Edison: the denial record

On January 24, 2025, Edison issued a settlement offer of $58,414.33, which was far below the actual damages sustained and failed to account for the Insured's public adjuster's documented estimates.

On October 29, 2022, the Insurer sent a letter to the Insured advising that the damages to the Property totaled $1,145.21 for Coverage A (Dwelling), $28.90 for Coverage C (Content), $138.47 for Coverage C (Food Loss).

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 $263,578.21, and other supporting documentation and/or information.

After assessing the damage and the true scope of repairs, the public adjuster produced an estimate identifying $172,928.42 in covered damage to the dwelling.

Given the emergency nature of the damage, the Insured retained water mitigation service who prepared an estimate identifying $2,998.82 to perform initial remediation services.

Edison can avoid a lawsuit for bad faith by immediately accepting full coverage under the subject insurance policy for this claim and by paying the Alsulemans $146,588.96, which is the policy limit for coverage A less the 2% hurricane deductible.

Subsequently, the insureds prepared a loss package in the amount of $146,850.00 needed to restore the property back to its pre-loss condition.

Based upon EIC's investigation and property inspection EIC has denied the claim and in fact "closed" the claim.

Subsequently, the insureds prepared a loss package in the amount of $129,309.86 needed to restore the property back to its pre-loss condition.

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.

Since the issuance of the coverage letter, counsel for the Insured has made repeated attempts for Edison to correct its coverage determination, apply the $2,500.00 deductible, and issue the correct payment.

This conduct can be cured by accepting coverage and paying all covered damages related to the loss at the property in the amount of the $78,282 (minus any prior payment and deductible) plus interest.

Lic. #E017211)) confirming partial coverage, denying the remainder, and issuing payment(s) for only $23,944.93.

To remedy and/or cure this CRN, Insurer must immediately tender payment in the amount of $72,220.00 less any applicable deductible and prior payment to the Insured to complete the repairs for the Insured property.

FIRM timely notified EDISON of the damages sustained to the property and contemporaneously provided an estimate of the damages in the amount of $68,250.39.

The Carrier happily relied upon the field adjuster's low-ball estimate and initially paid an unacceptable amount to cover all of the damages to put the Property back into its pre-loss condition, $12,853.09.

It is clear by the language of the carrier's denial letter that it did not determine what caused the damages observed at the property.

Edison came to its coverage determination by ignoring relevant facts and information provided by the Insured and his contractors that established the damages were unquestionably the result of wind and hail.

During the course of Edison's investigation, the Insureds made the property available for inspection, provided facts and information surrounding the loss, and complied with Edison's adjustment of the claim.

Edison has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insureds' insurance claim for damages.

Edison failed to pay the insureds' claim under the homeowners' insurance policy when, under all of the circumstances, it could and should have done so, had it acted fairly and honestly and with due regard for the interests of insured.

Insurer failed to retain the experts needed to perform the inspection and needed to address the damage at issue and determine the repairs needed to restore the property.

Edison then fraudulently misrepresented to the Insureds that the estimate for repairs created by [name redacted] an adjuster who never physically inspected the property, is slightly above the deductible in hopes the Insureds would accept the coverage determination and abandon their claim.

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.

The lease and monthly payment requirements were provided to Edison Insurance Company and so Edison Insurance Company was put on notice that the monthly rent is $4,500.00, for a total of $55,200.00 for the year.

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.

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.

Edisons handling and adjustment of the claim of loss reveals that it has failed to adopt or implement standards for the proper investigation of claims.

In fact, the carrier retained an inspector who opined to wind damage being identified on the insureds subject roof.