Civil Remedy Notice of Insurer Violations
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Filing Number:     805279
Filing Accepted:  2/5/2025
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Complainant
Last/Business Name *  
KATHERINE RUIZ   First Name   JEREMIAS RUIZ AND
Street Address * 1954 WEST NASSAU ROAD
City, State Zip * AVON PARK, FL 33825
Email Address * 128JOSE@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   KATHERINE RUIZ   First Name   JEREMIAS RUIZ AND
Policy # * W012753902 Claim #* 3300476548
Attorney
Attorney is Applicable
Last Name* KRAPF First Name * GRANT Initial W
Street Address* 2790 SUNSET POINT RD
City, State Zip* CLEARWATER , FL 33759
Email Address * GRANT@KRAPFLEGAL.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 AND ANY OTHER INDIVIDUAL FROM, OR AGENT OF, TOWER HILL INSURANCE EXCHANGE WHO WAS INVOLVED IN THE CLAIM.
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Denial
Claim Delay
Unfair Trade Practice
Other : Not treating the Insured with good faith claims conduct
Other : Looking for ways to deny full recovery to the Insured
Other : Looking for ways to delay full recovery to the Insured
Other : Failing to properly investigate the Insured's loss
Other : Failing to provide the Insured with the full benefits awarded under the contract of insurance in a t
Other : Not training, supervising, or managing adjusters properly so that prompt and full payments are made,
Other : Not adjusting claims and evaluating loss properly
Other : Shifting the burden of insuring the loss to the Insured
Other : Failing to implement proper standards for the adjustment and investigation of claims
Other : Making material misrepresentations
* 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)(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)(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)(d) Denying claims without conducting reasonable investigations based upon available information.
626.9541(1)(i)(3)(i) Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific policy language.
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Tower Hill Insurance Exchange (the "Insurer") has committed the following in handling the Insured's claim: 1) failing to act in due diligence and good faith to resolve claims; 2) placing the financial interest of Insurer before that of the Insured; 3) looking for ways to deny benefit payments and otherwise "low ball" or "stone wall" claims; 4) not adjusting the claims promptly and fairly; 5) not attempting in good faith to settle claims; 6) conducting inadequate investigations; 7) failing to employ policies and procedures to conduct adequate investigations; 8) denying a claim which it knew or should have known the policy and Florida law provided coverage for; 9) shifting the burden of investigating the loss onto the Insureds; and 10) making material misrepresentations. On or about October 12, 2023, while the subject policy was in full force and effect, the insured property suffered a loss caused by a water leak. The areas impacted include but are not limited to the master bedroom, master closet, bedroom, bedroom closet, A/C closet, office, office closet, bathroom, towel closet, hallway, living room, kitchen, laundry room, dining room, storage room, and closet. The Insured timely submitted a claim on October 24, 2023, to the Insurer for water damages and ensuing damage therefrom. Given the scope and nature of the damage, the Insured retained a public adjuster. After assessing the damage and the true scope of repairs, the public adjuster prepared an estimate identifying $41,622.55 in covered damage to the dwelling. The foregoing estimate, photographs, and a letter of representation from the public adjuster were sent to the Insurer. Thereafter, the Insurer assigned claim number 3300476548 to the loss and sent a field adjuster to inspect the property. Subsequently, in a coverage determination letter dated November 20, 2023, the Insurer notified the Insured that it was denying coverage for the loss. The Insurer misrepresented the loss and issued a wrongful denial. The Insurer based this denial on the rationale that the damage sustained was a result of " constant or repeated seepage or leakage..." The insurance policy issued by the Insurer still provides coverage for those damages which occurred within the first fourteen (14) days after the loss. See Hicks v. Am. Integrity ins. Co. Of Fla., 241 so.3d 925, (Fla. 5th DCA 2018). The Insurer has intentionally ignored this coverage afforded in the policy to further frustrate the Insured's ability to have his claim adjusted promptly and fairly. It is the Insurer's responsibility to properly train desk adjusters to pay for loss that occurred within the first 14 days of the sudden and accidental water loss. Upon receiving notice of the loss, the Insurer had the duty to provide the full benefits under the policy. This includes providing the Insured with a proper investigation and the funds necessary to return the home to its pre-loss condition. However, when the Insurer conducted its inspection of the insured property, the Insurer's adjuster failed to conduct a thorough and adequate investigation, or the adjuster intentionally ignored the damage observed and failed to make truthful and unbiased reports of the facts after investigating. As a result, the Insurer breached the policy by failing to fully indemnify the Insured for the covered loss. The conduct outlined above is done within the Insurer's routine course of the business. There may be further wrongful conduct which has not been made known to the Insured at this moment. Certain conduct or actions may be discovered throughout discovery or cannot be verified without a review of the Insurer's claim file and standards and procedures for the adjustment and investigation of claims. In short, the Insurer is not acting with due regard for the Insured's interests or safety. In Florida the work of adjusting insurance claims engages the public trust. The Insurer has breached this trust and its duty to the Insured. The Insurer and its agents conducted cursory and inadequate investigations and wrongfully denied coverage for a loss that should have been covered under the subject policy. Moreover, the Insurer has engaged in bad faith practices designed to delay claims and prevent the Insured from recovering what is rightfully owed under the subject policy of insurance. The Insurer's actions and inactions have continued to frustrate and delay the resolution of the Insured claim. The Insurer's actions amount to but are not limited to the following: 1. Claim denial 2. Claim delay 3. Not treating the Insured with good faith claims conduct 4. Looking for way to reduce recovery to the Insured 5. Looking for ways to deny recovery to the Insured 6. Not adjusting claims and evaluating loss properly, promptly and fairly to provide full and prompt indemnity to the Insured 7. Not training, supervising or managing adjusters properly so that prompt and full payments are made, but rather placing the company's interests before the Insured's' interests 8. Placing the financial interest of the Insurer over that of the health and safety of the Insured 9. Shifting the burden of investigating onto the Insured 10. Conducting inadequate investigations 11. Making material misrepresentations Therefore, to cure the defects outlined in this civil remedy notice, the Insurer must: (1). Admit full coverage for the Insured's loss. (2). Tender full benefits owed to the Insured under the insurance contract. A copy of this form submitted to the FDFS has been sent via e-mail to the following parties providing them notice of the filing of the civil remedy notice. Please e-mail any response to this civil remedy notice to badfaith@krapflegal.com. Via E-mail: Tower Hill Insurance Exchange P.O. Box 142230 Gainesville FL 32614 claims@thig.com
Comments
User Id Date Added Comment
nweber@thig.com 03-27-2025 March 27, 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 : Jeremias Ruiz Policy Number: W012753902 Claim Number : 3300476548 Date of Loss: 10/12/2023 DFS File Number: 805279 Accepted Date : 2/5/2025 Dear Sir/Madam: We are in receipt of a Civil Remedy Notice of Insurer Violation (“CRN”) filed on behalf of Jeremias Ruiz, our insured. The CRN shows Jeremias Ruiz and Katherine Ruiz. 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)(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)(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)(d): Denying claims without conducting reasonable investigations based Upon available information. §626.9541(1)(i)(3)(i): Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b). 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 failing to promptly settle claims when it could and should have done so; material misrepresentation made to an insured; failing to adopt and implement standards for the proper investigation of claims; misrepresenting pertinent facts; denying claims without conducting reasonable investigations; failing to affirm or deny full or partial coverage of claims; failing to pay personal injury protection insurance claims within the time periods, 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. This is a homeowner claim with a homeowner policy and the CRN lists a statute incorrectly addressing personal injury protection insurance claims. 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 “misrepresented the loss and issued a wrongful denial.” 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 “(the “Insurer”) has failed to act in due diligence and good faith to resolve claims.” That “placing the financial interest of Insurer before that of the Insured; looking for ways to deny benefit payments; not adjusting the claims promptly and fairly; not attempting in good faith to settle claims; conducting inadequate investigations; denying a claim which it knew or should have known the policy and Florida law provided coverage for, and shifting the burden of investigating the loss onto the insured, and making material misrepresentations.” While the CRN does name an adjuster, it includes “AND ANY OTHER INDIVIUAL FROM, OR AGENT OF, TOWER HILL INSURANCE EXCHANGE WHO WAS INVOLVED IN THE 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, “Reference to specific policy language: The violations alleged are statutorily based and do not rely on any specific language.” Yet the Complainant is claiming that Tower Hill wrongfully denied the claim based on specific policy language. 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. As noted above, the vague reference to the statement that there are no policy provisions specifically at issue or in dispute, is not enough to preserve a bad faith claim. The failure to cite to specific language 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 when there is no coverage. The fact that the CRN claims “the Insurer’s adjuster failed to conduct a thorough and adequate investigation” 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 performed. No specific claims were made as to what Tower Hill did wrong in its investigation. Conversely, Tower Hill directly refutes these allegations and can state that a licensed adjuster investigated the claim, 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 October 24, 2023 related to alleged water damage that insured discovered on October 12, 2023. The Complainant was out of town on an extended vacation and was not at the residence when the loss occurred, but was discovered when they returned to the residence. The inspection by the field adjuster revealed significant mold growth in the a/c closet plenum box, the baseboards of the living room, walls of the linen closet and bedroom 2 closet, as well as damage to laminate flooring in the bedrooms, closets and linen closets. Tower Hill assigned claim no. 3300476548 to this claim. The day after the reporting of the claim, Tower Hill sent the insured a Homeowner Bill of Rights letter. Tower Hill inspected the loss on November 9, 2023. On November 20, 2023, Tower Hill sent the insured a denial letter for constant or repeated seepage or leakage from a clogged a/c drain line. Mediation took place on January 25, 2024 but ended in impasse. 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