Filing Number: 797374
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| Filing Accepted: 12/18/2024 |
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JOHN A. RYBA, INDIVIDUALLY AND AS TRUSTEE OF THE JOHN A. RYBA REVOCABLE TRUST DATED 05/20/2020
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First Name |
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| Street Address
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1932 CRESTVIEW WAY |
| City, State Zip
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NAPLES,
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34119
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| Email Address
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ARTISTIC_CABINETRY@YAHOO.COM |
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Insured |
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| Last/Business Name* |
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JOHN A. RYBA, INDIVIDUALLY AND AS TRUSTEE OF THE JOHN A. RYBA REVOCABLE TRUST DATED 05/20/2020 |
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First Name |
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| Policy # * |
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W012857489 |
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Claim #* |
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3300501122 |
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Attorney is Applicable
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| Last Name* |
PETTINATO
First Name *
DAVID
Initial
J
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| Street Address* |
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1000 W. CASS STREET |
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TAMPA
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FLORIDA
33606
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| Email Address * |
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DPETTINATO@OLDERLUNDYLAW.COM, DJP-PARALEGALS@OLDER |
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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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,
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NAIC Company Code 17179 |
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| Name of individual responsible for violation (if any):*
JENNIFER LEWIS, RODRIGO J. VARGAS, AND ALL OTHER ADJUSTERS, SUPERVISORS, MANAGEMENT AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY TOWER HILL INSURANCE EXCHANGECOMPANY INVOLVED IN THE CLAIM.
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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 Denial
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Claim Delay
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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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Other
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Failure to properly investigate claim and with due regard to Insured’s interest
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Other
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Failure to acknowledge and act promptly to communications regarding claim
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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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| 624.155(1)(b)(3) |
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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.
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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)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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| 626.9541(1)(i)(3)(f) |
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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.
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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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| 626.9541(1)(i)(4) |
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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).
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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.
ADD’L STATUTES VIOLATED
§627.70131(3)(d)
§627.70131(7)(a)
POLICY LANGUAGE
The Insured may not be in possession of a complete copy the applicable policy of insurance, however, the specific policy language relevant to the violations outlined below is contained within Tower Hill Insurance Exchange Company’s Homeowners policy, Policy No. W012857489, issued to the Insured including, but is not limited to, the following:
Coverage A-Dwelling provisions (HO-00-03-04-91 / RPI HO 09 SP3 08 21)
Coverage B-Other Structures provisions (HO-00-03-04-91 / RPI HO 09 SP3 08 21)
Coverage C-Personal Property provisions (HO-00-03-04-91 / RPI HO 09 SP3 08 21)
Coverage D-Loss of Use provisions (HO-00-03-04-91 / RPI HO 09 SP3 08 21)
- Additional Living Expenses
Additional Coverages provisions (HO-00-03-04-91 / RPI HO 09 SP3 08 21)
- Debris Removal
- Reasonable Emergency Repairs
- Trees, Shrubs and Other Plants
- Glass or Safety Glazing Material
- Law and Ordinance
Windstorm Protective Devices endorsement (HO-04-21-10-94)
Ordinance or Law- Amount of Coverage endorsement (HP-0477-00 (01/09))
Limited Fungi, Wet or Dry Rot, or Bacteria Coverage endorsement (RPI HO 09 FCE 09 16)
Hurricane Deductible endorsement (RPI HO 09 HD 09 18)
Special Provisions-FL. endorsement (RPI HO 09 SP3 08 21)
The Declarations Page (RPI-HO-DEC (08/21))
Loss Payment or Loss Settlement provisions (HO-00-03-04-91 / RPI HO 09 SP3 08 21)
Duties in Event of Loss Policy provisions (HO-00-03-04-91 / RPI HO 09 SP3 08 21)
The insurance policy's definition sections (HO-00-03-04-91 / RPI HO 09 SP3 08 21)
The insurance policy's exclusion of coverage provisions (HO-00-03-04-91 / RPI HO 09 SP3 08 21)
Please advise if there are other applicable policy provisions that are not cited above but would provide coverage to the Insured for the September 28, 2022, Hurricane Ian / wind and/or hail loss.
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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.
In Florida, the work of adjusting insurance claims engages the Public Trust. TOWER HILL INSURANCE EXCHANGECOMPANY (“TOWER HILL”) has breached this duty by its failure or refusal to acknowledge its Insured’s claim of loss.
TOWER HILL 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 as set forth above. TOWER HILL has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s insurance claim for damages.
To date, notwithstanding the Insured’s pleas, TOWER HILL has continued to refuse to acknowledge its obligation to acknowledge and pay the full amount of its Insured’s claim.
This complaint is made on behalf of the Insured, John A. Ryba, individually and as Trustee of the John A. Ryba Revocable Trust dated 05/20/2020 (“MR. RYBA”). Further, this complaint is a statement that notice is hereby given in order to perfect the right to pursue the civil remedy authorized and pursuant to Florida Statute §624.155.
In consideration of the premium paid to it by MR. RYBA, TOWER HILL issued an Homeowners policy, Policy No. W012857489 (hereinafter referred to as “the Policy”), to MR. RYBA wherein the insurance policy provided coverage for all losses, including Hurricane Ian / wind and/or hail, except those losses which were expressly excluded.
The policy was in full force and effect at the time the damage occurred as a result of Hurricane Ian / wind and/or hail, and the ensuing damages as a direct result thereof, to the insured premises located at 1932 Crestview Way, Naples, FL 34119, on or about September 28, 2022.
On or about September 28, 2022, Hurricane Ian, a large and destructive Category 5 storm, struck the state of Florida, becoming the deadliest hurricane to strike the state of Florida in over 80 years. Hurricane Ian was the third-costliest weather disaster on record, causing complete destruction or extensive property damage to the structures, homes, businesses, and roadways in its path. Millions of people were left without power, while many others were entrapped or forced to seek refuge elsewhere. As a result of the extreme damage and loss of life, the name Ian will never be used again for an Atlantic hurricane.
MR. RYBA was a victim of Hurricane Ian’s destruction when his insured home suffered exterior and interior damages due to hurricane-force winds, and ensuing damages, including, but not limited to, extensive wind damage to the roof system, allowing water intrusion into the home, causing interior water damages throughout the home.
MR. RYBA’S insured property sustained damages to the interior and exterior of the home. On the exterior, MR. RYBA’S insured property sustained damages, including but not limited to, the roof system, the gutter, and the screened lanai.
On the interior, MR. RYBA’S insured property sustained damages, including but not limited to, the insulation, drywall, paint, ceiling, windows, etc. in the garage, hall bathroom, etc.
MR. RYBA timely notified TOWER HILL of the damages and opened a claim pursuant to the terms and conditions of the Policy.
In response, TOWER HILL assigned the claim to its representative to adjust and investigate the loss, as well as a field adjuster to inspect the damages. TOWER HILL’S representative visited the insured property and performed a cursory and inadequate investigation of the damaged property.
TOWER HILL retained experts from its preferred vendor list, ProNet Group, Inc., instead of retaining objective experts to provide it with thorough and completely objective opinions and conclusions. TOWER HILL retained “hired gun” experts to provide it with an outcome-oriented investigation and opinions to deny the claim, and/or reduce the amount of the claim pay out. This is unfair claims handling practices.
On or about July 26, 2024, TOWER HILL submitted a Denial Letter to MR. RYBA, stating their engineer “did not observe any roof tiles that were lifted, displaced, or broken in a manner consistent with wind”, and “the weather data researched by the engineer indicate the wind speed was insufficient to damage your tile roof”.
In contrast to TOWER HILL’S investigation of the damages, MR. RYBA’S damage estimate from Utopia Public Adjusting, totaled a loss of $86,394.70 in Dwelling damages (Coverage – A). This estimate was a more inclusive representation of the damages sustained to MR. RYBA’S insured property.
With regards to MR. RYBA’S claim determination process, TOWER HILL has misrepresented the extent of damages to his insured property and has delayed the process of bring its Insured’s home back to pre-loss condition.
To date, MR. RYBA has not received any owed insurance benefits from TOWER HILL.
To date, TOWER HILL has failed to tender any supplemental insurance benefits. TOWER HILL has admitted that MR. RYBA sustained covered damages as a result of the Hurricane Ian / wind and/or hail loss that occurred on or about September 28, 2022 but has denied tendering all owed insurance benefits to MR. RYBA. Pursuant to Florida Statute §626.9541(1)(i)(4), TOWER HILL is required to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 90 days after TOWER HILL received notice of the residential property insurance claim, determine the amounts of partial or full benefits, and agree 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). As TOWER HILL has failed to do so, TOWER HILL has wrongfully denied coverage.
Since the beginning of the claim, TOWER HILL has engaged in a pattern of delay, denial, and reckless disregard for MR. RYBA’S rights. The actions of TOWER HILL listed herein have been continuing in nature and given the totality of the circumstances, which includes TOWER HILL’S adjustment, actions and/or omissions post the filing of this CRN. MR. RYBA contends that given the past experience in this matter with TOWER HILL, it is reasonably foreseeable that TOWER HILL’S current actions will extend to its entire conduct in the handing of his claim, including the acts or omissions of TOWER HILL and/or its representatives, until the final resolution of his claim. As such, MR. RYBA contends adequate notice has been given should TOWER HILL’S actions and violations listed herein continue after the expiration of this notice.
TOWER HILL has failed and/or refused to settle the claim when it could and should have done so had it acted fairly and honestly towards MR. RYBA, and has failed to take into account the information and evidence provided that contradict its decisions.
Even upon receipt of additional and supporting evidence to the contrary, TOWER HILL has continued to stand by its claim denials. As such, MR. RYBA does not anticipate TOWER HILL will rescind its denial of his claim.
TOWER HILL’S conduct has been reckless and unfair to MR. RYBA, and has caused and continues to cause additional damages throughout the property. This is evidenced by the delay in paying the claim and the failure of TOWER HILL to evaluate the claim in total.
To date, TOWER HILL has failed and/or refused to provide MR. RYBA with all the insurance benefits due and owing and has not tendered the full amount needed to repair the Property despite knowing that MR. RYBA has sustained covered damages to his insured property.
As TOWER HILL must admit, it is implied within every insurance policy a duty of good faith and fair dealings. In an insurance contract, each party is prevented from interfering with the other’s right to benefit from the contract. The obligations of good faith and fair dealings encompass qualities of decency and humanity inherent in its responsibilities as a fiduciary. TOWER HILL is bound to conduct itself with the utmost good faith for the benefit of MR. RYBA. However, TOWER HILL has failed to comply with the obligations in connection with this claim and has never looked at the claim or the contract for insurance with good faith and fair dealing. Instead, TOWER HILL has looked for ways not to pay the claim in full, or at all, and these actions have been to the detriment of MR. RYBA.
The adjusters assigned to this claim have a duty to adjust and treat all claims equally. Since the beginning of this claim the representatives on behalf of TOWER HILL have approached this investigation in a manner prejudicial to MR. RYBA. TOWER HILL is using either untrained or improperly trained adjusters in connection with this claim. TOWER HILL should have been adjusting the loss with MR. RYBA but instead, it was looking for ways not to pay the claim at all, or pay the claim in full. If TOWER HILL handles all the claims in the manner in which MR. RYBA’S claim was adjusted, then it is improperly handling all claims.
TOWER HILL has refused and/or failed to comply with The Policy’s cooperation and/or “Loss Payment” provision. Under The Policy, TOWER HILL was to timely tender undisputed insurance benefits to MR. RYBA. TOWER HILL has failed and/or refused to timely tender owed insurance benefits, undisputed or otherwise. This is a breach of The Policy.
TOWER HILL has refused and/or failed to cooperate and/or “Adjust the Loss” by cooperating with MR. RYBA during the claims adjustment process in compliance with The Policy’s “Loss Payment” provision. This is a breach of The Policy.
The concept of insurance is that insurance is the insurer’s granting of timely and prompt indemnity or security against a contingent loss. Florida Statute §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 MR. RYBA may mitigate his damages and to put him back into the position he was in prior to the loss as quickly as possible. TOWER HILL has breached this duty.
TOWER HILL has refused and/or failed to tender all insurance proceeds to MR. RYBA upon demand. TOWER HILL’S refusal and/or failure to settle the insurance claim when under all circumstances it could have and should have done so had it acted fairly and honestly towards MR. RYBA is wrongful conduct. Furthermore, MR. RYBA contends that TOWER HILL’S adjusters and/or representatives financially benefit by such wrongful conduct.
It is clear that TOWER HILL’S adjusters have also failed to adhere to insurance industry rules and guidelines when adjusting a first party claim. It is also evident that TOWER HILL violated the Florida unfair claims practices, the adjuster’s ethical code of conduct, and acted irresponsibly in the handling of its insured’s claims. In this case, MR. RYBA paid a hefty premium for a service, the service is called claims adjusting (I encourage you to read the book titled, “The Claims Environment” written by James J. Markham, Kevin M. Quinley, and Layne S. Thompson-this book is taught in every first year AIC course).
The claim professional must dispense his or her knowledge and skill for the benefit of society. The general public expects claims representatives to pay all legitimate claims promptly and fairly. The claim professional must harness all of his or her knowledge and expertise to accomplish the objectives of the claim function. He or she must also adhere to the highest degree of ethical conduct. In addition to interacting with other insurance personnel and service providers in a professional manner, the claims professional must deal with public’s and regulator’s expectations. Insurance Companies provide such a vital and necessary service to society that the selling and servicing of insurance is imbued with a public trust. James J. Markham, Kevin M. Quinley, Layne S. Thompson, “The Claims Environment”, Insurance Institute of America, 1st ed., 1993.
Accordingly, TOWER HILL has a contractual and statutory obligation to investigate all possible bases which might support MR. RYBA’S claim and cannot deny a claim without thoroughly investigating the foundation for its denial or basis for withholding insurance benefits. TOWER HILL violated its obligations here.
- TOWER HILL has a contractual and statutory obligation to make a perfunctory investigation, not ignoring evidence that would support MR. RYBA’S claim. TOWER HILL violated its obligations here.
- TOWER HILL has a contractual and statutory obligation not to look the other way when confronted with facts revealing the possibility of coverage and resisting reasonable interpretations of its policy. TOWER HILL violated its obligations here.
- TOWER HILL has a contractual and statutory obligation not to deny the claim based on standards known to be impermissible or on an interpretation contrary to established law. TOWER HILL violated its obligations here.
These actions and violations were either done intentionally or as the result of TOWER HILL’S failure to adopt and implement the proper standards of the investigation and adjustment of claims.
Overall, TOWER HILL’S investigation of the claim was inadequate and contrary to its obligations under the insurance policy and Florida law.
MR. RYBA has done everything legally requested by TOWER HILL to date. To cure the violations set forth in this Civil Remedy Notice, TOWER HILL must now agree to acknowledge its duties and obligations under the law in adjusting its insured’s claim, and tender rightfully owed insurance benefits to return MR. RYBA to his pre-loss condition.
Further, to cure the violations set forth in this Civil Remedy Notice, MR. RYBA hereby requests that TOWER HILL tender at this time, or prior to the expiration of the statutory cure period, the amount of MR. RYBA’S damage estimate and demand which accurately reflects the true nature and extent of MR. RYBA’S damages. Therefore, TOWER HILL should tender $87,944.70 RCV (less any prior payments, depreciation, excess policy limits, and/or deductible) in insurance benefits at this time.
Although MR. RYBA has made a demand for payment in the amount of $87,944.70 RCV (less any prior payments, depreciation, excess policy limits, and/or deductible) and has provided TOWER HILL with all the necessary documentation in support thereof, he is still willing to consider and to potentially accept any reasonable counter-offer made by TOWER HILL. Therefore, if TOWER HILL is not in agreement with MR. RYBA’S reasonable demand for payment of his rightfully owed insurance benefits being submitted at this time, MR. RYBA hereby requests that TOWER HILL now make a reasonable counter-offer before the expiration of the cure period. MR. RYBA still hopes that his claim can be resolved amicably.
The concept of insurance is that insurance is the insurer’s granting of timely and prompt indemnity or security against a contingent loss. Florida Statute §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 MR. RYBA may mitigate his damages and to put him back into the position he was in prior to loss as quickly as possible. TOWER HILL breached this duty.
This notice is given in order to perfect the right to pursue the civil remedy authorized and pursuant to Florida Statute §624.155, including any and all bad faith/extra contractual, should TOWER HILL fail to cure the violations set forth in this Civil Remedy Notice within the given cure period.
While no specific “cure amount” is required for this Civil Remedy Notice to be valid, MR. RYBA will consider the allegations contained herein “cured” if TOWER HILL, without any requirement for a release:
(1) Immediately tenders the amount of MR. RYBA damage estimate in the amount of $86,394.70 RCV (less any prior payments, depreciation, excess policy limits, and/or deductible), which accurately reflects the true nature and extent of the damages to the Dwelling / Other Structures;
(2) Agrees to reimburse MR. RYBA for his expenses incurred by having to retain a public adjuster to present his claim; and
(3) Immediately tenders the amount of statutory interest due and owing to MR. RYBA pursuant to Florida Statute §627.70131(5)(a).
(4) Immediately provides MR. RYBA with the documentation TOWER HILL has used and/or continues to contend, supports the claim determination made by TOWER HILL in the adjustment of MR. RYBA’S claim. Specifically, TOWER HILL must provide MR. RYBA with its claim estimate(s), supporting photographs and/or videos, as well as any and all reports of any expert(s) or other individuals retained on behalf of TOWER HILL upon which TOWER HILL has relied on in reaching and/or further supporting its coverage determination in MR. RYBA’S claim.
MR. RYBA continues to remain open to a fair and reasonable settlement offer from TOWER HILL in an effort to avoid additional delay, costs and expenses, and hereby request the same prior to the expiration of the statutory “cure” period. MR. RYBA has provided TOWER HILL with all necessary estimates, documentation, etc. in support of the claim. TOWER HILL must act fairly and honestly in its response to MR. RYBA’S request for a prompt, fair and reasonable settlement offer and resolution of the claim.
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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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