Civil Remedy Notice of Insurer Violations
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Filing Number:     786278
Filing Accepted:  10/9/2024
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Complainant
Last/Business Name *  
ADDY ROSE HAIR STUDIO, LLC   First Name  
Street Address * 6729 COLONNADE AVE #106
City, State Zip * VIERA, FL 32940
Email Address * JALDERMAN01@AOL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   ADDY ROSE HAIR STUDIO, LLC   First Name   EDUARDO
Policy # * 13468272615218-22 Claim #* 300-0410822-2024
Attorney
Attorney is Applicable
Last Name* RAMIREZ First Name * EDUARDO Initial
Street Address* 325 FIFTH AVENUE, SUITE 103
City, State Zip* INDIALANTIC , FLORIDA 32903
Email Address * SERVICE@STRUBLECOHEN.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   SOUTHERN-OWNERS INSURANCE COMPANY
NAIC Company Code 10190
 
Name of individual responsible for violation (if any):* JOHNATHAN MATHIS, AND ANY AN ALL SPECIFIC REPRESENTATIVES OF INSURER RESPONSIBLE FOR THE VIOLATIONS HEREIN BUT UNKNOWN TO THE INSURED AT THIS TIME
Type of Insurance * Commercial Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
* 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.
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)(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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

There are no policy provision specifically at issue or in dispute, the policy provides coverage to building and business loss resulting from water Damage but Southern-Owners Insurance Company has failed to extend coverage for repairs needed for the insured property. The property also contains a Loss Settlement Provision.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Southern-Owners Insurance Company ("Insurer") issued an insurance policy bearing policy number D2LG03X0191382 with effective dates of coverage from September 27, 2023 to September 27, 20234 which insured the property located at 6729 Colonnade Ave #106, Viera, Florida 32940. The policy was in effect when the property sustained damage on or about June 27, 2024 due to a shared wall with the restaurant next door, Thai Hana, Inc. The damage was reported to Insurer which assigned Claim Number 300-0410822-2024 to the claim and investigated the claim. The Insurer failed to issue a timely coverage decision since the reporting of the claim and the Insureds and/or its representatives repeatedly requested coverage but Insurer failed to respond timely to Insured's communication. Insured was forced to retain counsel and provided a Signed Proof of Loss and Responsive Documents supporting the claim for building, contents and business loss income on October 2, 2024. 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. Insurer has been provided with documents establishing that the claim is covered, despite this being apparent from the condition of the property alone. Insurer has failed to extend coverage for payments owed and has refused to attempt to settle the claim with its insured. Insurer’s delay in issuing payment is causing and will cause the insured to sustain extra-contractual damages not covered by the property, including loss of use and enjoyment of the property and related damages, costs associated with hiring adjusters and experts, among other damages and these uninsured damages would not have occurred but for the insurer ’s failure to timely issue payments owed. In this claim and as a business practice, insurer fails to retain experts needed to investigate claims, ignores evidence establishing coverage and avoids covered repairs to attempt to avoid issuing payments owed pursuant to the insurance policy. Insurer can cure these violations by attempting to settle the claim in good faith and issuing payment for the remaining contractual damages owed. As Insurer is aware, issuing payment for contractual damages owed will preclude recovery of extra-contractual damages already incurred, and that will be incurred, and the contractual damages should immediately be paid and be paid within 60 days from the date of this notice. Due to applicable Florida Statutes, and the insurance policy’s payment provisions, the payment issued should also include interest. If insurer contends there is somehow more information needed that was not already provided, it should immediately advise the insured’s attorney what information is needed. Insurer has been provided with information establishing that the claim is covered but has failed to extend coverage for the claim. Insurer’s denial of the claim and refusal to issue payment is a breach of the insurance policy.
Comments
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.

Before submitting a Notice using this system, please verify that all text has been entered correctly and completely. Once the Notice has been submitted, the text cannot be changed or deleted.




DFS-10-363
Rev. 10/14/2008