Tower Hill: Milton roof, gutters, and skylight refused outright

February 20, 2025

Department of Financial Services Insurance Consumer Assistance Civil Remedy Section Larson Building [address redacted]reet Tallahassee, FL 32399-0322

RE: Company: Tower Hill Insurance Exchange Company Insured : [name redacted] Policy no. [redacted] Claim no. [redacted] Date of Loss: 10/07/2024 DFS File Number: 795091 Accepted Date : 12/3/2024

Dear Sir/Madam:

We are in receipt of a Civil Remedy Notice of Insurer Violation ("CRN") filed on behalf of [name redacted] our insured. The CRN lists [name redacted] . This correspondence will serve as Tower Hill Signature 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)(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)(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 [address redacted]atements 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.

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; making claims payments to insureds …not accompanied by a statement; failing to promptly settle claims; 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 affirm or deny full or partial coverage of claims; failing to promptly provide a reasonable explanation in writing; failing to promptly notify the insured of any additional information necessary; failing to clearly explain the nature of the requested information, 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 "performed a cursory inspection of the property that failed to retain the experts necessary to identify the repairs necessary to restore the property to its pre-loss condition."

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 knows it has failed to issue proper payment for the clearly covered loss to include damages and repairs covered by the policy and Florida law…Tower Hill has failed to comply with its loss settlement provision." 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 states, "The complainant will abbreviate the full policy language for purposes of brevity while clearly identifying the significant portions so the Respondent may identify the full language... THIS VIOLATION REFERENCES THE DEFINITIONS CONTAINED WITHIN THE POLICY AND ITS AMENDMENTS AND ENDORSEMENTS THAT PERTAIN TO COVERAGES FOR ROOF AND WATER DAMAGES (INDIVIDUALLY AND COLLECTIVELY) TO THE PROPERTY OF [name redacted] AND [name redacted] . THIS VIOLATION ALSO REFERENCES COVERAGES - COVERAGE A - DWELLING AND ALL APPLICABLE PORTIONS OF THE POLICY, INCLUDING BUT NOT LIMITED TO AMENDMENTS AND ENDORSEMENTS. THIS VIOLATION ALSO REFERENCES THE COVERAGE B - OTHER STRUCTURES PORTION OF THE POLICY, INCLUDING BUT NOT LIMITED TO AMENDMENTS AND ENDORSEMENTS. THIS VIOLATION ALSO REFERENCES PERILS INSURED AGAINST COVERAGE A - DWELLING AND COVERAGE B OTHER STRUCTURES, ITS APPLICABLE PORTIONS OF THE POLICY, INCLUDING BUT NOT LIMITED TO AMENDMENTS AND ENDORSEMENTS. THIS VIOLATION ALSO REFERENCES THE ORDINANCE AND LAW PORTION OF THE POLICY THAT WAS PURCHASED WITH PREMIUM DOLLARS PAID TO TOWER HILL INSURANCE . THIS VIOLATION ALSO REFERENCES SECTION I - CONDITIONS - SUBSECTION 3 LOSS SETTLEMENT AND ITS APPLICABLE PORTIONS OF THE POLICY, INCLUDING BUT NOT LIMITED TO AMENDMENTS AND ENDORSEMENTS. THIS VIOLATION ALSO REFERENCES FUNGI, WET OR DRY ROT OR BACTERIAL COVERAGE ENDORSEMENT."

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 mischaracterizes 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.

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.

The fact that the CRN claims "TOWER HILL performed a cursory inspection of the property that failed to retain the experts necessary to identify the repairs necessary to restore the property to its preloss condition." "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 claim determination, 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 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 18, 2024 related to alleged windstorm damage that occurred on October 7, 2024. Tower Hill assigned claim no. [redacted] to this claim. The day after the reporting of the claim, Tower Hill sent the insured a Homeowner Bill of Rights letter.

The IA inspection was completed on October 24, 2024. An estimate was prepared for roof repair that was less than the insured's hurricane deductible. A Claim Payment Letter and statement of loss was sent to the insured/attorney on October 27, 2024.

The carrier is currently working with the insured/representative toward a settlement resolution.

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 [phone redacted].

Sincerely,

Tower Hill Claims Services, LLC

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.