Civil Remedy Notice of Insurer Violations
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Filing Number:     791525
Filing Accepted:  11/12/2024
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Complainant
Last/Business Name *  
CARNAZZA   First Name   MICHAEL & KAREN
Street Address * 5657 ATALA AVE
City, State Zip * THE VILLAGES, FL 32163
Email Address * INSPECTOR22669@YAHOO.COM
Complainant Type: * Insured
Insured
Last/Business Name*   CARNAZZA   First Name   MICHAEL & KAREN
Policy # * W014121895 Claim #* 3300515737
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):* SUSAN DAVIES, DAN WALSH, AND 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 MICHAEL AND KAREN CARNAZZA. 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.
Enter all words or phrases (one at a time) that should be used to filter.

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, October 10, 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 hurricane Milton causing extensive damage to the property. TOWER HILL INSURANCE (“TOWER HILL”) received timely notice of the claim and assigned claim number 3300515737. 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 a hurricane event so severe that caused damage and requiring a full roof replacement, gutters and 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. 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 $29,398.91 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
nfluet@gallowayjohnson.com 01-08-2025 Dear Sir or Madam: Please accept this letter as Tower Hill Insurance Exchange’s (“Tower Hill”) response to the Civil Remedy Notice of Insurer Violation (“CRN”) filed by Michael Carnazza and Karen Carnazza (“Insureds”), with a filing accepted date of November 12, 2024, and an assigned filing number 791525. Michael Carnazza and Karen Carnazza were named insureds under Tower Hill policy number W014121895 (“Policy”). This CRN refers to claim number 3300515737 (“Claim”) for the property located at 5657 Atala Ave., The Villages, Florida 32163 (“Property”). The CRN allegations are without merit or factual support. At all times, Tower Hill acted in conformity with the Policy, Florida Statutes, all administrative codes, codes of ethics, and rendered its coverage decision in accordance with the terms, conditions, and exclusions of the Policy. CRN Insufficiencies The CRN is wholly without merit or factual support. At all times, Tower Hill acted in conformity with the Policy, Florida Statutes, all administrative codes and codes of ethics, rendering its coverage determination in accordance with the Policy and Florida law. First and foremost, the CRN lists several statutory violations without specificity as to how each were violated, factual support, or an explanation as to how such listed statutory sections are even relevant to the CRN allegations. The CRN additionally fails to identify any policy violation but instead, utilizes the policy section to continue reference to overly broad policy sections. The plain language of section 624.155(3)(b) instructs the policyholder to “state with specificity” information in the notice;; Julien v. United Prop. & Cas. Ins. Co., 311 So. 3d 875, 878 (Fla. 4th DCA 2021) (emphasis added). The Insureds have failed to do so. Furthermore, the CRN includes purported “cure” requests that lack specificity necessary for Tower Hill to respond. Accordingly, the CRN is invalid and lacks merit or support. Response Contrary to the allegations in the CRN, Tower Hill performed a thorough investigation once the Claim was reported by the Insured. At no time did Tower Hill violate any codes of ethics or administrative codes in its investigation of the Claim. The Insureds can provide no factual support for its allegations related to “willful and wonton business practice”, as no such factual support exists. Tower Hill did not breach the Policy nor any administrative codes or Codes of Ethics. Instead, at all times, Tower Hill investigated the Claim in a fair and reasonable manner, in accordance with the requirements of the Policy and Florida Statutes, and in compliance with applicable administrative codes and codes of ethics, as Tower Hill does with all claims. Therefore, the allegations in the CRN are wholly inaccurate and without merit. This response is subject to and without prejudice to Tower Hill’s rights and defenses under the Policy, each of which are reserved. In addition, this response is not an exhaustive statement of such rights and defenses but presents legally sufficient defenses to the unsubstantiated allegations in this CRN. Sincerely, /s/ Nicole M. Fluet Nicole M. Fluet, Esq. Anwar M. Mahmoud, 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