Filing Number: 810357
|
| Filing Accepted: 3/10/2025 |
| Last/Business Name
*
|
|
|
ARROLIGA
|
|
First Name |
|
REYNALDO & SUZANNE |
|
| Street Address
*
|
|
13327 LITTLE GEM CIRCLE |
| City, State Zip
*
|
|
FORT MYERS,
FL
33913
|
| Email Address
*
|
|
SMERILLO@FORTHEPEOPLE.COM |
| Complainant Type:
*
|
|
Insured |
|
| Last/Business Name* |
|
ARROLIGA |
|
First Name |
|
REYNALDO & SUZANNE |
| Policy # * |
|
EDH4009009-06 |
|
Claim #* |
|
EDI954422 |
|
Attorney is Applicable
|
| Last Name* |
KIMMEL
First Name *
GINA
Initial
|
| Street Address* |
|
20 N ORANGE AVE STE 400 |
| City, State Zip* |
|
ORLANDO
,
FLORIDA
32801
|
| Email Address * |
|
SMERILLO@FORTHEPEOPLE.COM |
|
|
| 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):*
CORP REP
|
| Type of Insurance
*
Residential Property & Casualty
|
|
|
| Reason for Notice
*
|
|
|
Non-renewal
|
|
|
*
Statutory provision(s) which the insurer allegedly violated.
|
|
|
|
| 626.9541(1)(o)(11) |
|
No insurer shall cancel or issue a non-renewal notice on any insurance policy or contract without complying with any applicable cancellation or non-renewal provision required under the Florida Insurance Code.
|
|
*
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, Reynaldo A. and Suzanne Arroliga’s (“Insured”) home belonging to Complainant was damaged during the policy period as a result of a 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 believe 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.
On October 25, 2023, Insurer issued a Notice of Non Renewal effective March 2, 2024. The issuance of the nonrenewal is forcing insured to get forced placed insurance which is more costly, with less coverage. The added expense should be considered a Bad Faith Damage.
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.
|
|
|
*
|
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
|