Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 807607

Filing Accepted: 2/20/2025

Print Filing

Complainant

Last/Business Name *

DITTON

First Name

ROY AND PATRICIA

Street Address *

1736 PINYON PINE DRIVE

City, State Zip *

SARASOTA, FL 34240

Email Address *

PADITTON@GMAIL.COM

Complainant Type: *

Insured

Last/Business Name*		DITTON		First Name		ROY AND PATRICIA
Policy # *		W014381363		Claim #*		3300530508

Attorney

Attorney is Applicable

Last Name*	MARKER First Name * SHAUN Initial J
Street Address*		ONE NORTH CLEMATIS STREET, SUITE 510
City, State Zip*		WEST PALM BEACH , FL 33401
Email Address *		SMARKER@MERLINLAWGROUP.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		TOWER HILL INSURANCE EXCHANGE
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code 17179

Name of individual responsible for violation (if any):* OFFICERS, SUPERVISORS, AND OR MANAGEMENT OF TOWER HILL SIGNATURE INSURANCE COMPANY NOW KNOWN AS TOWER HILL INSURANCE EXCHANGE, INCLUDING ALL CLAIMS REPRESENTATIVES, ADJUSTERS AND EXPERTS, GIAN FIGARO, ROBERT SCOTT FULLER, SUPRATIK BOSE AND POLARIS FO
Type of Insurance * Residential Property & Casualty

Reason for Notice *

	Claim Delay
	Claim Denial
	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)(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.

* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Building coverage provisions; additional coverages; duties in event of loss policy provisions; all terms and conditions of Section I of the insurance policy; the insurance policy's definition section; the insurance policy's exclusion of coverage provisions; loss payment policy provision; loss settlement provision; the declarations page; we will adjust all losses with you.

* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

In Florida, the work of adjusting insurance claims engages the public trust. Tower Hill Insurance Exchange Company (“Tower Hill”) has breached this duty by its handling of the Insureds’, Roy and Patricia Ditton’s, Claim of Loss (Claim Number 3300530508; D.O.L. 10/9/24). Tower Hill has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insureds’ insurance claim for damages. On or about October 9, 2024, the Insureds submitted a claim to Tower Hill for damages sustained as a result of Hurricane Milton. We have identified the following instances of bad faith conduct on the part of your company: • Refusing to pay for necessary repairs and attempting to coerce us into accepting a lower settlement amount by failing to properly consider all applicable statutes and building code requirements both at the state and local level. • Purposefully minimizing the value of the claim by using biased estimating software/pricing and low-balling the cost of repairs. Specifically, estimations and repair costs have been purposefully devalued to the benefit of the insurance company despite knowledge that these costs are woefully deficient. • Failure to acknowledge that the Monier Lifetile Brand concrete tiles installed on the structure are discontinued, no longer manufactured in the same dimensions, and do not have an active State of Florida Notice of Acceptance. • Failure to provide an adequate explanation to the Insureds as to why full payment for a roof replacement is not being provided, despite obvious and apparent wind damage from Hurricane Milton. Tower Hill issued untimely correspondence dated January 30, 2025, merely indicating that “the estimated damages for your Property claim are less than your deductible. Therefore, no payment is due at this time,” without providing further explanation as to what information was reviewed by Tower Hill or how this opinion was derived. See correspondence to Insureds from Tower Hill dated January 30, 2025. • The January 30, 2025 correspondence from Tower Hill to the Insureds fails to provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law. Rather, the correspondence merely indicates that the damages are below the deductible and no payment will be issued. • Misrepresenting to the Insureds that the roof is not in need of a full replacement as a result of wind from Hurricane Milton, and that the roof can be repaired. • The report of Polaris Forensics, who is biased and routinely hired by Tower Hill to render opinions that do not support a full roof replacement and/or the full costs of needed storm-related repairs, concluded that the subject structure “can be spot-repaired, and a complete roof replacement is not required.” However, this is inaccurate especially as the underlayment needs to be replaced to prevent back-lap repairs. See report of Roof Leak Detection Company. • Failing to act promptly by purposefully delaying the issuance of full payment due and owing to the Insureds. • Failure to account for and determine the full extent of roof damage including all fractured tiles, right corner fractures, and point load fractures that were damaged from winds of Hurricane Milton. • Implementing a claim handling process geared solely to the minimization of roof related damages. Specifically, taking a hardline stance on repairability of the roof rather than a roof replacement. This scheme is meant solely to benefit Tower Hill while hindering the Insureds from obtaining just compensation for the loss. These actions on the part of your company are unacceptable and are in violation of the insurance policy and the duty of good faith and fair dealing that Tower Hill owes to its policyholders. Based on conduct to date, these practices occur with such frequency as to constitute a general claims handling process/business practice imbedded within the company’s management of Hurricane Milton claims. To date, notwithstanding the Insureds’ pleas otherwise, Tower Hill has continued to refuse to acknowledge its obligation to tender all insurance proceed monies due and owing the Insureds or assist the Insureds in mitigation of the damages. The insurer has failed and refused to acknowledge coverage and restore the Insureds to their pre-loss condition. Tower Hill has sufficient information upon which to evaluate the Insureds’ claim for damages, and certainly has been provided with an independent means by which to determine the amount of loss. The Insureds have otherwise fully complied with the insurer's requests for post-loss compliance. Tower Hill Insurance Exchange has not properly paid all of the covered damages. These actions by Tower Hill occur with such frequency to indicate a general business practice of the company. The Insureds have complied with the policy of insurance and Florida law, and Tower Hill continues to wrongfully refuse to tender the insurance proceeds that are due and owing the Insureds. The concept of insurance is the granting of timely and prompt indemnity or security against a contingent loss. Florida Statutes section 624.02 defines "insurance" as a contract whereby one undertakes to indemnify another or pay a specified amount or a determinable benefit upon determinable contingencies. Inherent is the fact that payment must be made timely and promptly so that the Insureds may be put back into the position they were in prior to the loss as quickly as possible. Tower Hill breached this duty. The Insureds were and still are forced to expend out of pocket monies to submit the insurance claim to force Tower Hill to honor its obligations under the insurance policy to pay all the insurance proceeds due and owing them. Tower Hill has clearly displayed bad faith in its handling, processing, and wrongful delay of this claim. The Insureds merely request that Tower Hill "adjust the loss" with them in accordance with the policy of insurance for which Tower Hill has accepted a premium, and in accordance with Florida law. Tower Hill’s conduct has been reckless and unfair to its Insureds and has caused and continues to cause additional damages. We demand that Tower Hill immediately take steps to rectify the situation and handle this claim in a fair and appropriate manner. This includes providing full and fair compensation for the damages incurred and for any additional costs and expenses incurred as a result of Tower Hill’s bad faith conduct, including but not limited to, fees and costs related to the retention of personnel/counsel required to challenge Tower Hill’s improper handling of this claim. [As of this moment, the damages found and evaluated by the insured(s) value at minimum $129,302.94, and we request payment in that sum as a curative measure to the conduct described herein.]

Comments

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