Filing Number: 800778
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| Filing Accepted: 1/13/2025 |
| Last/Business Name
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| Street Address
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4322 NW 44TH TERRACE |
| City, State Zip
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COCONUT CREEK,
FL
33073
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| Email Address
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LCHILESE@COMCAST.NET |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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CHILES |
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First Name |
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LISA |
| Policy # * |
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W012650525 |
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Claim #* |
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3300459511 |
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Attorney is Applicable
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| Last Name* |
VELMOSKY
First Name *
AARON
Initial
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| Street Address* |
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800 EAST BROWARD BLVD, SUITE 501 |
| City, State Zip* |
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FT. LAUDERDALE
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FL
33301
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| Email Address * |
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AV@WEKLAW.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):*
ROBERT SCOTT FULLER, PA; CHLOE WILEY
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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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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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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)(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)(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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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Section I - Conditions - Loss Payment;
Section I - Conditions - Loss Settlement;
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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.
Lisa Chiles (the "Insured") purchased an insurance policy ("Policy") from Tower Hill Insurance Exchange Company ("Tower Hill"), with effective coverage on the date of the loss, on or about September 28, 2022, and policy number W012650525 to insure her home located at 4322 NW 44th Terrace, Coconut Creek, FL 33073 (the "Property"). On or about September 28, 2022, the aforementioned Property suffered severe damage as a result of Hurricane Ian’s winds and rains. As a result of this event, the Property sustained immediate direct damage to the roofing system; and, subsequent ensuing water damage to the garage, hallway, foyer and living room. After discovering the nature of the damage, the Insured promptly reported her claim to Tower Hill. Tower Hill acknowledged receipt of the claim by generating claim number 3300459511. Tower Hill sent its field adjuster to inspect the Property. At that time, the field adjuster was afforded an opportunity to inspect all of the sustained damage.
Upon discovering the sustained damage, the Insured retained Tarp & Restoration Geeks Corp. to performed tarping services in the sum of $6,120, mitigation services in the sum of $11,753.37; mold remediation services in the sum of $9,820.10 and re-tarping services in the sum of $1,040 (to allow Tower Hill to inspect the damage property). These services totaled $28,733.47. The Insured also retained Mold Details to perform a mold assessment.
To aid in the presentation of her claim to Tower Hill, the Insured also retained Home Safe Claims (“HSC”). counsel. HSC inspected the Property, assessed the observed damage and generated an estimate necessary to repair the damage arising from the Loss. Thereafter, the Insured executed a sworn statement in proof of loss in the sum of $110,719.70, which HSC sent to Tower Hill along with a supporting estimate.
After completing its investigation of the sustained damage, Tower Hill opened coverage to perform repairs, in the garage, living room, foyer, dining room, tv room/kitchen, east hall, stairway and upstairs hallway. These amounts were set forth in an estimate drafted by Tower Hill’s field adjuster in the sum of $13,400.10.
Tower Hill also opened coverage in the sum of $19,608.65 for post-loss mitigation services performed by Tarp & Restoration Geeks Corp. and $2,200 for services performed to Mold Details. This determination was set forth in correspondence dated August 30, 2023. However, Tower Hill did not provide any explanation as to how the $19,608.65 or $2,200 amounts were calculated. In total, the amounts paid on the claim totaled $21,808.65.
Tower Hill also retained an engineer to inspect the property. Based upon the engineer’s opinions, Tower Hill denied coverage for the sustained damage to the roofing system. Based upon these findings and its repeated concession of coverage for the sustained interior damage and mitigation services, it is apparent that Tower Hill’s investigation of the claim was not prejudiced.
As the Insured objected to Tower Hill’s coverage determination, she retained counsel, who submitted a notice of intent to initiate litigation (the “Notice”) in reliance upon HSC’s estimate on or about May 21, 2024.
In response to receipt of the Notice, Tower Hill made an underwhelming settlement offer. Thus, suit was filed. In response to the litigation, Tower Hill raised numerous affirmative defenses asserting that coverage for the claim was precluded due to Plaintiff failure to comply with her post-loss obligations owed under the insurance contract, including her alleged failure to promptly report the loss, promptly submit a sworn statement in proof of loss, failure to show and retain damaged property, failure to protect property from further damage and failure to keep records of repairs.
By stating the above detailed facts, it is clear that Tower Hill has violated the following Florida 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 their interest;
• 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) 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; or
• 626.9541(1)(i)(3)(b) Failing to adopt and implement standards for the proper investigation of claims;
• 626.9541(1)(i)(3)(c) Failing to acknowledge and act promptly upon communications with respect to claims, by failing to respond to the Insured’ public adjuster, and Insured’ counsel with respect to supplemental requests for payments;
• 626.9541(1)(i)(3)(f) Failing to promptly provide a reasonable explanation in writing to the Insured and/or their public adjuster of the basis in the insurance policy, in relation to the facts or applicable law, for the offer of a compromise settlement;
To date, Tower Hill has failed to accept and fully perform its obligations under the operable insurance contract. The Insured’s property remains in an unsafe condition because he has not been paid the necessary, covered insurance proceeds sufficient to return the Property to its pre-loss condition. Similarly, Tower Hill did not identify the true RCV value that would allow the Insured to return the Property to its pre-loss condition.
As a direct result of Tower Hill’s initial insufficient investigation and handling of the claim, deficient extension of coverage and subsequent breaches of not only the policy of insurance, but also Florida Statutes, the Insured had no choice other than to seek the help of licensed professionals to assist her, including, but not limited to a public adjuster and legal counsel. Considering the aforementioned conduct, it is irrefutable that Tower Hill knowingly and intentionally, and in bad faith delays the claims process in order to further disadvantage the Insured. The financial detriment caused to the Insured is a direct result of Tower Hill’s dismissive, reckless treatment of the claims process. The Insured submitted all available requested documents in her possession in a timely fashion, made the Property available for inspection and submitted additional documentation in support of the insurance proceeds sought under the Policy. Nevertheless, Tower Hill failed to properly assess this information and reach the logical conclusion resulting in its gross mismanagement of the claim. Moreover, despite its prior concession of coverage and waiver of its coverage defenses as result thereof, Tower Hill has sought to delay the legal proceedings by asserting its previously waived coverage defenses to avoid its clear further indemnity obligation to the Insured.
To deny the Insured the remaining benefits clearly due and owing under the Policy, for which she has time and time again been making premium payments for and after she have satisfied all his obligations is morally and ethically reprehensible, and reeks of Unfair Claims Practice and Bad Faith. Upon information and belief, the above identified actions taken by Tower Hill, among others, were made so often as to constitute a general business practice, evidencing a motive to enhance Tower Hill’s profits, and designed to cause a detrimental effect to its policyholders.
This notice is given to perfect the right to pursue the civil remedy authorized by Section 624.155, Florida Statutes, should Tower Hill fail to cure the violations set forth in this Civil Remedy Notice within the given cure period. Therefore, to cure the defects outlined in this Civil Remedy Notice, Tower Hill must: (1) Immediately tender all proceeds due and owing to the Insured that are fairly owed to the Insured under the insurance policy that would reasonably compensate the Insured for the cost to replace the roofing system in the sum of $91,840.71; (2) Immediately tender all proceeds due and owing to the Insured that are fairly owed to the Insured under the insurance policy that would reasonably compensate the Insured for the cost to repair the remainder of the incurred amounts for mitigation services $9,124.82; (3) Agree to reimburse the Insured's reasonable attorneys’ fees and costs for having to become involved to resolve the claim; (4) Agree to reimburse the Insured for interest on the amount of benefits that was found to be due and owing to the Insured, relating back to the date of loss.
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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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