Civil Remedy Notice of Insurer Violations
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Filing Number:     785997
Filing Accepted:  10/7/2024
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Complainant
Last/Business Name *  
LOBOGUERRERO   First Name   MAGDALENA
Street Address * 629 RYAN CT
City, State Zip * WINTER SPRINGS, FL 32708-20
Email Address * MOLOBO@HOTMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   LOBOGUERRERO   First Name   MAGDALENA
Policy # * W015159207 Claim #* 3300500235
Attorney
Attorney is Applicable
Last Name* LINE First Name * KACI Initial A
Street Address* 2431 LEE ROAD
City, State Zip* WINTER PARK , FL 32789
Email Address * KACI@TAGUSLAW.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):* ALL ADJUSTERS, SUPERVISORS, MANAGEMENT, AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY TOWER HILL INSURANCE INVOLVED IN THIS CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
* Statutory provision(s) which the insurer allegedly violated.
 
624.155(1)(b)(1) Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
624.155(1)(b)(2) Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
624.155(1)(b)(3) Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
626.9541(1)(i)(3)(a) Failing to adopt and implement standards for the proper investigation of claims.
626.9541(1)(i)(3)(b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims.
626.9541(1)(i)(3)(d) Denying claims without conducting reasonable investigations based upon available information.
626.9541(1)(i)(3)(e) Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
626.9541(1)(i)(3)(f) Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement.
626.9541(1)(i)(3)(g) Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
626.9541(1)(i)(3)(h) Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.
* 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 complainant will abbreviate the full policy language for purposes of brevity while clearly identifying the significant portions so the Respondent may identify the full language... THIS VIOLATION REFERENCES THE DEFINITIONS CONTAINED WITHIN THE POLICY AND ITS AMENDMENTS AND ENDORSEMENTS THAT PERTAIN TO COVERAGES FOR ROOF AND WATER DAMAGES (INDIVIDUALLY AND COLLECTIVELY) TO THE PROPERTY OF MAGDALENA LOBOGUERRO. THIS VIOLATION ALSO REFERENCES COVERAGES - COVERAGE A - DWELLING AND ALL APPLICABLE PORTIONS OF THE POLICY, INCLUDING BUT NOT LIMITED TO AMENDMENTS AND ENDORSEMENTS. THIS VIOLATION ALSO REFERENCES THE COVERAGE B - OTHER STRUCTURES PORTION OF THE POLICY, INCLUDING BUT NOT LIMITED TO AMENDMENTS AND ENDORSEMENTS. THIS VIOLATION ALSO REFERENCES PERILS INSURED AGAINST COVERAGE A - DWELLING AND COVERAGE B OTHER STRUCTURES, ITS APPLICABLE PORTIONS OF THE POLICY, INCLUDING BUT NOT LIMITED TO AMENDMENTS AND ENDORSEMENTS. THIS VIOLATION ALSO REFERENCES THE ORDINANCE AND LAW PORTION OF THE POLICY THAT WAS PURCHASED WITH PREMIUM DOLLARS PAID TO TOWER HILL INSURANCE. THIS VIOLATION ALSO REFERENCES SECTION I - CONDITIONS - SUBSECTION 3 LOSS SETTLEMENT AND ITS APPLICABLE PORTIONS OF THE POLICY, INCLUDING BUT NOT LIMITED TO AMENDMENTS AND ENDORSEMENTS. THIS VIOLATION ALSO REFERENCES FUNGI, WET OR DRY ROT OR BACTERIAL COVERAGE ENDORSEMENT.
 
* Facts and circumstances giving rise to the violation.
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Section I Property Coverages provides coverage for the claim and there are no exclusions that apply. TOWER HILL INSURANCE has failed to issue payment pursuant to the Loss Settlement Provision. On out about, June 6, 2024, during the coverage period while the policy was in full force and effect, the subject property sustained a sudden and accidental covered loss as a result of a hail and windstorm causing extensive damage to the property. TOWER HILL INSURANCE (“TOWER HILL”) received timely notice of the claim and assigned claim number 3300500235. TOWER HILL performed a cursory inspection of the property that failed to retain the experts necessary to identify the repairs necessary to restore the property to its pre-loss condition. TOWER HILL continued the intentional path of claim delay and underpayment by failing to implement policies and procedures for payment of clearly covered claims. TOWER HILL time and time again, relies upon “cookie-cutter” reports that less than ironically state the cause of the damage to be identical to those exclusions found inside of TOWER HILL’s policy of insurance. TOWER HILL continues to fail to promptly settle the claim when its obligation to settle has, under all the circumstances, become reasonably clear. There is no question the roof of the Insured’s home was stuck by hail and winds so severe that caused damage and requiring a full roof replacement and extensive interior repairs. Despite this, TOWER HILL denied coverage for the clearly covered loss. TOWER HILL continues to rely upon more restrictive definitions of damage that is not contained within the policy and appears to only look for damage that would not be covered while intentionally not photographing or documenting the extensive covered damage. However, TOWER HILL continues to use more restrictive definitions of definitions of “hail” to deny a hail claim. Furthermore, TOWER HILL intentionally did not photograph multiple damaged area of the Insured’s property and did not use clearly damaged property areas while determining the covered loss. TOWER HILL relies upon the report and estimate of its adjuster which bears little to no relationship to the actual, visible damage to the roof and its necessary repair/replacement. It is clear that TOWER HILL has put its own interest over that of its insured and has made this case about protecting its bottom line as opposed to living up to the contract of insurance it was paid premium dollars for. The insurer’s conduct in this case occurs with such frequency as to constitute a general business practice. TOWER HILL knows it has failed to issue proper payment for the clearly covered loss to include damages and repairs covered by the policy and Florida law. Moreover, TOWER HILL has failed to comply with its loss settlement provision. Rather than issuing the proper payment or attempting to reach an agreement with its insured, TOWER HILL is delaying and denying the claim. Upon information and belief, TOWER HILL performs the subject actions as a business practice, including delaying and denying the claim and issuing "low ball" payments in an attempt to dissuade its insureds from pursuing the claim to the detriment of its insureds to increase financial profits. TOWER HILL INSURANCE can cure the violations contained herein by issuing a payment for all contractual damages owed, per estimates of $56,189.02 plus interest, costs, and attorney’s fees. This willful and wanton business practice in reckless disregard for the right of insurer’s insureds and is a violation of Florida Statute 624.155(1)(B)(1) which states it is an unfair claims settlement practice in “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 interest.” This willful and wanton business practice of insurer, in reckless disregard for the rights of its insureds, is in violation of Florida Statute 624.155(1)(B)(3), which defines unfair claims settlement practices to include “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.” This willful and wanton business practice of insurer, in reckless disregard for the rights of its insureds, is in violation of Florida Statute 626.9542(1)(I)(3)(a), which defines unfair claims settlement practices to include “failing to adopt and implement standards for the proper investigation of claims.”
Comments
User Id Date Added Comment
jlinhart@gspalaw.com 11-01-2024 November 1, 2024 Via Electronic Posting to DFS Website Department of Financial Services Civil Remedy Notice Department 200 East Gaines Street Tallahassee, Florida 32399 RE: Insured: Magdalena Loboguerrero Claim No.: L100500235 Policy No.: W015159207 Date of Loss: June 6, 2024 Our File No.: CSEX.48393-AL CRN No.: 785997 To Whom It May Concern: Tower Hill Insurance Exchange (“Tower Hill”) is in receipt of the Civil Remedy Notice of Insurer Violation (“Notice”) submitted by the Complainant/Insured, Magdalena Loboguerrero, that was accepted by the Department of Financial Services (“Department”) on October 7, 2024 and assigned Filing Number 785997. In sum, Tower Hill denies each and every assertion of bad faith in the Notice. Tower Hill handled the subject claim in accordance with the insurance contract and all statutory and regulatory requirements. Tower Hill has not failed to attempt to settle this claim in good faith; and at no time did Tower Hill misrepresent any aspect of the claims handling process, facts, policy provisions, or applicable insurance coverage(s); Tower Hill did conduct a diligent and reasonable investigation and considered all available information prior to making a claim decision, and upon making such decision, Tower Hill promptly provided the explanation in writing to the Complainant/Insured for the decision and referenced the relevant facts and contractual exclusions for the decision on the Insureds’ claim. Tower Hill handled the claim in accordance with the insurance contract and all statutory and regulatory requirements. Tower Hill contends that the Notice filed by the Complainant is deficient as a matter of law as it fails to comply with Fla. Stat. §624.155. See 316, Inc. v. Maryland Cas. Ins. Co., 526 F. Supp. 2d 1187 (N.D. Fla. 2008); Rousso v. Liberty Surplus Ins. Corp., 2010 WL 7367059, (S. D. Fla. 2010); Heritage Corp. of South Fla. v. Nat’l Union Fire Ins. Co. of Pittsburgh, P.A., 580 F. Supp. 2d 1294 (S.D. Fla. 2008); Talat Enterprises, Inc. v. Aetna Cas. & Surety Co., 753 So. 2d 1278 (Fla. 2000). Pursuant to § 624.155(3)(b), Fla. Stat., the Notice “shall state with specificity” the following information: 1. The statutory provision, including the specific language, which the authorized insurer allegedly violated; 2. the facts and circumstances giving rise to the violation; 3. the name of any individual involved in the violation; 4. reference to specific policy language that is relevant to the violation, if any…..; 5. a statement that the notice is given in order to perfect the right to pursue the civil remedy authorized by this section. In addition to the criteria cited above, the Florida legislature created “Form DFS-10-363”, which is a Civil Remedy Notice form that lays out an additional fifteen (15) requirements: 1. Complainant’s Name; 2. Complainant’s Address; 3. Complainant’s email address; 4. Complainant type (Insured or otherwise) 5. Insured’s Name; 6. Insurance Policy Number; 7. Insurance Claim Number; 8. Attorney’s Name; 9. Attorney’s Address; 10. Attorney’s email Address; 11. Type of Insurer (authorized or otherwise) 12. Name of Insurer; 13. Address of Insurer; 14. Type of Insurance (Commercial Property & casualty or otherwise); and 15. Reason for Notice. Similar to the five (5) criteria specifically listed in Fla. Stat. § 624.155, the fifteen (15) additional items required by the Department of Financial Services must be correctly stated with specificity in order to satisfy a condition precedent to bringing an action under Fla. Stat. § 624.155. See, Pin-Pon Corp. v. Landmark Am. Ins. Co., 20-CV-14013, 2020 WL 3038576, at * 3-4 (holding that the plaintiff’s Civil Remedy Notice was deficient as a matter of law because the email address listed for the Complainant was the attorney’s email address); Mathurin v. State Farm Mut. Auto Ins, Co., 285 F. Supp. 3d 1311 (M.D. Fla. 2018) (holding that the correct policy number, one of the above listed requirements promulgated by the Florida Department of Financial Services, must be on a Civil Remedy Notice for it to be valid because Fla. Stat. § 624.155 requires a Civil Remedy Notice to have the information required by the Florida Department of Financial Services). To put it simply, a CRN is defective as a matter of law if any of the twenty (20) mandatory items cited above are missing or otherwise incorrect. Here, Tower Hill properly investigated the claim thoroughly, including but not limited to retaining an engineer to inspect and properly issued a denial. The Complainant has produced no evidence that the Complainant is entitled to the damages demanded. Tower Hill asserts it has been diligent in responding to the named insured’s (or Complainant’s) requests and investigating the claim. The subject policy of insurance, governing statutes, and case law only permit submission of a claim and payment for covered losses. While an insurance company is required to settle claims that should be settled, it is not required to settle claims that are legitimately contested. Florida law continually affirms the principle that an insurer has the right to investigate claims presented for payment. An insurance company is expressly afforded an opportunity to evaluate its rights and liabilities. After reviewing the Civil Remedy Notice, Tower Hill conducted a thorough review of its handling of the claim and allegations. Tower Hill denies that it violated any statutes, administrative code provisions, or ethical rules or obligations in connection with its investigation and handling of the Insured’s claim. Notwithstanding, Tower Hill remains committed to resolving this matter. As outlined above, the alleged statutory violations and factual allegations set forth in the Notice are devoid and without merit. Tower Hill has abided by the policy and the coverage determination was made in accordance with the terms agreed upon by the parties. Further, Complainant’s Civil Remedy Notice failed to comply with the strict requirements of F.S. § 624.155, in that it failed to offer a proper and valid cure by demanding payment of extra-contractual damages by the way of its demand for Tower Hill’s payment of attorney’s fees and costs. As of the date the Civil Remedy Notice was filed against Tower Hill, there was no pending lawsuit filed by Complainant against Tower Hill. There was no further Tower Hill policy provisions which obligated Tower Hill to pay Complainants its attorneys fees and/or costs. Accordingly, there was no mechanism under which Tower Hill would have been obligated to pay any attorney’s fees or costs to the Complainant at the time the Civil Remedy Notice was filed and the demand for the same as part of the CRN cure was for extra-contractual damages, which renders the Civil Remedy Notice defective and invalid. Thank you for your attention to the foregoing. Please feel free to contact the undersigned should the Department have any questions with regard to this response. Very truly yours, GROELLE & SALMON, P.A. /s/ Jacob J. Linhart Jacob J. Linhart For the Firm cc: Kaci Fine, Esq. Via email Katie@TAGUsLaw.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