Civil Remedy Notice of Insurer Violations
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Filing Number:     785611
Filing Accepted:  10/3/2024
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Complainant
Last/Business Name *  
CHACON   First Name   XIOMARA
Street Address * 51 GLENRIDGE BOULEVARD
City, State Zip * HOMOSASSA, FL 34446
Email Address * JLOCKE7@TAMPABAY.RR.COM
Complainant Type: * Insured
Insured
Last/Business Name*   CHACON   First Name   XIOMARA
Policy # * W017883320 Claim #* 3300491520
Attorney
Attorney is Applicable
Last Name* KRAPF First Name * GRANT Initial W
Street Address* 2790 SUNSET POINT RD
City, State Zip* CLEARWATER , FL 33759
Email Address * GRANT@KRAPFLEGAL.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):* KAREN COLLIER, JENNIFER JEFFRIES, ROBERT SCOTT FULLER, JODE L. BALLARD, AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, TOWER HILL INSURANCE EXCHANGE COMPANY WHO WAS INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unfair Trade Practice
Other : Not treating the Insured with good faith claims conduct
Other : Looking for ways to deny full recovery to the Insured
Other : Looking for ways to delay full recovery to the Insured
Other : Failing to properly investigate the Insured's loss
Other : Failing to provide the Insured with the full benefits awarded under the contract of insurance in a
Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made,
Other : Not adjusting claims and evaluating loss properly
Other : Shifting the burden of insuring the loss to the Insured
Other : Intentionally misstating the terms, conditions, and benefits of the insurance policy to the insured
Other : Failing to implement proper standards for the adjustment and investigation of claims
Other : Misrepresenting the terms of the insurance policy
* 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.
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)(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.

Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Tower Hill Insurance Exchange Company (the "Insurer") has committed the following in handling the Insured's claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the policyholder and the Insured; 3) looking for ways to deny benefit payments and otherwise "low ball" or "stone wall" claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; 8) denying a claim which it knew or should have known the policy and Florida law provided coverage for; 9) treating represented and unrepresented Insured differently; and 10) shifting the burden of investigating the loss onto the Insured. On or about February 4, 2024, while the subject policy was in full force and effect, the insured property suffered a loss caused by wind and hail. The areas impacted include but are not limited to the roofing system and gutters. The Insured timely submitted a claim to the Insurer for damage caused by wind and hail and the ensuing damage therefrom. Thereafter, the Insurer assigned claim number 3300491520 to the loss and sent a field adjuster to inspect the property. Then in a letter dated April 30, 2024, the Insurer notified the Insured that it was denying coverage for the loss. This coverage decision is incorrect. Denying coverage for the damage was wrongful as the damages are covered under the policy. Given the denial, the Insured's disagreement with the coverage decision, and the scope and nature of the damage resulting from wind and hail, the Insured retained a public adjuster. After assessing the damage and the true scope of repairs, the public adjuster produced an estimate identifying $50,400.47 in covered damage to the dwelling. The foregoing estimate, photographs, and a letter of representation from the public adjuster were sent to the Insurer. In response, the Insurer retained an engineer who inspected the property on May 21, 2024. Then, in a letter dated May 31, 2024, the Insurer notified the Insured that it was extending partial coverage for the loss. However, the Insurer wrongfully determined that it would only require $1,537.56 to restore the insured property to its pre-loss condition. The Insurer's lowball estimate is that of a classic under scope and under value of the claim. The Insurer continued to deny coverage for the roof. The reevaluation and subsequent findings clearly demonstrate that the Insurer's initial inspection was inadequate. In layman's terms, the Insurer tried to "pull a fast one" on the Insured. Furthermore, this shows that the Insurer treats represented Insureds differently than those who are unrepresented. Upon receiving notice of the loss, the Insurer had the duty to provide the full benefits under the policy. This includes providing the Insured with a proper investigation and the funds necessary to return the home to its pre-loss condition. However, when the Insurer conducted its inspections of the insured property, the Insurer's representatives failed to conduct a thorough and adequate investigation, or the representatives intentionally ignored the damage observed and failed to make truthful and unbiased reports of the facts after investigating. As a result, the Insurer breached the policy by failing to fully indemnify the Insured for the covered loss. The Insurer misrepresented the loss and wrongfully denied coverage for the damage sustained to the Insured's property. According to the second claims determination letter, the Insurer's field engineer observed damage to the Insured's roof but attributed the cause of this damage to age related deterioration and workmanship. The Insurer knows or should know that when independent perils converge and no single cause can be considered the sole or proximate cause, it is appropriate to apply the concurring cause doctrine. Sebo v. Am. Home Assurance Co., 208 So. 3d 694, 697 (Fla. 2016). The concurring cause doctrine states that coverage may exist where an insured risk constitutes a concurrent cause of the loss even when it is not the prime or efficient cause. Id. at 698. A covered peril that meets with an uncovered peril may still provide for coverage under a policy when the covered peril triggered the events that eventually led to the loss. Id. at 697. The Insurer intentionally ignored covered damage to deny the reported loss and wrongfully fail to pay the Insured. This is an underhanded attempt to place the financial interests of the Insurer over those of the Insured and to delay and frustrate the Insured's ability to have his claim adjusted promptly to begin restoring her property. The conduct outlined above is done within the Insurer's routine course of the business. There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer's claim file and standards and procedures for the adjustment and investigation of claims. In short, the Insurer is not acting with due regard for the Insured's interests or safety. In Florida the work of adjusting insurance claims engages the public trust. The Insurer has breached this trust and its duty to the Insured. The Insurer and its agents conducted cursory and inadequate investigations and wrongfully denied coverage for the roof. Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer's actions and inactions have continued to frustrate and delay the resolution of the Insured claim. The Insurer's actions amount to but are not limited to the following: 1. Claim denial 2. Claim delay 3. Not treating the Insured with good faith claims conduct 4. Looking for way to reduce recovery to the Insured 5. Looking for ways to deny recovery to the Insured 6. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured 7. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company's interests before the Insured's interests 8. Placing the financial interest of the Insurer over that of the health and safety of the Insured 9. Shifting the burden of investigating onto the Insured 10. Conducting inadequate investigations 11. Making material misrepresentations Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must: (1). Admit full coverage for the Insured's loss. (2). Tender full benefits owed to the Insured under the insurance contract. A copy of this form submitted to the FDFS has been sent via e-mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to badfaith@krapflegal.com. Via E-mail: Tower Hill Insurance Exchange Company P.O. Box 142230 Gainesville, FL 32614 claims@thig.com
Comments
User Id Date Added Comment
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 Insurance Exchange Company Insured : John B Locke Policy Number: W017883320 Claim Number : 3300491520 Date of Loss: 02/04/2024 DFS File Number: 785611 Accepted Date : 10/03/2024 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 Xiomara Chacon. 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. 626.9541(1)(i)(2) A material misrepresentation made to an insured or any other person 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)(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 “(the "Insurer") has committed the following in handling the Insured's claim: 1) failure to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the policyholder and the Insured; 3) looking for ways to deny benefit payments and otherwise "low ball" or "stone wall" claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; 8) denying a claim which it knew or should have known the policy and Florida law provided coverage for; 9) treating represented and unrepresented Insured differently; and 10) shifting the burden of investigating the loss onto the Insured. 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. 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 claim determination, 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 “the Insurer breached the policy by failing to fully indemnify the Insured for the covered loss. The Insurer misrepresented the loss and wrongfully denied coverage for the damage sustained to the Insured's property” 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 coverage determination is not enough to allege bad faith. Conversely, Tower Hill directly refutes these allegations and can state that an independent adjuster, along with 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 April 8, 2024 related to alleged hail damage that occurred on February 4, 2024. Tower Hill assigned claim no. 3300491520 to this claim. The day after the reporting of the claim, Tower Hill sent the insured a Bill of Rights letter along with a Reservation of Rights letter as well as a letter informing the insured that the carrier was invoking its Option to Repair. The Reservation of Rights letter informed the Complainant that there were questions as to whether there is coverage of the claim, including whether the claim was timely reported. The letter further included language from the subject policy and is evidence of Tower Hill’s active investigation and communication with the insured. On April 12, 2024 the loss was inspected by an independent. On April 30, 2024 a denial letter was sent to the insured as the inspection by the independent adjuster showed no evidence of wind, hail, or weather-related damage to the roof surface, but revealed mechanical damage to the roof surfacing due to manufacturers defect and/or blistering of the shingles. On April 30, 2024 a denial letter was sent to the insured as the inspection by the independent adjuster showed no evidence of wind, hail, or weather-related damage to the roof surface, but revealed mechanical damage to the roof surfacing due to manufacturers defect and/or blistering of the shingles. A subsequent inspection by an independent engineering firm determined that “The seven dented downspouts were consistent with hail-related damage from the February 4, 2024 hailstorm. The hip/ridge and field shingles with localized granule loss and/or blisters along the shingles surface resulted from shingle manufacturing deficiencies and/or foot traffic, and there was no damage to the roof system from the hailstorm on February 4, 2024 or any other single weather event.” On May 31, 2024 Tower Hill sent a letter to the insured informing him that his claim for hail damage to downspouts was covered, however, coverage was not provided for the roof. Payment was made to the insured for the hail damage to the downspouts. Mediation took place on September 16, 2024 but ended in impasse. 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