Edison: a $173,710 loss package answered with below-deductible

We represent Edison Insurance Company (hereinafter, "Edison") in the dispute filed by you on behalf of [name redacted] as the Complainants (hereinafter, "Complainants"), against Edison for Claim no. [redacted]. This correspondence constitutes Edison's Response to the Civil Remedy Notice of Insurer Violation which your office filed on behalf of the Complainants on December 2, 2024, with the Florida Department of Financial Services ("DFS"), DFS filing number 794899 (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 Complainants 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). 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, 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 Complainants and their 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 Complainants list numerous purported reasons for submitting the CRN which are 1) Claim Delay and 2) 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 Delay: This allegation is without basis and therefore denied. Complainants 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. 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 18, 2024, thus issuing the coverage determination promptly and timely. Additionally, after receiving additional information and documentation from the Insureds, Edison continued in its investigation and promptly issued its supplemental coverage determination and corresponding payments. 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 Unfair Trade Practice: This allegation is without basis in law or in fact and is therefore denied. Counsel for Complainants 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 and coverage opened and the appropriate corresponding payment issued, 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 Insureds and with due regard for the interests of the Insureds, as it does on every claim. Moreover, the subject CRN cites several 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 Complainants believe 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 and drone assist company 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 Insureds regarding its coverage determination along with the accompanying estimate for clarity purposes. Further, after receiving additional information and documentation from the Insureds, Edison continued in its investigation and ultimately issued its supplemental coverage determination with the estimate for clarity purposes and appropriate corresponding payment. 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 Insureds and with due regard for the interests of the Insureds, 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 Insureds and/or their 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)(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 Complainants believe 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 and drone assist company 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 Insureds regarding its coverage determination along with the accompanying estimate for clarity purposes. Further, after receiving additional information and documentation from the Insureds, Edison continued in its investigation and ultimately issued its supplemental coverage determination with the estimate for clarity purposes and appropriate corresponding payment. 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 Insureds and with due regard for the interests of the Insureds, 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 Insureds and/or their representatives. Moreover, it is unclear what other portions of the policy coverage Complainants claim 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)(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 Complainants believe 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 and drone assist company 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 Insureds regarding its coverage determination along with the accompanying estimate for clarity purposes. Further, after receiving additional information and documentation from the Insureds, Edison continued in its investigation and ultimately issued its supplemental coverage determination with the estimate for clarity purposes and appropriate corresponding payment. 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 Insureds and with due regard for the interests of the Insureds, 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 and drone assist company 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 Insureds regarding its coverage determination along with the accompanying estimate for clarity purposes. Additionally, Edison honestly and accurately issued its supplemental coverage determination with the estimate for clarity purposes and appropriate corresponding payment. 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 Insureds and with due regard for the interests of the Insureds, 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 Insureds and/or their representatives. Edison has not made misrepresentations to the Insureds and/or their 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 and appropriate corresponding payment 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 Insureds and with due regard for the interests of the Insureds, 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 Insureds and their 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)(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 Complainants believe 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 and drone assist company 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 Insureds regarding its coverage determination along with the accompanying estimate for clarity purposes. Additionally, Edison promptly and timely issued its supplemental coverage determination with the estimate for clarity purposes and appropriate corresponding payment. 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 Insureds and with due regard for the interests of the Insureds, 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 Complainants fail 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. Alleged Violations of Policy of Insurance The CRN requires the Complainants to reference the specific policy language that is relevant to the violation. Rather than complying with this requirement, the CRN solely and vaguely identifies the "Loss settlement provision" which 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 Complainants take 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 Complainants subsequently intend to rely on specific additional policy provisions, they are precluded from doing so as they failed to properly include those provisions in the CRN. Notwithstanding, Edison denies violating any provision or duty set forth in the policy. [name redacted] 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 Insureds and the Insureds' representatives about the claim, and provided the Insureds 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 [address redacted]ive, Sarasota, FL (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 and drone assist company. 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 initial coverage determination letter on November 18, 2024 providing a detailed explanation explaining the coverage determination and providing the accompanying estimate and statement of loss for the covered portions of the claimed loss. Based on the information and reasonable investigation at that time, Edison determined that the covered loss was less than the deductible. At the time of issuing the coverage determination, the Insureds had not provided any estimate to Edison. Thereafter, Edison received additional information and documentation (provided to Edison on the same date this CRN was filed) and continued in its good faith investigation and adjustment of the claim. As a result, on December 24, 2024, Edison issued a supplemental coverage determination and estimate with accompanying statement of loss explaining that Edison was issuing payments in the amount of $813.62 for Coverage A payment and $3,445.03 for Coverage C Personal Property, which was the net payment after applying the $13,852.00 policy 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 Complainants' claims, Edison has and continues to promptly respond to all communications, communicate honestly with the Insureds and their 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 Complainants are 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 Complainants 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 Complainants requires that it be invalidated and rejected. Notably, the CRN requests that in order to cure the alleged violations, Edison must: 1) pay $173,710.35, less prior payments and deductible and 2) pay statutory interest. Based on its thorough investigation, the information received at this time, and the terms and conditions of the Policy, Edison properly determined the appropriate amount of the covered claim and issued payments pursuant to the Policy and Florida law, therefore properly determining that no additional 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 Complainants feel 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 December 2, 2024. 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.

[name redacted] 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.