Civil Remedy Notice of Insurer Violations
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Filing Number:     810571
Filing Accepted:  3/11/2025
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Complainant
Last/Business Name *  
SHANER   First Name   SARAH
Street Address * 28213 ISLET TRAIL
City, State Zip * BONITA SPRINGS, FL 34135
Email Address * SSHANER945@GMAIL.COM
Complainant Type: * Insured
Insured
Last/Business Name*   SHANER   First Name   SARAH
Policy # * W015488771 Claim #* 3300535273
Attorney
Attorney is Applicable
Last Name* RUDDOCK First Name * OMARI Initial S
Street Address* 4770 BISCAYNE BLVD, STE 600
City, State Zip* MIAMI , FL 33137
Email Address * OMARI@WARDRUDDOCK.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):* TANGI FORMAN, JOHN SERNAQUE, TOWER HILL CLAIM DECISION MAKERS
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.
 
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)(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)(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.
* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

Dwelling Coverage Provisions All Additional coverage provisions loss payment or settlement provision duties in event of loss provision
 
* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

On or around October 9, 2024, the insured, Sarah Shaner, experienced property damage at her home located at 28213 Islet Trail, Bonita Springs, FL 341358510. Tower Hill Insurance Exchange Company (referred to here as "Tower Hill") held an active insurance policy for the property, Policy Number W015488771, on the date of the loss. The loss was caused by a significant windstorm from Hurricane Milton. The insured submitted a claim to Tower Hill, which assigned it claim number #3300535273. However, the insurer did not fully compensate the claimant as stipulated by the policy, leading to a material breach of contract. These damages are covered under the policy, and the insurer's failure to fully investigate the claim and make the required payment constitutes a material breach. The insurer further delayed the claim by continuously providing inadequate settlement offers despite having sufficient information to make an adequate offer. Specifically, on March 5, 2025 and March 10, 2025, the insurer provided very low offers to settle the claim despite being placed on notice of their poor conduct in assessing the claim where there is recognizable wind damage shown to the home. Instead they seek to blame the damage on foot traffic. A copy of this notice has been provided to the insured. Tower Hill has engaged in a customary business practice and a deliberate course of conduct to hinder resolution of its claims until they enter litigation. It has become a pattern of practice for Tower Hill to not settle claims when it has the ability to do so, and these dilatory tactics serve no purpose other than to increase profits. Tower Hill has violated the following statutory provisions: §642.155(1)(b)(1) - Not attempting in good faith to settle claims when, under all circumstances, it could and should have done so, had it acted fairly and honestly towards its insured and with due regards 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 reasonable clear, under one portion of the insurance policy coverage in order to influence settlement under other provisions 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) – Committing or performing with such frequency as to indicate a general business practice any of the following: (a) Failing to adopt and implement standards for the proper investigation of claims; (b) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue; (c) Failing to acknowledge and act promptly upon communications with respect to claims; (d) Denying claims without conducting reasonable investigations based upon available information; (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. To remedy this Civil Remedy Notice and to cure the conduct giving rise to the violations described herein, Tower Hill must immediately: (i) tender the full payment to the insured; (ii) make payment of any pre-judgment interest owed under Florida law, including §627.70131(5)(a), which is accruing daily; (iii) make payment for the additional expense incurred by the insured in hiring an attorney; and (iv) implement appropriate standards and procedures for claims investigations and resolution in regard to the outstanding amount of this Claim. The aforementioned payments should be tendered to the insured’s attorneys at Ward Ruddock, PLLC, 4770 Biscayne Blvd., Ste. 600, Miami, Florida 33137.
Comments
User Id Date Added Comment
nweber@thig.com 05-09-2025 May 9, 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 Insured : Sarah Shaner Policy Number: W0158488771 Claim Number : 3300535273 Date of Loss: 10/8/2024 DFS File Number: 810571 Accepted Date : 3/11/2025 Dear Sir/Madam: We are in receipt of a Civil Remedy Notice of Insurer Violation (“CRN”) filed on behalf of Sarah Shaner, our insured. This correspondence will serve as Tower Hill Insurance Exchange’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)(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)(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. 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 or insurance policy provisions; failing to acknowledge and act promptly upon communications; denying claims without conducting reasonable investigations; failing to promptly provide a reasonable explanation in writing, 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 “provide adequate settlement offer.” 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 “Tower Hill has engaged in a customary business practice and a deliberate course of conduct to hinder resolution of its claims until they enter litigation.” That “insurer did not fully compensate the claimant as stipulated by the policy.” 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, “Dwelling Coverage Provisions; All Additional coverage provisions; loss payment or settlement provision; duties in event of loss provision.” 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 this claim was a denial, 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 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 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 above the deductible. There is no evidence that the claimed roof damage is covered under the policy 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, this policy is clear that there must be a direct physical loss and that there is no coverage for wear, tear and deterioration. Tower Hill is unable to settle a claim that is not covered under the insurance policy and the mere statement in the policy that “the insurer provided very low offers to settle the claim despite being placed on notice of their poor conduct in assessing the claim where there is recognizable wind damage shown to the home. Instead they seek to blame the damage on foot traffic.” is not enough to put Tower Hill on notice as to what was overlooked in the investigation of this claim. The fact that the CRN claims “The insurer further delayed the claim by continuously providing inadequate settlement offers” 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 coverage decision, is not enough to allege bad faith. Conversely, Tower Hill directly refutes these allegations and can state that an independent expert engineering firm inspected the loss 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 November 30, 2024 related to alleged windstorm damage that occurred on October 8, 2024. Tower Hill assigned claim no. 3300535273 to this claim. The day after the reporting of the claim, Tower Hill sent the insured a Homeowner Bill of Rights letter along with a Reservation of Rights letter informing the insured that there were questions as to whether there is coverage of the claim. The letter further included language from the subject Policy and is evidence of Tower Hill’s active investigation and communication with the insured and their representative. The engineering firm inspected the loss on January 7, 2025 and a letter was sent to the insured informing them that the engineer inspection found no damage caused by windstorm. On February 4, 2025 Tower Hill sent a letter to the insured informing him that his claim for roof damages had been denied as the loss was not covered by the Policy. The letter further detailed an explanation for why the loss was not covered including that the inspection revealed that “the cracked tiles found at the time of our inspection were not consistent with damage caused by storm activity.” The letter also cited applicable language from the Policy for the denial as the aforementioned causes of loss are not covered under the policy. A Notice of Intent to Litigate was received on February 28,2025 and a settlement offer was made despite the fact that the claim is a denial. Insured’s representative rejected the settlement offer. 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 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