Civil Remedy Notice of Insurer Violations
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Filing Number:     786860
Filing Accepted:  10/15/2024
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Complainant
Last/Business Name *  
GARCIA   First Name   NICOLE
Street Address * 715 MABBETTE STREET
City, State Zip * KISSIMMEE, FL 34741
Email Address * CGONZALEZ@GIONISLILLY.COM
Complainant Type: * Insured
Insured
Last/Business Name*   GARCIA   First Name   NICOLE
Policy # * W020807474 Claim #* 3300508933
Attorney
Attorney is Applicable
Last Name* ROMERO First Name * MARIO Initial
Street Address* 715 MABETTE STREET
City, State Zip* KISSIMMEE , FL 34741
Email Address * CGONZALEZ@GIONISLILLY.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):* TAYLOR RAMSDELL
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
* 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)(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)(4) Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees 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).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Portion or specific language of policy violated: WE ADOPT AND INCORPORATE BY REFERENCE THE ENTIRE SECTION 1 OF THE POLICY. INSURER HAS VIOLATED SECTION 1 OF THE POLICY WHICH REQUIRES THEM TO PAY FOR THE COVERED DAMAGE INCURRED In addition to the above statutory provisions that have been violated, the following provisions of the Florida Statutes have also been violated: 69B-22.201(3)(a) – adjuster shall disclose all financial interests and any direct or indirect aspect of an adjusted transaction 69B-22.201(3)(b) – an adjuster shall treat all claims equally 69B-22.201(3)(c) – an adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured 69B-22.201(3)(d) – an adjuster shall make truthful and unbiased reports of the facts after making a complete investigation 69B-22.201(3)(e) – an adjuster shall handle every adjustment and settlement with honesty, integrity, and allow fair adjustment or settlement to all parties without any remuneration to himself except to that which he is legally entitled 69B-22.201(3)(f) – an adjuster, upon undertaking the handling of a claim shall act with dispatch and due diligence in achieving proper disposition of the claim
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Description of facts: Tower Hill Insurance (“Insurer”) has improperly devaluated this claim. In doing so, 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 financial interest of Insurer before that of the Policy Holder and Claimants; 3. Not adjusting the claims promptly and fairly; 4. Not attempting in good faith to handle claims; 5. Looking for ways to deny full recovery to the Insured. On the date of loss, the Insured took video and picture of the wind and storm that caused the damages to her roof. Despite the Insured’s effort and diligent expense tracking of the loss Insurer have unfairly and irresponsibly assessed the damage and devaluated the loss in bad faith. To date, Insurer has failed to make appropriate payment and has delayed the appropriate settlement of the claim. Accordingly, the Insured continues to have damage to inside of her home even though she has mitigated her damages by covering the damage with a tarp. The Insurer’s action amount to but are not limited to: not treating the policy holder with good faith claims conduct; looking for ways to reduce or deny recovery to the Insured; not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the insured; not training supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company’s interests before the policyholder’s interests; placing the financial interest of the Insurer over that of the Insured. Florida law imposes no requirement to specify a definite cure amount to a civil remedy notice. Talet Enterprises v. Aetna Casualty & Surety Co., 753 So.2d 1278 (2000). To cure the defects outlined in this civil remedy notice, the Insurer needs to pay the full amount necessary to bring the Insured’s home back to its pre-loss condition, the estimates for which have been previously provided to Insurer. The insurer must also pay for any statutory costs and fees to which the Insured is entitled. This includes, but is not limited to, attorney’s fees and costs IF INCURRED pursuant to Florida Statute 627.428, plus a 2.5 multiplier in accordance with the principles of attorney’s fees calculation. Florida Patient’s Compensation Fund v. Rowe, 472 So.2d 1145 (Fla. 1985).
Comments
User Id Date Added Comment
nweber@thig.com 12-04-2024 December 4, 2024 Department of Financial Services Insurance Consumer Assistance Civil Remedy Section Larson Building 200 Gaines Street Tallahassee, FL 32399-0322 RE: Company: Tower Hill Exchange Insurance Company Insured : Nicole Garcia Policy Number: W020807474 Claim Number : 3300508933 Date of Loss: 09/04/2024 DFS File Number: 786860 Accepted Date : 10/15/2024 Dear Sir/Madam: We are in receipt of a Civil Remedy Notice of Insurer Violation (“CRN”) filed on behalf of Nicole Garcia, our insured. This correspondence will serve as Tower Hill Exchange 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)(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)(4): Failing to pay undisputed amounts of partial or full benefits owed under first party property insurance policies within 90 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by an act of God, prevented by the impossibility of performance, or due to actions by the insured or claimant that constitute fraud, lack of cooperation, or intentional misrepresentation regarding the claim for which benefits are owed. 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 promptly settle claims when it could and should have done so; failing to adopt and implement standards for the proper investigation of claims; failing to acknowledge and act promptly upon communications with respect to claims, failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, 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 “have unfairly and irresponsibly assessed the damage and devaluated the loss in bad faith. 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 failed to make appropriate payment and has delayed the appropriate settlement of the claim.” That ” 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 financial interest of Insurer before that of the Policy Holder and Claimants; 3. Not adjusting the claims promptly and fairly; 4. Not attempting in good faith to handle claims; 5. Looking for ways to deny full recovery to 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, but simply states, “WE ADOPT AND INCORPORATE BY REFERENCE THE ENTIRE SECTION 1 OF THE POLICY. INSURER HAS VIOLATED SECTION 1 OF THE POLICY WHICH REQUIRES THEM TO PAY FOR THE COVERED DAMAGE INCURRED”. 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, because this claim was not covered, the vague reference to the statement that there are no policy provision specifically at issue or in dispute, “WE ADOPT AND INCORPORATE BY REFERENCE THE ENTIRE SECTION 1 OF THE POLICY. INSURER HAS VIOLATED SECTION 1 OF THE POLICY WHICH REQUIRES THEM TO PAY FOR THE COVERED DAMAGE INCURRED” 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. As more thoroughly described below, there is no evidence that Tower Hill should have attempted “in good faith to settle claims” when the circumstances do not support any settlement amount above the deductible. There is no evidence that the claimed roof damage is covered under the policy and the CRN is devoid of any facts in support of same. Similarly, as it relates to the purported statutory violation for the failure to promptly settle claims, this policy is clear that there must be a direct physical loss that occurs within the policy period and that there is no coverage for wear, tear and deterioration. Tower Hill is unable to settle a claim that is not covered under the insurance policy and the mere statement in the policy that “Insurer has failed to make appropriate payment and has delayed the appropriate settlement of the claim.” is not enough to put Tower Hill on notice as to what was overlooked during the investigation of this claim. The fact that the CRN claims “the Insured continues to have damage to inside of her home even though she has mitigated her damages by covering the damage with a tarp.” 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 and denying claims without a reasonable investigation, 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 decision, is not enough to allege bad faith. Conversely, Tower Hill directly refutes these allegations and can state that a licensed adjuster investigated the claim, 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 September 9, 2024 related to alleged windstorm damage that occurred on September 4, 2024. Tower Hill assigned claim no. 3300508933 to this claim. The day after the reporting of the claim, Tower Hill sent the insured a Homeowner Bill of Rights letter and a letter providing contact information of the desk adjuster assigned. Tower Hill inspected the loss on September 13, 2024 and aerial photographs dated 08/17/2023 were obtained showing missing shingles and prior repairs made to the roof. Other photographs were obtained showing missing shingles dating back to 12/12/2018. On October 14, 2014, Tower Hill sent a letter to the insured informing him that his claim for roof damages had been denied as the loss did not occur within the policy period. The inception date of insured’s policy is May 31, 2024 and the roof had damages pre-dating the date of the policy inception. The letter also cited applicable language from the Policy for the denial as the aforementioned damages are not covered under the policy. 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. 786Florida 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