Civil Remedy Notice of Insurer Violations
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Filing Number:     788893
Filing Accepted:  10/28/2024
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Complainant
Last/Business Name *  
MCKOY   First Name   JUDITH
Street Address * 401 SW 75TH WAY
City, State Zip * NORTH LAUDERDALE, FL 33068
Email Address * CLAIMS@WINDLAWGROUP.COM
Complainant Type: * Insured
Insured
Last/Business Name*   MCKOY   First Name   JUDITH
Policy # * W013347423 Claim #* 3300479173
Attorney
Attorney is Applicable
Last Name* AVARELLO First Name * ALEXANDER Initial L.
Street Address* 8570 STIRLING RD, SUITE 102-406
City, State Zip* HOLLYWOOD , FLORIDA 33024
Email Address * ALEX@WINDLAWGROUP.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):* THE ASSIGNED DESK ADJUSTER, FIELD ADJUSTER, SUPERVISOR(S) AND/OR MANAGER(S); AND ANY OTHER INDIVIDUAL THAT HAS REVIEWED THIS CLAIM OR MADE DETERMINATIONS WITH RESPECT TO THIS CLAIM
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
Other : Unfair Settlement 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.
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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

TOWER HILL INSURANCE EXCHANGE COMPANY failed to adequately adjust and pay the claim covered under the subject insurance policy. Specifically, but not limited to, TOWER HILL INSURANCE EXCHANGE COMPANY failed to properly apply the Loss Settlement and Loss Payment provisions of the policy. In addition to the policy sections, all endorsements and changes to the subject policy are relevant to the insured’s claim for civil remedy. There may be additional policy language relevant to this violation that may be discovered.
 
* 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 November 19, 2023, while the insurance policy (Policy Number: W013347423) was in full force and effect, the subject property located at 401 SW 75TH WAY, NORTH LAUDERDALE, FL 33068 sustained a covered loss as a result of a windstorm and ensuing water damage. The insured filed a claim (Claim Number: 3300479173) per the terms of the insurance policy with TOWER HILL INSURANCE EXCHANGE COMPANY (the “carrier”). TOWER HILL INSURANCE EXCHANGE COMPANY received timely notice of the claim but failed to perform a thorough and prompt investigation so the subject property could be restored to its pre-loss condition. The carrier’s adjuster did not properly adjust the loss to include obviously related damages resulting from windstorm and ensuing damages. The insured retained a representative, who performed a comprehensive investigation of the property that identified the damage that the carrier knew existed but failed to address. The insured’s representative determined there were damages and repairs necessary to restore the property to its pre-loss condition and submitted claim-related documentation to TOWER HILL INSURANCE EXCHANGE COMPANY, including a detailed estimate for repairs. TOWER HILL INSURANCE EXCHANGE COMPANY knows that it is acting in direct violation of Florida Statute 624.155(1)(b)(1) and that it has failed to issue proper payment for the claim to include damages and repairs covered by the insurance policy and Florida law. Rather than issuing the proper payment or attempting to reach an agreement with the insured, TOWER HILL INSURANCE EXCHANGE COMPANY is delaying and denying the claim. The carrier refuses to make any fair settlement offer to resolve this claim. Not made whole by the carrier per the terms of the insurance policy, the insured has been forced to seek legal counsel to protect the insured’s rights and interests. The above are all examples of TOWER HILL INSURANCE EXCHANGE COMPANY’S unfair trade practices, improper investigation and adjustment of the claim, and unfair claim settlement practices. These actions demonstrate the carrier is 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 the insured. The insured gives this notice to perfect the right to pursue the civil remedy authorized by Florida Statute § 624.155. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: (1) Pay the complete covered loss in the amount of $73,767.94, less any prior payments and less any applicable policy deductible; (2) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made; and (3) implement appropriate standards and procedures for claims investigations and resolution in regard to the outstanding amount of this claim.
Comments
User Id Date Added Comment
cwahab@bressler.com 12-27-2024 To Whom It May Concern: Please accept this response on behalf of Tower Hill Insurance Exchange (“Tower Hill”) to Civil Remedy Notice No. 788893 (“CRN”), filed on behalf of Judith McKoy (the “Insured” or “Complainant”) and accepted by the Florida Department of Financial Services on October 28, 2024, as a result of, and in connection with, property damage allegedly sustained at the property located at 401 SW 75th Way, North Lauderdale, FL 33068 on or about November 19, 2023. The CRN alleges to arise out of the adjustment of claim 3300479173, but the body of the CRN fails to contain any facts whatsoever to elaborate upon same or apprise Tower Hill of the basis of the allegations. Rather, the CRN merely indicates that the Complainant disagrees with Tower Hill’s coverage determination and provides no support for her position. The CRN alleges that Tower Hill violated the following Florida 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 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)(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. To summarize the below, Tower Hill hereby denies any allegation of bad faith, and states that it has at all times handled and adjusted the subject insurance claim with the utmost diligence, fairness, and good faith. Any and all allegations of bad faith and/or that Tower Hill violated any of the above enumerated statutes or codes are hereby vehemently denied and rejected in their entirety by Tower Hill. As a preliminary matter, the CRN is deficient for a number of reasons, including its failure to identify Complainant’s email address, the names of the individuals involved in the alleged violations, or any Policy language that is pertinent to the allegations of bad faith. The CRN does not even attempt to reference the specific Policy language, which would also be insufficient. The failure to provide specific reference to Policy language is direct and clear noncompliance with the requirements of Florida Statute § 624.155(2)(b)4, which requires that the Complainant set forth “specific policy language that is relevant to the violation.” “Courts have found that listing whole sections of the insurance policy constitutes insufficient specificity.” Fox v. Starr Indem. & Liab. Co., No. 8:16-cv-3254-T-23MAP, 2017 WL 1541294 at *2 (M.D. Fla. 2017); Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875, 879 (Fla. 4th DCA 2021) (“Here, Julien did not substantially comply with the specificity standard and this was more than a mere technical defect.”). Here, the Complainant’s failure to include any Policy language whatsoever renders the CRN deficient on its face, as to form and substance, and is insufficient to place Tower Hill on notice of the allegations set forth against it in connection with this CRN. Further, the CRN fails to provide an adequate description of facts or circumstances that give rise to each and every statutory violation alleged, which, which, in addition to its failure to identify the names of the individuals involved in the alleged violations and reference the specific Policy language relative to the alleged violations, renders it deficient. Florida law requires the Complainant to state the facts and circumstances giving rise to the alleged violations with specificity to allow the insurer to cure the alleged violation within the sixty-day statutory period. See Fla. Stat. § 624.155(2)(b)2; Lane v. Westfield Ins. Co., 862 So. 2d 774 (Fla. 5th DCA 2003). Unfortunately, however, the CRN does no more than recite the aforesaid statutory provisions alongside minimal “factual” allegations that are incorrect, half-truths, contradictory, and/or conclusory allegations without merit or factual support. For example, the CRN falsely alleges, based only upon Complainant’s disagreement with Tower Hill’s assessment of the subject loss and coverage determination—and without any factual support whatsoever—that Tower Hill “failed to perform a thorough and prompt investigation,” “did not properly adjust the loss,” and “delay[ed] . . . the claim,” when in fact Tower Hill promptly and thoroughly investigated the subject loss, and, after conducting a meticulous inspection of the Insured’s property by multiple, licensed professionals—including an engineer—rightfully denied coverage for the loss pursuant to the Policy’s express terms, conditions, limitations, exclusions, and endorsements. Finally, but certainly not the last of the false and misleading statements, the CRN suggests that Tower Hill disregarded its duty to properly communicate with Complainant and failed to attempt in good faith to settle the claim, despite Tower Hill having maintained constant, prompt communication with the Complainant and/or her representatives from the moment the claim was reported through its investigation and issuance of a coverage determination, and in the months following, during which Tower Hill stood by its decision but nevertheless attempted, in good faith, to amicably resolve this matter. With regard to the actual underlying facts of the insurance claim from which this CRN purportedly arises, the Insured reported the subject claim on November 30, 2023, for the insured property located at 401 SW 75th Way, North Lauderdale, FL 33068, which allegedly sustained damage on November 19, 2023. Promptly thereafter, a field adjuster (“FA”) inspected the property on December 12, 2023, fining no wind/storm-related damage to the property’s 4 year old roof—he found no lifted shingles or any other damage to the roof, and only observed some shingles bearing scrapes in circular patterns consistent with repeated scraping by palm fronds hanging over the roof. A subsequent inspection by a licensed forensic engineer on January 29, 2024, revealed (1) that there was no wind damage or storm-created openings to the roof, nor any evidence of water intrusion through the roof covering; (2) sporadic diagonal creases on sealed shingle tabs which were sustained prior to the installation and sealing of the shingles, i.e., construction/installation defects; (3) various spots of irregularly shaped and sized granule loss throughout the roof due to normal age-related deterioration and inadvertent man-made damage; (4) linear areas of granule loss and smoothly worn shingle edges below an overhanging palm tree due to repetitive abrasions from palm fronds; (5) that the stains on the bathroom ceilings were due to condensation on the HVAC refrigerant line in the attic (which was inadequately insulated); and (6) deteriorated grout, displaced tiles, and missing tiles in the shower installations that were due to improper installation. Accordingly, on February 20, 2024, Tower Hill sent written correspondence to Complainant rightfully denying her claim, enclosing a copy of its engineering report to ensure Complainant was apprised of the full circumstances of its investigation and denial of the claim. Thereafter, on May 6, 2024, the Insured filed a Notice of Intent to Initiate Litigation. Notwithstanding the sound basis for the claim’s denial, and Tower Hill’s fulfillment of its contractual obligations under the Policy, on May 6, 2024, Tower Hill, in good faith, offered the Insured $5,000 to resolve the claim. Unfortunately, Tower Hill was completely ignored by Complainant, who initiated litigation against Tower Hill on August 20, 2024, and proceeded to file the instant CRN shortly thereafter. Additionally, the “cure” proposed in the CRN is deficient, as it does not actually put Tower Hill on notice of what the Insured proposes would cure the conclusory allegations of bad faith, and essentially demands that Tower Hill “pay [Complainant] everything [she has] asked for.” Rousso v. Liberty Surplus Ins. Corp., 2010 WL 7367059, *5 (S.D. Fla. 2010). However, “[i]nsurers are not required to pay any amount demanded by their insureds [or other beneficiaries] to avoid a bad-faith claim.” Id. By demanding that Tower Hill “[p]ay the complete covered loss in the amount of $73,767.94, less any prior payments and less any applicable policy deductible . . . [and] the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made”—without any explanation, justification, or support—and “implement appropriate standards and procedures for claims investigations and resolution in regard to the outstanding amount of this claim,” in addition to asking Tower Hill to acknowledge that it has acted in bad faith—which it has not, and Complainant has failed to demonstrate—Complainant is asking Tower Hill to make a calculation as to the total cure amount, which is especially unascertainable from the face of the CRN. Accordingly, and without specifically stating the complete cure amount with adequate sufficiency, the CRN fails on its face. The CRN simply does not provide the contemplated and mandated notice of alleged bad faith that is required as a condition precedent to any civil claim for bad faith pursuant to Fla. Stat. § 624.155, and, in the absence of further information, Tower Hill is left entirely without the opportunity to “cure” the alleged violations, should Tower Hill elect to do so. For these reasons alone, the CRN fails at its inception. As outlined in detail above, Tower Hill maintains that it acted fairly and honestly toward the Insured/Complainant, and any other person having an interest in the subject Policy or assisting them in connection with the instant claim. Tower Hill consistently and promptly communicated with the Insured and/or her agents throughout all stages of the investigation and conducted a thorough evaluation before rendering its ultimate coverage determination. To the extent that the CRN is intended to address any other facts or circumstances that purport to establish bad faith on the part of Tower Hill, the CRN provides insufficient identification of any such facts or circumstances and therefore prevents Tower Hill from addressing any other aspect herein. Notwithstanding, Tower Hill believes that the above facts demonstrate beyond dispute that it has at all times acted in good faith with regard to its investigation and adjustment of the subject claim. If we can provide any additional information, or be of any further assistance, please do not hesitate to contact us at your convenience. Sincerely, /s/ Chafic R. Wahab Chafic R. Wahab, Esq.
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