Filing Number: 789375
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| Filing Accepted: 10/30/2024 |
| Last/Business Name
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TONCZ
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First Name |
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VALENTIN AND FLORICA |
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| Street Address
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545 NORTH ISORA STREET |
| City, State Zip
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CLEWISTON,
FL
33440
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| Email Address
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WITHHELD |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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TONCZ |
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First Name |
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VALENTIN AND FLORICA |
| Policy # * |
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SOIHA799494-01-0000 |
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Claim #* |
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61688 |
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Attorney is Applicable
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| Last Name* |
ZATIK
First Name *
ALEX
Initial
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| Street Address* |
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4000 HOLLYWOOD BLVD., SUITE 685-S |
| City, State Zip* |
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HOLLYWOOD
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FL
33021
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| Email Address * |
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AZATIK@CASSEL.LAW |
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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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SOUTHERN OAK 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 12247 |
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| Name of individual responsible for violation (if any):*
ETHAN CAMPBELL, LEON RIVERA AND ALL OTHER ADJUSTERS, SUPERVISORS, MANAGEMENT AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY SOUTHERN OAK INSURANCE COMPANY INVOLVED IN THIS CLAIM.
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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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Claim Denial
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Claim Delay
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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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Other
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Violation of Adjusters' Ethical Requirements
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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)(2) |
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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.
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| 626.9541(1)(i)(3)(a) |
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Failing to adopt and implement standards for the proper investigation of claims.
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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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
The violations asserted herein regarding Southern Oak Insurance Company's bad faith actions are based heavily on the facts and circumstances asserted in the below section designated for same as well as violations of the portions of Florida Insurance Code and Florida Administrative Code upon which the bad faith statutes contained within Sections 624.155 & 626.9541, Florida Statutes, are based.
Despite requests for a complete copy of the policy, Southern Oak Insurance Company has not provided same and, as such, the exact verbiage of the terms of the subject policy are “UNKNOWN.” With that said, the based on prior experiences with policies issued by Southern Oak Insurance Company or its related companies, it is anticipated that the following policy language is relevant to Southern Oak Insurance Company's statutory violations and bad faith conduct:
AGREEMENT
We will provide the insurance described in this policy in return for the premium and compliance with all applicable provisions of this policy.
10. Loss Payment.
We will adjust all losses with you.
COVERAGE C – PERSONAL PROPERTY
We insure for direct physical loss to the property described in Coverage C
Special Limits of Liability
Business Property
E. ADDITIONAL COVERAGES
“Fungi,” Mold, Wet or Dry Rot, Or Bacteria
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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.
Form DFS-10-363, Rev. 10/14/2008, contains a field for the insureds to include their email addresses. Prior to filing the CRN, said form contains an instruction that, in the event the insureds do not with for certain information to become part of the public record, the insureds must simply include the term “WITHHELD” to satisfy the filing requirement. This is further established through the following statement with appears on Civil Remedy Notices which have been filed:
Warning! Information submitted as part of this civil remedy notice is a public record. Data entered into this form will be displayed on the DFS website for public review. Please DO NOT enter Social Security Numbers, personal medical information, personal financial information or any other information you do not want available for public review.
As any information contained herein becomes part of the public record, the insureds have withheld their email addresses so as not to make same available for public review and indicated same accordingly. Furthermore, as the insureds are represented by counsel, it would be improper for any representative of Southern Oak Insurance Company to contact the insureds directly for any reason utilizing their email addresses and, as such, the information is neither material to Southern Oak Insurance Company’s ability to correct the violations contained herein nor required by the Department of Financial Services. Southern Oak Insurance Company should direct all follow-up correspondences to the attorney listed above.
Furthermore, as the above section requesting people with knowledge as to the allegations in the instant CRN often gets cut off, the following are those responsible for the violations alleged herein:
Ethan Campbell, Leon Rivera and all other adjusters, supervisors, management and individuals associated with or retained by Southern Oak Insurance Company involved in this claim.
The facts and circumstances giving rise to the insurer's violation as the insureds understand them at this time:
Valentin Toncz and Florica Toncz (hereinafter the “insureds”) purchased an all-risk property insurance policy, policy number SOIHA799494-01-0000 (hereinafter the “Subject Policy”) from Southern Oak Insurance Company (hereinafter “Southern Oak”) which, at all times material hereto, provided property insurance for the property located at 545 North Isora Street, Clewiston, FL 33440 (hereinafter the “Subject Property”).
On or about May 8, 2022, fire, a covered cause of loss, caused direct physical loss and resultant ensuing damages to the Subject Property.
The insureds timely notified Southern Oak of the loss. Southern Oak assigned claim number 61688 to the loss (hereinafter the "claim") and, enlisted the assistance of a desk adjuster, Ethan Campbell, and a field adjuster, Leon Rivera, employed by Southern Oak, to perform an inspection of the Subject Property.
The carrier determined the damages to the Contents totaled $327,743.88, but made payment in the amount of $48,528.98. The reduction and application of sub-limits is erroneous and not in compliance with the Subject Policy or applicable Florida law. The carrier applied a limit of $2,500 to “business tools”, but the Contents at the Subject Property were never used for business while at the Subject Property, nor were they used for business during the issuance of the Subject Policy. The Contents limit is $87,500, and thus the insureds were significantly under insured as a result of the carrier and insurance agents underwriting of the risk. It is unknown how the carrier determined to apply this sub limit, how the respective contents fell under this sub limit, and what arbitrary judgment calls were made by the carrier in regards to the same. As a result the insureds have been prejudiced and continue to suffer damages.
The carrier determined damages for the structure in excess of the Coverage B Limit of $7,000. The insureds were significantly under insured for Coverage B as a result of the carrier and insurance agents underwriting of the risk. The estimated damage to the structure totaled $106,508.51. The carrier estimated the damage to the structure at $83,144.35.
To date, the carrier has failed to tender the coverage C limits and the interest due an owing. Additionally, as a result of the carrier’s underwriting the Subject Property was significantly under insured, which has caused the insured additional damages.
The insureds have been left with no choice but to hire an attorney in order to file a notice of intent to initiate litigation subject to Fla. Stat. § 627.70152. Based on the documentation previously submitted, and the coverage afforded, Southern Oak could have requested participation in alternative dispute resolution in line with the terms and conditions of the Subject Policy and governing Florida law or, at a minimum, engaged in settlement negotiations with the insureds in order to allow them to move on from this chapter and effectuate the necessary repairs to the Subject Property; instead, Southern Oak chose to sit back and wait before Southern Oak ever thought to act in a manner inconsistent with their own self-interest, forcing the insureds into hiring an attorney, thereby coming further out of pocket and leaving less of the outstanding due and owing insurance proceeds for actual repairs. This delay in claims adjustment constitutes a pattern of de facto bad faith conduct.
Through its actions/inactions, subject to the facts and circumstances understood at this time as outlined herein, Southern Oak has violated the following sections of Florida Statutes:
§624.155(1)(b)(1)
Not attempting in good faith to settle claims when, under all circumstances, it could have and should have done so, had it acted fairly and honestly toward its Insured and with due regard.
§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;
Additionally, through its actions/inactions, subject to the facts and circumstances understood at this time as outlined herein, Southern Oak has failed to comply with the following sections of Florida Administrative Code:
69B-220.201(3)(b)(2)
An adjuster shall adjust all claims strictly in accordance with the insurance contract.
69B-220.201(3)(c)
An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured.
69B-220.201(3)(d)
An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.
69B-220.201(3)(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 compensation or remuneration to himself or herself except that to which he or she is legally entitled.
As a direct result of Southern Oak's actions, the insureds have sustained irreparable harm. Upon information and belief, the aforementioned actions complained of herein, among others, are effectuated by Southern Oak so often as to constitute a general business practice evidencing a motive to enhance Southern Oak's profits and cause a detrimental effect to its policyholders. Southern Oak clearly failed to adopt and implement standards for the proper investigations of claims. As a direct and proximate result of Southern Oak's handling of the claim, the insureds sustained extra-contractual damages, including, but not limited to, a public adjuster's fee and attorneys’ fees and costs. Southern Oak's implemented claims programs and practices that were improper which directly resulted in additional losses to its insureds. Southern Oak, as part of its routine business pattern and practices, employs outcome-oriented adjusters/vendors/experts who purposely looked for ways to minimize coverage instead of affording coverage to its policyholders. In contrast to the legislative intent which motivated the enumeration of an insurance adjuster’s responsibilities outlined in the Florida Administrative Code, the insureds were not afforded the professional duties entrusted and imposed on Southern Oak by the Public Trust. The outcome-oriented claim adjustment practices undertaken by Southern Oak led to Southern Oak's failure to adequately adjust the Claim.
This notice is given in order to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should Southern Oak fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. In order to cure the defects outlined in this Civil Remedy Notice, Southern Oak must act as follows: immediately deliver payment of all insurance proceeds due and owing to the insureds which would reasonably place the Subject Property back in its pre-loss condition or, alternatively, if appraisal is or has been requested, complete the appraisal process and deliver payment of the executed award; and keep the claim open for the adjustment of any supplemental claim and payment of any as of yet unincurred costs. If Southern Oak disagrees with the extent of the cure requested or asserts that the payment of any of the above cure categories may not be required, Southern Oak should cure to the extent it believes it must under the Subject Policy and governing laws to correct the allegations of bad faith contained herein. While it is not being requested as a cure for the bad faith alleged herein, the insureds remain willing to entertain any reasonable counteroffer of settlement.
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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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