute, they choose to avoid such expense for self-gain when they know that doing so will serve to increase the amount to be paid on a per claim basis;
(d.) By way of the cited legal authorities and considerations, EDISON INSURANCE COMPANY knows that it would be in their insureds’ and their assignees’ interests and their obligation under the insurance policy to utilize personnel/vendors to perform moisture meter assessments throughout the insured property to honestly assess the full extent of damages and losses suffered by its insureds. Like the other duties and actions described herein, such practice is a basic, inexpensive, efficient and industry wide accepted means of protecting its insureds, however, «Abv_» knows that it does not serve its financial interest since it will increase its financial obligations to insureds such as the Complainant;
(e.) By way of the cited legal authorities and considerations, EDISON INSURANCE COMPANY knows that it would be in their insureds’ and their assignees’ interests and their obligation under the insurance policy to utilize personnel/vendors to perform thermal imaging assessments throughout the insured property to honestly assess the full extent of damages and losses suffered by their insureds, or for that matter, secondary cause of losses that may exist and thereby extend the loss and damages to be claimed by insureds such as the Complainant;
(f.) By way of the cited legal authorities and considerations, EDISON INSURANCE COMPANY knows that it would be in their insureds’ and their assignees’ interests and as is the insurer’s obligation under the insurance policy to utilize personnel/vendors to perform detailed, thorough, reliable and qualified assessments of the materials within the home which were exposed to moisture and subject to losing their structural integrity and/or developing toxic conditions;
3. EDISON INSURANCE COMPANY knows that the usual and customary reimbursement charges in the community, as well as the usual and customary reimbursement rates in the community for the remediation services in question, fall in excess of the reimbursement rate being afforded. As such, EDISON INSURANCE COMPANYhas failed to duly adjust and pay the claim pursuant to reliable principles and methods which serve to dictate an equitable, lawful and reasonable reimbursement rate of the Complainant’s service charges.
4. EDISON INSURANCE COMPANYknows that the amount paid to the Complainant per the stated scheme is unreasonable since it falls below the median of usual and customary service charges in the locale wherein they were rendered and in which they have historically admitted to same via payment, settlement or otherwise.
5. On a per assignee and/or insured basis, and in consideration of factors that extend beyond the payment of the claim per the Policy, EDISON INSURANCE COMPANY will arbitrarily and capriciously denied coverage for services or alternatively selected a reimbursement rate that it deemed fit in order to meet their own self-serving financial interests. This includes, but is not limited to, categorizing insureds and/or assignees on the basis of whether EDISON INSURANCE COMPANY is likely to incur liability in association with attorney’s fees and Fla. Stat. Sec. 627.428 or 627.7152. Point in fact, the insurer has made it a customary business practice since the legislative enactment of 627.7152 to pigeon hole every assignment of benefits s statutorily non-compliant rendering the assignment invalid under the statute as basis to deny coverage, delay payment forcing the assignee to pursue years of litigation enforce the policy and compel payment on valid assignments, all the while defending in litigation and appeals the legal sufficiency of the assignment as part of a calculate scheme to deny, delay and defend until court order payment of the services rendered for the sole purpose of self gain and to manufacture favorable appellate rulings.
6. EDISON INSURANCE COMPANY’s reduction of the Complainant’s service charges are performed via means which it knows, or should know, a court of law would deem unreliable and thereby inadmissible. EDISON INSURANCE COMPANY knows this to be so, and does not disclose in a meaningful, specific and/or substantive form the method upon which it can substantiate its basis for denial or alternatively implementing reductions were had. Consequently, the Complainant is unnecessarily left doubting as to its rights under the Policy. Moreover, the proper payment of the claim is unduly delayed, and the Complainant suffers consequential damages as result thereof. These consequential damages include, but are not limited to, business interruption, unnecessary administrative costs, inability to use funds owed for the efficient operation of the business, an inability to duly assess operational costs and reimbursement rates to cover same, etc.
To cure the above stated immoral, deceptive, unfair, unlawful and bad faith conduct which is part of a general practice that is knowingly being utilized by EDISON INSURANCE COMPANY for its own financial gain, within sixty (60) days, EDISON INSURANCE COMPANY must perform as follows:
a. issue payment to the Complainant for the full amount of the invoice as found by a jury, plus interest from the date the claim was noticed; plus full payment of reasonable attorney's fees and costs incurred.
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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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