Civil Remedy Notice of Insurer Violations
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Filing Number:     785101
Filing Accepted:  10/1/2024
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Complainant
Last/Business Name *  
LERMAN AS DURABLE POWER OF ATTORNEY FOR PATRICIA A. LEONARD   First Name   DIANNE
Street Address * 12432 JOVE TERRACE
City, State Zip * PORT CHARLOTTE, FL 33981
Email Address * PATRICIALEONARD423@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   LERMAN AS DURABLE POWER OF ATTORNEY FOR PATRICIA A. LEONARD   First Name   DIANNE
Policy # * 8001684397 Claim #* 3300426588
Attorney
Attorney is Applicable
Last Name* ROSS First Name * VANESSA Initial
Street Address* 1800 2ND STREET, SUITE 892
City, State Zip* SARASOTA , FLORIDA 34236
Email Address * ESERVICE@ROSSLEGALFL.COM
Violation
Insurer Type *   Authorized Insurer Unauthorized Insurer
 
Insurer Name*   TOWER HILL INSURANCE EXCHANGE
NAIC Company Code 17179
 
Name of individual responsible for violation (if any):* LORETTA WALLEN PATTERSON, FL LICENSE #P230820; AND ALL ADJUSTERS, SUPERVISORS, MANAGEMENT AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY TOWER HILL INSURANCE EXCHANGE INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unsatisfactory Settlement Offer
Claim Denial
Claim Delay
Unfair Trade Practice
Other : Failure to properly investigate claim and with due regard to the Insured’s interest
* 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)(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)(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.
* 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 Insured(s) may not be in possession of a complete copy the applicable policy of insurance, however, the specific policy language relevant to the violations outlined below is contained within INSURER’S policy, Policy No. 8001684397 (“Policy”), issued to the Insured including, but is not limited to, the following: Dwelling Coverage provisions Perils Insured Against Loss Payment Loss Settlement Please advise if there are other applicable policy provisions that are not cited above but would provide coverage to the Insured for the September 28, 2022, windstorm/hurricane force winds loss.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

In Florida, the work of adjusting insurance claims engages the public trust. Tower Hill Insurance Exchange (“INSURER”) has breached the public’s trust by its adjustment of Patricia Leonard and Dianne Lerman as Durable Power of Attorney for Patricia A. Leonard (“INSURED”) claim of loss. Tower Hill Insurance Exchange’s mailing address is 7201 Northwest 11th Place, Gainesville, FL 32605. INSURER has failed to create and implement adequate guidelines for the proper investigation and evaluation of claims, claims handling, and for training and supervision of employees resulting in statutory violations as set forth above. INSURER has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the INSURED’S insurance claim for damages. INSURER has failed to promptly settle the INSURED’S insurance claim when the obligation to settle the insurance claim had become reasonably clear. To date, notwithstanding the INSURED’S pleas otherwise, INSURER has continued to refuse to acknowledge its obligation to conduct a proper investigation, and to tender the full amount of insurance monies due and owing its INSURED under the policy. This claim involves the INSURED’S property located at 12432 Jove Terrace, Port Charlotte, FL 33981 which sustained significant damage from wind/hurricane-force winds and ensuing losses as a result of Hurricane Ian on or about September 28, 2022. On or about September 28, 2022, Hurricane Ian struck the state of Florida. INSURED was a victim of Hurricane Ian’s destruction and subsequently incurred wind damage to the exterior and interior of their home due to hurricane-force winds, and ensuing damages. INSURED’S insured home suffered extensive hurricane-force winds damage to the tile roof system at the front, rear, left and right elevations, including the soffit, fascia, gutters, and downspouts which allowed water intrusion into the home, causing ensuing interior damages throughout to the master bedroom, master bathroom, master closet, master sitting room, entry to master bedroom sitting area, dining room, sitting room, storage area off the garage, rear left bedroom, rear left bedroom closet, middle left bedroom, middle left bedroom closet. INSURED timely notified INSURER of the damages and opened a claim pursuant to the terms and conditions of the Policy. In response, on October 3, 2022, INSURER’S Claims Representative, Loretta Wallen Patterson, FL License #P230820, advised INSURED the INSURER had assigned the claim to its third-party representative, Olympia Claim Service Inc., to adjust and investigate the loss, as well as an independent field adjuster with to inspect the damages. INSURER’S third-party field adjuster with Olympia Claims Service Inc., IVAN REYNOSO - FL LICENSE #W191574, visited the insured property and performed a cursory and inadequate investigation of the damaged property. MR. REYNOSO’s estimate was severely deficient, as it did not take into account the full extent of damages to INSURED’S insured property. This is unfair claims handling practices. Concerned that INSURER had no intention to fairly investigate and adjust their claim, INSURED retained the services of an insurance claim professional from Guardian Adjustment Group. (‘Guardian’), to assist in submitting their claim to INSURER which would adequately and fairly detail all the damages sustained as a result of the loss. On October 3, 2022, INSURER acknowledged receipt of Guardian’s letter of representation. Despite the claim having been reported on OCTOBER 3, 2022, and MR. REYNOSO having inspected the Property in October of 2022, the initial loss estimate authored by MR. REYNOSO was not completed until November 22, 2022. In correspondence dated November 25, 2022, INSURER’S Claims Representative, Loretta Wallen Patterson, FL License #P230820, sent INSURED correspondence which advised that the damages INSURER had investigated and undisputed payment was being issued based on $177,796.22 RCV, less Recoverable Depreciation $52,467.31 totaling $75,001.05 ACV under Coverage A – Dwelling. INSURER stated payment under Coverage B- other Structures has already been issued and was calculated using MR. REYNOSO’S November 22, 2022, estimate and came out to $50,328.36 RCV, less Recoverable Depreciation for $36,866.96 totaling $25,000.00 ACV under Coverage B – Other Structures had been issued. INSURER had previously deducted the deductible of $11,340.00 from Coverage B in the over limits/recoverable depreciation amount of $36,866.96. INSURER admitted that INSURED’S insured property sustained wind damages to certain areas of the property, but excluded coverage for other areas. INSURER sent its last correspondence to INSURED on or about November 2, 2023, stating additional payments in the amount of $2,748.00 would be issued, along with a recapitulation of all prior payments made as of November 2, 2023, totaling: $210,248.49 RCV under Coverage A – Dwelling; $15,808.04 RCV for water mitigation under Coverage A – Dwelling $55,413.57 RCV under Coverage B – Other Structures $63,205.49 RCV under Coverage C – Contents. - $42,531.25 Recoverable Depreciation (as a total amount, not broken down by coverage) -$11,340.00 Deductible -$19,073.57 over-limits amount was applied to Coverage B – Other Structures $268,982.77 in prior payments issued See attached, Payment Letter dated November 2, 2023. From November 23, 2022, through May 22, 2024, INSURER has issued the following payments: $190,646.80 – Coverage A ($179,432.28 ACV and $11,214.49 Recoverable Depreciation) $25,000.00 ACV Coverage B – Other Structures $64,239.72 RCV – Coverage C – Contents $279,886.50 total payments under all coverages INSURED has provided INSURER with proof of repairs in the amount of $315,844.22 RCV under Coverage A – Dwelling; however, to date, INSURER has only issued payments in the amount of $190,646.77 under Coverage A. See, Insured Receipts attached hereto. It took INSURER almost 20 months after the Category-4 hurricane and notice of claim for it to provide, and well beyond the time allowed by statute to issue all undisputed payments. To date, INSURER has failed to tender all insurance benefits. INSURER has admitted that INSURED sustained covered damages as a result of hurricane-force winds loss that occurred on or about September 28, 2022, but has denied tendering all owed insurance benefits to INSURED required to place the property in pre-loss condition. This is an unfair and wrongful denial of all owed insurance benefits due to INSURED and unfair claims handling practices. Pursuant to Florida Statute §626.9541(1)(i)(4), INSURER is required to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after INSURER received notice of the residential property insurance claim, determine the amounts of partial or full benefits, and agree 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). As INSURER has failed to do so, INSURER has wrongfully denied coverage. Since the beginning of the claim, INSURER has engaged in a pattern of delay, denial, and reckless disregard for INSURED’S rights. The actions of INSURER listed herein have been continuing in nature and given the totality of the circumstances, which includes INSURER’S adjustment, actions and/or omissions post the filing of this CRN. INSURED contend that given the past experience in this matter with INSURER, it is reasonably foreseeable that INSURER’S current actions will extend to its entire conduct in the handing of their claim, including the acts or omissions of INSURER and/or its representatives, until the final resolution of their claim. As such, INSURED contend adequate notice has been given should INSURER’S actions and violations listed herein continue after the expiration of this notice. INSURER has failed and/or refused to settle the claim when it could and should have done so had it acted fairly and honestly towards INSURED and has failed to take into account the information and evidence provided that contradict its decisions. INSURER’S conduct has been reckless and unfair to INSURED and has caused and continues to cause additional damage throughout the property. This is evidenced by the delay in paying the claim and the failure of INSURER to evaluate the claim in total. To date, INSURER has failed and/or refused to provide INSURED with all the necessary insurance benefits due and owing and has not tendered the full amount needed to repair the Property despite knowing that INSURED have sustained covered damages to their insured property. As the INSURER must admit, it is implied within every insurance policy a duty of good faith and fair dealings. In an insurance contract, each party is prevented from interfering with the other’s right to benefit from the contract. The obligations of good faith and fair dealings encompass qualities of decency and humanity inherent in its responsibilities as a fiduciary. INSURER is bound to conduct itself with the utmost good faith for the benefit of INSURED. However, INSURER has failed to comply with the obligations in connection with this claim and has never looked at the claim or the contract for insurance with good faith and fair dealing. Instead, INSURER has looked for ways not to pay the claim in full, or pay the claim at all, and these actions have been to the detriment of INSURED. The adjusters assigned to this claim have a duty to adjust and treat all claims equally. Since the beginning of this claim the representatives on behalf of INSURER have approached this investigation in a manner prejudicial to INSURED. INSURER is using either untrained or improperly trained adjusters in connection with this claim. INSURER should have been adjusting the loss with INSURED but instead, it was looking for ways not to pay the claim at all or pay the claim in full. If the INSURER handles all the claims in the way INSURED’S claim was adjusted, then it is improperly handling all claims. Therefore, demand is hereby made as follows: Insured Damages $407,770.93 Less Prior Payments $279,886.49 Less Deductible $11,340.00 TOTAL $116,544.44 The concept of insurance is that the insurer will investigate and grant timely and prompt indemnity or security against a contingent loss. Florida Statute §624.02 defines “insurance” as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit upon determinable contingencies. Inherent in that definition is the fact that payment must be made timely and promptly so that the INSURED may mitigate their damages and be put back into the position they were in prior to the loss as quickly as possible. INSURER has breached this duty. The INSURED was, and still is, forced to expend out of pocket monies to submit her insurance claim, e.g., retaining an attorney and other experts to force INSURER to honor its obligations under the insurance policy and to pay all the insurance proceeds due and owing to them. INSURER has refused and/or failed to tender all the insurance proceeds due and owing to the INSURED. INSURER’s refusal and/or failure to settle the insurance claim when under all circumstances it could have and should have done so had it acted fairly and honestly towards the INSURED is wrongful conduct. Furthermore, the INSURED contends that INSURER’s adjusters and/or representatives financially benefit from such wrongful conduct. INSURER has refused and/or failed to comply with The Policy’s cooperation and/or “Loss Payment” provision. Under The Policy, INSURER was to timely tender undisputed insurance benefits to INSURED. INSURER has failed and/or refused to timely tender owed insurance benefits, undisputed or otherwise. This is a breach of The Policy. INSURER has refused and/or failed to cooperate and/or “Adjust the Loss” by cooperating with INSURED during the claims adjustment process in compliance with The Policy’s “Loss Payment” provision. This is a breach of The Policy. This notice is given in order to perfect the right to pursue the civil remedy authorized by Fla. Stat. §624.155. Therefore, to cure the defects outlined in this Civil Remedy Notice, INSURER must: (1) Create and implement adequate guidelines for the proper investigation and evaluation of claims and for the training and supervision of employees, which will avoid future statutory violations as set forth above, and prevent this from occurring in the future; (2) INSURER must create and implement adequate guidelines for the proper investigation and evaluation of these types of claims and for the training and supervision of employees with regard to these claims to ensure that the claims handling procedure with regard to these types of losses are adequate to prevent other Insureds from being treated unfairly and wrongfully; (3) INSURER must tender to the INSURED $407,770.93as set forth above; and, (4) INSURER must act fairly and honestly towards its INSURED and with due regard for her interests in attempting to settle its INSURED’S claim. Or, in the alternative, should INSURER not be in agreement with INSURED’S reasonable demand for payment of their rightfully owed insurance benefits being submitted at this time, INSURED may still be willing to consider and potentially accept a reasonable counter-offer made by INSURER. As such, INSURED hereby request that INSURER now make a reasonable counter-offer before the expiration of the cure period. INSURED still hope that their claim can be resolved amicably. Attachments: Carrier Estimate, Insured Receipts, Photos, Payment Letter, and Redacted Checks
Comments
User Id Date Added Comment
eservice@rosslegalfl.com 12-27-2024 The Insured, Patricia Leonard and Dianne Lerman as Durable Power of Attorney for Patricia A. Leonard, hereby provide notice to the Florida Department of Financial Services and Tower Hill Insurance Exchange, that the issues outlined in Civil Remedy Notice filing #785101 have been resolved between the parties and Tower Hill Insurance Exchange has cured all allegations listed therein. Accordingly, Patricia Leonard and Dianne Lerman as Durable Power of Attorney for Patricia A. Leonard, hereby withdrawals Civil Remedy Notice filing #785101 filed on 10/01/2024.
nweber@thig.com 11-26-2024 November 26, 2024 Department of Financial Services Insurance Consumer Assistance Civil Remedy Section Larson Building 200 Gaines Street Tallahassee, FL 32399-0322 RE: Company: Tower Hill Signature Insurance Company Insured : Patricia Leonard Policy Number: 8001684397 Claim Number : 3300426588 Date of Loss: 09/28/2022 DFS File Number: 785101 Accepted Date : 10/01/2024 Dear Sir/Madam: We are in receipt of a Civil Remedy Notice of Insurer Violation (“CRN”) filed on behalf of Patricia Leonard, our insured. The CRN shows Dianne Lerman as Durable Power of Attorney for Patricia A. Leonard. This correspondence will serve as Tower Hill Signature Insurance Company’s (“Tower Hill’s”) response to the CRN. The CRN alleges that Tower Hill Exchange violated the following statutes: 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)(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)(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. To summarize the below, Tower Hill hereby denies any allegation of not attempting to settle claims in good faith when it could and should have done so; failing to adopt and implement standards for the proper investigation of claims; misrepresenting pertinent facts or insurance policy provisions; failing to acknowledge and act promptly upon communications with respect to claims, Denying claims without conducting reasonable investigations based upon available information, and any other allegations of bad faith specifically stated or implied and further asserts that it has at all times handled and adjusted the Complainant’s claim with utmost good faith. Simply put, Tower Hill denies any acts or omission that could be construed or found to be deemed bad faith and/or a violation of Florida Statutes § 624.155 and § 626.9541, whether expressly stated in the Civil Remedy Notice or implied. Any and all allegations of bad faith are hereby denied and rejected in their entirety by Tower Hill. Tower Hill denies and rejects the instant CRN as it fails to comply with the requirements of Fla. Stat. § 624.155. Specifically, Fla. Stat. § 624.155(1)(b)(1) requires that a CRN “state with specificity”, inter alia, the facts and circumstances giving rise to the violation(s) alleged. Here, Complainant wholly fails to provide specific facts or circumstances giving rise to each and every statutory violation alleged in the CRN, and instead alleges generally that Tower Hill “INSURER has failed to tender all insurance benefits. INSURER has admitted that INSURED sustained covered damages as a result of hurricane-force winds loss that occurred on or about September 28, 2022, but has denied tendering all owed insurance benefits to INSURED required to place the property in pre-loss condition. This is an unfair and wrongful denial of all owed insurance benefits due to INSURED and unfair claims handling practices. Pursuant to Florida Statute §626.9541(1).” To be clear, there is not a single fact contained in the CRN that gives rise to bad faith or that supports the filing of the CRN and the statutory violations cited therein. The extent of the allegations include that the “INSURER has engaged in a pattern of delay, denial, and reckless disregard for INSURED’S rights. There is no description of the allegedly illegal, bad faith “business practice” that Tower Hill engages in and no facts to support a bad faith claim of any kind. For these reasons, including the lack of any facts contained in the CRN in support of these claims, the CRN must be rejected. As further support of the deficiencies contained within the CRN, when asked to reference the policy language at issue, the Insured included no reference to the policy whatsoever, but simply states, “Dwelling Coverage provisions Perils Insured Against Loss Payment Loss Settlement Please advise if there are other applicable policy provisions that are not cited above but would provide coverage to the Insured for the September 28, 2022, windstorm/hurricane force winds loss.” The CRN further fails to comply with the requirements of Fla. Stat. § 624.155. Specifically, Fla. Stat. §624.155(3) requires that a civil remedy notice of insurer violation “state with specificity,” inter alia, the facts, and circumstances giving rise to the violation and the “specific” language of the subject insurance policy that is relevant to the violation. Florida law requires specific citation to policy language. As such, the CRN is deficient. It is evident from the above that the Complainant fails to cite any actions that would be indicative of bad faith and mischaracterize the statutory regulations governing the handling and adjustment of an insurance claim. The fact that the CRN alleges that Tower Hill misrepresented policy language, but the CRN fails to tell Tower Hill what policy language was violated, is substantial evidence that the CRN is non-compliant with Florida Standards and fails to apprise Tower Hill about the actions that led to the purported statutory violations. As noted above, the insured is not satisfied with the settlement amount, the vague reference to the statement that there are no policy provisions specifically at issue or in dispute, is not enough to preserve a bad faith claim. The policy issued by Tower Hill has a “loss settlement” section that is amended by the Special Provisions. There are numerous subsections related to whether the carrier will repair or replace the damaged property, how replacement cost is factored in and actual cash value as compared to replacement cost value. The failure to cite to specific language within this section is fatal to the Insured’s claim because Tower Hill is at a complete loss as to what language was violated on this claim that is less than the insured’s deductible. On top of the above, the CRN filed on behalf of the insured fails to set forth any specific acts, facts, or circumstances, which would give rise to the claimed statutory violations, thus preventing Tower Hill from providing any meaningful or complete response thereto. The fact that the CRN claims “INSURER has refused and/or failed to cooperate and/or “Adjust the Loss” by cooperating with INSURED during the claims adjustment process in compliance with The Policy’s “Loss Payment” provision. This is a breach of The Policy” is not enough to put Tower Hill on notice as to what was overlooked during the investigation of this claim. Finally, the broad statement and claimed violation as it relates to standards for investigating claims, is undermined by the few facts contained within the CRN as they do not relate to the investigation that was conducted. No specific claims were made as to what Tower Hill did wrong in its investigation and the sole fact that the Insured is dissatisfied with the settlement amount, is not enough to allege bad faith. Conversely, Tower Hill directly refutes these allegations and can state that an independent expert engineering firm inspected the loss, and Tower Hill applied the policy provisions to the loss in question with a clear explanation to the Insured as to its position. By way of background, the insured reported a claim on October 3, 2022 related to alleged windstorm damage that occurred on September 28 2022. Tower Hill assigned claim no. 3300426588 to this claim. The day after the reporting of the claim, Tower Hill sent the insured a Homeowner Bill of Rights letter. An acknowledgement of the PA representation was also sent, along with a Proof of Loss. On September 25, 2022, Tower Hill sent a letter to the insured informing him that his claim for damages had been paid and a check was sent. Enservio was assigned to inspect and assess the contents damage; water mitigation was paid. Numerous supplements were presented, reviewed and paid. A settlement offer was made in exchange for a signed Policy Holder Release, however, the insured declined the offer. A Notice of Intent to Initiate Litigation was received on October 2, 2024 and mediation was requested by the carrier. As this timeline demonstrates, Tower Hill properly investigated and handled the instant claim and the allegations of the CRN are by design vague and clearly do not accurately reflect the issues presented by this claim. Moreover, the CRN is facially deficient, fails to cite any actions that would be indicative of bad faith, and mischaracterizes the statutory regulations governing the handling and adjustment of an insurance claim. The CRN filed on behalf of the Complainant fails to set forth any specific acts, facts, or circumstances, which would give rise to the claimed statutory violations, thus preventing Tower Hill from providing any meaningful or complete response thereto. The remaining allegations of the CRN do not state with specificity the information required by the Department, as Complainant failed to describe with specificity the facts and circumstances giving rise to the violation(s), and the specific policy language at issue. The CRN lacks factual support as it relates to its allegations that Tower Hill did not handle the claim correctly. Florida Courts have held that CRNs that are similarly broad and merely list general policy provisions do not satisfy the statutory requirements. The inclusion of only conclusory statements without the requisite specificity renders the CRN facially deficient. Notwithstanding these deficiencies, Tower Hill expressly denies the allegations contained within the CRN. Tower Hill denies any failure to handle, investigate and adjust the claim, and all of the allegations contained in the CRN are hereby denied. To the extent that this response does not address each and every allegation of bad faith conduct made by the Complainant, Tower Hill hereby expressly denies any and all allegations of bad faith conduct, or omission set forth in the CRN, and/or any alleged violation(s) of Florida Statutes or any other statutory section set forth therein. Again, Tower Hill insists it has acted, at all times, in utmost good faith. Tower Hill expressly denies all allegations against it. Should you need any additional information from Tower Hill regarding the foregoing, please feel free to contact us 800-216-3711. Sincerely, Tower Hill Claims Services, LLC claims@thig.com
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