Preview
wes CASE NUMBER: 502020CA010045XXXXMB Div: AJ ****
Filing # 113491502 E-Filed 09/16/2020 05:51:39 PM
IN THE CIRCUIT COURT OF THE
15™ JUDICIAL CIRCUIT IN AND
FOR PALM BEACH COUNTY,
FLORIDA
PAUL STEIDLE,
Cc .
Plaintiff, a
- JURY TRIAL DEMANDED
TOWER HILL PRIME INSURANCE
COMPANY,
Defendant.
COMPLAINT
Plaintiff, by and through undersigned counsel, submit this Complaint against
Defendant TOWER HILL PRIME INSURANCE COMPANY (“TOWER HILL”). As his
Complaint, Plaintiff asserts and alleges as follows:
Introduction
1. This action arises from the denial of insurance benefits. Plaintiff's residence was
damaged by a windstorm. Plaintiff made a claim with Defendant (claim #
3300313231) under his policy with Defendant (policy # E000243563), Defendant
improperly denied the claim, has failed to acknowledge a substantial amount of the
damage caused by the covered peril and failed to calculate properly the amount of
damage for the items it admitted were damaged.
2. Defendant’s refusal to cover all the damage caused by the covered peril violated its
contractual duty. Moreover, its failure to fairly adjust the claim and cover
undisputed damage constitutes bad faith. Plaintiff therefore brings this action to
FILED: PALM BEACH COUNTY, FL, SHARON R. BOCK, CLERK, 09/16/2020 05:51:39 PMobtain the benefits due under the insurance policy. A complete copy of the policy
is within Defendant’s nossession,
Parties and Jurisdiction
3. Plaintiff is a natural person and full-time residents of this County.
4. Defendant is an insurance company with its principal place of
business in Gainesville, Florida. Defendant has engaged in business in this County
by issuing insurance policies and adjusting claims.
5. The amount at issue in this case is in excess of $30,000.00, exclusive
of interest, attorneys’ fees and costs.
. 6 Venue is proper in this Circuit because the conduct at issue occurred
in this County and Defendant is present in this Circuit through its business
activities.
Daateal Aland:
Patiuar aucgau
7. Pursuant to a policy numbered E000243563. Defendant insured
Plaintiffs against loss to their residence and property, including loss from
windstorm.
8. A substantial loss caused by windstorm occurred and causing
substantial damage to Plaintiffs residence and property.
9. Plaintiff made a claim under his insurance policy for the damage
from the covered peril.
10. Defendant’s field adjuster acknowledged the extensive damage.
Nonetheless, Defendant declined coverage for a substantial portion of the damage
caused by the covered peril.11. Defendant admitted coverage for the event. Defendant, however,
neril Defendant tank a nacitinn
denied coverage for damage caused by the covered peril, Defendant took a position
that the damage was not due to wind forces or windborne debris. Defendant
improperly calculated actual cash value of the property damage.
Causes of Action
. COUNT I
BREACH OF INSURANCE CONTRACT
12. Plaintiff incorporates by reference paragraphs 1-2 and 7-through-11
above, as if alleged in this Count.
13. Plaintiff and Defendant entered into a valid and enforceable
insurance contract.
14. Defendant breached the insurance contract by denying coverage for
Plaintiff above-referenced claim, which was a covered peril not subject to any
exclusion.
15. Defendant further breached the insurance contract by improperly
calculating the actual cash value of the damage that it admitted was covered.
16. Plaintiff complied with his obligations under the insurance contract,
17. Plaintiff has been injured and suffered financial harm as a result of
Defendant’s breach of the insurance contract.
COUNT II
STATUTORY BAD FAITH CLAIM PURSUANT TO FLA. STAT. SEC. 624.15
18. Plaintiff adopts and realleges paragraphs 1 through 17, as fully
alleged herein.19. Pursuant to Fla. Stat. Sec. 624.155, the Plaintiffhas a statutory cause
of action for had faith due to the Defendant's general business practice of willful,
wanton, immoral, unlawful, malicious and/or deceptive claims handling practices
(misconduct collectively referred to as "Bad Faith").
20. The exhaustively stated basis for which this action is predicated is
set forth in the civil remedies notice (CRN) which is attached hereto, incorporated
by reference, and identified as Exhibit "A."
21. Including its subparts, the CRN comports with the condition
precedent set forth under Fla. Stat. Sec. 624.155(3).
22. The CRN was duly filed with the Florida Department of Financial
Services, and was served upon the insurer by way of, inter alia, service of this
Complaint.
a Dae anvaening laur thie antian ic omhi. i i
23. Per governing law this action is subject to abatement until such time
as the sixty (60) day notice requirement for the CRN expires and liability is
adjudicated and/or confessed in the Plaintiffs favor as it relates to the claim(s) for
relief per Count I and/or II of this Complaint.
24, However, and for the reasons stated in the CRN, Plaintiffs are
entitled to punitive damages, attorneys’ fees, extra-contractual damages, and costs once
the referenced conditions have been qualified and the abatement has been lifted. Allstate
Ins. Co., v, Lovell, 530 So. 2d 1106 (Fla. 3d DCA 1988); Schimmel v. Aetna Casualty &
Sur. Co., 506 2d. 1162 (Fla. 3d DCA 1987).
Praver for Relief
WHEREFORE, Plaintiff requests that after a trial on the merits, the Court award. A judgment declaring Defendant in breach of the insurance contract for denying
hic claim:
aus C.20M >
. A judgment awarding Plaintiffs compensatory damages for Defendant’s denial
of the claim;
. A judgment awarding Plaintiffs attorney’s fees pursuant to Fla. Stat. § 627.428;
. A judgment awarding Plaintiffs pre-judgment interest pursuant to Fla. Stat. §
627.70131.
: ‘A judgment awarding Plaintiff's post-judgment interest; and
. Such other relief that that Court deems proper.
Jury Demand
Plaintiff demands a jury trial on all issues to which they are so entitled.
Respectfully submitted this 15'" day of September 2020.
7.
is Matthew D. Landau
Matthew D. Landau
Fla. Bar. No. 445967
Eric Fischer
Fla. Bar. No. 962422
Paul Kunz
Fla. Bar. No. 159492
THE LANDAU LAW GROUP, P.A.
1200 North Federal Highway, Ste. 200
Boca Raton, FL 33432
Phone: (954) 964-0900
matt@thelandaulawgroup.com
Co-Counsel for PlaintiffsExhibit A
Steidle v. Tower HillFLORIDA
DEPARTMENT OF
FINANCIAL SERVICES
Filing Number: 515001
Filing Accepted: 9/15/2020
Warning! Information submitted as part of this civil remedy notice is a public record. Data entered into
this form will be displayed on the DFS website for public review. Please DO NOT enter Social Security
Numbers, personal medical information, personal financial information or any other information you do not
want available for public review.
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.
ef u ELUEUL
Name: PAUL STEIDLE
Street Address: 313 HUMMINGBIRD PT
City, State Zip: JUPITER, FL 33458
Email Address:
Complainant Type: Insured
Name: PAUL STEIDLE
Policy #: E000243563
Claim #: 3300313231
Name: MATTHEW LANDAU
Street Address: 1200 NORTH FEDERAL HIGHWAY, SUITE 200
City, State Zip: BOCA RATON, FL 33432
Email Address: MATT@THELANDAULAWGROUP.COM
Insurer Type: Authorized Insurer
Name: TOWER HILL PRIME INSURANCE COMPANY
Street Address:
City, State Zip: 7
Please identify the person or persons representing the insurer who are most responsible for/knowledgeable of the
facts giving rise to the allegations in this notice.
MATTHEW
Type of Insurance: Residential Property & Casualty
DFS-10-363
Rev. 10/14/2008me FLORIDA
im) FINANCIAL SERVICES
Filing Number: 515001
Reasons for Notice:
Claim Denial
Ciaim Delay
Unsatisfactory Settlement Offer
Unfair Trade Practice
PURSUANT TO SECTION 624.155, F.S. please indicate all statutory provisions alleged to have been 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 i acted fairly and honestly toward its
624.155(1)(b)(3) Except as to Tiabtity 6 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)(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.
626.9541(1)(I)(3)(i) Unfair claim settlement practices
Reference to specific policy language that is relevant to the violation, if any. If the person bringing the civil action is a
third party claimant, she or he shall not be required to reference the specific policy language if the authorized insurer
has not provided a copy of the policy to the third party claimant pursuant to written request.
DFS-10-363
Rev. 10/14/2008TOWER HILL’s claim settlement procedures resulting in delays, denials and undue hardship to the
Insured/Complainant, more specifically Insurance Company’s misapplication and misinterpretation of
policy terms and conditions found in (but not limited to) the Policy “Definitions”, the section of Conditions
and the section of Additional Coverages, as well as the terms of the Special Provisions and Endorsements.
698-220.201(3)(b) An Adjuster : shall treat all. claimants equall
AP 99n ana (MLD An aetaatee ta 2, a san ae to
SSb-2eu.c01 (oye Ali aujustal Sian aujust au ce
69B-220.201 (3)(c) An adjuster shall not approach investigations, adjustments, and settlements in a manner
Prejudicial to the insured
69B-220.201 (3)(e) An adjuster shall handle every adjustment and settlement with honesty and integrity and
allow a fair adjustment or settlement to all parties without any remuneration to himself except that to which
he is legally entitled
69B-220.201 (3)(m) An adjuster shall not knowingly fail to advise a claimant of the claimant’s rights in
accordance with the terms and conditions of the contract and of the applicable laws of this state. And
adjuster shall exercise care not to engage in the unlicensed practice of law as prescribed by the Florida Bar.
698-220(3)(0) An adjuster shall not undertake the adjustment of any claim concerning which the adjuster is
not currently competent and knowledgeable as to the terms and conditions of the insurance coverage, or
which otherwise exceeds the adjuster’s current expertise or the matter as you understand at the time.
To enable the insurer to investigate and resolve your claim, describe the facts and circumstances giving rise to the
insurer's violation as you understand them at this time.
This claim remains improperly and insufficiently adjusted for substantial damage to their residence due to
Hurricane Irma. To date TOWER HILL has not responded sufficiently to its insured’s claim correspondence.
They have conducted an inadequate e evaluation of this claim and failed to respond in a timely manner to this
a senate in
. TOWER MILL has improperly failed to acknowledge supsiantiai damage io ihe siruciure, inciuding
extensive damage to the roof and internal structure.
The Insured’s residence was damaged by Hurricane Irma. The Insured therefore made a claim for the
damage under their policy with TOWER HILL. TOWER HILL has summarily failed to acknowledge the full
extent of the claim and improperly denied the claim. Since then there has been no response or
communication from TOWER HILL regarding this claim.
TOWER HILL, by and through their claim’s examiner have falled to acknowledge a substantial portion of
this damage and have failed to fully indemnify the Insured for their loss.
TOWER HILL clearly has no intention of honoring its obligations under the policy and the law. It is apparent
that TOWER HILL and its adjuster have failed to properly document the file and have not placed a priority
on this claim. It is believed this is not conduct that is unique to this particular claim but is rather a product
of a systematic approach as to how TOWER HILL handles claims as a general business policy.
TOWER HILL knows that it would be in the Insureds’ interests and their obligation under the insurance
policy to promptly adjust and issue unencumbered payment for the substantial damages in order avoid
additional damages to the premises and the Insured.
Despite the fact that the home continues to contain substantial damages TOWER HILL has refused and/or
failed to tender all insurance proceeds to the Insured as required by the policy and law.
TOWER HILL has breached its statutory and contractual responsibilities by its refusal and/or failure to
settle the Insured’s claim when under all the circumstances it could have and should have done so had it
acted fairly and hanaetly trumede tha Incurad
SONG rainy One WOnCSuy wWrrarus ure aisurea.
TOWER HILL has unlawfully, immorally, unfairly, deceptively and/or in bad faith pursuant to the above-
stated legal authorities that govern the insurance policy (“Policy”), adopted and implemented a general
business practice of misconstruing the Policy for their own financial gain. More specifically, and although
TOWER HILL has a fiduciary duty to duly and promptly investigate, adjust, pay and/or settle claims in strict
accordance with the Policy and Florida law, they have willfully, wantonly, contumaciously and/or recklessly
disregarded the rights of the Insureds as further outlined below.
Upon information and belief, TOWER HILL performs the subject actions as a business practice, including
delaying the claim and Issuing “low ball" payments In an attempt to dissuade its insureds from pursuing
the claim to the detriment of its insureds to increase financial profits.
It is clear that TOWER HILL is not treating the Insured with good faith claims conduct; failing to pay the full
value of a claim clearly owed; failing to recognize the proper scope of the loss and pay the proper value of
the policy. Specifically, they have refused to make payments with respect to the dwelling, contents, law and
ordinance changes as applicable; have not adjusted the claim nor evaluated the loss properly, promptly and
fairly to provide full and prompt indemnity to the Insured; failed to implement proper standards for the
adjustment and investigation of claims; failed to utilize and/or apply, reliable principals and methods as it
relates to extending full coverage for a claim once sufficient facts and/or data gathered in relation to same,
including failing to utilize proper rebuilding cost in its damage assessment and failed to provide adequately
for alternative living expenses; failed to make a timely, written coverage determination; not trained,
supervised or manaaed adiusters pronerly so that nromnt and full navments are made. bi
placed the company’s 's interests before the Insured’s interests; refused to pay the full amount owed to the
DFS-10-363
Rev. 10/14/2008Insured despite the fact that the damages are covered under the policy; looked for ways to delay full
recovery; and low-balled the Insured. The Insured has suffered consequential damages as a result of the
stated misconduct herein, including but not limited to inability to use funds owed to rebuild their property.
The adjusters acting on behalf of TOWER HILL have acted in contravention of one or more standards of
conduct that constitute the code of ethics that is binding on all adjusters, as more fully set forth in Florida
Administrative Code Section 69B-220.201 Ethical Requirements for All Adjusters (company employee,
independent, and puouc). Pursuant to subsections 2(2} and (b} thereof. a violation of anv provision of this
rule shall constitute grounds for administrative action against the licensee and a breach of any provision of
this rule constitutes an unfair claims settlement practice.
Therefore, to cure the defects outlined in this Civil Remedy Notice, TOWER HILL must (1) Stipulate and fully
confess and tender all insurance proceeds due and owing to the Insured that would reasonably place the
Insured back into a pre-loss condition; (2) Issue payment to the Complainant per an amount that
corresponds with its own highest usual and customary reimbursement rates for vendors in the community
providing the services in question; (3) Pay statutory interest on the amount of unpaid contract damages
from the date of the loss to the present time pursuant to F.S. §627.70131 as well as all other applicable
statutes, (3) Pay Insured’s reasonable attorney's fees and costs incurred In relation to litigation arising from
conduct referenced herein ; (4) Tender additional payment to the insured for aii consequenii damages
resulting from TOWER HILL’s bad faith actions as determined by Florida law; (5) stipulate and fully confess
that the Complainant is entitled to judgment in its favor as it relates to, and detailed in the Petition for
Declaratory Relief that is currently pending and; (6) Stipulate and confess that the Policy Cap under the
Policy runs in conflict with Coverage A of the subject policy and therefore, has been improperly and/or
inconsistently considered in relation to the Complainant's service charges as a matter of course; (7) If there
is a disagreement as to the reimbursement rate of the service charges, and to avoid a cost prohibitive
appraisal process to resolve same, that Prepared submit to mediation in accordance with the Policy.
All of the foregoing must be done timely to avoidi/limit any additional delays, costs, and prejudice that
TOWER ‘S has caused and cot es to cause the Insured. Complainant reserves all rights
and remedies at law or in equity and nothing stated herein is intended to waive any such rights or remedies.
Nor is this list intended to imply that no other actions were taken by TOWER HILL that could be deemed a
violation of law and failing to list them here shall not preclude the Insured from raising It at a later time.
TOWER HILL or their agent should contact counsel for the Insured to obtain an up-to-date payment amount
necessary to cure these violations.
Complainant requests relief under all Florida Statutes cited in this CRN. Pursuant to Section 624.155(3)(b)5,
this notice is given in order to perfect the Insured’s right to pursue all civil remedies authorized by this
section and Florida Law.
ACOPY OF THIS FORM SUBMITTED TO THE
FOLLOWING PARTIES PROVIDING
Claims@TOWER HILL.com
RINTED OUT AND EMAILED TO THE
AAR TUE ANNE HEMENY MATIC‘.
(G OF ING Civin KRemcur WUTC.
User Id Date Added Comment
DFS-10-363
Rev. 10/14/2008
Preview
wes CASE NUMBER: 502020CA010045XXXXMB Div: AJ **** Filing # 113491502 E-Filed 09/16/2020 05:51:39 PM IN THE CIRCUIT COURT OF THE 15™ JUDICIAL CIRCUIT IN AND FOR PALM BEACH COUNTY, FLORIDA PAUL STEIDLE, Cc . Plaintiff, a - JURY TRIAL DEMANDED TOWER HILL PRIME INSURANCE COMPANY, Defendant. COMPLAINT Plaintiff, by and through undersigned counsel, submit this Complaint against Defendant TOWER HILL PRIME INSURANCE COMPANY (“TOWER HILL”). As his Complaint, Plaintiff asserts and alleges as follows: Introduction 1. This action arises from the denial of insurance benefits. Plaintiff's residence was damaged by a windstorm. Plaintiff made a claim with Defendant (claim # 3300313231) under his policy with Defendant (policy # E000243563), Defendant improperly denied the claim, has failed to acknowledge a substantial amount of the damage caused by the covered peril and failed to calculate properly the amount of damage for the items it admitted were damaged. 2. Defendant’s refusal to cover all the damage caused by the covered peril violated its contractual duty. Moreover, its failure to fairly adjust the claim and cover undisputed damage constitutes bad faith. Plaintiff therefore brings this action to FILED: PALM BEACH COUNTY, FL, SHARON R. BOCK, CLERK, 09/16/2020 05:51:39 PMobtain the benefits due under the insurance policy. A complete copy of the policy is within Defendant’s nossession, Parties and Jurisdiction 3. Plaintiff is a natural person and full-time residents of this County. 4. Defendant is an insurance company with its principal place of business in Gainesville, Florida. Defendant has engaged in business in this County by issuing insurance policies and adjusting claims. 5. The amount at issue in this case is in excess of $30,000.00, exclusive of interest, attorneys’ fees and costs. . 6 Venue is proper in this Circuit because the conduct at issue occurred in this County and Defendant is present in this Circuit through its business activities. Daateal Aland: Patiuar aucgau 7. Pursuant to a policy numbered E000243563. Defendant insured Plaintiffs against loss to their residence and property, including loss from windstorm. 8. A substantial loss caused by windstorm occurred and causing substantial damage to Plaintiffs residence and property. 9. Plaintiff made a claim under his insurance policy for the damage from the covered peril. 10. Defendant’s field adjuster acknowledged the extensive damage. Nonetheless, Defendant declined coverage for a substantial portion of the damage caused by the covered peril.11. Defendant admitted coverage for the event. Defendant, however, neril Defendant tank a nacitinn denied coverage for damage caused by the covered peril, Defendant took a position that the damage was not due to wind forces or windborne debris. Defendant improperly calculated actual cash value of the property damage. Causes of Action . COUNT I BREACH OF INSURANCE CONTRACT 12. Plaintiff incorporates by reference paragraphs 1-2 and 7-through-11 above, as if alleged in this Count. 13. Plaintiff and Defendant entered into a valid and enforceable insurance contract. 14. Defendant breached the insurance contract by denying coverage for Plaintiff above-referenced claim, which was a covered peril not subject to any exclusion. 15. Defendant further breached the insurance contract by improperly calculating the actual cash value of the damage that it admitted was covered. 16. Plaintiff complied with his obligations under the insurance contract, 17. Plaintiff has been injured and suffered financial harm as a result of Defendant’s breach of the insurance contract. COUNT II STATUTORY BAD FAITH CLAIM PURSUANT TO FLA. STAT. SEC. 624.15 18. Plaintiff adopts and realleges paragraphs 1 through 17, as fully alleged herein.19. Pursuant to Fla. Stat. Sec. 624.155, the Plaintiffhas a statutory cause of action for had faith due to the Defendant's general business practice of willful, wanton, immoral, unlawful, malicious and/or deceptive claims handling practices (misconduct collectively referred to as "Bad Faith"). 20. The exhaustively stated basis for which this action is predicated is set forth in the civil remedies notice (CRN) which is attached hereto, incorporated by reference, and identified as Exhibit "A." 21. Including its subparts, the CRN comports with the condition precedent set forth under Fla. Stat. Sec. 624.155(3). 22. The CRN was duly filed with the Florida Department of Financial Services, and was served upon the insurer by way of, inter alia, service of this Complaint. a Dae anvaening laur thie antian ic omhi. i i 23. Per governing law this action is subject to abatement until such time as the sixty (60) day notice requirement for the CRN expires and liability is adjudicated and/or confessed in the Plaintiffs favor as it relates to the claim(s) for relief per Count I and/or II of this Complaint. 24, However, and for the reasons stated in the CRN, Plaintiffs are entitled to punitive damages, attorneys’ fees, extra-contractual damages, and costs once the referenced conditions have been qualified and the abatement has been lifted. Allstate Ins. Co., v, Lovell, 530 So. 2d 1106 (Fla. 3d DCA 1988); Schimmel v. Aetna Casualty & Sur. Co., 506 2d. 1162 (Fla. 3d DCA 1987). Praver for Relief WHEREFORE, Plaintiff requests that after a trial on the merits, the Court award. A judgment declaring Defendant in breach of the insurance contract for denying hic claim: aus C.20M > . A judgment awarding Plaintiffs compensatory damages for Defendant’s denial of the claim; . A judgment awarding Plaintiffs attorney’s fees pursuant to Fla. Stat. § 627.428; . A judgment awarding Plaintiffs pre-judgment interest pursuant to Fla. Stat. § 627.70131. : ‘A judgment awarding Plaintiff's post-judgment interest; and . Such other relief that that Court deems proper. Jury Demand Plaintiff demands a jury trial on all issues to which they are so entitled. Respectfully submitted this 15'" day of September 2020. 7. is Matthew D. Landau Matthew D. Landau Fla. Bar. No. 445967 Eric Fischer Fla. Bar. No. 962422 Paul Kunz Fla. Bar. No. 159492 THE LANDAU LAW GROUP, P.A. 1200 North Federal Highway, Ste. 200 Boca Raton, FL 33432 Phone: (954) 964-0900 matt@thelandaulawgroup.com Co-Counsel for PlaintiffsExhibit A Steidle v. Tower HillFLORIDA DEPARTMENT OF FINANCIAL SERVICES Filing Number: 515001 Filing Accepted: 9/15/2020 Warning! Information submitted as part of this civil remedy notice is a public record. Data entered into this form will be displayed on the DFS website for public review. Please DO NOT enter Social Security Numbers, personal medical information, personal financial information or any other information you do not want available for public review. 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. ef u ELUEUL Name: PAUL STEIDLE Street Address: 313 HUMMINGBIRD PT City, State Zip: JUPITER, FL 33458 Email Address: Complainant Type: Insured Name: PAUL STEIDLE Policy #: E000243563 Claim #: 3300313231 Name: MATTHEW LANDAU Street Address: 1200 NORTH FEDERAL HIGHWAY, SUITE 200 City, State Zip: BOCA RATON, FL 33432 Email Address: MATT@THELANDAULAWGROUP.COM Insurer Type: Authorized Insurer Name: TOWER HILL PRIME INSURANCE COMPANY Street Address: City, State Zip: 7 Please identify the person or persons representing the insurer who are most responsible for/knowledgeable of the facts giving rise to the allegations in this notice. MATTHEW Type of Insurance: Residential Property & Casualty DFS-10-363 Rev. 10/14/2008me FLORIDA im) FINANCIAL SERVICES Filing Number: 515001 Reasons for Notice: Claim Denial Ciaim Delay Unsatisfactory Settlement Offer Unfair Trade Practice PURSUANT TO SECTION 624.155, F.S. please indicate all statutory provisions alleged to have been 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 i acted fairly and honestly toward its 624.155(1)(b)(3) Except as to Tiabtity 6 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)(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. 626.9541(1)(I)(3)(i) Unfair claim settlement practices Reference to specific policy language that is relevant to the violation, if any. If the person bringing the civil action is a third party claimant, she or he shall not be required to reference the specific policy language if the authorized insurer has not provided a copy of the policy to the third party claimant pursuant to written request. DFS-10-363 Rev. 10/14/2008TOWER HILL’s claim settlement procedures resulting in delays, denials and undue hardship to the Insured/Complainant, more specifically Insurance Company’s misapplication and misinterpretation of policy terms and conditions found in (but not limited to) the Policy “Definitions”, the section of Conditions and the section of Additional Coverages, as well as the terms of the Special Provisions and Endorsements. 698-220.201(3)(b) An Adjuster : shall treat all. claimants equall AP 99n ana (MLD An aetaatee ta 2, a san ae to SSb-2eu.c01 (oye Ali aujustal Sian aujust au ce 69B-220.201 (3)(c) An adjuster shall not approach investigations, adjustments, and settlements in a manner Prejudicial to the insured 69B-220.201 (3)(e) An adjuster shall handle every adjustment and settlement with honesty and integrity and allow a fair adjustment or settlement to all parties without any remuneration to himself except that to which he is legally entitled 69B-220.201 (3)(m) An adjuster shall not knowingly fail to advise a claimant of the claimant’s rights in accordance with the terms and conditions of the contract and of the applicable laws of this state. And adjuster shall exercise care not to engage in the unlicensed practice of law as prescribed by the Florida Bar. 698-220(3)(0) An adjuster shall not undertake the adjustment of any claim concerning which the adjuster is not currently competent and knowledgeable as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster’s current expertise or the matter as you understand at the time. To enable the insurer to investigate and resolve your claim, describe the facts and circumstances giving rise to the insurer's violation as you understand them at this time. This claim remains improperly and insufficiently adjusted for substantial damage to their residence due to Hurricane Irma. To date TOWER HILL has not responded sufficiently to its insured’s claim correspondence. They have conducted an inadequate e evaluation of this claim and failed to respond in a timely manner to this a senate in . TOWER MILL has improperly failed to acknowledge supsiantiai damage io ihe siruciure, inciuding extensive damage to the roof and internal structure. The Insured’s residence was damaged by Hurricane Irma. The Insured therefore made a claim for the damage under their policy with TOWER HILL. TOWER HILL has summarily failed to acknowledge the full extent of the claim and improperly denied the claim. Since then there has been no response or communication from TOWER HILL regarding this claim. TOWER HILL, by and through their claim’s examiner have falled to acknowledge a substantial portion of this damage and have failed to fully indemnify the Insured for their loss. TOWER HILL clearly has no intention of honoring its obligations under the policy and the law. It is apparent that TOWER HILL and its adjuster have failed to properly document the file and have not placed a priority on this claim. It is believed this is not conduct that is unique to this particular claim but is rather a product of a systematic approach as to how TOWER HILL handles claims as a general business policy. TOWER HILL knows that it would be in the Insureds’ interests and their obligation under the insurance policy to promptly adjust and issue unencumbered payment for the substantial damages in order avoid additional damages to the premises and the Insured. Despite the fact that the home continues to contain substantial damages TOWER HILL has refused and/or failed to tender all insurance proceeds to the Insured as required by the policy and law. TOWER HILL has breached its statutory and contractual responsibilities by its refusal and/or failure to settle the Insured’s claim when under all the circumstances it could have and should have done so had it acted fairly and hanaetly trumede tha Incurad SONG rainy One WOnCSuy wWrrarus ure aisurea. TOWER HILL has unlawfully, immorally, unfairly, deceptively and/or in bad faith pursuant to the above- stated legal authorities that govern the insurance policy (“Policy”), adopted and implemented a general business practice of misconstruing the Policy for their own financial gain. More specifically, and although TOWER HILL has a fiduciary duty to duly and promptly investigate, adjust, pay and/or settle claims in strict accordance with the Policy and Florida law, they have willfully, wantonly, contumaciously and/or recklessly disregarded the rights of the Insureds as further outlined below. Upon information and belief, TOWER HILL performs the subject actions as a business practice, including delaying the claim and Issuing “low ball" payments In an attempt to dissuade its insureds from pursuing the claim to the detriment of its insureds to increase financial profits. It is clear that TOWER HILL is not treating the Insured with good faith claims conduct; failing to pay the full value of a claim clearly owed; failing to recognize the proper scope of the loss and pay the proper value of the policy. Specifically, they have refused to make payments with respect to the dwelling, contents, law and ordinance changes as applicable; have not adjusted the claim nor evaluated the loss properly, promptly and fairly to provide full and prompt indemnity to the Insured; failed to implement proper standards for the adjustment and investigation of claims; failed to utilize and/or apply, reliable principals and methods as it relates to extending full coverage for a claim once sufficient facts and/or data gathered in relation to same, including failing to utilize proper rebuilding cost in its damage assessment and failed to provide adequately for alternative living expenses; failed to make a timely, written coverage determination; not trained, supervised or manaaed adiusters pronerly so that nromnt and full navments are made. bi placed the company’s 's interests before the Insured’s interests; refused to pay the full amount owed to the DFS-10-363 Rev. 10/14/2008Insured despite the fact that the damages are covered under the policy; looked for ways to delay full recovery; and low-balled the Insured. The Insured has suffered consequential damages as a result of the stated misconduct herein, including but not limited to inability to use funds owed to rebuild their property. The adjusters acting on behalf of TOWER HILL have acted in contravention of one or more standards of conduct that constitute the code of ethics that is binding on all adjusters, as more fully set forth in Florida Administrative Code Section 69B-220.201 Ethical Requirements for All Adjusters (company employee, independent, and puouc). Pursuant to subsections 2(2} and (b} thereof. a violation of anv provision of this rule shall constitute grounds for administrative action against the licensee and a breach of any provision of this rule constitutes an unfair claims settlement practice. Therefore, to cure the defects outlined in this Civil Remedy Notice, TOWER HILL must (1) Stipulate and fully confess and tender all insurance proceeds due and owing to the Insured that would reasonably place the Insured back into a pre-loss condition; (2) Issue payment to the Complainant per an amount that corresponds with its own highest usual and customary reimbursement rates for vendors in the community providing the services in question; (3) Pay statutory interest on the amount of unpaid contract damages from the date of the loss to the present time pursuant to F.S. §627.70131 as well as all other applicable statutes, (3) Pay Insured’s reasonable attorney's fees and costs incurred In relation to litigation arising from conduct referenced herein ; (4) Tender additional payment to the insured for aii consequenii damages resulting from TOWER HILL’s bad faith actions as determined by Florida law; (5) stipulate and fully confess that the Complainant is entitled to judgment in its favor as it relates to, and detailed in the Petition for Declaratory Relief that is currently pending and; (6) Stipulate and confess that the Policy Cap under the Policy runs in conflict with Coverage A of the subject policy and therefore, has been improperly and/or inconsistently considered in relation to the Complainant's service charges as a matter of course; (7) If there is a disagreement as to the reimbursement rate of the service charges, and to avoid a cost prohibitive appraisal process to resolve same, that Prepared submit to mediation in accordance with the Policy. All of the foregoing must be done timely to avoidi/limit any additional delays, costs, and prejudice that TOWER ‘S has caused and cot es to cause the Insured. Complainant reserves all rights and remedies at law or in equity and nothing stated herein is intended to waive any such rights or remedies. Nor is this list intended to imply that no other actions were taken by TOWER HILL that could be deemed a violation of law and failing to list them here shall not preclude the Insured from raising It at a later time. TOWER HILL or their agent should contact counsel for the Insured to obtain an up-to-date payment amount necessary to cure these violations. Complainant requests relief under all Florida Statutes cited in this CRN. Pursuant to Section 624.155(3)(b)5, this notice is given in order to perfect the Insured’s right to pursue all civil remedies authorized by this section and Florida Law. ACOPY OF THIS FORM SUBMITTED TO THE FOLLOWING PARTIES PROVIDING Claims@TOWER HILL.com RINTED OUT AND EMAILED TO THE AAR TUE ANNE HEMENY MATIC‘. (G OF ING Civin KRemcur WUTC. User Id Date Added Comment DFS-10-363 Rev. 10/14/2008