Civil Remedy Notice of Insurer Violations
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Filing Number:     798073
Filing Accepted:  12/23/2024
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Complainant
Last/Business Name *  
BARBARA MIZELL   First Name   BARBARA MIZELL
Street Address * 5113 SOUTHEAST 4TH STREET
City, State Zip * OCALA, FL 34471
Email Address * BARBMIZELL37@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   BARBARA MIZELL   First Name   BARBARA MIZELL
Policy # * W013568404 Claim #* 3300504940
Attorney
Attorney is Applicable
Last Name* LINE First Name * KACI Initial A
Street Address* 2431 LEE ROAD
City, State Zip* WINTER PARK , FLORIDA 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):* 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 BARABARA MITZELL. 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, August 4, 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 a hail and windstorm causing extensive damage to the property. TOWER HILL INSURANCE (“TOWER HILL”) received timely notice of the claim and assigned claim number 3300504940. 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 hail and winds so severe that caused damage and requiring a full roof replacement, gutters, exterior repairs and extensive 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. However, TOWER HILL continues to use more restrictive definitions of definitions of “hail” to deny a hail claim. Furthermore, TOWER HILL intentionally did not photograph multiple damaged area of the Insured’s property and did not use clearly damaged property areas while determining the covered loss. 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 $63,603.58 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
nweber@thig.com 02-19-2025 February 19, 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 : Barbara Mizell Policy Number: W013568408 Claim Number : 3300504940 Date of Loss: 08/04/2024 DFS File Number: 798073 Accepted Date : 12/23/2024 Dear Sir/Madam: We are in receipt of a Civil Remedy Notice of Insurer Violation (“CRN”) filed on behalf of Barbara Mizell, our insured. This correspondence will serve as Tower Hill Exchange Insurance 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)(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. 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; making claims payments to insureds or beneficiaries not accompanied by a statement; 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; denying claims without conducting reasonable investigations, failing to affirm or deny full or partial coverage of claims; failing to promptly provide a reasonable explanation in writing; failing to promptly notify the insured of any additional information necessary; failing to clearly explain the nature of the requested information, 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 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 “Tower Hill knows it has failed to issue proper payment for the clearly covered loss; Tower Hill has failed to comply with its loss settlement provision; Tower Hill is delaying and denying the claim.” Noticeably absent from the CRN, is the name of the purportedly “unqualified” individual who was retained to evaluate the cause of the loss, the basis for believing that the loss was covered under the Policy, the “sufficient evidence” provided to Tower Hill to support coverage for the subject claim. 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, “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 BARABARA MITZELL. 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.” 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. In that same regard, the Insured failed to name a single individual who engaged in the purported bad faith handling making it impossible to consider or cure the alleged allegations. Without knowledge of the individuals who purportedly violated the statutory provisions, Tower Hill is unable to even track down the complained of conduct. The CRN references “ALL ADJUSTERS, SUPERVISORS, MANAGEMENT, AND INDIVIDUALS ASSOCIATED WITH OR RETAINED BY TOWER HILL INSURANCE INVOLVED IN THIS CLAIM”. As noted above, because this claim was denied, 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 a denial. 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. There is no evidence that the claimed roof damage is covered under the policy and the CRN is devoid of any facts in support of same. Similarly, as it relates to the purported statutory violation for the failure to promptly settle claims, this policy is clear that there must be a direct physical loss and that there is no coverage for wear, tear and deterioration. Tower Hill is unable to settle a claim that is not covered under the insurance policy and the mere statement in the policy that “TOWER HILL intentionally did not photograph multiple damaged area of the Insured’s property and did not use clearly damaged property areas while determining the covered loss.” Not only did the independent adjuster photograph the damaged areas, but a subsequent inspection by an engineer also photographed the damaged areas. The fact that the CRN claims “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.” 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 individuals were referenced, 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 coverage decision, is not enough to allege bad faith. Conversely, Tower Hill directly refutes these allegations and can state that a licensed adjuster investigated the claim, as well as an independent expert engineering firm, 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 reported a claim on August 8, 2024 related to alleged windstorm/hail damage that occurred on August 4, 2024. Tower Hill assigned claim no. 3300504940 to this claim. Additionally, insured filed a previous claim on September 9, 2022 for windstorm damage with the same areas of damage as being claimed on this claim. The day after the reporting of the claim, Tower Hill sent the insured a Homeowner Bill of Rights letter and assigned an independent adjuster to inspect the loss. Tower Hill inspected the loss on August 16, 2024, and a subsequent inspection by an engineer took place on September 3, 2024. The engineer determined that the “…house and shed roof revealed no creased, torn, or missing shingles consistent with wind-related damage. The unsealed shingles were due to thermal movement and were not due to wind-related damage. The moisture intrusion in the garage was a historical and ongoing condition due to hidden deficiencies on the metal ridge vent over the garage of the house. The moisture intrusion was not the result of a storm-created opening in the roofing or the exterior cladding.” On October 17, 2024, Tower Hill sent a letter to the insured informing him that his claim for roof damages had been denied as the loss was not covered by the Policy. The letter further detailed an explanation for why the loss was not covered including that the inspection revealed that there “was widespread shingle failures on all sides of the roof caused by thermal movement as the shingles and sealant repeatedly expand and contract due to temperatures and moisture exposures.” The letter also cited applicable language from the Policy for the denial as the aforementioned causes of loss are not covered under the policy. A Notice of Intent to Litigate was received on December 26, 2024 and a settlement offer was made, however, there has been no response to the settlement offer. 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), the names of the individuals involved in 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. The CRN does not contain the statement that the notice is given in order to perfect the right to pursue the civil remedy authorized by this section. 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