Filing Number: 797336
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| Filing Accepted: 12/18/2024 |
| Last/Business Name
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| Street Address
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13222 FAWN LILY DR |
| City, State Zip
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RIVERVIEW,
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33579
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| Email Address
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MLEWIS20785@MSN.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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LEWIS |
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First Name |
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MAURICE |
| Policy # * |
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W014 120 561 |
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Claim #* |
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3300 527 632 |
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Attorney is Applicable
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| Last Name* |
ADAMS
First Name *
JOHN
Initial
W
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| Street Address* |
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1074 BLOOMINGDALE AVE |
| City, State Zip* |
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VALRICO
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FL
33596
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| Email Address * |
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JADAMS@ADAMSLAWASSOCIATION.COM |
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| Insurer Type
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 Authorized Insurer
 Unauthorized Insurer
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| Insurer Name |
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| Insurer Name* |
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TOWER HILL INSURANCE EXCHANGE
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| Insurer Name* |
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| Street Address* |
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| City, State Zip* |
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,
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NAIC Company Code 17179 |
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| Name of individual responsible for violation (if any):*
NAETA BEST
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| Type of Insurance
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Residential Property & Casualty
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| Reason for Notice
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Claim Delay
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Unfair Trade Practice
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Other
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Failure to provide coverage for a covered loss
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Other
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Failure to investigate claim in consultation with the insured
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Other
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Failure to issue all payments due and owing
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Other
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Failure to address concerns of health and safety at the insured property
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Statutory provision(s) which the insurer allegedly violated.
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| 624.155(1)(b)(1) |
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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.
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| 626.9541(1)(i)(2) |
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A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
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| 626.9541(1)(i)(3)(a) |
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Failing to adopt and implement standards for the proper investigation of claims.
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| 626.9541(1)(i)(3)(b) |
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Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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| 626.9541(1)(i)(3)(c) |
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Failing to acknowledge and act promptly upon communications with respect to claims.
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| 626.9541(1)(i)(3)(g) |
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Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Reason for Notice:
Claim Delay
Unfair Trade Practice
Other: Failure to provide coverage for a covered loss
Other: Failure to investigate claim in consultation with the insured
Other: Failure to issue all payments due and owing
Other: Failure to address concerns of health and safety at the insured property
PURSUANT TO SECTION 624.155, F.S. please indicate all statutory provisions alleged to have been 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) -- Unfair claim settlement practices.
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)(g) -- Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
627.70131 – (5)(a) Within 90 days after an insurer receives notice of a property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay such claim or a portion of the claim is caused by factors beyond the control of the insurer which reasonably prevent such payment.
626.9541(1)(a)(1) -- Misrepresenting the terms of an insurance policy.
626.9541(1)(i)(2) -- Making a material misrepresentation to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
69B-220.201(3)(B)(2) – An adjuster shall adjust all claims strictly in accordance with the insurance contract.
69B-220.201(3)(C) – An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured.
69B-220.201(3)(D) – An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation.
69B-220.201(3)(E) – An adjuster shall handle every adjustment and settlement with honesty and integrity, and allow a fair adjustment or settlement to all parties.
69B-220.201(3)(F) – An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim.
69B-220.201(3)(G) – An adjuster shall promptly report to the department any conduct by any licensed insurance representative of this state which violates any provision of the insurance code or department rule or order.
Reference to specific policy language…
THE POLICY LANGUAGE RELEVANT TO THE VIOLATIONS INCLUDES ALL APPLICABLE POLICY COVERAGES, VALUATION PROVISIONS, AND OTHER TERMS AND CONDITIONS OF THE POLICY.
SEE:
SECTION I COVERAGES;
COVERAGE “A” (DWELLING);
COVERAGE “C” (PERSONAL PROPERTY);
COVERAGE “D” (LOSS OF USE);
THE DECLARATIONS PAGE;
LOSS PAYMENT AND SETTLEMENT PROVISIONS;
DUTIES IN EVENT OF LOSS POLICY PROVISIONS;
ALL TERMS AND CONDITIONS OF THE INSURANCE POLICY; AND
ALL ENDORSEMENTS TO THE POLICY, INCLUDING ALL FLORIDA ENDORSEMENTS
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Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
FACTS OF THE CASE:
THIS IS THE FIRST CIVIL REMEDY NOTICE FILED IN AN ATTEMPT TO PLEA FOR THE PROPER ADJUSTMENT OF THIS CLAIM. TOWER HILL INSURANCE HAS COMMITTED THE FOLLOWING IN INTERACTIONS WITH THE CLAIM: 1) FAILURE TO ACT IN DUE DILIGENCE AND GOOD FAITH TO RESOLVE CLAIMS; 2) PLACING THE FINANCIAL INTEREST OF INSURER BEFORE THAT OF POLICYHOLDERS AND CLAIMANTS; 3) FAILURE TO PROPERLY TRAIN, EVALUATE, AND MANAGE ADJUSTERS RETAINED TO REPRESENT THE POLICIES AND PROCEDURES OF TOWER HILL INSURANCE; (4) LOOKING FOR WAYS TO DELAY BENEFIT PAYMENTS AND OTHERWISE OR “STONE WALL” CLAIMS; (5) THE REASONS FOR THIS MAY BE ATTRIBUTED TO IMPROPER TRAINING, SUPERVISION, AND/OR MOTIVATION OF OUTSIDE ADJUSTERS AND CLAIMS SUPERVISORS TO PROMPTLY AND FAIRLY ADJUST AND PAY FULL BENEFITS AVAILABLE TO PARTIES WITH AN INSURABLE INTEREST IN THE PROPERTY. (6) MAKING MATERIAL MISREPRESENTATIONS OF FLORIDA LAW TO THE INSUREDS. ULTIMATELY, THE INSURER FAILED TO ADOPT PROPER STANDARDS OF INVESTIGATION AND ADJUSTMENT OF LOSSES OR IS OTHERWISE NOT IMPLEMENTING THOSE STANDARDS BECAUSE A PROPER ADHERENCE TO THE REQUIREMENTS OF FLORIDA STATUTES CHAPTER 624, 626 AND 627 IS NOT OCCURRING.
ON OCTOBER 11, 2024 THE INSURED’S HOME WAS DAMAGED BY WIND AND WINDSTORM EVENT AND THE INSURED SUFFERED A SUBSTANTIAL LOSS REGARDING THE REAL PROPERTY AND PERSONAL PROPERTY.
THEREAFTER THE INSURED CALLED TOWER HILL INSURANCE TO REPORT THE CLAIM FOR PROPERTY DAMAGE TO THE PROPERTY AND REQUEST MUCH NEEDED HELP AND DIRECTION AFTER THE INSURED’S LIFE HAD BEEN TURNED UPSIDE DOWN. TOWER HILL INSURANCE INVESTIGATED THE CLAIM, ENGAGED AN INSURANCE CLAIMS ADJUSTER. TOWER HILL INSURANCE‘S ADJUSTER OR THIRD-PARTY CLAIMS ADMINISTRATOR TOOK PHOTOGRAPHS, INTERVIEWED THE INSUREDS BY TAKING STATEMENTS, AND VISITED AND INSPECTED THE PROPERTY. UPON INFORMATION AND BELIEF, THE CARRIER NOR THEIR THIRD-PARTY CLAIMS ADMINISTRATOR ENGAGED ANY ENGINEERS TO CONDUCT AN INVESTIGATION AT THE PROPERTY IN LIGHT OF THE CLEAR STRUCTURAL DAMAGE. ADDITIONALLY, UPON INFORMATION AND BELIEF, THE CARRIER NOR THEIR THIRD-PARTY CLAIMS ADMINISTRATOR PRODUCED ANY REPORT AS A BASIS OF THEIR CLAIMS DECISION.
TOWER HILL INSURANCE ISSUED ITS ESTIMATE DENYING ALMOST ALL OF THE DAMAGE TO THE PROPERTY WITHOUT ANY EVIDENCE, PROOF, REPORT OR PHOTOGRAPHS. TOWER HILL INSURANCE HAS YET TO EXPLAIN AT ALL WHY IT HAS CHOSEN TO DENY THE DAMAGE OR EXPLAIN WHY DAMAGES ARE SUBJECT TO EXCLUSIONS OR EXCEPTIONS WITHOUT ANY BASIS OR FACTUAL EXPLANATION.
TOWER HILL INSURANCE CONTINUES TO STALL AND BALK AT THE INSURED’S CONTINUOUS ATTEMPTS FOR HELP AS THEY ARE LEFT IN A DANGEROUS CONDITION AND LEFT ONLY TO THEIR OWN VERY LIMITED RESOURCES TO REPAIR THE DAMAGE.
MEANWHILE, THE INSURED CONTINUES TO BE TREATED LIKE A SECOND-CLASS CITIZEN FORCED TO REPAIR WHAT IS CLEARLY A DANGEROUS CONDITION AFTER THE WINDSTORM AND WATER DAMAGE INSPITE OF TOWER HILL INSURANCE BEING PLACED ON NOTICE AND BEGGED FOR HELP. IT IS UNCONSCIONABLE THAT TOWER HILL INSURANCE COULD ACCEPT PREMIUMS, CONDUCT AN INITIAL INVESTIGATION, AND DENY ALMOST ALL LIABILITY WITHOUT ANY ENGINEERING REPORTS, INVESTIGATIONS OR EXPLANATION.
TOWER HILL INSURANCE HAS BEEN GIVEN COMPLETE ACCESS TO THE INSURED PROPERTY, HAS NOTICE OF THE CONDITION OF THE PROPERTY THROUGH THEIR OWN INSPECTION AND PHOTOGRAPHS. TOWER HILL INSURANCE HAS ALSO BEEN PLACED ON NOTICE THROUGH THE REPEATED CALLS FROM THE INSURED ASKING FOR UPDATES AND REQUESTING FULL PAYMENT TO RETURN THE PROPERTY TO ITS PRE-LOSS CONDITION. INSTEAD OF RE-INSPECTING THE PROPERTY AND ISSUING PAYMENT UNDER THE POLICY, WHICH WAS IN FULL FORCE, TOWER HILL INSURANCE HAS INSTEAD IGNORED THE INSURED.
ON OCTOBER 18, 2024, THE ADAMS LAW ASSOCIATION, RETAINED BY THE INSURED IN ORDER TO BEG AND PLEA FOR THE CARRIER TO PROPERLY ADJUST THE LOSS, PREPARED A NOTICE OF CLAIM, REQUEST TO RE-OPEN AND RE-ADJUST CLAIM AS WELL AS REQUESTED COPIES OF ALL ADJUSTER REPORTS, ENGINEER REPORTS, ESTIMATES, PHOTOGRAPHS AND DOCUMENTS WHICH SUPPORT THEIR DENIAL. IN THE CORRESPONDENCE, THE LAW FIRM REQUESTED AND DEMANDED THE CARRIER ASSIGN AN ADJUSTER, REVIEW THE CLAIMS FILE AND RE-INSPECT THE PROPERTY TO FULLY AND PROPERTY ADJUST THE LOSS. UNFORTUNATELY, THE CARRIER HAS NOT PRODUCED ANY DOCUMENTS. THE INSURED, THROUGH ITS ATTORNEY, HAS REPEATEDLY REQUESTED THE CARRIER FOR DOCUMENTS WHICH SUPPORT ITS CONTENTION THAT THE DAMAGE WAS CAUSED BY EXCLUSIONS OR EXCEPTIONS OF THE POLICY. AT THIS TIME, THE CARRIER STILL HAS NOT PROVIDED ANY REASON FOR THE CONTINUED CLAIMS DELAY AND HAS OUTRIGHT REFUSED TO EXPLAIN ITS CLAIMS DECISION WITHOUT ANY CLARITY OR DIRECTION.
AT THIS POINT, THE CARRIER HAS REFUSED TO PROPERLY ADJUST THE LOSS AND REFUSES TO COMMUNICATE WITH ITS INSURED THROUGH EITHER FORMAL MEANS OR INFORMAL MEANS. THIS INACTION IS PRIMA FACIE EVIDENCE THAT THE CARRIER HAS REFUSED TO ADJUST THE LOSS BY REFUSING TO ISSUE FULL PAYMENT.
THE INSURER’S FEIGNED ATTEMPTS TO ADJUST THE LOSS ARE NOTHING MORE THAN TO WRONGFULLY DENY OR DELAY THIS CLAIM. THE ACTIONS TAKEN BY TOWER HILL INSURANCE IN THE HANDLING/ADJUSTMENT OF THE HOMEOWNER’S CLAIM WERE WILLFUL, WANTON, IN BLATANT DISREGARD FOR THE RIGHTS OF THE HOMEOWNERS, AND OCCUR WITH SUCH A FREQUENCY AS TO INDICATE A GENERAL BUSINESS PRACTICE IN VIOLATION OF FLA. STAT. §§ 624.155 AND 626.9541.
IN FLORIDA THE WORK OF ADJUSTING INSURANCE CLAIMS ENGAGES THE PUBLIC TRUST. TOWER HILL INSURANCE HAS BREACHED THIS DUTY BY ITS IMPROPER HANDLING OF THE INSURED’S CLAIM OF LOSS. TOWER HILL INSURANCE HAS FAILED TO CREATE AND IMPLEMENT ADEQUATE GUIDELINES FOR PROPER INVESTIGATION TO EVALUATE CLAIMS HANDLING AND FOR TRAINING AND SUPERVISION OF EMPLOYEES RESULTING IN STATUTORY VIOLATIONS SET FORTH ABOVE. TOWER HILL INSURANCE HAS FAILED AND/OR REFUSED TO THOROUGHLY, ACCURATELY, AND COMPLETELY INVESTIGATE AND EVALUATE THE INSURED’S INSURANCE CLAIM FOR DAMAGES.
FLA. STAT. § 624.02 DEFINES INSURANCE AS A CONTRACT WHEREBY ONE UNDERTAKES TO INDEMNIFY ANOTHER OR PAY OR ALLOW SPECIFIED AMOUNT OR A DETERMINABLE BENEFIT UPON DETERMINABLE CONTINGENCIES. INHERENT IS THE FACT THAT PAYMENT MUST BE MADE TIMELY AND PROMPTLY SO THAT THE INSURED MAY MITIGATE HIS/HER DAMAGES AND TO PUT THEM BACK INTO THE POSITION THEY WERE PRIOR TO LOSS AS QUICKLY AS POSSIBLE. TOWER HILL INSURANCE BREACHED THIS DUTY.
THE ACTIONS TAKEN BY TOWER HILL INSURANCE IN THE HANDLING OF THE INSURED’S CLAIM WERE WILLFUL, WANTON, AND IN DISREGARD OF THE RIGHTS OF ITS INSURED AND OCCUR WITH SUCH A FREQUENCY AS TO INDICATE A GENERAL BUSINESS PRACTICE, AND ARE IN VIOLATION OF FLA. STAT. §§ 624.155 AND 626.9541.
TOWER HILL INSURANCE’S ACTIONS AMOUNT TO BUT ARE NOT LIMITED TO THE FOLLOWING:
1. FAILURE TO RECOGNIZE A CLAIM
2. FAILURE TO RESPOND TO AN INSURED’S REQUEST TO ADJUST THE LOSS
3. FAILURE TO ASSIGN AN ENGINEER TO INSPECT THE DAMAGE
4. FAILURE TO COMMUNICATE TO AN INSURED AFTER A CLAIM WAS MADE
5. CLAIM DELAY
6. NOT CONDUCTING FULL AND PROMPT INVESTIGATION
7. FAILING TO PROVIDE REPORTS REQUESTED
8. NOT TREATING POLICYHOLDERS WITH GOOD FAITH CLAIMS CONDUCT
9. NOT ADJUSTING CLAIMS AND EVALUATING LOSSES PROPERLY, PROMPTLY AND FAIRLY TO PROVIDE FULL AND PROMPT INDEMNITY TO THE INSURED
10. FAILING TO IMPLEMENT PROPER STANDARDS FOR THE ADJUSTMENT AND INVESTIGATION OF CLAIMS
11. NOT TRAINING, SUPERVISING OR MANAGING ADJUSTERS PROPERLY SO THAT PROMPT AND FULL PAYMENTS ARE MADE, BUT RATHER PLACING THE COMPANY’S INTERESTS BEFORE THOSE OF THE POLICYHOLDER.
12. FAILING TO OFFER ALL COVERAGES AVAILABLE IN SPITE OF THE CLEAR EVIDENCE OF WINDSTORM AND WATER DAMAGE.
THEREFORE, TO CURE THE DEFECTS OUTLINED IN THIS CIVIL REMEDY NOTICE, TOWER HILL INSURANCE MUST:
(1) ADMIT FULL COVERAGE FOR THE INSURED’S LOSS;
(2). TENDER COVERAGE APPLICABLE FOR THE DAMAGE CAUSED BY THE WIND AND WATER DAMAGE IN THE AMOUNT OF $56,634.08.
(3). PAY STATUTORY INTEREST ON THE AMOUNT OF UNPAID CONTRACT DAMAGES FROM THE DATE OF THE LOSS TO THE PRESENT TIME PURSUANT TO F.S. §627.70131, AND PAY REASONABLE COSTS INCURRED.
A COPY OF THIS FORM SUBMITTED TO THE FDFS HAS BEEN SENT TO THE FOLLOWING PARTIES PROVIDING THEM NOTICE OF THE FILING OF THE CIVIL REMEDY NOTICE:
TOWER HILL INSURANCE
ATTN: CLAIMS DEPARTMENT AND NAETA BEST
PO BOX 142230
GAINESVILLE, FL 32614
SENT VIA EMAIL & FAX: CLAIMS@THIG.COM
(352) 332-7999
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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.
Before submitting a Notice using this system, please verify that all text has been entered
correctly and completely. Once the Notice has been submitted, the text cannot be changed
or deleted.
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DFS-10-363
Rev. 10/14/2008
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