Filing Number: 790208
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| Filing Accepted: 11/4/2024 |
| Last/Business Name
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WILLIAMS
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First Name |
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STEVEN |
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| Street Address
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3309 29TH ST. SW |
| City, State Zip
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LEHIGH ACRES,
FL
33976
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| Email Address
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OWENWILLIAMS802@GMAIL.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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WILLIAMS |
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First Name |
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STEVEN |
| Policy # * |
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SOIH5047706 |
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Claim #* |
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59266 |
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Attorney is Applicable
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| Last Name* |
OREN
First Name *
REICH
Initial
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| Street Address* |
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6100 HOLLYWOOD BLVD., STE. 520 |
| City, State Zip* |
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HOLLYWOOD
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FLORIDA
33024
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| Email Address * |
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OREICH@LEVINLITIGATION.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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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):*
SOUTHERN OAK INS. CO. AND/OR CARRIER’S INDEPENDENT ADJUSTER AND/OR FIELD ADJUSTER, AND/OR MIMI HIDALGO, JEREMIAH MORALES, TATYANA LEWIS, SOUTHERN OAK CLAIMS TEAM AND/OR NAVSAV HOLDINGS II, LLC
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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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627.60131
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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)(2) |
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Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
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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)(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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| 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)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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| 626.9541(1)(i)(3)(e) |
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Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
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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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| 626.9541(1)(i)(3)(g) |
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Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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| 626.9541(1)(i)(3)(h) |
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Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
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| 626.9541(1)(i)(4) |
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Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
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| 626.9541(1)(i)(3)(j) |
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Altering or amending an insurance adjuster’s report without:
(I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and
(II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or
(III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change;
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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.
Governed by the cited authorities, the subject policy provides coverage for sudden and accidental losses and damages arising from wind, windstorm, and rain. The loss payment provision and governing law provides that the insurer has a fiduciary duty to in good faith promptly investigate, adjust, and issue payment of the undisputed amount of the loss and damages. Furthermore, the policy provides coverage for, inter alia, assessments in relation to remediation, as well as the amount necessary to perform remediation.
Florida Admin Code:
69B-220.201(3)(b) An adjuster shall treat all claimants equally.
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)(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 remuneration to himself except that to which he is legally entitled.
69B-220.201(3)(j) An adjuster shall not knowingly fail to advise a claimant of the claimant's claim options in accordance with the terms and conditions of the insurance contract.
69B-220.201(3)(k) An adjuster shall not undertake the adjustment of any claim concerning which the adjuster is not currently competent and knowledgeable as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster's current expertise.
69J-166.031 Selectively and detrimentally choosing which alternative dispute resolution to utilize.
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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.
On or about September 28, 2022, the Complainant suffered significant damage to the insured property as a result of a leak. Complainant promptly and quickly reported the loss to the Insurer. Complainant incurred great expenses in mitigating and remediating the damage as required under the policy. The Carrier did not send and/or promptly send a duly qualified environmental scientist, mold assessor, contractor, leak detection specialist or engineer to inspect, adjust and/or investigate the loss. Carrier failed to have a Field Adjuster and/or Independent Adjuster and/or other agent, employee or representative promptly and properly adjust and investigate the loss. No Field Adjuster and/or Independent Adjuster and/or other agent, employee or representative promptly took any and/or performed any moisture readings, thermal imaging, mold assessment, mold testing, or even performed the most basic “tap test.”
Carrier refused to perform its own testing and/or procedures to confirm and/or ascertain the existence of damage, and then asserted that such damage simply did not exist, despite being given full access by Complainant to perform said tests and/or procedures. Carrier did not contact nor attempt to contact any of the individuals who performed testing and/or repairs despite detailed documentation from those individuals being provided to Carrier with those individuals’ contact information. Carrier failed to perform their own tests or procedures to ascertain or confirm the damage observed and/or other facts or information determined by those individuals.
Carrier refused to acknowledge obvious covered damage that occurred during the policy period.
Carrier failed to take basic, obvious, industry-standard measures to determine if damage was present, such as the use of moisture meters, leak detection, thermal imaging, mold assessment, mold testing, or even the most basic “tap test.” Complainant made the property available for inspection and for the use of such tools by Carrier. Carrier is providing illusory coverage, a promise to insure against property damage that it never intended to fulfill, and/or Carrier failed to ascertain the pre-policy period condition of the property, and/or failed to take into consideration the pre-policy period condition of the property when adjusting or investigating or purporting to adjust or investigate the subject claim, and in doing so falsely promised insurance coverage to the homeowner. Carrier has not taken basic actions to determine cause of loss or extent of loss.
Carrier uses and used in this particular claim misleading communications with its insured, including but not limited to requesting documents and/or actions in such a manner as to create unreasonable burdens, such as large lists of documents that are unlikely to exist and/or be in the possession of the homeowner without indicating that only existing documents and/or documents in the Complainant’s possession need be provided, unreasonably requesting that the Complainant and/or Complainant’s representative contact the Carrier to schedule important events rather than simply providing proposed dates and times in order to facilitate the scheduling and coordination of said events in good faith, and/or having agents and/or employees of Carrier communicate with Complainant while being unclear, vague and misleading as to whether said agents and/or employees of Carrier are agents and/or employees of Carrier. Carrier routinely and as a matter of business practice insists that certain documents be provided, despite the fact that such documents cannot be provided if they do not exist, and not required to be provided if they do not exist. Carrier has a well-known routine practice of requesting every kind of document that could exist, and then when a category of document is not provided, knowingly and falsely accusing their own insureds of failing to perform their duties under the policy, and of misleading its insureds as to whether its agents, employees or representatives are in fact agents, employees or representatives of Carrier and/or neutral actors and/or representatives of the insureds.
Carrier has made no attempt to contact the names of individuals and/contractors that performed repairs despite documentation with their contact information and a description of their work being provided to Carrier.
Carrier failed to implement policies and procedures for the proper investigation of claims. Carrier has refused to provide a coverage decision as required by the policy and Fla. Stat. 627.70131—failing to act promptly.
In refusing to properly assess the cause and origin the Carrier has failed to adopt and implement standards for the proper investigation of claims. The carrier commits the above referenced acts with such frequency as to amount to a general business practice. Due to the Carrier’s failure to implement policies and procedures for the proper investigation of claims.
To cure the above stated immoral, deceptive, unlawful and collectively defined general business practice of Bad Faith claim handling practices that are knowingly, willfully, wantonly and/or with a reckless disregard for the insured’s interests being implemented as a general business practice, the Insurer must issue payment in the amount of $73,507.29, minus any applicable deductible, within 60 days of receiving this Complaint.
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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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