Civil Remedy Notice of Insurer Violations
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Filing Number:     797040
Filing Accepted:  12/16/2024
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Complainant
Last/Business Name *  
CHAD PELT   First Name  
Street Address * 6125 SE 46TH AVE ROAD
City, State Zip * OCALA, FL 34480
Email Address * CHAD.PELT@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   CHAD PELT   First Name  
Policy # * W013051184 Claim #* 3300532383
Attorney
Attorney is Applicable
Last Name* ATTIA First Name * JEREMY Initial
Street Address* 925 FEDERAL HWY
City, State Zip* BOCA RATON , FL 33432
Email Address * JATTIA@KPATTORNEY.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):* MONICA SCOTT
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unsatisfactory Settlement Offer
Unfair Trade Practice
Claim Delay
* 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)(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)(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.

Loss settlement provision
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The carrier was put on notice of the insured’s Hurricane Helene claim. The carrier initially attempted to low-ball the claim. Subsequently, the insured prepared a loss package in the amount of $25,185.32 needed to restore the property back to its pre-loss condition. Whereas, the carrier furnished a wrongful estimate and, having withheld the deductible, offered a deficient payment in the amount of $4,802.62 only, leaving a remainder in the amount of $20,382.70 to be paid in order to cure the breach, less any applicable policy deductible. The insured has complied with all of the carrier’s requests to date and the carrier has still failed to treat this claim with good faith. This intentional delay with the claim has led to direct prejudice of the insured. About eighty-five days have passed since the original date of loss. The carrier has still refused to pay the fully covered amount owed under the policy. The carrier is aware of damage sustained by the insured’s property and has not taken any meaningful ensuing action. It is clear that the carrier is not treating the insured with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insured; failing to implement proper standards for the adjustment and investigation of claims by its adjusters and placing the company’s interests before the insured’s interests; refusing to pay the full amount owed to the insured despite the fact that the carrier has been on notice of the damages and looking for ways to delay full recovery or any recovery to the insured, when a reasonable carrier in a similar position would have tendered a full payment in accordance with both the policy language and statutory requirements. The carrier’s actions are in violation of Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(i)(3)(a); 626.9541(1)(i)(3)(b), 626.9541(1)(i)(3)(c) and 626.9541(1)(i)(3)(f), as well as Section I- Perils Insured Against, subsection 1, providing coverage for direct loss to property unless the damage was caused solely by an excluded or excepted cause of loss; and the loss payment provision under Section I- Conditions requiring payment of a claim within 90 days. All the aforementioned are part of what appears to be an ongoing pattern and practice of behavior of the carrier that it demonstrates a wanton and reckless disregard for the insureds’ rights and a pattern and practice of bad faith claims practices to its insureds across the state of Florida. Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $25,185.32, less any prior payments and less any applicable policy deductible; and 2.) Pay the statutory interest on the amount of unpaid damages from the date of loss to the date payment is finally made. A copy of this letter and filed form submitted to the FDFS has been sent to the carrier. Please do not hesitate to contact the undersigned or Stephanie Alexandre at (561)-892-9925 if you have any questions or concerns. Sincerely, Jeremy Attia Attorney at Law
Comments
User Id Date Added Comment
nweber@thig.com 02-12-2025 February 12, 2025 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 : Chad Pelt Policy Number: W013051184 Claim Number : 3300532383 Date of Loss: 09/26/2024 DFS File Number: 797040 Accepted Date : 12/16/2024 Dear Sir/Madam: We are in receipt of a Civil Remedy Notice of Insurer Violation (“CRN”) filed on behalf of Chad Pelt, our insured. This correspondence will serve as Tower Hill Insurance Exchange 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. §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)(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 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; misrepresenting pertinent facts or insurance policy provisions; failing to acknowledge and act promptly upon communications, failing to promptly provide a reasonable explanation in writing, 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 failed to issue full payment for the “covered loss.” 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 “the carrier is not treating the insured with good faith claims conduct; failing to pay a claim clearly owed; not adjusting the claim and evaluating the loss properly, promptly and fairly to provide full and prompt indemnity to the insured; failing to implement proper standards for the adjustment and investigation of claims by its adjusters and placing the company’s interests before the insured’s interests; refusing to pay the full amount owed to the insured despite the fact that the carrier has been on notice of the damages and looking for ways to delay full recovery or any recovery to the insured, when a reasonable carrier in a similar position would have tendered a full payment in accordance with both the policy language and statutory requirements.” 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, “Loss settlement provision”. 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 paid at actual cash value and the policy does not include Ordinance or Laqw, the vague reference to the statement that there are no policy provision 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. 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. This insured’s policy is paid at actual cash value and appropriate depreciation is applied, as well as the insured’s deductible. The policy does not include Ordinance or Law coverage. The fact that the CRN claims “The insured has complied with all of the carrier’s requests to date and the carrier has still failed to treat this claim with good faith. This intentional delay with the claim has led to direct prejudice of the insured.” 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 payment amount, 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’s attorney reported a claim on November 11, 2024 related to alleged windstorm damage that occurred on September 26, 2024, more than six (6) weeks post date-of-loss. Tower Hill assigned claim no. 3300532383 to this claim. The day after the reporting of the claim, Tower Hill sent the insured a Homeowner Bill of Rights letter and a Reservation of Rights letter informing the insured that there were questions as to whether there is coverage of the claim. The letter further included language from the subject Policy and is evidence of Tower Hill’s active investigation and communication with the insured and their representative. Tower Hill inspected the loss on November 15, 2024. An estimate was prepared for full roof replacement based on bids submitted by Roof Market Place, and payment made on November 18, 2024, seven (7) days after the IA inspection. Insured’s attorney submitted an estimate, along with a Proof of Loss, on December 16, 2024 and a response sent the following day. A settlement offer was made on December 17, 2024, and subsequently increased our offer on January 2, 2025. The claim is pending response from insured’s attorney as to whether or not the insureds accept the offer to settle. 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