Filing Number: 805956
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| Filing Accepted: 2/10/2025 |
| Last/Business Name
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ARTHUR
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First Name |
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PAUL AND LISA |
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| Street Address
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1015 SANGRIA CIRCLE |
| City, State Zip
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ROCKLEDGE,
FL
32955
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| Email Address
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LARTHUR@GOTCHAROOFCOVERED.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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ARTHUR |
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First Name |
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PAUL AND LISA |
| Policy # * |
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SOIH6092102 |
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Claim #* |
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61272 |
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Attorney is Applicable
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| Last Name* |
ALTMAN
First Name *
ALEXIS
Initial
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| Street Address* |
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925 SOUTH FEDERAL HIGHWAY, 7TH FLOOR |
| City, State Zip* |
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BOCA RATON
,
FL
33432
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| Email Address * |
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AALTMAN@KPATTORNEY.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):*
MIMI HIDALGO
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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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Unfair Trade Practice
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Claim Denial
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Claim Delay
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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)(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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
loss settlement provision
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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.
Southern Oak Insurance Company (“carrier”) has not attempted in good faith to settle the insureds’ claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insureds and with due regard for their interests. The carrier has done everything possible to delay the claim and refuses to pay the complete covered loss amount due under the policy. Furthermore, the carrier is required to properly investigate and adjust claims and cannot place that burden upon the insureds. This was made clear by the appellate court and the Florida Supreme Court in Allstate Indemnity Co. v. Ruiz, 899 So. 2d 1121 (Fla. 2005) (“The Legislature has clearly chosen to impose on the insurance companies a duty to use good faith and fair dealing in processing and litigating the claims of their insureds…”).
The carrier was put on notice of the insureds’ plumbing claim which caused substantial damage to the insureds’ property. Although the insured believed the nightmare was alone the plumbing loss, the nightmare truly began after they reported the loss to Southern Oak. Southern Oak wrongfully denied the claim on the basis of prejudice. The insured sent an estimate of damages, but Southern Oak has refused to do what is right and pay the claim.
Pursuant to Florida Statute §624.155(1)(b)(1), Southern Oak has failed to settle the claim in good faith when it could and should have done so. The Insured reported the Loss and the Property was presented for inspection. The damage to the insured’s home was clearly caused by a covered peril under the Policy, but Southern Oak intentionally and callously delayed the claim process and wrongfully denied the claim.
Southern Oak has not shown a good faith intention to pay what was owed but rather has denied the claim for financial gain and profit.
Pursuant to Florida Statute 626.9541(1)(i)(3)(c), Southern Oak has a duty to acknowledge all communications and continues to violate this statute by failing to acknowledge the correspondence from the carrier. A communication made to or by a representative of an insurer with respect to a claim shall constitute communication to or by the insurer.
Pursuant to Florida Statute §626.9541(1)(i)(3)(a), Southern Oak has a duty to adopt and implement standards for the proper investigation of claims. The carrier refused to investigate the claim properly.
Florida law mandates that insurers and adjusters do not mislead the Insured. Florida Insurance companies that fail to follow these Florida laws and regulations, designed to protect consumers, do not only breach their duties under the policy of insurance but do so in bad faith. In violation of Florida Statute §626.9541(1)(i)(3)(b), Southern Oak intentionally misrepresented the available coverage under the policy and has misrepresented that the policy does not provide coverage for the loss.
Consequently, these actions have caused undo frustration and financial harm to the Insured. As a direct and proximate result of the poor handling of this Claim by Southern Oak the Insured sustained extracontractual damages. Due to the bad faith actions of Southern Oak, Insured was forced to engage the services of the Public Adjuster to attempt to recover the settlement to which they are rightfully entitled.
All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless regard for the insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida.
Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must:
1.) Pay the complete covered loss in the amount of $27,763.40 any applicable policy deductible;
2.) Pay all mitigation invoices for emergency services;
3.) Pay all mold;
4.) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made.
A copy of this letter and filed form submitted to the FDFS has been sent to the carrier.
Please do not hesitate to contact the undersigned or Stephanie Alexandre at (561)-892-9925 if you have any questions or concerns.
Sincerely,
Alexis Altman
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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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