Filing Number: 650219
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| Filing Accepted: 10/5/2022 |
| Last/Business Name
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COOPER
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First Name |
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CHRISTOPHER & CATHERINE |
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| Street Address
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6150 9TH AVE CIRCLE NE |
| City, State Zip
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BRADENTON,
FL
34212
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| Email Address
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DOCOOP@YAHOO.COM |
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Insured |
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| Last/Business Name* |
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COOPER |
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First Name |
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CHRISTOPHER & KATHERINE |
| Policy # * |
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E005042411 |
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Claim #* |
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3300309914 |
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Attorney is Applicable
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| Last Name* |
SCHULZ
First Name *
SEAN
Initial
P
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| Street Address* |
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947 LONGDALE AVENUE |
| City, State Zip* |
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LONGWOOD
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FL
32750
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| Email Address * |
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DEMAND@KSLAWGROUP.NET |
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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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TOWER HILL PRIME 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 11027 |
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| Name of individual responsible for violation (if any):*
ALL ADJUSTERS WITH TOWER HILL PRIME INSURANCE COMPANY WHO WERE INVOLVED IN THE SUBJECT CLAIM INCLUDING BUT NOT LIMITED TO CLAIRE HATCHER
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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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Not attempting in good faith to settle claims when, under all the circumstances, it could and should
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Other
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material misrepresentation made to an insured or any other person having an interest in the proceeds
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Other
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Failing to adopt and implement standards for the proper investigation of claims
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Other
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Misrepresenting pertinent facts or insurance policy provisions relating to coverage at issue
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Other
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Denying claims without conducting reasonable investigations based upon available information
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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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| 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)(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)(i) |
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Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
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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 following includes but is not limited in the policy provisions Tower Hill Prime Insurance Company has violated. See also a complete copy of the policy. Specifically:
SECTION I – PERILS INSURED AGAINST
COVERAGE A – DWELLING and COVERAGE B –
OTHER STRUCTURES
We insure against risk of direct loss to property described
in Coverages A and B only if that loss is a
physical loss to property. We do not insure, however,
for loss:
“HOMEOWNERS 3 SPECIAL FORM” (HO 00 03 04 91) policy under the heading
“SECTION I – PERILS INSURED AGAINST” which states in part:
“COVERAGE A – DWELLING and COVERAGE B – OTHER STRUCTURES
We insure against risk of direct loss to property described in Coverages A and B
only if that loss is a physical loss to property, however we do not insure loss:
. . .
2. Caused by:
. . .
e. Any of the following:(1) Wear and tear, marring, deterioration;
(2) Inherent vice, latent defect, mechanical breakdown;
. . .
(6) Settling, shrinking, bulging or expansion, including resultant cracking, of
pavements, patios, foundations, walls, floors, roofs or ceilings;
. . .
If any of these cause water damage not otherwise excluded, from a plumbing,
heating, air conditioning or automatic fire protective sprinkler system or
household appliance, we cover loss caused by the water including the cost of
tearing out and replacing any part of a building necessary to repair the system
or appliance. We do not cover loss to the system or appliance from which this
water escaped.”
“HOMEOWNERS 3 SPECIAL FORM” (HO 00 03 04 91) policy under the
heading “SECTION I – EXCLUSIONS” which states in part:
. . .
“2. We do not insure for loss to property described in Coverages A and B caused by
any of the following. However, any ensuing loss to property described in
Coverages A and B not excluded or excepted in this policy is covered.
. . .
c. Faulty, inadequate or defective:
(1) Planning, zoning, development, surveying, siting;
(2) Design, specifications, workmanship, repair, construction, renovation,
remodeling, grading, compaction;
(3) Materials used in repair, construction, renovation or remodeling; or
(4) Maintenance;
of part or all of any property whether on or off the "residence premises."
12. Accidental discharge or overflow of water or
steam from within a plumbing, heating, air conditioning
or automatic fire protective sprinkler system
or from within a household appliance.
This peril does not include loss:
a. To the system or appliance from which the water
or steam escaped;b. Caused by or resulting from freezing except as
provided in the peril of freezing below; or
c. On the "residence premises" caused by accidental
discharge or overflow which occurs off the
"residence premises."
In this peril, a plumbing system does not include a
sump, sump pump or related equipment.
SECTION I – EXCLUSIONS:
2. We do not insure for loss to property described in
Coverages A and B caused by any of the following.
However, any ensuing loss to property described in
Coverages A and B not excluded or excepted in this
policy is covered.
a. Weather conditions. However, this exclusion
only applies if weather conditions contribute in
any way with a cause or event excluded in paragraph
1. above to produce the loss;
b. Acts or decisions, including the failure to act or
decide, of any person, group, organization or
governmental body;
c. Faulty, inadequate or defective:
(1) Planning, zoning, development, surveying,
siting;
(2) Design, specifications, workmanship, repair,
construction, renovation, remodeling, grading,
compaction;
(3) Materials used in repair, construction, renovation
or remodeling; or
(4) Maintenance;
of part or all of any property whether on or off the
"residence premises."
LIMITED FUNGI, WET OR DRY ROT, OR BACTERIA
COVERAGE
FOR USE WITH FORM HO 00 03
SCHEDULE*
1. Section I - Property Coverage Limit of Liability for the
Additional Coverage "Fungi", Wet Or Dry Rot, Or Bacteria
$ Each Covered Loss
$ Policy Aggregate
2. Section II - Coverage E Aggregate Sublimit of Liability for
"Fungi", Wet Or Dry Rot, Or Bacteria
$
* Entries may be left blank if shown elsewhere in this policy for this coverage.
DEFINITIONS
The following definition is added:
"Fungi"
a. "Fungi" means any type or form of fungus,
including mold or mildew, and any mycotoxins,
spores, scents or by-products produced or
released by fungi.
b. Under Section II, this does not include any
fungi that are, are on, or are contained in, a
good or product intended for consumption.
SECTION I – PROPERTY COVERAGES
ADDITIONAL COVERAGES
The following Additional Coverage is added:
12. "Fungi", Wet Or Dry Rot, Or Bacteria
a. The amount shown in the Schedule above
is the most we will pay for:
(1) The total of all loss payable under
Section I - Property Coverages caused
by "fungi", wet or dry rot, or bacteria;
(2) The cost to remove "fungi", wet or dry
rot, or bacteria from property covered
under Section I - Property Coverages;
(3) The cost to tear out and replace any part
of the building or other covered property
as needed to gain access to the "fungi",
wet or dry rot, or bacteria; and
(4) The cost of testing of air or property to
confirm the absence, presence or level
of "fungi", wet or dry rot, or bacteria
whether performed prior to, during or
after removal, repair, restoration or
replacement. The cost of such testing
will be provided only to the extent that
there is a reason to believe that there is
the presence of "fungi", wet or dry rot, or
bacteria.
b. The coverage described in 12.a. only
applies when such loss or costs are a result
of a Peril Insured Against that occurs during
the policy period and only if all reasonable
means were used to save and preserve the
property from further damage at and after
the time the Peril Insured Against occurred.
c. The Each Covered Loss amount shown in
the Schedule for this coverage is the most
we will pay for the total of all loss or costs
payable under this Additional Coverage
resulting from any one covered loss; and
The Policy Aggregate amount shown in
the Schedule for this coverage is the most
we will pay for the total of all loss or costs
payable under this Additional Coverage for
all covered losses, regardless of the
number of locations insured under this
endorsement or number of claims-made.d. If there is covered loss or damage to
covered property, not caused, in whole or in
part, by "fungi", wet or dry rot, or bacteria,
loss payment will not be limited by the terms
of this Additional Coverage, except to the
extent that "fungi", wet or dry rot, or bacteria
causes an increase in the loss. Any such
increase in the loss will be subject to the
terms of this Additional Coverage.
This coverage does not increase the limit of
liability applying to the damaged covered
property.
SECTION I – PERILS INSURED AGAINST
Coverage A – Dwelling and Coverage B - Other
Structures
Paragraph 2.e.(3) is deleted and replaced by the
following:
(3) Smog, rust or other corrosion;
SECTION I – EXCLUSIONS
Exclusion 1.i. is added.
i. "Fungi", Wet Or Dry Rot, Or Bacteria
"Fungi", Wet Or Dry Rot, Or Bacteria meaning
the presence, growth, proliferation, spread or
any activity of "fungi", wet or dry rot, or bacteria.
This Exclusion does not apply:
(1) When "fungi", wet or dry rot, or bacteria
results from fire or lightning; or
(2) To the extent coverage is provided for in the
"Fungi", Wet Or Dry Rot, Or Bacteria
Additional Coverage under Section I –
Property Coverages with respect to loss
caused by a Peril Insured Against other
than fire or lightning.
Direct loss by a Peril Insured Against resulting
from "fungi", wet or dry rot, or bacteria is
covered.
SECTION II – CONDITIONS
Condition 1. Limit Of Liability is deleted and replaced
by the following:
1. Limit Of Liability
Our total liability under Coverage E for all damages
resulting from any one "occurrence" will not be
more than the Coverage E limit of liability shown in
the Declarations. All "bodily injury" and "property
damage" resulting from any one accident or from
continuous or repeated exposure to substantially
the same general harmful conditions will be
considered to be the result of one "occurrence".
However, our total liability under Coverage E for
the total of all damages arising directly or
indirectly, in whole or in part, out of the actual,
alleged or threatened inhalation of, ingestion of,
contact with, exposure to, existence of, or
presence of any "fungi", wet or dry rot, or bacteria
will not be more than the Section II Coverage E
Aggregate Sublimit of Liability for "Fungi", Wet Or
Dry Rot, Or Bacteria. That sublimit is the amount
shown in the Schedule. This is the most we will
pay regardless of the:
a. Number of locations insured under the policy to
which this endorsement is attached;
b. Number of persons injured;
c. Number of persons whose property is
damaged;
d. Number of "insureds"; or
e. Number of "occurrences" or claims made.
This sublimit is within, but does not increase, the
Coverage E limit of liability. It applies separately to
each consecutive annual period and to any
remaining period of less than 12 months, starting
with the beginning of the policy period shown in the
Declarations.
With respect to damages arising out of "fungi", wet or
dry rot, or bacteria described in 1. Limit Of Liability of
this endorsement, Condition 2. Severability Of
Insurance is deleted and replaced by the following:
2. Severability Of Insurance
This insurance applies separately to each
"insured" except with respect to the Aggregate
Sublimit of Liability described in this endorsement
under Section II Conditions 1. Limit Of Liability.
This condition will not increase the limit of liability
for this coverage.
SECTIONS I AND II CONDITIONS
Condition 1. Policy Period is deleted and replaced with
the following:
1. Policy Period
This policy applies only to loss or costs in
Section I or "bodily injury" or "property damage" in
Section II, which occurs during the policy period.
All other provisions of the policy apply.
In form HO 00 03, Item 10.k. under SECTION I – ADDITIONAL
COVERAGES is deleted and replaced by
the following:
k. Accidental Discharge or Overflow of Water
or Steam from within a plumbing, heating, air
conditioning or automatic fire protective sprinkler
system or from within a household appliance.
This peril does not include loss:
(1) To the system or appliance from which the
water or steam escaped;
(2) Caused by or resulting from freezing except
as provided in the peril of freezing below;
(3) On the “residence premises” caused by accidental
discharge or overflow which occurs
off the “residence premises”;
(4) Caused by constant or repeated seepage or
leakage of water or steam, or the presence
or condensation of humidity, moisture or
vapor; which occurs over a period of 14 or
more days, whether hidden or not; or
(5) Otherwise excluded or limited elsewhere in
the policy.In this peril, a plumbing system or household
appliance does not include:
(1) A sump, sump pump, irrigation system or
related equipment; or
(2) A roof drain, gutter, down spout, or similar
fixtures or equipment.
In form HO 00 03, the last paragraph of item 2.e. under
SECTION I – PERILS INSURED AGAINST,
COVERAGE A – DWELLING and COVERAGE B –
OTHER STRUCTURES is deleted and replaced by
the following:
If any of these cause water damage not otherwise
excluded or limited elsewhere in the policy, from a
plumbing, heating, air conditioning or automatic fire
protective sprinkler system or household appliance,
we cover loss caused by the water, including the
cost to tear out and repair only that part or portion of
a building or other structure covered under Coverage
A or B, on the "residence premises", necessary
to access the system or appliance.(1) The cost that we will pay for the tear out and repair
of the part or portion of the building or other
structure covered under Coverage A or B as
specified above is limited to only that part or
portion of the covered building or other structure
which is necessary to provide access to the part
or portion of the system or appliance that
caused the covered loss, whether the system or
appliance, or any part or portion of the system
or appliance, is repairable or not.
(2) In no event will we pay for the repair or replacement
of the system or appliance that
caused the covered loss.
We do not cover loss to the system or appliance
from which this water escaped.
For purposes of this provision, a plumbing system or
household appliance does not include:
(1) A sump, sump pump, irrigation system, or related
equipment; or
(2) A roof drain, gutter, down spout, or similar fixtures
or equipment.
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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 March 19, 2019, Christopher Cooper and Catherine Cooper (hereafter referred to as “the Insureds”) suffered a covered water loss due to water escaping from a hot water line which first occurred on or about March 19, 2019 causing water damages to the interior of their property (hereafter referred to as the “Loss”) at the insured property located 6150 9th Avenue Circle NE, Bradenton, FL 34212 (hereafter referred to as the “Insured Property”). The Loss caused extensive water damage to the interior of the Insured Property. Prior to the Loss, the Insureds purchased and obtained an insurance policy from Towe Hill Prime Insurance Company (hereafter referred to as “Tower Hill”), bearing policy number E005042411, which afforded homeowners insurance coverage for the Insured Property (hereafter referred as the “Policy”). Of note, the policy lists the Insured Property address of 6150 9th Avenue Circle NE, Lakewood Ranch, FL 34212, however, this is a typo in the subject policy issued by Tower Hill. The subject Policy was in full force and effect at the time of the Loss and provided for replacement cost coverage including damages caused by water.
Following the covered Loss to the Property, the Insureds timely notified Tower Hill of the covered Loss on or about March 20, 2019, one day after the Loss occurred. Tower Hill assigned claim number 3300309914 to the subject Loss. In light of the damage to the Property, the Insureds mitigated their damages and protected the property from further damage by hiring a licensed plumber, LT Plumbing, LLC to inspect the Property and taken protective action by accessing the audio/video room closet where the pipe leak occurred and perform a repair of the pipe to further prevent any further water damages to the property. This LT Plumbing, LLC invoice was timely provided to Tower Hill. Furthermore, the Insureds documented cause of the loss by taking a photograph of the subject hole in the plumbing pipe which was timely provided to Tower Hill. It is undisputed that a finishing nail caused a hole in the plumbing pipe and the water loss first occurred on March 19, 2022, when the Insureds came home to find water coming from the closet located in the audio/video room. According to the Insureds’ general contractor as well as the Insureds, the finishing nail which was believed to have been nailed into the pipe prior to the Loss during the installation of the drywall and pecky cypress on the walls of the property, the finishing nail did not at that time did not cause any water leakage as the nail into the pipe caused a seal and eventually as the end of the finishing nail inside the pipe wore away as the water went over the end of the finishing nail which was inside the pipe, the nail finally gave way on or about March 19, 2019 allowing for the sudden and accidental water event to occur causing extensive water damages to the interior of the property.
After the Insureds contacted LT Plumbing to perform the temporary emergency repairs, the Insureds then contacted Start to Finish Restoration (hereafter referred to as “Start to Finish”) to come out to the Insured Property to perform an inspection and begin to document the loss and perform any emergency water mitigation to prevent any further damages to the property. Anthony Cali of Start to Finish inspected the property on or about March 20, 2019, and performed a preliminary assessment of the affected areas, thermal imaging & moisture mapping determining a large area of the home has been impacted by the sudden and accidental water loss. At the same time, Start to Finish installed dehumidifiers and air movers to begin drying out the property to prevent any further damages.
Upon the Insureds’ timely notification of the Loss to Tower Hill, Tower Hill assigned a field adjuster, Richard Mount, to inspect the Property. The Insureds complied with the subject policy and allowed for Tower Hill’s unfettered inspection of the property. Mr. Mount inspected the Property on March 23, 2019. Tower Hill’s agent, Mr. Mount, inspected the property for three and a half hours. This was the one and only inspection request and performed by Tower Hill despite the extensive water damages and extensive amount of repairs required to restore the property to its pre-loss condition. During his inspection, Mr. Mount documented the extensive water damages to the interior of the property including cupping of the wood flooring and water damages to the walls of multiple rooms of the interior first floor of the property. Furthermore, during the inspection of the property Mr. Mount did not recall any different smells which would indicate this water issue was long-term causing mold or other long term water issues such as rot or deterioration indicating these issues were not sudden and accidental. Mr. Mount has testified that he agreed with the professional moisture mapping serviced performed by Start to Finish thus he did not document his moisture mapping photos in his photo report provided to Tower Hill. After the inspection and during the remediation of the property, Start to Finish provided Tower Hill’s agent, Mr. Mount six photographs showing the cause of the loss and the temporary emergency report to the pipe in the audio/video closet. Start to Finish also provided Tower Hill’s agent, Mr. Mount with a detailed Drying Plan and Daily Log outlining the work performed at the property from March 20, 2019 through April 18, 2019.
Throughout the claim investigation process, the Insureds and Start to Finish complied with all of the duties after loss pursuant to the policy. Furthermore, between March 20, 2019 and Tower Hill’s claim denial of July 2, 2019, the Insureds and their contractor, Start to Finish provided Tower Hill with Drying Logs and Daily Log of activities and various photographs of the damages prior to beginning the rebuild services. At no time during the claim investigation did Tower Hill every request a reinspection of the property or any documents from the Insureds.
Without any basis and improperly applying exclusions of the policy, Tower Hill made a coverage determination on June 11, 2019, stating as follows: “Start to Finish mentioned in their log that the plumber cut out a section of pipe that had penetrated the waterline pipe. Tower Hill also has a photo of that pipe with the nail in it. This appears to have been done by your builder 2 years ago and was an ongoing slow leak until recently, when it was noticed by you the insured. This caused your water intrusion in your audio/video closet. There is no coverage for faulty construction in your policy.” despite the obvious sudden and accidental water loss.
In this coverage determination, Tower Hill improperly applied two policy exclusions as follows:
“In regard to the water damage to your home, these damages were caused by the builder
negligence which is not covered by your policy. Please review pages 6 and 7 of your
“HOMEOWNERS 3 SPECIAL FORM” (HO 00 03 04 91) policy under the heading
“SECTION I – PERILS INSURED AGAINST” which states in part:
“COVERAGE A – DWELLING and COVERAGE B – OTHER STRUCTURES
We insure against risk of direct loss to property described in Coverages A and B
only if that loss is a physical loss to property, however we do not insure loss:
. . .
2. Caused by:
. . .
e. Any of the following:
(1) Wear and tear, marring, deterioration;
(2) Inherent vice, latent defect, mechanical breakdown;
. . .
(6) Settling, shrinking, bulging or expansion, including resultant cracking, of
pavements, patios, foundations, walls, floors, roofs or ceilings;
. . .
If any of these cause water damage not otherwise excluded, from a plumbing,
heating, air conditioning or automatic fire protective sprinkler system or
household appliance, we cover loss caused by the water including the cost of
tearing out and replacing any part of a building necessary to repair the system
or appliance. We do not cover loss to the system or appliance from which this
water escaped.”
We refer you to the exclusionary language regarding the construction negligence in your policy
on page 9 of your “HOMEOWNERS 3 SPECIAL FORM” (HO 00 03 04 91) policy under the
heading “SECTION I – EXCLUSIONS” which states in part:
. . .
“2. We do not insure for loss to property described in Coverages A and B caused by
any of the following. However, any ensuing loss to property described in
Coverages A and B not excluded or excepted in this policy is covered.
. . .
c. Faulty, inadequate or defective:
(1) Planning, zoning, development, surveying, siting;
(2) Design, specifications, workmanship, repair, construction, renovation,
remodeling, grading, compaction;
(3) Materials used in repair, construction, renovation or remodeling; or
(4) Maintenance;
of part or all of any property whether on or off the "residence premises."
Tower Hill provided a copy of this claim determination to the Insureds via email correspondence of July 2, 2019 stating “this would be under faulty construction in the policy”. Nowhere in the policy is there an exclusion for “builder negligence” or “construction negligence” as cited to by Tower Hill in their June 11, 2019 coverage determination letter to the Insureds. In fact, the two policy exclusions cited in the June 11, 2019 coverage determination letter cited as follows:
“2. Caused by:
. . .
e. Any of the following:
2
(1) Wear and tear, marring, deterioration;
(2) Inherent vice, latent defect, mechanical breakdown;
. . .
(6) Settling, shrinking, bulging or expansion, including resultant cracking, of
pavements, patios, foundations, walls, floors, roofs or ceilings;”
and
“2. We do not insure for loss to property described in Coverages A and B caused by
any of the following. However, any ensuing loss to property described in
Coverages A and B not excluded or excepted in this policy is covered.
. . .
c. Faulty, inadequate or defective:
(1) Planning, zoning, development, surveying, siting;
(2) Design, specifications, workmanship, repair, construction, renovation,
remodeling, grading, compaction;
(3) Materials used in repair, construction, renovation or remodeling; or
(4) Maintenance;
of part or all of any property whether on or off the "residence premises."
However, as seen above, each of the polocy exclusions cited have exceptions to the cited exclusions. Specifically, under the Section I – Perils Insured Against, Section 2. Subsections (1), (2), and (6), provide that if any of these cause water damage not otherwise excluded, from a plumbing system … we cover loss caused by the water including the cost of tearing out and replacing any part of a building necessary to repair the system or appliance. We do not cover loss to the system or appliance from which this water escaped.
Furthermore, Section - I Exclusions, section 2. C. also has an exception to the exclusion stating that “We do not insure for loss to property described in Coverages A and B caused by any of the following. However, any ensuing loss to property described in Coverages A and B not excluded or excepted in this policy is covered”. Thus, whether the damages were caused by Section I – Perils Insured Against, Section 2. Subsections (1), (2), and (6), or by Section -I Exclusions, 2. C the ensuing water damages caused by the accidental discharge of the water from the hole in the pipe would be covered under the subject policy. Despite Tower Hill stating that the loss was from an “ongoing slow leak until recently, when it was noticed by you the insured.” there was no indication or facts obtained by Tower Hill which would justify that the water loss has been occurring for any extended period of time. In fact, as seen by the voluminous photographs taken by Start to Finish and Mr. Mount, there is no indication that this leak occurred for any extended period of time. Specifically, the photographs taken by Start to Finish show very little visible mold growth (the small amount of visible mold growth seen was due to the 3 day time between when the loss occurred until Tower Hill was able to inspect the property and then the Insureds were able to begin removal of the walls and flooring) or long term deterioration (other than water staining) of any of the drywall or wood framing of the subject property evidencing that this was no an ongoing leak but a sudden and accidental discharge of water by a onetime event.
Due to this obvious improper denial of the claim, the Insureds were forced to retain counsel. As of the date of this civil remedy notice Tower Hill has failed to provide any settlement offer. Despite Tower Hill’s improper application of the aforementioned policy provisions, the Insureds at their own expense had all mitigation and restoration services competed by Start to Finish Restoration totaling $167,937.52. The Insureds provided Tower Hill with a water mitigation invoice totaling $25,904.07, mold mitigation invoice totaling $31,261.20 and a rebuild invoice totaling $110,772.26. The subject policy has a $25,000.00 mold sublimit and $5,000.00 all other perils deductible. As such, the $5,000.00 deductible would be absorbed into the coverage in the mold mitigation coverage. Thus, the Insured entitled to benefits under the policy totaling $161,676.33 which is the full amount of the water mitigation invoice, the full amount of the rebuild invoice and the full amount of $25,000.00 of the mold sublimit with the deductible of $5,000.00 is applied to over in the mold mitigation invoice.
As of this writing, Tower Hill has abjectly failed to address the information that the Insureds provided to Tower Hill, and has further failed properly apply the policy to the loss, failed to provide coverage for damage, in direct violation of Florida Statutes referenced below.
This is a pattern of Tower Hill to specifically deny covered water claims in direct violation of Florida Statutes and the subject Policy despite the obvious covered damages. Tower Hill failed to provide any reasonable explanation in writing as to the basis of its denial of the claim., misrepresented the facts of the claim and the applicable policy provisions, manufactured false exclusions of “builder negligence” and “construction negligence”, failed to perform a reasonable investigation of the claim, failed 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, failed to make a claim payment when it knows it should have, failed to adopt and implement standards for the proper investigation of the claim, and denied the claim without conducting a reasonable investigation of the claim. Ultimately, Tower Hill failed to act in favor of int Insureds despite clear photographic evidence of the sudden and accidental water loss at the Insureds’ Property, and clear evidence of the ensuing water damages.
As shown above, Tower Hill has failed to adopt and implement standards for the proper investigations of claims, failed to acknowledge and act promptly upon communications with respect to claims, failed to promptly provide any reasonable explanation in writing to the Insureds of the basis in the insurance policy or in relation to the fact or applicable law, for the denial of a claim. In addition, based on the facts, Tower Hill has failed to adjust the claim properly and blatantly refused to acknowledge the facts and extent of the damages to the Insured Property. Tower Hill has failed to promptly notify the Insureds of any additional information necessary for the processing of their claim. Further, Tower Hill has failed to promptly settle the claim, when the obligation to settle the 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, and Tower Hill has also misrepresented pertinent facts or policy provisions relating to coverage at issue in this claim. The aforementioned issues demonstrate a pattern and practice of unfair claim settlement practices by Tower Hill.
The subject Policy of insurance is a Replacement Cost Value policy that requires the payment of the costs incurred by an insured in completing the covered repairs. Tower Hill consistently and purposefully improperly denies claim in spite of the obvious covered damages. Furthermore, Tower Hill consistently and purposefully denies claims despite being provided ample documentation. This happens with such frequency that it is a pattern and practice. Tower Hill has either failed to train and supervise its employees and agents, or Tower Hill simply denies claims and refuses to conduct claims investigations in good faith toward its insureds and refuses to conduct claims investigations in good faith toward its insureds as a routine business practice.
Tower Hill has failed to adequately state in writing the basis for its denial of the Replacement Cost Value benefits owed, and failed to state with any specificity why it refused to cover and pay for covered damage in violation of Florida law, and in purposeful disregard for the Replacement Cost coverage afforded by the subject Policy. Furthermore, Tower Hill has internal practices of not paying for, or including payment for necessary loss-related repair expenses unless asked for, as a practice aimed at issuing lower claim payments and maximizing profits. This practice occurs with such frequency as to constitute not acting in good faith while adjusting claims.
Tower Hill is on notice that its adjustment practices are inadequate, and has failed or otherwise refused to address the issue by enacting sufficient guidelines to ensure that claims are investigated, adjuster, and otherwise handled in good faith.
Tower Hill has failed to pay the Insureds for the full amount of the Loss, including replacement cost of the covered damage, due to a lack of training, supervision, competence, and understanding of the cost of materials and labor as a part of Tower Hill’s general pattern and practice of purposefully underpaying and denying claims, thus result in the Insureds not being fully indemnified as required by the subject insurance policy and in violation of Florida Statute. In light of Tower Hill’s failures above, the Insureds’ were forced to indemnity themselves. If any other reasonable insurer was provided all of the above information, the insurer would have acted promptly to extend any pay the fully replacement cost value coverage afforded by the subject policy and Florida Statute.
Tower Hill has violated the following statutory provisions, including but not limited to:
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 claim 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)(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.
626.9541(1)(i)(3)(i): Unfair claim settlement practices
To remedy this Civil Remedy Notice of Insurer Violation, Tower Hill must immediately tender payment totaling $161,676.33, before the passage of 60 days. This payment should be tendered to the Insureds’ attorney, Sean P. Schulz, Esq, with KS Law Group, PLLC at 947 Longdale Avenue, Longwood, FL 32750
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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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