Civil Remedy Notice of Insurer Violations
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Filing Number:     810466
Filing Accepted:  3/11/2025
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Complainant
Last/Business Name *  
KRAFT   First Name   DAVID
Street Address * 3103 42ND AVE E
City, State Zip * BRADENTON, FL 34208
Email Address * SERVICE@PROPERTYPEOPLELAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   KRAFT   First Name   DAVID
Policy # * EDH5539955-00 Claim #* EDI967283
Attorney
Attorney is Applicable
Last Name* ILANI First Name * DANIEL Initial
Street Address* 80 SW 8TH STREET, SUITE 2590
City, State Zip* MIAMI , FLORIDA 33130
Email Address * SERVICE@PROPERTYPEOPLELAW.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):* ALL ADJUSTERS, SUPERVISORS, MANAGERS, ATTORNEYS, AND INDIVIDUALS ASSOCIATED WITH AND/OR RETAINED BY EDISON INSURANCE COMPANY CONCERNING THE CLAIM AT ISSUES; EDISON INSURANCE COMPANY’S DESK ADJUSTER(S); EDISON INSURANCE COMPANY’S FIELD ADJUSTER(S).
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
* 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)(2) Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
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)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
626.9541(1)(i)(3)(e) Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
626.9541(1)(i)(3)(f) 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.
626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
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.

EDISON INSURANCE COMPANY failed to adequately adjust and pay the claim covered under the subject insurance policy. Specifically, but not limited to, EDISON INSURANCE COMPANY failed to properly apply the Loss Settlement and Loss Payment provisions of the policy. In addition to the policy sections specifically cited herein, any endorsements or changes to said sections are relevant to the Insured’s claim for civil remedy. There may be additional policy language relevant to this violation that may be discovered.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

EDISON INSURANCE COMPANY (hereinafter the “Insurance Company”) issued a homeowners insurance policy to its insured, DAVID KRAFT (the “Insured”), for the insured property located at 3103 42nd Ave E, Bradenton, FL 34208. The subject Policy afforded various types of coverages including coverage for damage to dwelling, other structures, personal property, and for loss of use. On or about October 10, 2024, while the subject Policy was in full force and effect, the Insured’s home was damaged as a result of a covered loss. The Insured subsequently notified the Insurance Company of this loss. Thereafter, the Insurance Company acknowledged the loss and assigned claim number EDI967283 to the loss. The Insured complied with all policy conditions and cooperated with the Insurance Company’s investigation efforts. The Insurance Company performed a cursory inspection and failed to retain the unbiased experts necessary to adequately inspect the property to restore the property to its pre-loss condition. Shortly after, the insurance company denied this loss based upon an unqualified evaluation of the damages. Notably, the Insurance Company failed to retain an expert to inspect the property to fully evaluate this claim, relying solely on an inadequate inspection concerning a subject matter and claim their representative is ill-equipped and unqualified to properly evaluate. The Insured and Insured’s representative provided the Insurance Company with all claim-related documents including an estimate to repair covered damages in the amount of $112,382.36 and other supporting documentation and/or information. Nonetheless, the Insurance Company continues to disregard and ignore the Insured’s claim and request for adequate payment. The Insurance Company has failed to issue proper payment for the claim and has failed to issue sufficient payment to compensate the Insured for damages and repairs covered by the policy and held to be contractually covered by Florida law. The Insured provided the Insurance Company with documentation evaluating the loss, and rather than issuing the proper payment or attempting to reach an agreement with its Insured, the Insurance Company is delaying and denying the claim. Upon information and belief, the Insurance Company performs the subject actions as a business practice, including delaying the claim and/or issuing insufficient payments in an attempt to dissuade its insured from pursuing the claim to the detriment of its insured to increase financial profits. Based upon self-serving conclusions regarding the cause of loss, the Insurance Company’s conclusions are disconcerting because they are demonstrably incorrect. Further, they directly conflict with the only first-hand accounts of the loss. To be clear, the Insured had personal knowledge of the condition of the property prior to the date of the loss and the amounts owed to make the necessary repairs. That said, the Insurance Company’s refusal to properly investigate, adjust, and fully compensate the Insured for their claim evidences the Insurance Company’s violation of Section 626.9541(1)(i)(3)(a), Florida Statutes, which requires the Insurance Company to “adopt and implement standards for the proper investigation of claims.” All available information leads to one conclusion—the Insured’s property was damaged by a covered cause of loss for which the Insured is entitled to full and complete compensation. The Insurance Company’s obligation to promptly settle the Insured’s claim is undeniable, and therefore, the Insurance Company has also violated sections 624.155(1)(b)(1), Florida Statutes. The Insurance Company’s conduct is egregious because the Insurance Company purposely ignored relevant facts, even facts from its own experts, that would have confirmed coverage for the Insured’s loss to avoid having to compensate the Insured for damages. To make matters even worse, the Insurance Company has failed to timely respond to the Insured and issue payment for the damages to the property to allow necessary repairs. The actions taken by the Insurance Company in the handling and adjustment of the Insured’s claim are willful, wanton, and in disregard for the rights of the Insured, and have occurred with such frequency as to indicate a general business practice in violation of the law. The practice includes the Insurance Company’s ongoing inaction of ignoring relevant and accessible information that supports coverage in order to avoid compensating its Insured for covered losses. To be clear, the recent ruling in Fortune v. First Protective Insurance Company d/b/a Frontline Insurance, out of Florida’s 2nd District Court of Appeal, clears up what this carrier must do the cure this CRN. Similar to here, In Fortune, the Insureds timely filed a claim with their homeowners insurance policy upon suffering damage to their property. The Insurer investigated the claim and denied, contending that the amount of damage did not exceed the Insureds’ deductible. Upon presenting the public adjuster’s estimate and all other materials to the insurance company, the Insurer invoked the appraisal process under the policy.Thereafter, the Insureds filed a Civil Remedy Notice alleging that the insurer made a lowball offer and “flagrantly breached” its duty to attempt in good faith to settle claims, under applicable Florida statutes. Additionally, the Insureds alleged that the Insurer refused to reassess its payment of benefits and the basis for payment and that the Insurer “turn[ed] a blindeye and refuse[d] to properly adjust and settle the claim.” Noteworthy in Fortune is that although the Homeowners' CRN did not state a specific cure amount, it did state that they had provided their public adjustor's estimate to the Insurer which covered "the full scope of necessary repairs to the direct and ensuing damages." Thus, the Insured had the public adjuster's estimate and knew the amount the Homeowners sought. Neither the statute nor this court's precedent requires the CRN to contain a specific amount sought to cure the alleged bad faith. See § 624.155(3)(b); see Hunt v. State Farm Fla. Ins. Co., 112 So. 3d 547, 549 (Fla. 2d DCA 2013) (recognizing that an appraisal award satisfies the condition precedent of "a determination of liability and extent of damages owed"). In addition to the above statutory violations, the Insurance Company’s adjuster violated the following ethical requirements of Florida Administrative Code 69B-220.201. (3) Code of Ethics…An adjuster shall put the duty for fair and honest treatment of the claimant above the adjuster’s own interests in every instance. The following are standards of conduct that define ethical behavior, and shall constitute a code of ethics that shall be binding on all adjusters: (b) An adjuster shall treat all claimants equally. 2. An adjuster shall adjust all claims strictly in accordance with the insurance contract. (c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured. (d) An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation. (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. (f) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim. (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. In Florida, the work of adjusting insurance claims engages the public trust. During the adjustment of the Insured’s claim, the Insurance Company breached this duty by failing to adhere to and comply with the above referenced obligations. To cure the defects outlined above, the Insurance Company must: 1. Immediately pay the Insured a cure of $112,382.36for losses suffered as a result of the claim; 2. Immediately issue payments for statutory interest for the late payments and owed profit/overhead; 3. Act fairly and honestly towards the Insured and with due regard for their interests; 4. Hire a fair and unbiassed adjuster and experts to properly assess the Insured’s damages; 5. Tender any additional insurance proceeds due and owing to the Insured that would reasonably place the Insured back into a pre-loss condition; 6. Timely adjust the claim with the insured and avoid/limit any additional delay, costs, and prejudice that the Insurance Company’s conduct above has caused and continues to cause the Insured; and 7. Compensate the Insured for the attorneys’ fees and costs accrued as a result of the Insurance Company’s bad faith conduct. Failure to cure all defects during the 60-day safe harbor period may result in additional extra-contractual damages.
Comments
User Id Date Added Comment
april@zinoberdiana.com 05-09-2025 We represent Edison Insurance Company (hereinafter, “Edison”) in the dispute filed by you on behalf of David Kraft as the Complainant (hereinafter, “Complainant”), against Edison for Claim No. EDI967283. This correspondence constitutes Edison’s Response to the Civil Remedy Notice of Insurer Violation which your office filed on behalf of the Complainant on March 11, 2025, with the Florida Department of Financial Services (“DFS”), DFS filing number 810466 (hereinafter, the “CRN”). While Edison welcomes the opportunity to respond to this CRN, Edison specifically denies each and every allegation contained in the CRN filed in relation to this claim. Further, Edison asserts that the CRN should be rejected and returned by DFS, as the CRN fails to comply with the specific information requirements as set forth within § 624.155, Florida Statutes, and Florida case law, and is therefore facially invalid and deficient. I. The CRN fails to satisfy the requirements of Florida law. Concerning the contents of the CRN, the law requires strict compliance with the specificity requirements in § 624.155, Florida Statutes, which the CRN fails to satisfy. Both § 624.155(3), Florida Statutes, and the Civil Remedy Notice form require the Complainant to specifically state, among other things, the statutory provisions, including the specific language of the statute, which the insurer allegedly violated, the facts and circumstances giving rise to the violation, the name of any individual involved in the violation, and the specific policy language that is relevant to the violation. Additionally, § 624.155(3)(b) mandates that the Civil Remedy Notice must be “on a form provided by the [Department] and shall state with specificity … such other information as the department may require.” (emphasis added). Notably, in the section that requires the Complainant identify the person or persons representing the insurer who are most responsible for or knowledgeable of the facts giving rise to the allegations in this notice, the Complainant solely states “all adjusters, supervisors, managers, attorneys, and individuals associated with and/or retained by Edison Insurance Company concerning the claim at issues; Edison Insurance Company’s desk adjuster(s); Edison Insurance Company’s field adjuster(s).” This statement clearly provides no actual information that is responsive to the request. Rather, this is clearly nonspecific, inaccurate, and fails to provide Edison with a proper ability to identify the proper individuals therefore rendering the CRN deficient. Additionally, the CRN fails to contain the necessary information in the section that requires the Complainant’s email address be provided, instead again providing the email address for the Complainant’s counsel. Further, the purpose of the specificity requirement for a civil remedy notice is to put the insurer on notice of an alleged violation, the circumstances surrounding same, and indicate the details of the alleged violation in order to provide an insurer with 60 days to “cure” the alleged claim defects and otherwise avoid litigation. See Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So. 2d 1278, 1283-4 (Fla. 2000); Rousso v. Liberty Surplus Ins. Corp., 2010 U.S. Dist. LEXIS 82328 (S.D. Fla. Aug. 13, 2010). Uninformative recitations that do not inform the insurer of the facts underlying the alleged violations or match up with the statutes that the complainant identifies as the statutes that were purportedly violated are insufficient to fulfill the requirements of § 624.155. Rousso, 2010 U.S. Dist. LEXIS 82328. The CRN fails to meet the specificity requirements of § 624.155, Florida Statutes, and therefore is invalid and deficient. Notably, in contravention of the statutory and form requirements that a complainant must state the specific statutory provisions allegedly violated and the facts and circumstances giving rise to the violation, the CRN identifies numerous statutory provisions (almost every potential statute) and administrative codes, though they are not wholly relevant or applicable to the alleged facts or claimed violations contained in the CRN or fail to correlate with any specific facts or circumstances giving rise to the alleged violations. Likewise, the CRN identifies numerous “reason[s] for notice” without providing sufficient facts to support each. Additionally, 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, incomplete, generic, conclusory, and insufficient allegations with no basis in fact or circumstance, as well as omits specific facts to support its allegations of violations. The CRN includes a minimal information, commentary on unsupported, conclusory accusations, unqualified opinion, legal conclusions, conjecture, and inaccurate statements of facts cast in the light most favorable to the Complainant and his representatives. In short, the facts alleged are simply inaccurate, fail to paint a complete picture of the handling of this claim, fail to apprise Edison of how its actions constituted a violation of said statutes, or were identified without any factual support. II. Despite the deficiencies, Edison denies all allegations contained in the CRN. Notwithstanding the deficiencies in the CRN and without waiving the objections above, Edison explicitly denies any violation of the Florida Statutes sections referenced in the CRN. Edison hereby denies each and every allegation contained in the CRN, either explicitly or implicitly, and denies any wrongdoing in the handling of this matter. Rather, Edison handled the claim both diligently and properly under the terms and conditions of the insurance policy, as well as in accord with Florida law. Edison denies each and every allegation contained in the CRN and responds to them individually as follows: The Complainant lists numerous purported reasons for submitting the CRN which are 1) Claim Denial; 2) Claim Delay; 3) Unsatisfactory Settlement Offer; and 4) Unfair Trade Practice. As indicated in detail below, the CRN fails to establish or set forth any specific facts that would support the allegations asserted in support of the perceived violations and Edison denies each and every allegation. Specifically, Edison responds as follows: Allegation of Claim Denial: This allegation is without basis in law or in fact and is therefore denied. Counsel for Complainant should immediately withdraw this allegation from the CRN as it cannot be established by any credible evidence. Edison handled the claim both diligently and properly under the terms and conditions of the insurance policy as well as in accord with Florida law, a determination of coverage was made based on a good faith and reasonable investigation and the terms and conditions of the subject policy, a good faith attempt to investigate this claim has and continues to be made, and at all times material to this claim, Edison has and continues to act fairly and honestly towards the Insured and with due regard for the interests of the Insured, as it does on every claim. In sum, the policy provides coverage for certain events and excludes others. Declining coverage on the claim based on the policy does not equate to an exercise in bad faith by Edison. Allegation of Claim Delay: This allegation is without basis and therefore denied. Complainant should immediately withdraw this allegation from the CRN as it cannot be established by any credible evidence. At all times material to this claim, Edison acted timely, diligently, and responsibly in its pursuit of coverage. First and foremost, the CRN identifies no facts whatsoever supporting the inclusion of “claim delay” as a purported violation. Moreover, after the claim was first reported to Edison on October 14, 2024, Edison immediately began its thorough investigation and issued its initial coverage determination letter on November 21, 2024, thus issuing the coverage determination promptly and timely. Additionally, Edison promptly and timely addressed each subsequently received documents and information submitted thus resulting in an EMC coverage determination letter being issued on January 9, 2025 and a supplemental coverage determination letter issued on February 28, 2025. Moreover, any perceived delays alleged in the CRN are not due to the actions of Edison, nor did Edison have control over any actions causing any perceived delays. Further, claim delay, in and of itself, is not a valid reason for filing a CRN. Allegation of Unsatisfactory Settlement Offer: This allegation is wholly without basis in law or in fact and is therefore denied. Complainant should immediately withdraw this allegation from the CRN as it cannot be established by any credible evidence. Edison handled the claim both diligently and properly under the terms and conditions of the insurance policy as well as in accord with Florida law, a determination of coverage was made based on a good faith and reasonable investigation and the terms and conditions of the subject policy, a good faith attempt to investigate this claim has and continues to be made, and at all times material to this claim, Edison has and continues to act fairly and honestly towards the Insured and with due regard for the interests of the Insured, as it does on every claim. Moreover, “unsatisfactory” settlement offer, in and of itself, is not a valid reason for filing a CRN. Allegation of Unfair Trade Practice: This allegation is without basis in law or in fact and is therefore denied. Counsel for Complainant should immediately withdraw this allegation from the CRN as it cannot be established by any credible evidence. Edison handled the claim both diligently and properly under the terms and conditions of the insurance policy as well as in accord with Florida law, a determination of coverage was made based on a good faith and reasonable investigation and the terms and conditions of the subject policy, a good faith attempt to investigate this claim has and continues to be made, and at all times material to this claim, Edison has and continues to act fairly and honestly towards the Insured and with due regard for the interests of the Insured, as it does on every claim. Moreover, the subject CRN cites numerous (every one which is impermissible rendering the CRN deficient) statutes Edison has allegedly violated. While Edison categorically and unequivocally denies violating any statutes, Edison will briefly address the specific statutes alleged to have been violated, in an abundance of caution. § 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 denies this allegation. The CRN sets forth no actual facts to support this allegation, only opinions as to how the Complainant believes the claim should have been resolved. The CRN also sets forth several inaccuracies and incomplete information regarding the claim based solely on unsupported opinions. Edison retained a qualified independent adjuster to inspect the insured property in the subject claim. Additionally, Edison made a determination of coverage on this claim based on the totality of its good faith investigation and the terms and conditions of the subject policy and Florida law and issued a detailed explanation to the Insured regarding its coverage determination along with the estimates, Statement of Loss, and applicable policy language. While Edison has and continues to make a good faith attempt to investigate this claim and has and continues to act fairly and honestly towards the Insured and with due regard for the interests of the Insured, Edison is also not obligated to settle a claim in a matter beyond that which is covered under the terms, conditions and exclusions of the subject policy. The remainder of the CRN simply states disparaging and unsubstantiated opinions regarding Edison and its agents assisting in the investigation of the subject claim. At no time has Edison acted dishonestly or unfairly toward the Insured and/or his representatives. All actions have been performed in good faith for the purpose of moving the claim towards a just and equitable resolution. Edison acted in accordance with Florida Statute § 624.155(1)(b)(1) and has in no way violated said statutory provisions. § 624.155(1)(b)(2) Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made. Edison denies this allegation. The CRN sets forth no actual facts to support this allegation, only opinions as to how the Complainant believes the claim should have been resolved. The CRN also sets forth several inaccuracies and incomplete information regarding the claim based solely on unsupported opinions. Edison retained a qualified independent adjuster to inspect the insured property in the subject claim. Additionally, Edison made a determination of coverage on this claim based on the totality of its good faith investigation and the terms and conditions of the subject policy and Florida law and issued a detailed explanation to the Insured regarding its coverage determination along with the estimates, Statement of Loss, and applicable policy language. While Edison has and continues to make a good faith attempt to investigate this claim and has and continues to act fairly and honestly towards the Insured and with due regard for the interests of the Insured, Edison is also not obligated to settle a claim in a matter beyond that which is covered under the terms, conditions and exclusions of the subject policy. The remainder of the CRN simply states disparaging and unsubstantiated opinions regarding Edison and its agents assisting in the investigation of the subject claim. Notably, the only payment issued by Edison for this claim was for Coverage C – food spoilage which is clearly stated in the coverage determination letters; therefore, it is completely unclear as to why this is included other than as evidence that the CRN is not specifically tailored to the claim. All actions have been performed in good faith for the purpose of moving the claim towards a just and equitable resolution. Edison acted in accordance with Florida Statute § 624.155(1)(b)(2) and has in no way violated said statutory provisions. § 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. Edison denies this allegation. The CRN sets forth no actual facts to support this allegation, only opinions as to how the Complainant believes the claim should have been resolved. The CRN also sets forth several inaccuracies and incomplete information regarding the claim based solely on unsupported opinions. Edison retained a qualified independent adjuster to inspect the insured property in the subject claim. Additionally, Edison made a determination of coverage on this claim based on the totality of its good faith investigation and the terms and conditions of the subject policy and Florida law and issued a detailed explanation to the Insured regarding its coverage determination along with the estimates, Statement of Loss, and applicable policy language for transparency purposes. While Edison has and continues to make a good faith attempt to investigate this claim and has and continues to act fairly and honestly towards the Insured and with due regard for the interests of the Insured, Edison is also not obligated to settle a claim in a matter beyond that which is covered under the terms, conditions and exclusions of the subject policy. The remainder of the CRN simply states disparaging and unsubstantiated opinions regarding Edison and its agents assisting in the investigation of the subject claim. At no time has Edison acted dishonestly or unfairly toward the Insured and/or his representatives. Moreover, it is unclear what other portions of the policy coverage Complainant claims Edison was trying to influence the settlements of. All actions have been performed in good faith for the purpose of moving the claim towards a just and equitable resolution. Edison acted in accordance with Florida Statute § 624.155(1)(b)(3) and has in no way violated said statutory provisions. § 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. Edison denies this allegation. The CRN sets forth no actual facts to support this allegation. The CRN also sets forth several inaccuracies and incomplete information regarding the claim based solely on unsupported opinions. Edison had a qualified adjuster inspect the insured property in the subject claim and conducted a reasonable investigation of the claim. Additionally, Edison made a determination of coverage on this claim based on the totality of its good faith investigation and the terms and conditions of the subject policy and Florida law, and issued a detailed and honest explanation to the Insured explaining its coverage determination thoroughly and honestly along with the estimates, Statement of Loss, and applicable policy language. While Edison has and continues to make a good faith attempt to investigate this claim and has and continues to act fairly and honestly towards the Insured and with due regard for the interests of the Insured, Edison is also not obligated to settle a claim in a matter beyond that which is covered under the terms, conditions and exclusions of the subject policy. The remainder of the CRN simply states disparaging and unsubstantiated opinions regarding Edison and its agents assisting in the investigation of the subject claim. Moreover, the CRN fails to identify and explain what in particular Edison allegedly misrepresented and how any statements made by Edison constituted misrepresentations other than disagreeing with the coverage determination. On the contrary, at no time has Edison acted dishonestly or unfairly toward the Insured and/or his representatives. Edison has not made misrepresentations to the Insured and/or his representatives. All actions have been performed in good faith and for the purpose of moving the claim towards a just and equitable resolution. Edison acted in accordance with Florida Statute § 626.9541(1)(i)(2) and has in no way violated said statutory provisions. § 626.9541(1)(i)(3)(a) Failing to adopt and implement standards for proper investigation of claims. Edison denies this allegation. The CRN sets forth no actual facts to support this allegation, only opinions as to how the Complainant believes the claim should have been resolved. The CRN also sets forth several inaccuracies and incomplete information regarding the claim based solely on unsupported opinions. Edison retained a qualified independent adjuster to inspect the insured property in the subject claim. Additionally, Edison made a determination of coverage on this claim based on the totality of its good faith investigation and the terms and conditions of the subject policy and Florida law and issued a detailed explanation to the Insured regarding its coverage determination along with the estimates, Statement of Loss, and applicable policy language. While Edison has and continues to make a good faith attempt to investigate this claim and has and continues to act fairly and honestly towards the Insured and with due regard for the interests of the Insured, Edison is also not obligated to settle a claim in a matter beyond that which is covered under the terms, conditions and exclusions of the subject policy. The remainder of the CRN simply states disparaging and unsubstantiated opinions regarding Edison and its agents assisting in the investigation of the subject claim. 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. Edison acted in accordance with Florida Statute § 626.9541(1)(i)(3)(a) and has in no way violated said statutory provisions. § 626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. Edison denies this allegation. The CRN sets forth no actual facts to support this allegation. The CRN also sets forth several inaccuracies and incomplete information regarding the claim based solely on unsupported opinions. Edison retained a qualified independent adjuster to inspect the insured property in the subject claim. Additionally, Edison made a determination of coverage on this claim based on the totality of its good faith investigation and the terms and conditions of the subject policy and Florida law and issued an honest and detailed explanation to the Insured regarding its coverage determination along with the estimates, Statement of Loss, and applicable policy language for transparency purposes. While Edison has and continues to make a good faith attempt to investigate this claim and has and continues to act fairly and honestly towards the Insured and with due regard for the interests of the Insured, Edison is also not obligated to settle a claim in a matter beyond that which is covered under the terms, conditions and exclusions of the subject policy. The remainder of the CRN simply states disparaging and unsubstantiated opinions regarding Edison and its agents assisting in the investigation of the subject claim. Moreover, the CRN fails to identify and explain what in particular Edison allegedly misrepresented and how any statements made by Edison constituted misrepresentations other than disagreeing with the coverage determination. On the contrary, at no time has Edison acted dishonestly or unfairly toward the Insured and/or his representatives. Edison has not made misrepresentations to the Insured and/or his representatives. All actions have been performed in good faith and for the purpose of moving the claim towards a just and equitable resolution. Edison acted in accordance with Florida Statute § 626.9541(1)(i)(3)(b) and has in no way violated said statutory provisions. § 626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims. Edison denies this allegation. The CRN sets forth no actual accurate facts to support this allegation. The CRN also sets forth several inaccuracies and incomplete information regarding the claim based solely on unsupported opinions. After the claim was reported, Edison immediately began its thorough investigation and issued its coverage determination letter promptly and timely. Additionally, Edison promptly acted and responded to all received documents and information provided with regards to the claim. While Edison has and continues to make a good faith attempt to investigate this claim and has and continues to act fairly and honestly towards the Insured and with due regard for the interests of the Insured, Edison is also not obligated to settle a claim in a matter beyond that which is covered under the terms, conditions and exclusions of the subject policy. The remainder of the CRN simply states disparaging and unsubstantiated opinions regarding Edison and its agents assisting in the investigation of the subject claim. Notably, the CRN wholly fails to identify any specific communications which Edison did not promptly respond to or acknowledge. On the contrary, Edison has, in fact, communicated promptly with the Insured and his representatives. All actions have been performed in good faith and for the purpose of moving the claim towards a just and equitable resolution. Edison acted in accordance with Florida Statute § 626.9541(1)(i)(3)(c) and has in no way violated said statutory provisions. § 626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information. Edison denies this allegation. The CRN sets forth no actual facts to support this allegation, only opinions as to how the Complainant believes the claim should have been resolved. The CRN also sets forth several inaccuracies and incomplete information regarding the claim based solely on unsupported opinions. Edison retained a qualified independent adjuster to inspect the insured property in the subject claim and conducted a reasonable investigation of the claim. Additionally, Edison made a determination of coverage on this claim based on the totality of its good faith investigation and the terms and conditions of the subject policy and Florida law and issued a detailed explanation to the Insured regarding its coverage determination along with the estimates, Statement of Loss, and applicable policy language for transparency purposes. While Edison has and continues to make a good faith attempt to investigate this claim and has and continues to act fairly and honestly towards the Insured and with due regard for the interests of the Insured, Edison is also not obligated to settle a claim in a matter beyond that which is covered under the terms, conditions and exclusions of the subject policy. The remainder of the CRN simply states disparaging and unsubstantiated opinions regarding Edison and its agents assisting in the investigation of the subject claim. Edison made the coverage determination after it conducted a reasonable investigation based upon available information. The policy provides coverage for certain events and excludes others. Declining coverage on the claim based on the policy does not equate to an exercise in bad faith by Edison. Moreover, the claim was opened but the covered damages were determined to be below the Hurricane deductible. All actions have been performed in good faith for the purpose of moving the claim towards a just and equitable resolution. Edison acted in accordance with Florida Statute § 626.9541(1)(i)(3)(d) and has in no way violated said statutory provisions. § 626.9541(1)(i)(3)(e) Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed. Edison denies this allegation. The CRN sets forth no actual facts to support this allegation, only opinions as to how the Complainant believes the claim should have been resolved. The CRN also sets forth several inaccuracies and incomplete information regarding the claim based solely on unsupported opinions. Edison promptly and timely issued its coverage determination and all communications to the Insured in accordance with statutory requirements. Notably, the CRN claims that the Insured provided Edison with a statement of loss and that Edison did not properly respond by including this statute without providing any specific facts supporting this allegation; however, Edison issued its coverage determination letter on November 21, 2024 and the proof of loss was not submitted until approximately January 17, 2025. This was clearly after Edison had issued its coverage determination and shows a lack of transparency in the allegations of the CRN. On the contrary, Edison has repeatedly complied with all requirements for timely providing its coverage determination letter and issuing communications to the Insured. While Edison has and continues to make a good faith attempt to investigate this claim and has and continues to act fairly and honestly towards the Insured and with due regard for the interests of the Insured, Edison is also not obligated to settle a claim in a matter beyond that which is covered under the terms, conditions and exclusions of the subject policy. The remainder of the CRN simply states disparaging and unsubstantiated opinions regarding Edison and its agents assisting in the investigation of the subject claim. At no time has Edison acted dishonestly or unfairly toward the Insured and/or his representatives. All actions have been performed in good faith for the purpose of moving the claim towards a just and equitable resolution. Edison acted in accordance with Florida Statute § 626.9541(1)(i)(3)(e) and has in no way violated said statutory provisions. § 626.9541(1)(i)(3)(f) 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. Edison denies this allegation. The CRN sets forth no actual facts to support this allegation, only opinions as to how the Complainant believes the claim should have been resolved. The CRN also sets forth several inaccuracies and incomplete information regarding the claim based solely on unsupported opinions. Edison retained a qualified independent adjuster to inspect the insured property in the subject claim. Additionally, Edison made a determination of coverage on this claim based on the totality of its good faith investigation and the terms and conditions of the subject policy and Florida law and issued a prompt and detailed explanation to the Insured regarding its coverage determination along with the estimate, Statement of Loss, and applicable policy language for transparency purposes. While Edison has and continues to make a good faith attempt to investigate this claim and has and continues to act fairly and honestly towards the Insured and with due regard for the interests of the Insured, Edison is also not obligated to settle a claim in a matter beyond that which is covered under the terms, conditions and exclusions of the subject policy. The remainder of the CRN simply states disparaging and unsubstantiated opinions regarding Edison and its agents assisting in the investigation of the subject claim. On the other hand, the Complainant fails to specify how or why the communications from Edison were not sufficient other than essentially disagreeing with the decision. All actions have been performed in good faith and for the purpose of moving the claim towards a just and equitable resolution. Edison acted in accordance with Florida Statute § 626.9541(1)(i)(3)(f) and has in no way violated said statutory provisions. § 626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim. Edison denies this allegation. The CRN sets forth no actual facts to support this allegation. The CRN also sets forth several inaccuracies and incomplete information regarding the claim based solely on unsupported opinions. Edison retained a qualified independent adjuster to inspect the insured property in the subject claim. Additionally, Edison made a determination of coverage on this claim based on the totality of its good faith investigation and the terms and conditions of the subject policy and Florida law and issued a detailed explanation to the Insured regarding its coverage determination along with the estimates, Statement of loss, and applicable policy language for transparency purposes. In Edison’s communications and correspondences, Edison provided reasonable and detailed explanations regarding its coverage determinations to the Insured and his representatives, explained what information was necessary, and explained why the requested information was necessary. While Edison has and continues to make a good faith attempt to investigate this claim and has and continues to act fairly and honestly towards the Insured and with due regard for the interests of the Insured, Edison is also not obligated to settle a claim in a matter beyond that which is covered under the terms, conditions and exclusions of the subject policy or without being given the opportunity to fully investigate the claim. The remainder of the CRN simply states disparaging and unsubstantiated opinions regarding Edison and its agents assisting in the investigation of the subject claim. Edison continuously provided clear communications and explanations to the Insured and his representatives regarding the investigation of the claim and additional information to be provided to Edison to assist in the further and thorough investigation of the claim. Moreover, the Complainant fails to specify how or why the communications from Edison were not sufficient other than essentially disagreeing with the decision. All actions have been performed in good faith and for the purpose of moving the claim towards a just and equitable resolution. Edison acted in accordance with Florida Statute § 626.9541(1)(i)(3)(g) and has in no way violated said statutory provisions. § 626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. Edison denies this allegation. The CRN sets forth no actual facts to support this allegation. The CRN also sets forth several inaccuracies and incomplete information regarding the claim based solely on unsupported opinions. Edison retained an independent adjuster to inspect the insured property in the subject claim. Additionally, Edison made a determination of coverage on this claim based on the totality of its good faith investigation and the terms and conditions of the subject policy and Florida law and issued detailed explanation to the Insureds regarding its coverage determination along with the Statement of Loss, estimate, and applicable policy language for transparency purposes along with issuing the corresponding payment for food spoilage. In Edison’s communications and correspondences, Edison provided reasonable and detailed explanations regarding its coverage determinations to the Insured and his representatives, explained what information was necessary, and explained why the requested information was necessary. While Edison has and continues to make a good faith attempt to investigate this claim and has and continues to act fairly and honestly towards the Insured and with due regard for the interests of the Insured, Edison is also not obligated to settle a claim in a matter beyond that which is covered under the terms, conditions and exclusions of the subject policy or without being given the opportunity to fully investigate the claim. The remainder of the CRN simply states disparaging and unsubstantiated opinions regarding Edison and its agents assisting in the investigation of the subject claim. Edison continuously provided clear communications and explanations to the Insured and his representatives regarding the investigation of the claim and additional information to be provided to Edison to assist in the further and thorough investigation of the claim. All actions have been performed in good faith and for the purpose of moving the claim towards a just and equitable resolution. Edison acted in accordance with Florida Statute § 626.9541(1)(i)(3)(h) and has in no way violated said statutory provisions. § 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). Edison denies this allegation. The CRN sets forth no actual facts to support this allegation, and moreover cannot ever include facts to support this alleged statutory violation. The statute cited pertains only to personal injury protection insurance claims, whereas the policy and claim at issue are for a homeowners policy and claim. Therefore, the cited statute is inapplicable, and it is unclear as to why this statute has been included as Edison could not have possibly violated this subsection. Moreover, to the extent the Complainant intended to include § 626.9541(1)(i) as a “catchall” to all subsections within 626.9541(1)(i), this improperly makes it over general and unclear as to what provisions and subsections within 626.9541(1)(i) Edison allegedly violated. Notwithstanding, Edison vehemently denies that it violated § 626.9541(1)(i) and any portion or subsection within. Edison handled the claim both diligently and properly under the terms and conditions of the insurance policy, as well as in accord with Florida law, a determination of coverage was made based on a good faith investigation and the terms and conditions of the subject policy, a good faith attempt to investigate this claim has and continues to be made, and all parties have and continue to act fairly and honestly towards the Insured and with due regard for the interests of the Insured. The remainder of the CRN simply states disparaging and unsubstantiated opinions regarding Edison and its agents assisting in the investigation of the subject claim. At no time has Edison acted dishonestly or unfairly toward the Insured and/or his representatives. At no point has Edison violated § 626.9541(1)(i) or any portion or subsection within with regards to the claim. ADJUSTER’S CODE OF ETHICS, 69B-220.201 In the section of the CRN for the relevant policy language, Complainant claims that Edison also violated Fla. Admin. Code Ann. R. 69B-220.201. Edison denies allegations regarding any violation of these or any other administrative codes. The CRN also sets forth several inaccuracies and incomplete information regarding the claim based solely on unsupported opinions. Edison retained a qualified independent adjuster to inspect the insured property in the subject claim. Additionally, Edison made a determination of coverage on this claim based on the totality of its reasonable and good faith investigation and the terms and conditions of the subject policy and properly determined that the damages claimed were not covered pursuant to the Policy. In Edison’s communications, Edison provided reasonable explanations regarding its coverage determinations to the Insureds and their representatives along with supporting documentation and explained what information was necessary for Edison to investigate the claim. Edison has and continues to make a good faith attempt to investigate this claim and has and continues to act fairly and honestly towards the Insured and with due regard for the interests of the Insured, Edison is also not obligated to settle a claim in a matter beyond that which is covered under the terms, conditions and exclusions of the subject policy. The remainder of the CRN simply states disparaging and unsubstantiated opinions regarding Edison and its agents assisting in the investigation of the subject claim. At no time has Edison acted dishonestly or unfairly toward the Insured and/or his representatives. All actions have been performed in good faith and for the purpose of moving the claim towards a just and equitable resolution. Edison acted in accordance with the Adjuster’s Code of Ethics. Alleged Violations of Policy of Insurance The CRN requires the Complainant to reference the specific policy language that is relevant to the violation. Rather than complying with this requirement, the CRN only generally and vaguely refers to “the Loss Settlement and Loss Payment provisions of the policy” and states “[i]n addition to the policy sections specifically cited herein, any endorsements or changes to said sections are relevant to the Insured’s claim for civil remedy” and “[t]here may be additional policy language relevant to this violation that may be discovered.” This is clearly improper, nonspecific, over generalized, and noncompliant with the CRN requirements. The failure to comply with this requirement or to provide factual support as to what and how Edison purportedly violated the policy prevents Edison from engaging in any meaningful review of the policy terms and conditions or actions that the Complainant takes issue with and addressing any issues regarding the policy. Edison cannot hit a moving target by attempting to determine what provisions of the policy are actually at issue. As for public policy, this appears to be the exact purpose for the statutory requirements referenced above, which you have violated by failing to accurately provide the policy provisions at issue. Moreover, to the extent the Complainant subsequently intends to rely on specific additional policy provisions, he is precluded from doing so as he failed to properly include those provisions in the CRN. Notwithstanding, Edison denies violating any provision or duty set forth in the policy. Alleged Factual and Circumstantial Support for the CRN A review of the facts and circumstances surrounding the investigation and claim decisions on the subject claim reveals Edison acted in good faith and diligently investigated, handled, and adjusted the claim at issue in this dispute. Edison acted fairly, honestly, and in good faith, acknowledged and acted promptly upon receipt of the claim, attempted in good faith to adjust the claim pursuant to the terms of the policy, took reasonable steps to investigate the claim, communicated reasonably and honestly with the Insured and the Insured’s representatives about the claim, and provided the Insured reasonable explanations for its actions. The subject claim involves alleged windstorm damage with a reported date of loss of October 9, 2024 (Hurricane Milton) to the property located at 3103 42nd Ave E, Bradenton, FL 34208 (the “Property”) reported to Edison on October 14, 2024. Edison promptly responded with acknowledgement of the claim and the Homeowner Claims Bill of Rights and initiated its investigation of the claim, which included an inspection of the Property by a qualified independent adjuster. Edison made a determination of coverage on this claim based on the totality of its diligent, reasonable, and good faith investigation and the terms and conditions of the subject policy and Florida law. Based on the investigation, Edison issued its coverage determination letter on November 21, 2024 providing a detailed explanation explaining that the coverage damages did not exceed the Hurricane deductible (as well as providing the estimate and Statement of Loss reflecting the same) but that a $400.00 payment was being issued for Coverage C – Food Spoilage after taking into account the $100.00 food spoilage deductible. Additionally, Edison promptly and timely addressed all subsequently received documents and information submitted thus resulting in an EMC coverage determination letter being issued on January 9, 2025 and a supplemental coverage determination letter issued on February 28, 2025. While Edison continued in its adjustment of the claim, Edison determined that the dwelling and screen enclosure damages did not exceed the Hurricane deductible. Edison has continued to promptly and fairly adjust the claim as information is made available to it. Edison promptly and honestly made all coverage determinations based on its reasonable investigation of the claim. Moreover, contrary to the Complainant’s claims, Edison has and continues to promptly respond to all communications, communicate honestly with the Insured and his representatives, and conduct a fair and good faith ongoing investigation of the claim. There is no indication in the CRN nor anywhere within the record evidence to suggest that Edison handled the subject claim in bad faith or incongruent with the applicable Florida Statutes. Rather, the record evidence establishes the opposite, and shows that Edison properly handled and adjusted the subject claim and has continued to do so from the time it was first received through the present. Furthermore, under the circumstances, and upon information and belief, the filing of the CRN appears to be an effort to strong-arm Edison into payment for repairs and excessive benefits for which the Complainant is not entitled under the policy. The disagreement with the claim decision does not in any way constitute bad faith on the part of Edison. Under the circumstances presented, Edison cannot in good faith issue a payment for damages that are claimed and demanded by the Complainant as doing so would, in essence, breach Edison’s duty of good faith and fair dealing owed toward each and every one of its other policyholders. Accordingly, there is no evidence that Edison has acted in any way, whatsoever, contrary to the terms of the policy or in violation of the statutes listed in the CRN. III. Demands to Cure Defects. Moreover, the CRN does not specify a cure for the alleged violations that comports with the provisions of the subject Policy. Further, the CRN requests “cures” that are improper according to Florida law and Fla. Stat. §624.155. See Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So. 2d 1278, 1281 (Fla. 2000). The Talat decision provides that a “cure” must be limited to contract damages. Additionally, Section 624.155, Florida Statutes, does not impose on an insurer the obligation to pay whatever its insured demands. Talat, 753 So. 2d at 1282. On the contrary, the Florida Supreme Court holds that the scope of what can be “cured” in responding to a Civil Remedy Notice, is limited to contractual amounts due to the insured. See Talat, 753 So. 2d at 1281. The subject Notice is deficient as it does not provide an opportunity to “cure” the alleged violations without imposing obligations on Edison not owed or contemplated by the Policy. To the extent the CRN requests anything other than contract proceeds, the CRN is defective and should be rejected. The offer to cure in the CRN, rather, is illusory and even a reading of the CRN in a light most favorable to the Complainant requires that it be invalidated and rejected. Notably, the CRN requests that in order to cure the alleged violations, Edison must: 1) pay $112,382.36; 2) pay statutory interest for late payments and owed profit/overhead; 3) act fairly and honestly towards the Insured and with due regard for their interests; 4) hire a fair and unbiased adjuster and experts to assess the Insured’s damages; 5) tender additional insurance proceeds due and owing that would place the Insured back into a pre-loss condition; 6) timely adjust the claim and avoid/limit any additional delay, costs, and prejudice; and 7) pay attorneys’ fees and costs. First and foremost, Edison continuously acted fairly and honestly towards the Insured and with due regard for his interests, hired a fair an unbiased adjuster to assess the damages, and has timely adjusted the claim and continues to do so. Moreover, based on its thorough investigation, the information received at this time, and the terms and conditions of the Policy, Edison properly determined the amount of the covered damages pursuant to the Policy and Florida law, and therefore properly determining that no amounts are due and owing at this time. IV. Conclusion. In closing, Edison first believes that the CRN does not comply with section 624.155, Florida Statutes, and should therefore be rejected and returned by DFS due to its failure to comply with § 624.155, Florida Statutes, and Florida case law. Regardless of the rejection and lack of compliance, Edison denies all allegations contained in the CRN and submits there are no violations. While this Response is meant to be comprehensive, Edison’s Response above is based upon the limited information provided in the CRN and the information we have to date. If the Complainant feels 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 the lack of compliance with Florida Statute § 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 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 CRN filed on March 11, 2025. Should you have any questions regarding this matter or need anything further, please do not hesitate to contact the undersigned. Respectfully submitted, ZINOBER DIANA & MONTEVERDE, P.A. April L. Zinober cc: 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