Civil Remedy Notice of Insurer Violations
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Filing Number:     806419
Filing Accepted:  2/12/2025
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Complainant
Last/Business Name *  
CRESS   First Name   PATRICIA
Street Address * 1924 SAGAMORE ST
City, State Zip * THE VILLAGES, FL 32162
Email Address * COLLIN@CMGPROPERTYSOLUTIONS.NET
Complainant Type: * Insured
Insured
Last/Business Name*   CRESS   First Name   PATRICIA
Policy # * W013570649 Claim #* 3300529632
Attorney
Attorney is Applicable
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):* MICHELLE PAUL AND WILLIAM PAUL
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Claim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
Other : Misrepresentation
* 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.
626.9541(1)(i)(3)(a) 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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

"We insure for sudden and accidental direct loss to property described in Coverages A and B only a physical loss to covered property."
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The insurer has engaged in systemic inconsistency, unfair claim-handling practices, and undervaluation of the loss, resulting in a failure to properly indemnify the insured in accordance with policy terms. Summary of Claim Handling Issues: Inconsistent and Arbitrary Claim Determinations Following Hurricane Milton, CMG Property Solutions has represented numerous insureds within a few miles of Patricia Cress’s property, all with similar or less damage but significantly larger roofs (40 sq, 70 sq, 84 sq). Despite these larger roofs having fewer than 10 damaged shingles, Tower Hill approved full replacements upon initial inspections. Conversely, Patricia Cress’s smaller 27 sq roof, with over 50 damaged shingles, was deemed repairable, despite the evident severity of the damage. Failure to Restore Property to Pre-Loss Condition The policy requires the insurer to restore the insured’s property to its pre-loss condition. Tower Hill’s decision to scatter over 50 mismatched replacement shingles across a 16-year-old
Comments
User Id Date Added Comment
nweber@thig.com 04-04-2025 April 4, 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 : Patricia Cress Policy Number: W013570649 Claim Number : 3300529632 Date of Loss: 10/09/2024 DFS File Number: 806419 Accepted Date : 2/12/2025 Dear Sir/Madam: We are in receipt of a Civil Remedy Notice of Insurer Violation (“CRN”) filed on behalf of Patricia Cress, 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. 626.9541(1)(i)(3)(a) 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. 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 adopt and implement standards for the proper investigation of claims; failing to acknowledge and act promptly upon communications, 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 engaged in undervaluation of the 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 the “Insurer has engaged in systemic inconsistency, unfair claim-handling practices, and undervaluation of the loss.” That “The Insurer… resulting in a failure to properly indemnify the insured in accordance with policy terms.” 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, “We insure for sudden and accidental direct loss to property described in Coverages A and B only a physical loss to property.” 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, because insured disagrees with the payment amount, 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 less than the insured’s deductible. 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 a total roof replacement. There is evidence of a prior roof repair and the only damage to the roof is along the hip sections. We have secured confirmation from an objective third party, independent roofer who is ready, willing and able to repair the roof. The fact that the CRN claims “Inconsistent and Arbitrary Claim Determinations” 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 payment amount, is not enough to allege bad faith. Conversely, Tower Hill directly refutes these allegations and can state that a licensed adjuster investigated the claim, and repairability confirmation was made by an independent roofer, 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, 2024 related to alleged windstorm damage that occurred on October 9, 2024. Tower Hill assigned claim no. 3300529632 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 11/05/2024 and a letter was sent to the insured informing them that the covered damage was repairable and payment made. Mediation was offered, however, the insured’s public adjuster rejected mediation. A Notice of Intent to Litigate was received and an offer of settlement made, to which the public adjuster did not respond. The desk adjuster made the same settlement offer and sent a Policy Holder Release to the insured, which is pending signature and return. 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. 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
collin@cmgpropertysolutions.net 02-12-2025 Facts and Circumstances cut out relevant information. Please see the remainder of the explanation: Summary of Claim Handling Issues: Inconsistent and Arbitrary Claim Determinations Following Hurricane Milton, CMG Property Solutions has represented numerous insureds within a few miles of Patricia Cress’s property, all with similar or less damage but significantly larger roofs (40 sq, 70 sq, 84 sq). Despite these larger roofs having fewer than 10 damaged shingles, Tower Hill approved full replacements upon initial inspections. Conversely, Patricia Cress’s smaller 27 sq roof, with over 50 damaged shingles, was deemed repairable, despite the evident severity of the damage. Failure to Restore Property to Pre-Loss Condition The policy requires the insurer to restore the insured’s property to its pre-loss condition. Tower Hill’s decision to scatter over 50 mismatched replacement shingles across a 16-year-old roof would fail to maintain uniformity, structural integrity, and aesthetic consistency. Given the age of the roof, shingle color and type matching is impossible, making repairs an unreasonable resolution. Reliance on a Biased Preferred Vendor Assessment Tower Hill sent its preferred vendor, who deemed the roof repairable, despite objective evidence proving otherwise. CMG Property Solutions has access to multiple roofing experts who contradict this determination and confirm the roof is unrepairable. The insurer’s reliance on this vendor, while dismissing other assessments, raises concerns of bias and lack of due diligence. Bad Faith Conduct and Dismissal of Concerns When CMG Property Solutions raised concerns about these inconsistencies, Tower Hill’s desk adjuster and claims supervisor dismissed the evidence and discredited the claim by stating that CMG was only concerned with its commission. This response ignores documented proof of Tower Hill’s inconsistent handling of claims in the same area and shows a pattern of delaying and underpaying claims rather than acting in the best interest of the insured. Resolution Sought: CMG Property Solutions formally requests that Tower Hill immediately reassess this claim in good faith and approve the full roof replacement, as has been done for numerous similar claims in the same area. Additionally, we request: A written explanation detailing how Tower Hill justifies its inconsistent claim determinations. The make, model, and color of the shingles Tower Hill believes can be used for a “repair” that maintains uniformity. An independent, unbiased inspection of the roof, rather than relying solely on a preferred vendor with clear conflicts of interest.
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