Civil Remedy Notice of Insurer Violations
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Filing Number:     791492
Filing Accepted:  11/12/2024
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Complainant
Last/Business Name *  
BERGMAN   First Name   LEI
Street Address * 5516 SW 14TH PLACE
City, State Zip * CAPE CORAL, FL 33914
Email Address * SERVICE@PROPERTYPEOPLELAW.COM
Complainant Type: * Insured
Insured
Last/Business Name*   BERGMAN   First Name   LEI
Policy # * SOIH8928433 Claim #* 61973
Attorney
Attorney is Applicable
Last Name* ILANI First Name * DANIEL Initial
Street Address* 80 SW 8TH STREET, SUITE 2590
City, State Zip* MIAMI , FLORIDA 33130
Email Address * SERVICE@PROPERTYPEOPLELAW.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   SOUTHERN OAK INSURANCE COMPANY
NAIC Company Code 12247
 
Name of individual responsible for violation (if any):* ALL ADJUSTERS, SUPERVISORS, MANAGERS, ATTORNEYS, AND INDIVIDUALS ASSOCIATED WITH AND/OR RETAINED BY SOUTHERN OAK INSURANCE COMPANY CONCERNING THE CLAIM AT ISSUES; SOUTHERN OAK INSURANCE COMPANY’S DESK ADJUSTER(S); SOUTHERN OAK INSURANCE COMPANY’S FIE
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
* 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.
624.155(1)(b)(2) Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
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.
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)(e) 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.
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.
626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
626.9541(1)(i)(3)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

SOUTHERN OAK INSURANCE COMPANY failed to adequately adjust and pay the claim covered under the subject insurance policy. Specifically, but not limited to, SOUTHERN OAK INSURANCE COMPANY failed to properly apply the Loss Settlement and Loss Payment provisions of the policy. In addition to the policy sections specifically cited herein, any endorsements or changes to said sections are relevant to the Insured’s claim for civil remedy. There may be additional policy language relevant to this violation that may be discovered.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

SOUTHERN OAK INSURANCE COMPANY (hereinafter the “Insurance Company”) issued a homeowners insurance policy to its insured, LEI & IGOR BERGMAN (the “Insured”), for the insured property located at 5516 SW 14th Place, Cape Coral, FL 33914. The subject Policy afforded various types of coverages including coverage for damage to dwelling, other structures, personal property, and for loss of use. On or about June 13, 2024, while the subject Policy was in full force and effect, the Insured’s home was damaged as a result of a covered loss. The Insured subsequently notified the Insurance Company of this loss. Thereafter, the Insurance Company acknowledged the loss and assigned claim number 61973 to the loss. The Insured complied with all policy conditions and cooperated with the Insurance Company’s investigation efforts. The Insurance Company performed a cursory inspection and failed to retain the unbiased experts necessary to adequately inspect the property to restore the property to its pre-loss condition. Shortly after, the insurance company denied this loss based upon an unqualified evaluation of the damages. Notably, the Insurance Company failed to retain an expert to inspect the property to fully evaluate this claim, relying solely on an inadequate inspection concerning a subject matter and claim their representative is ill-equipped and unqualified to properly evaluate. 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 $156,307.15 and other supporting documentation and/or information. Nonetheless, the Insurance Company continues to disregard and ignore the Insured’s claim and request for adequate payment. The Insurance Company has failed to issue proper payment for the claim and has failed to issue sufficient payment to compensate the Insured for damages and repairs covered by the policy and held to be contractually covered by Florida law. The Insured provided the Insurance Company with documentation evaluating the loss, and rather than issuing the proper payment or attempting to reach an agreement with its Insured, the Insurance Company is delaying and denying the claim. Upon information and belief, the Insurance Company performs the subject actions as a business practice, including delaying the claim and/or issuing insufficient payments in an attempt to dissuade its insured from pursuing the claim to the detriment of its insured to increase financial profits. Based upon self-serving conclusions regarding the cause of loss, the Insurance Company’s conclusions are disconcerting because they are demonstrably incorrect. Further, they directly conflict with the only first-hand accounts of the loss. To be clear, the Insured had personal knowledge of the condition of the property prior to the date of the loss and the amounts owed to make the necessary repairs. That said, the Insurance Company’s refusal to properly investigate, adjust, and fully compensate the Insured for their claim evidences the Insurance Company’s violation of Section 626.9541(1)(i)(3)(a), Florida Statutes, which requires the Insurance Company to “adopt and implement standards for the proper investigation of claims.” All available information leads to one conclusion—the Insured’s property was damaged by a covered cause of loss for which the Insured is entitled to full and complete compensation. The Insurance Company’s obligation to promptly settle the Insured’s claim is undeniable, and therefore, the Insurance Company has also violated sections 624.155(1)(b)(1), Florida Statutes. The Insurance Company’s conduct is egregious because the Insurance Company purposely ignored relevant facts, even facts from its own experts, that would have confirmed coverage for the Insured’s loss to avoid having to compensate the Insured for damages. To make matters even worse, the Insurance Company has failed to timely respond to the Insured and issue payment for the damages to the property to allow necessary repairs. The actions taken by the Insurance Company in the handling and adjustment of the Insured’s claim are willful, wanton, and in disregard for the rights of the Insured, and have occurred with such frequency as to indicate a general business practice in violation of the law. The practice includes the Insurance Company’s ongoing inaction of ignoring relevant and accessible information that supports coverage in order to avoid compensating its Insured for covered losses. To be clear, the recent ruling in Fortune v. First Protective Insurance Company d/b/a Frontline Insurance, out of Florida’s 2nd District Court of Appeal, clears up what this carrier must do the cure this CRN. Similar to here, In Fortune, the Insureds timely filed a claim with their homeowners insurance policy upon suffering damage to their property. The Insurer investigated the claim and denied, contending that the amount of damage did not exceed the Insureds’ deductible. Upon presenting the public adjuster’s estimate and all other materials to the insurance company, the Insurer invoked the appraisal process under the policy.Thereafter, the Insureds filed a Civil Remedy Notice alleging that the insurer made a lowball offer and “flagrantly breached” its duty to attempt in good faith to settle claims, under applicable Florida statutes. Additionally, the Insureds alleged that the Insurer refused to reassess its payment of benefits and the basis for payment and that the Insurer “turn[ed] a blindeye and refuse[d] to properly adjust and settle the claim.” Noteworthy in Fortune is that although the Homeowners' CRN did not state a specific cure amount, it did state that they had provided their public adjustor's estimate to the Insurer which covered "the full scope of necessary repairs to the direct and ensuing damages." Thus, the Insured had the public adjuster's estimate and knew the amount the Homeowners sought. Neither the statute nor this court's precedent requires the CRN to contain a specific amount sought to cure the alleged bad faith. See § 624.155(3)(b); see Hunt v. State Farm Fla. Ins. Co., 112 So. 3d 547, 549 (Fla. 2d DCA 2013) (recognizing that an appraisal award satisfies the condition precedent of "a determination of liability and extent of damages owed"). In addition to the above statutory violations, the Insurance Company’s adjuster violated the following ethical requirements of Florida Administrative Code 69B-220.201. (3) Code of Ethics…An adjuster shall put the duty for fair and honest treatment of the claimant above the adjuster’s own interests in every instance. The following are standards of conduct that define ethical behavior, and shall constitute a code of ethics that shall be binding on all adjusters: (b) An adjuster shall treat all claimants equally. 2. An adjuster shall adjust all claims strictly in accordance with the insurance contract. (c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured. (d) An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation. (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. (f) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim. (o) 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. In Florida, the work of adjusting insurance claims engages the public trust. During the adjustment of the Insured’s claim, the Insurance Company breached this duty by failing to adhere to and comply with the above referenced obligations. To cure the defects outlined above, the Insurance Company must: 1. Immediately pay the Insured a cure of $156,307.15for losses suffered as a result of the claim; 2. Immediately issue payments for statutory interest for the late payments and owed profit/overhead; 3. Act fairly and honestly towards the Insured and with due regard for their interests; 4. Hire a fair and unbiassed adjuster and experts to properly assess the Insured’s damages; 5. Tender any additional insurance proceeds due and owing to the Insured that would reasonably place the Insured back into a pre-loss condition; 6. Timely adjust the claim with the insured and avoid/limit any additional delay, costs, and prejudice that the Insurance Company’s conduct above has caused and continues to cause the Insured; and 7. Compensate the Insured for the attorneys’ fees and costs accrued as a result of the Insurance Company’s bad faith conduct. Failure to cure all defects during the 60-day safe harbor period may result in additional extra-contractual damages.
Comments
User Id Date Added Comment
jshanholtzer@tlsslaw.com 01-08-2025 Ryan S. Parker, Esquire, on behalf of Southern Oak Insurance Company, responded to the Civil Remedy Notice in letter format on January 8, 2025 via electronic mail to: Lei Bergman and Igor Bergman c/o Daniel Ilani, Esq. 80 SW 8th Street, Suite 2590 Miami, Florida 33130 service@propertypeoplelaw.com RE: Insureds : Lei Bergman and Igor Bergman Claim Number : 61973 Date of Loss : June 13, 2024 Policy Number : SOIH8928433-02-0000 DFS File Number : 791492 Filing Accepted Date : November 12, 2024 Dear Mr. Ilani, This firm has the pleasure of representing Southern Oak Insurance Company (“Southern Oak”) in connection with the above-referenced matter. Southern Oak is in receipt of the above-referenced Civil Remedy Notice of Insurer Violations (“Notice”) filed against Southern Oak. The Florida Department of Financial Services assigned Filing Number 791492 and an acceptance date of November 12, 2024. Southern Oak’s response to the Notice will follow. The Notice alleges “Claim Denial,” “Claim Delay,” “Unsatisfactory Settlement Offer,” and “Unfair Trade Practice,” as well as violations of Sections 624.155(1)(b)(1), (2) & (3), 626.9541(1)(i)(2), and 626.9541(1)(i)(3)(a), (b), (c), (d), (e), (f), (g), (h) & (i), Florida Statutes. The allegations contained in the Notice constitute generic, boilerplate accusations against Southern Oak, are wholly without merit, and lack sufficient legal and factual support. Accordingly, Southern Oak denies each and every alleged violation of Florida law. As an initial matter, the Notice is deficient because it fails to comply with the requirements of the Florida Statutes. Section 624.155(3)(b), Florida Statutes, requires that a Civil Remedy Notice “state with specificity” the statutory provisions 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 relevant to the violation. Rather than include the specifics required by Statute, when asked to identify the specific policy language relevant to the alleged violations, the Notice references, in part, the “Loss Settlement and Loss Payment” provisions and “any endorsements or changes to said sections…” The Notice does not explain how Southern Oak failed to comply with the specific terms of the policy with specific factual support or specific language in the policy pertaining to the alleged incident. The failure to include the information required by Florida Statute §624.155(3)(b) renders the Notice defective. See Julien v. United Property & Casualty Insurance Company, 311 So. 3d 875 (Fla. 4th DCA 2021); and Demase v. State Farm Fla. Ins. Co., 351 So. 3d 136 (Fla. 5th DCA 2022). Additionally, the Civil Remedy Notice is defective as a matter of law. As stated by the Florida Supreme Court, the purpose of 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. See Talat Enterprises, Inc. v. Aetna Casualty and Surety Co., 753 So.2d 1278 (Fla. 2000). The purpose of Fla. Stat. §624.155 is to provide the insurer with an opportunity to resolve a first-party coverage dispute and otherwise avoid litigation. See Talat Enterprises, Inc.; see also Lane v. Westfield Ins. Co., 862 So.2d 744 (Fla. 5th DCA 2003). Further, a Civil Remedy Notice must be sufficiently specific to provide the insurer with an opportunity to cure the alleged violations. This would include i) identifying the specific policy provision(s) at issue, ii) citing specific language of the statutory provision(s) the insurer allegedly violated, and iii) specifically identifying what actions the insurer must take to remedy the alleged violations. Rousso v. Liberty Surplus Ins. Corp., 2010 WL 7367059 (S.D. Fla. Aug. 13, 2010); Heritage Corp. of South Florida v. National Union Fire Ins. Co. of Pittsburgh, PA, 580 F. Supp. 2d 1294, 1299-1300 (S.D. Fla. 2008). Further, the “facts and circumstances” section of the Notice is not in compliance with Florida law. Contrary to the requirements of Florida Statutes, the Notice makes false, boilerplate accusations, and does not contain any specific facts supporting the violations alleged. For example, the Notice alleges that Southern Oak violated Florida Statute §626.9541(1)(i)(3)(b) – Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue. However, the body of the Notice does not identify the facts or policy provisions that Southern Oak allegedly misrepresented. Instead, the Notice includes vague allegations without any factual support. Similarly, the Notice does not provide factual support for various allegations listed above, including but not limited to how Southern Oak’s investigation was conducted in bad faith or how Southern Oak has engaged in unfair trade practices. As more fully discussed below, the allegations contained within the Notice are untrue, and the Notice contains no facts to support them. Contrary to the allegations in the Notice, Southern Oak acted promptly, responsibly, and in good faith at every opportunity in connection with this claim. The failure to provide any factual support for the alleged violations of Florida law renders the Notice deficient and in violation of Florida Statute §624.155(3)(b). A summary of the pertinent facts regarding the investigation and handling of this claim will follow. On or about June 13, 2024, Southern Oak was notified of a claim for damage to the property located at 5516 SW 14th Place, Cape Coral, Florida 33914, with an alleged date of loss of June 13, 2024. Southern Oak immediately began investigating the claim and sent the Insureds a copy of the Homeowner Claims Bill of Rights. In separate correspondence, Southern Oak informed the Insureds of their Duties After Loss. Thereafter, Southern Oak set up an inspection of the property. Additionally, Joe Taylor Restoration reported to the property to install a tarp on the roof and perform mitigation. Southern Oak, through its field adjuster, inspected the property on June 14, 2024. Unfortunately, due to rain, the field adjuster was unable to inspect the property on that date. Additionally, following the inspection, Sleuth was retained to determine the source of the interior water damage. On June 23, 2024, Southern Oak sent correspondence to the Insureds requesting documents, including a pre-purchase inspection report (the Home was purchased in 2023). On July 1, 2024, upon receipt of Sleuth’s findings, Southern Oak sent correspondence to the Insureds indicating that water damage was occurring due to water intrusions through the roof. The correspondence also once again requested a copy of the pre-purchase inspection report. In correspondence dated July 6, 2024, Southern Oak once again requested a copy of the pre-purchase inspection report and advised that the field adjuster would assess the roof. The field adjuster completed his inspection of the roof in July 2024. The inspection revealed evidence of prior repairs. On July 10, 2024, the Insureds advised that they did not have a pre-purchase inspection report. Additionally, during the course of Southern Oak’s claim investigation, it became apparent that the prior owner of the property submitted a claim for damage relating to Hurricane Ian. Accordingly, Southern Oak requested a copy of documents relating to that claim from the prior insurance company. Southern Oak informed the Insureds of these efforts in correspondence dated July 12, 2024 & July 18, 2024. On July 22, 2024, Southern Oak sent the Insureds a letter advising that it was continuing its investigation under a reservation of rights. The letter also once again discussed the Duties After Loss in the Policy and requested copies of certain documents to assist in Southern Oak’s investigation, including a pre-purchase inspection report, prior loss documents, prior repair documents, and photos of the damages right after the damages were discovered. Through subsequent correspondence, Southern Oak and the Insureds discussed Southern Oak’s pending request for documents from the prior insurance company. Additionally, Joe Taylor Restoration reported to the property to reinstall the tarp that was placed on the roof. Thereafter, Southern Oak regularly updated the Insureds in its efforts to secure documents from the prior insurance company. On September 17, 2024, Southern Oak received a letter of representation from All Service Adjuster, Inc. along with a contract between All Service Adjuster, Inc. and the Insureds. On September 23, 2024, Southern Oak sent correspondence to the public adjuster attaching a copy of the Policy and advising that it was awaiting necessary documents from the prior insurance carrier due to the prior Hurricane Ian claim from the prior owner. In subsequent correspondence, Southern Oak continued to keep the public adjuster updated regarding its efforts to secure the documents. Thereafter, Southern Oak received the public adjuster’s estimate in the amount of $156,307.15 and a proof of loss in the amount of $129,337.15. Southern Oak acknowledged receipt of the proof of loss on November 25, 2024, and informed the public adjuster that the determination of coverage is still ongoing. In separate correspondence, Southern Oak informed the public adjuster that the proof of loss is rejected. In subsequent correspondence, Southern Oak continued to keep the public adjuster updated regarding its efforts to secure documents relating to the prior claim. Unfortunately, the documents were not provided. Thereafter, Southern Oak sent correspondence to the Insured discussing its efforts to investigate the claim, including its requests for documents from the Insureds, which were not complied with. The letter also advised that the failure to comply with the conditions of the Policy prejudiced Southern Oak’s investigation of the claim, and therefore there is no coverage for the claim. After Southern Oak sent its coverage letter, it received correspondence from the public adjuster expressing disagreement with the coverage determination. In response, Southern Oak once again requested copies of documents that were previously requested. To date, no additional documents have been provided. Without waiving its rights to contest the validity of the subject defective and improper Notice, as the facts clearly demonstrate, Southern Oak has, and continues to comply with both Florida law and the applicable policy of insurance throughout the entire handling of this claim. As outlined above, with regard to the investigation and handling of this claim, Southern Oak’s actions were prompt, thorough, and conducted in good faith. Therefore, Southern Oak specifically denies each and every violation alleged in the Notice. I trust this response addressed all concerns raised by the Notice. However, please do not hesitate to contact the undersigned should you require additional information. Sincerely, RYAN S. PARKER TYLER T. CALEY cc: Southern Oak Insurance Company
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.

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