Filing Number: 813740
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| Filing Accepted: 3/28/2025 |
| Last/Business Name
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ANDERSON
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First Name |
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JAMES |
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| Street Address
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16681 CROWNSBURY WAY |
| City, State Zip
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FORT MYERS,
FL
33908
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| Email Address
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JMAPHOTOGRAPHY@CS.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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ANDERSON |
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First Name |
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JAMES |
| Policy # * |
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EDH4087125-03 |
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Claim #* |
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EDI952056 |
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Attorney is Applicable
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| Last Name* |
GIBBONS
First Name *
SHAWN
Initial
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| Street Address* |
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925 S FEDERAL HW 6TH FLOOR |
| City, State Zip* |
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BOCA RATON
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FLORIDA
33432
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| Email Address * |
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SGIBBONS@KPATTORNEY.COM |
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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):*
RYAN SCOTT
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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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Non-renewal
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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)(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)(c) |
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Failing to acknowledge and act promptly upon communications with respect to claims.
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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.
Failure to Comply with Loss Settlement Provision
Failure to Comply with Non-Renewal Statute
Unfair Claims Handling
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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.
Dear Edison Insurance Company:
This is the Insureds’ second Civil Remedy Notice on this Claim.
After Carrier was afforded notice of the instant Claim and issued a coverage decision on same, the carrier has now sent a “Notice of Non-Renewal” dated March 9, 2025, which violates Fla. Stat. 627.4133. That non-renewal states:
The Carrier in this instant claim found that a covered loss (wind damage) was identified throughout the course of the carrier’s investigation. In fact, the carrier retained an inspector who opined to wind damage being identified on the insureds subject roof. The carrier further indicated repairs for the roof were needed but same were under the insureds applicable Hurricane Deductible. Plaintiff has provided evidence that said damages were as a result of natural and uncontrollable event which is substantiated by the carrier’s own investigation and inspectors.
Florida Statute Section 627.4133(2)(c)(e)(1)(a), Notice of cancellation, non-renewal, or renewal premium, states in relevant part (emphasis added):
(e)1. An authorized insurer may not cancel or nonrenew a personal residential or commercial residential property insurance policy covering a dwelling or residential property located in this state:
a. For a period of 90 days after the dwelling or residential property has been repaired, if such property has been damaged as a result of a hurricane or wind loss that is the subject of the declaration of emergency pursuant to s. 252.36 and the filing of an order by the Commissioner of Insurance Regulation.
Additionally,
Florida Statute Section 627.4133(3), Notice of cancellation, non-renewal, or renewal premium, states in relevant part (emphasis added):
(3) Claims on property insurance policies that are the result of an Act of God may not be used as cause for cancellation or nonrenewal, unless the insurer can demonstrate, by claims frequency or otherwise, that the insured has failed to take action reasonably necessary as requested by the insurer to prevent recurrence of damage to the insured property.
The reported cause of loss for this claim is in fact an Act of God, a weather event, a Hurricane. The carrier’s final coverage determination was made on April 21, 2023, approximately Six Hundred and Eighty Eight (688) days before the carrier decided to non-renew the insureds policy and demand the insured to either repair or replace the same roof for which the carrier is continuing to deny any coverage for.. This is despite there being identified wind damage by a the Defendants own representatives. It’s important to note that Fla. Stat. 627.4133 does not require an insured to prove coverage, however, the insured needs to show there is a policy of insurance for which a claim has been made and the carrier is inappropriately non-renewing the policy. Like the claim at hand, the carrier inspected the loss and identified damage to be caused by a uncontrolled, unpredictable weather event outside of any possible human control. Nowhere in the notice does the carrier demonstrate, by claims frequency or otherwise, that the insured has failed to take action reasonably necessary as requested by the insurer to prevent recurrence of damage to the insured property.
The notice of non-renewal has an expiration date of May 16, 2025, and despite the carrier knowing this case has been in litigation since November 10 of 2023 over this exact issue (i.e. roof damage and replacement of same) the carrier is now intentionally withholding homeowners insurance until the insured pays for a roof replacement or makes repairs for which the insureds is claiming the carrier is responsible for based on the policy of insurance. This is a disturbing trend by the Carrier essentially telling the Insured it will not afford full coverage for the claim yet requiring Insureds to repair the home as if the Carrier had paid the full claim all the while still collecting increased premiums. The Carrier’s actions are both unconscionable and contrary to Florida law and just another instance of bad faith on this file.
It is clear that the carrier is not treating the insured with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insured; failing to implement proper standards for the adjustment and investigation of claims its adjusters and placing the company’s interests before the insured’s interests; refusing to pay the full amount owed to the insured despite the fact that the carrier has been on notice of the damages and looking for ways to delay full recovery or any recovery to the insured, when a reasonable carrier in a similar position would have tendered a full payment in accordance with both the policy language and statutory requirements. The Carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c) and 626.9541(1)(i)(3)(f), as well as Section I- Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss; and the loss payment provision under Section I- Conditions requiring payment of a claim within 90 days.
All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless regard for the insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss; 2.) withdraw the notice of non-renewal until the insured is able to make all necessary repairs and/or replacement of claim associated damages; (3) Pay the Insured’s attorneys’ fees and costs as they have been forced to retain counsel; 3.) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been printed out and mailed.
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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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