Civil Remedy Notice of Insurer Violations
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Filing Number:     807731
Filing Accepted:  2/20/2025
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Complainant
Last/Business Name *  
STOKES   First Name   RICHARD
Street Address * 3627 SW 15TH STREET
City, State Zip * GAINESVILLE, FL 32608
Email Address * RASTOKES49@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   STOKES   First Name   RICHARD
Policy # * W013340398 Claim #* 3300512358
Attorney
Attorney is Applicable
Last Name* STOCKHAM First Name * DONNA Initial
Street Address* 109 S. EDISON AVENUE
City, State Zip* TAMPA , FL 33606
Email Address * DSTOCKHAM@STOCKHAMLAWGROUP.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):* DARRYL SUGGS
Type of Insurance * Residential Property & Casualty   
Reason for Notice *
Unsatisfactory Settlement Offer
Claim Delay
Other : Unreasonable Investigation
Other : Misrepresenting pertinent facts or policy provisions
* 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)(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)(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).
* 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 – PERILS INSURED AGAINST COVERAGE A – DWELLING and COVERAGE B – OTHER STRUCTURES We insure against risk of direct loss to property described in Coverages A and B only if that loss is a physical loss to property… Loss Settlement. Covered property losses are settled as follows: b. Buildings under Coverage A or B at replacement cost without deduction for depreciation, subject the following: (4) we will initially pay at least the actual cash value of the insured loss, less any applicable deductible. We will then pay any remaining reasonable and customary amounts necessary to perform such repairs a work is performed and expenses are incurred. If a total loss of the covered dwelling occurs, we will pay the “replacement cost” coverage without reservation or holdback of any depreciation in value, pursuant to Florida Statutes, 627.702. 10. Loss Payment. We will adjust all losses with you. We will pay you unless some other person is named in the policy or is legally entitled to receive payment. Loss will be payable upon the earliest of: a. 20 days after we receive your proof of loss and reach written agreement with you; b. 60 days after we receive your proof of loss and; (1) there is an entry of final judgment; or (2) there is a filing of an appraisal award or a mediation settlement with us; or c. within 90 days of receiving notice of an initial claim, supplemental claim, reopened claim for property insurance. We will pay or deny such claims, or portions thereof, unless there are factors beyond our control that would reasonably prevent payments. Item 8. Appraisal is deleted and replaced by the following: 8. Mediation or Appraisal. b. If you and we fail to agree on the amount of any loss, we can demand that the amount of the loss be set by appraisal. Our demand for appraisal must be in writing. If we demand appraisal: (1) Each party must select a competent, disinterested appraiser and notify the other party of the appraiser’s identity within 15 days of your receipt of our written demand for appraisal. By that same deadline, Tower Hill and you must provide to each other a written, itemized list of all disputes as to the amount of loss, identifying separately each item being disputed. The appraisal will apply only to those disputes on the amount of loss identified in writing by the parties subject to paragraph (7) below. If you dispute the amount set by Tower Hill for an item, but do not identify that dispute in the required list, the amount of the loss for that item will be the amount previously set by Tower Hill. (2) The appraisers will then attempt to set the amount of the loss of each item in dispute as specified by each party. If the appraisers agree on all items, they will jointly submit to each party a written report of agreement signed by them. In all instances the written report of agreement must be itemized and state separately the “actual cash value”, “replacement cost”, and if applicable, the market value of each item submitted by the parties as set forth in paragraph (1). A written report of agreement that meets these requirements will constitute the appraisal. The appraisal will set the amount of the loss for each properly submitted item in dispute and will be binding upon you and us. A written report of agreement that does not itemize and resolve all disputes submitted by the parties pursuant to paragraph (1) does not constitute an appraisal and is not binding upon you and us. In such a case, the matter must be returned to the appraisers for completion. In the event the appraisers submit a written report that includes items not submitted pursuant to paragraph (1), such additional items have no effect and will be disregarded. If the written report otherwise meets the requirement of an appraisal, it will be binding upon you and us as to the items properly submitted in writing by you and us. If the written report does not otherwise meet the requirements of an appraisal, the matter must be returned to the appraisers for completion. (3) If the two appraisers fail to agree on the submitted disputes within 20 days, unless the period of time is extended by mutual agreement, they will select a competent, disinterested umpire and will submit their differences to the umpire. If the appraisers are unable to agree upon an umpire within 5 days, you or we may make a written application for a judge of a court of record in the same state and county (or city if the city is not within a county) where the Described Location is located to select an umpire. If the umpire reaches an agreement with one of the appraisers on all items, they will jointly submit to each party a written report of agreement signed by them. In all instances the written report of agreement must be itemized and state separately the “actual cash value”, “replacement cost”, and if applicable, the market value of each item in dispute and address all disputes submitted by the parties pursuant to paragraph (1). A written report of agreement that meets these requirements will constitute the appraisal. The appraisal will set the amount of the loss for each properly submitted item in dispute and will be binding upon you and us. A written report of agreement that does not itemize and resolve all disputes submitted by the parties pursuant to paragraph (1) does not constitute an appraisal and is not binding upon you and us. In to the appraisers and the umpire for completion. In the event an appraiser and umpire submit a written report that includes items not submitted pursuant to paragraph (1), such additional items have no effect and will be disregarded. If the written report otherwise meets the requirement of an appraisal, it will be binding upon you and us as to the items properly submitted in writing by you and us. If the written report does not otherwise meet the requirements of an appraisal, the matter must be returned to the appraisers and umpire for completion.
 
* Facts and circumstances giving rise to the violation.
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In Florida, the work of adjusting insurance claims engages the public trust. Tower Hill Insurance Exchange (“Tower Hill”) has breached the public’s trust by its adjustment of Richard Stokes’s (“Insured”) claim of loss. Tower Hill’s address is 7201 N.W. 11th Place, Gainesville, FL 32605. Tower Hill has failed to create and implement adequate guidelines for the proper investigation and evaluation of claims, claims handling, and for training and supervision of employees resulting in statutory violations as set forth above. Tower Hill has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the Insured’s insurance claim for damages. Tower Hill has failed to promptly settle the Insured’s insurance claim when the obligation to settle the insurance claim has become reasonably clear. To date, notwithstanding the Insured’s pleas otherwise, Tower Hill has continued to refuse to acknowledge its obligation to conduct a proper investigation, and to tender the full amount of insurance monies due and owing its Insureds under the policy. This claim involves the Insured’s property located at 3627 SW 15th Street, Gainesville, FL 32608, which was damaged by Hurricane Helene on September 26, 2024, when a large tree fell onto the house, damaging the roof surface, roof structure, wall structure and flooring. Tower Hill assigned the claim to an adjuster, Darryl Suggs. Adjuster Suggs provided his initial estimate and an undisputed payment of $56,215.40, and advised he would be sending an engineer, Grindley Williams, to inspect the damage. The Insured’s Public Adjuster, Claim Concepts (“PA”), met the Grindley Williams’ engineer on site. The engineer photographed the damage and discussed with the PA all of the damage. Unfortunately, once the engineer’s report was released, the PA discovered that a large part of what was discussed with and photographed by the engineer did not make it into the engineering report. At Adjuster Suggs’s request, the PA subsequentially met with Paul David Restoration (PDR), a General Contractor and approved vendor of Tower Hill. The PDR estimator was concerned that the damage related to the tree impact was not fully reflected in the engineer report. The estimator was also concerned as to how he was going to write his estimate, and stated that he was going to speak with Adjuster Suggs. Unfortunately, when the PDR estimate was released, it was also missing a substantial amount of scope and damage. PDR’s estimate totals $118,105.38 (RCV). According to the PA, following the release of the PDR estimate, Adjuster Suggs became very aggressive and stated he needed to know if the Insured agreed with this PDR estimate to “settle this loss.” In his email, Adjuster Suggs also put a three (3) day time limit on the Insured’s response. The PA advised Adjuster Suggs that the Insured needed more time to appropriately respond, and also asked for a time to review the scope and damages with Adjuster Suggs in order to point out all of the issues and discrepancies. Adjuster Suggs refused to discuss the claim, and advised that he would be demanding appraisal per the policy if the parties could not reach an immediate agreement. As the Insured now had an estimate from Tower Hill’s preferred vendor/GC, the PA asked Adjuster Suggs to release an undisputed payment of $60,662.99, that would reflect the difference of the PDR estimate and Tower Hill’s original estimate. Adjuster Suggs refused to release the undisputed payment, and advised he would be demanding appraisal per the policy. He also stated that PDR’s estimate was not approved and had some non-covered scope items in it. The PA asked for clarification of what those scope items were, but has not received a response. On February 13, 2025, Adjuster Suggs wrote to the Insured requesting appraisal, but conditioned the request with the following inappropriate conditions: “We require that you agree, in writing, not to file a Civil Remedy Notice of Insurer Violation while the appraisal is being conducted. Should there be a disagreement on any issue that arises following the appraisal award, you may then file a Civil Remedy Notice of Insurer Violation concerning those post-appraisal award issue(s) only. If a Civil Remedy Notice…has been filed prior to this date, we require that it/they be withdrawn…and proof of same be provided to us prior to the appraisal process beginning. Finally, we require that the enclosed memorandum of appraisal be agreed upon, signed and dated by both parties.” Adjuster Suggs then quoted the language to an apparent HO-3 Special Form policy. However, the policy in effect is actually a DP-1 Basic Form policy and its endorsements. The HO-3 policy has request language as it relates to the appraisal process, and the DP-1 has demand language, but only a demand from Tower Hill. The Memorandum of Appraisal (which is not mentioned in the policy as being a requirement for the appraisal process) requests the Insured to sign this letter containing inaccurate misinformation. Despite the information known to Tower Hill, Adjuster Suggs’s actions are tantamount to a misrepresentation of the Appraisal Provision of the policy and Florida law. The Insured’s PA has submitted to Tower Hill an estimate in the amount of $260,908.16 (RCV), $249,508.28 (ACV) under Coverage A, and $9,843.97 (RCV), $9,414.09 under Coverage B, that reflects the true scope and amount of the Insured’s damage. The concept of insurance is that the insurer will investigate and grant timely and prompt indemnity or security against a contingent loss. Florida Statute §624.02 defines “insurance” as a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit upon determinable contingencies. Inherent in that definition is the fact that payment must be made timely and promptly so that the Insured may mitigate his damages and be put back into the position he was in prior to the loss as quickly as possible. Tower Hill has breached this duty. The Insured was, and still is, forced to expend out of pocket monies to submit the insurance claim, e.g., retaining an attorney, Public Adjuster, and other experts to force the Insurer to honor its obligations under the insurance policy and to pay all the insurance proceeds due and owing to him. Tower Hill has refused and/or failed to tender all the insurance proceeds due and owing to the Insureds Tower Hill’s refusal and/or failure to settle the insurance claim when under all circumstances it could have and should have done so had it acted fairly and honestly towards the Insured is wrongful conduct. Furthermore, the Insured contends that Tower Hill’s adjusters and/or representatives financially benefit from such wrongful conduct. In Florida, the work of adjusting insurance claims engages the public trust. During the adjustment of the Insured’s claim, Tower Hill breached this duty by failing to adhere to and comply with the above referenced obligations. To cure the defects outlined above, Tower Hill must promptly tender all insurance proceeds due and owing to the Insured that would reasonably place the Insured back into his pre-loss condition, including the tender of accrued interest due and owing to the Insured. This notice is given in order to perfect the right to pursue the civil remedy authorized by Fla. Stat. §624.155.
Comments
User Id Date Added Comment
mcassida@stockhamlawgroup.com 09-03-2025 The parties have amicably resolved their dispute. Accordingly, this CRN is WITHDRAWN.
nweber@thig.com 04-16-2025 April 16, 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 : Richard Stokes Policy Number: W013340398 Claim Number : 3300512358 Date of Loss: 09/28/2024 DFS File Number: 807731 Accepted Date : 2/20/2025 Dear Sir/Madam: We are in receipt of a Civil Remedy Notice of Insurer Violation (“CRN”) filed on behalf of Richard Stokes, 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. §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) 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)(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 an act of God, prevented by the impossibility of performance, or due to actions by the insured or claimant that constitute fraud, lack of cooperation, or intentional misrepresentation regarding the claim for which benefits are owed. 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; failing to adopt and implement standards for the proper investigation of claims; misrepresenting pertinent facts or insurance policy provisions; failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days, 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 failed to “create and implement adequate guidelines for the proper investigation and evaluation of claims, claims handling, and for training and supervision of employees resulting in statutory violations as set forth above.” 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 “Tower Hill has failed and/or refused to thoroughly, accurately, and completely investigate and evaluate the insured’s insurance claim for damages.” That “Tower Hill has failed to promptly settle the Insured’s insurance claim when the obligation to settle the insurance claim has become reasonably clear.” 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 reference to the policy, however, the CRN references incorrect policy language for this DP1 Dwelling Basic Policy regarding Mediation or Appraisal. The correct policy language states, in part, . . . . . b. If you and we fail to agree on the amount of loss, either may request an appraisal of the loss by presenting the other party with a written request for appraisal of the amount of loss. If the other party agrees in writing to participate in appraisal, then appraisal shall proceed.” 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 the correct policy language that 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 the Insured does not agree with the payment amount, the vague reference to the incorrect mediation/appraisal clause, 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 correct, 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” but then the Insured/PA rejects the demand for appraisal. There is no evidence that the claimed damage is worth the amount demanded, and the CRN is devoid of any facts in support of same. Similarly, as it relates to the purported statutory violation for the failure to promptly settle claims, the undisputed payment was made in less than 30 days after the date of the reported claim. The fact that the CRN claims “The Insured was, and still is, forced to expend out of pocket monies to submit the insurance claim, e.g., retaining an attorney, Public Adjuster, and other experts to force the Insurer to honor its obligations under the insurance policy and to pay all the insurance proceeds due and owing to him.” 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 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, as well as an independent expert engineering firm, 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 September 28, 2024 related to alleged windstorm damage that occurred on September 28, 2024. Tower Hill assigned claim no. 3300512358 to this claim. The day after the reporting of the claim, Tower Hill sent the insured a Homeowner Bill of Rights letter. An acknowledgement of the PA representation was also sent. Tower Hill inspected the loss on 10/18/2024. A subsequent inspection by an engineer took place on 12/11/2024. The engineer confirmed wind damage to roof joists, roof sheathing, soffits, fascia, and drip edges, as well as CMU wall cracks at the front-right corner, right elevation, and back-left corner. The displaced CMU wall, front door framing, and front-right windows were also affected by the fallen tree. A copy of the engineer report was sent to the insured and PA. On February 5, 2025, a contractor estimate was prepared by a Castle Care contractor, Paul Davis Restoration. That estimate included items that were not covered under the insured’s policy and, therefore, was not utilized for any additional payment as undisputed payment had been previously made. A request was appraisal was offered, however, the Insured/PA has not agreed to appraisal. 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), and the correct, 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
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