Civil Remedy Notice of Insurer Violations
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Filing Number:     802010
Filing Accepted:  1/17/2025
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Complainant
Last/Business Name *  
DE LA IGLESIA   First Name   PABLO
Street Address * 4264 MAHOGANY RIDGE DRIVE
City, State Zip * WESTON, FL 33331
Email Address * INSURED@MCDONALDBARNHILL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   DE LA IGLESIA   First Name   PABLO
Policy # * P003604703 Claim #* 3300361286
Attorney
Attorney is Applicable
Last Name* MCDONALD First Name * ANDREW Initial P
Street Address* 505 S. MAGNOLIA AVENUE
City, State Zip* TAMPA , FL 33606
Email Address * AMCDONALD@MCDONALDBARNHILL.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):* DANIELLE TARTER. CLAIRE HATCHER, “CHAMBERS IA”
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.
 
626.9541(1)(i)(1) Attempting to settle claims on the basis of an application, when serving as a binder or intended to become a part of the policy, or any other material document which was altered without notice to, or knowledge or consent of, the insured.
626.9541(1)(i)(2) 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.
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.
626.9541(1)(i)(4) 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).
626.9541(1)(i)(3)(j) Altering or amending an insurance adjuster’s report without: (I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and (II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or (III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change;
* Specific policy language that is relevant to the violation.
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* ADDITIONAL Statutory provision(s) which the insurer allegedly violated. * §624.155(1)(a) Any person may bring a civil action against an insurer when such person is damaged: By the commission of any of the following acts by the insurer: 1. Section 626.9541(1)(i), (o), or (x); §624.155(1)(a) Any person may bring a civil action against an insurer when such person is damaged: By the commission of any of the following acts by the insurer: 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 towards its insured and with due regard for his interests; 2. Making claims payments to insures or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made; or 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. §624.155 (5) No punitive damages shall be awarded under this section unless the acts giving rise to the violation occur with such frequency as to indicate a general business practice and these acts are: a. Willful, wanton, and malicious; b. In reckless disregard for the rights of any insured; or c. In reckless disregard for the rights of a beneficiary under a life insurance contract; (8) The damages recoverable pursuant to this section shall include those damages which are a reasonably foreseeable result of a specified violation of this section by the authorized insurer and may include an award or judgment in an amount that exceeds the policy limits. §627.70131 Insurer’s duty to acknowledge communications regarding claims; investigation (1)(a) Upon an insurer’s receiving a communication with respect to a claim, the insurer shall, within 14 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer which reasonably prevent such acknowledgement. If the acknowledgement is not in writing, a notification indicating acknowledgement shall be made in the insurer’s claim file and dated. A communication made to or by an agent of an insurer with respect to a claim shall constitute communication to or by the insurer. (b) As used in this subsection, the term “agent” means any person to whom an insurer has granted authority or responsibility to receive or make such communications with respect to claims on behalf of the insurer. (c) This subsection shall not apply to claimants represented by counsel beyond those communications necessary to provide forms and instructions. (2) Such acknowledgement shall be responsive to the communication. If the communication constitutes a notification of a claim, unless the acknowledgement reasonably advises the claimant that the claim appears not to be covered by the insurer, the acknowledgement shall provide necessary claim forms, and instructions, including an appropriate telephone number. (3) Unless otherwise provided by the policy of insurance or by law, within 10 working days after an insurer receives proof of loss statements, the insurer shall begin such investigation as is reasonably necessary unless the failure to begin such investigation is caused by factors beyond the control of the insurer which reasonably prevent the commencement of such investigation. (4) For purposes of this section, the term “insurer” means any residential property insurer. (5) Within 90 days after an insurer receives notice of a property insurance claim from a policyholder, the insurer shall pay or deny such claim unless the failure to pay such claim is caused by factors beyond the control of the insurer which reasonably prevent such payment. Failure to comply with this subsection constitutes a violation of this code. * Specific policy language that is relevant to the violation. * Tower Hill Signature Insurance Company (now Tower Hill Insurance Exchange (“Tower Hill”)) failed to adequately adjust and pay the claim covered under the subject insurance policy. Specifically, but not limited to, Tower Hill failed to properly apply the Loss Settlement and Loss Payment provisions of the policy. In addition to the policy sections specifically cited herein, any endorsements or changes to said sections are relevant to the Insured’s claim for civil remedy. There may be additional policy language relevant to this violation that may be discovered.
 
* Facts and circumstances giving rise to the violation.
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Pablo De La Iglesia’s claim results from damage from a plumbing leak which occurred on or about November 10, 2020, to his property located at 4264 Mahogany Ridge Dr., Weston FL 33331. The property was insured under policy number P003604703. The water from the leak spread throughout the property causing damage to the walls, baseboards, and floors in multiple rooms, as well as affecting cabinetry. The claim was reported to Tower Hill Signature Insurance Company (now Tower Hill Insurance Exchange (“Tower Hill”)) and was assigned claim number 3300361286. Tower Hill assigned a series of desk adjusters, including Danielle Tarter and Claire Hatcher, and sent a field adjuster only identified as “Chambers IA” to inspect the property. Chambers inspected the property and estimated the damage to the property to total just $12,657.93 for the dwelling. This estimate failed to include the full scope or price of the damage, including only one cabinet, minimal floor amounts, and inconsistent line items. After the deductible Tower Hill paid just $8,651.84 for the loss to the dwelling. Mr. De La Iglesia hired Stellar Public Adjusting Services (“Stellar”) to represent his interests in the claim. Stellar inspected the property and prepared an estimate totaling $113,397.75. Stellar sent their estimate, along with photos, plumbing, and mold documentation and requested supplemental payment, as well as appraisal. Tower Hill refused to proceed with appraisal, further delaying the claim. Unfortunately, there is no evidence Tower Hill has ever actually considered the documentation sent by Stellar or done anything further to adjust the loss. It took the insured retaining counsel and filing a motion to compel appraisal to force Tower Hill to comply with its policy’s terms. Tower Hill’s course of action has delayed indemnification while the Insured’s costs continue to rise. In Florida, the work of adjusting insurance claims engages the public trust. Tower Hill has breached this duty in the adjustment of this loss by refusing to provide proper indemnity, unnecessarily delaying resolution of the claim, and failing to take into consideration documentation provided to them which would support compensation. Tower Hill has failed to create and implement adequate guidelines for proper investigation of claims handling and for training and supervision of employees and representatives, which have resulted in some of the statutory violations set forth above. Tower Hill charged the Insureds a substantial premium for this coverage but has refused to tender proper payment when under all circumstances it could have and should have done so had it acted fairly and honestly. Additionally, it appears this is done companywide. The Insureds have been forced to retain legal counsel to protect their interests. Therefore, to cure the defects outlined in this Civil Remedy Notice, Tower Hill must: 1. Immediately tender all insurance monies due to the Insureds for the loss; 2. Act fairly and honestly towards the Insureds and with due regard for her interests in attempting to settle the claim; 3. Pay statutory interest on the amount of unpaid contractual damages from the date the claim was reported; 4. Cease and desist all present and future bad faith actions with regard to the Insureds’ claim; Failure to cure all defects during the 60-day safe harbor period may result in additional extra-contractual damages.
Comments
User Id Date Added Comment
vgomez@kelleykronenberg.com 03-05-2025 Although per an agreement with our office, your office has agreed to withdraw the above referenced Civil Remedy Notice (“CRN”) Filing Number 802010, please accept this correspondence as Tower Hll Insurance Exchange (“Tower Hill”) response to the CRN filed by you, on behalf of Pablo De La Iglesia (“Insured”), dated January 17, 2025. After reviewing the CRN, Tower Hill denies all allegation contained in the Insured’s CRN. Tower Hill conducted a thorough review of its handling of the Insured’s claim, subject Claim No. 3300361286. Tower Hill denies that it has violated any of the statutes as alleged in the CRN. At all times, Tower Hill acted in good faith, fairly and honestly toward its Insured and with due regard for the Insured’s interests. At the outset, Tower Hill denies that any of its actions taken with regard to the Insured’s claim has resulted in a violation of Florida’s bad faith laws as alleged in the CRN. Rather, Tower Hill has acted at all times in good faith in its investigation and handling of the above-claim and with regards to the best interest of our Insured. Tower Hill specifically denies each and every allegation contained in the CRN referenced above. In large part, the cited provisions appear to be nothing more than boilerplate and conclusory language that have no application to the governing facts or law of this claim. Tower Hill’s actions in handling the claim were prompt, thorough, conducted in accordance with the insurance policy and Florida law, and most importantly, in good faith. Furthermore, Tower Hill complied with all obligations under the insurance policy and Florida Statutes. Tower Hill communicated promptly with the Insured and/or his representatives. As such, Tower Hill denies each and every allegation contained in the Notice. Although this CRN has been withdrawn, you will find a copy of the response submitted to the Florida Department of Financial Services on its website.
kaley@mcdonaldbarnhill.com 01-17-2025 CRN is withdrawn. Please refer to filing number 802013.
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.

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.




DFS-10-363
Rev. 10/14/2008