Titular de Insurance Insights
Volume 5, No. 10 - October 2016

Esquina de Cumplimiento

This section has been created to assist you in keeping your insurance business in compliance. The items are intended as reminders only. Note: Division publications may include references to the Estatutos de la Florida and/or the Código Administrativo de la Florida. The laws noted in our publications are/were in effect at the time of publication but may have been repealed, amended or replaced and new laws may have been enacted subsequently.

Compliance Topic of the Month ~ Contractors Acting As Public Adjusters

Se necesita licencia de tasador público para ayudar con reclamaciones

Sometimes contractors attempt to help victims of disasters by offering assistance with their insurance claim. If they do, they may illegally be engaging in the practice of public adjusting without being properly licensed by the Department of Financial Services.

A public adjuster is defined in s. 626.854, F.S., as any person, except an attorney, who, for money or any other thing of value (which would include securing a contract for repairs):

  • Prepara, completa o presenta un formulario de reclamación de seguros para un asegurado
  • Aids an insured in negotiating for or effecting the settlement of a claim
  • Advertises for employment as an adjuster of such claims

However, the contractor may discuss or explain a bid for construction or repair of covered property with the residential property owner who has suffered loss or damage covered by a property insurance policy, or the insurer of such property, if the contractor is doing so for the usual and customary fees applicable to the work to be performed as stated in the contract between the contractor and the insured. [See s.626.854(1), Estatuto de la Florida]

If you are acting as a public adjuster in any manner by negotiating or effecting the settlement of an insurance claim on behalf of an insured and you are performing any of these services for money, commission or anything of value without being licensed as a public adjuster, you could be subject to arrest and may be charged with a third-degree felony as provided by s. 626.8738, Estatutos de la Florida

If you become licensed as a Public Adjuster, you cannot enter into a contract to do both the public adjusting and construction work on the same property per s. 626.8795, F.S., Public adjusters; prohibition of conflict of interest:

"A public adjuster may not participate, directly or indirectly, in the reconstruction, repair, or restoration of damaged property that is the subject of a claim adjusted by the licensee; may not engage in any other activities that may be reasonably construed as a conflict of interest, including soliciting or accepting any remuneration from, of any kind or nature, directly or indirectly; and may not have a financial interest in any salvage, repair, or any other business entity that obtains business in connection with any claim that the public adjuster has a contract or an agreement to adjust."

If you have any questions about the activities constitute acting as a public adjuster, please contact the Department of Financial Services' Bureau of Investigation at Adjusters@MyFloridaCFO.com.

Ver el Boletín Informativo DBPR de Otoño de 2007.

Business And Trade Practices

Your profession as a licensed and appointed agent or adjuster engages the public trust. Therefore, your insurance activities and your business practices must be conducted in accordance with the laws and regulations of Florida. There are certain prohibited practices, such as false advertising, unfair discrimination, unfair claim practices, coercion, providing free insurance, unlawful rebates, refusing to insure, misrepresentation, premium surcharges and illegal dealings in premiums that would be considered an unfair trade practice. Please review s. 626.9541, F.S., for the full text of the unfair trade practices laws.

Reporting of Actions Against You

You are required to let us know within 30 days of a final disposition of any administrative action. This includes any action by a governmental agency in this or any other state or jurisdiction relating to the business of insurance, the sale of securities, or activity involving fraud, dishonesty, trustworthiness, or breach of fiduciary duty. A copy of the order, consent to order or other relevant legal documents should be directed to: The Florida Department of Financial Services, Bureau of Licensing, 200 East Gaines Street, Tallahassee, FL 32399-0319, or by email to AgentLicensing@MyFloridaCFO.com. [See s. 626.536, Estatuto de la Florida]

You must inform the Department in writing within 30 days after pleading guilty or nolo contendere to, or being convicted or found guilty of, any felony or a crime punishable by imprisonment of 1 year or more under the law of the United States or of any state thereof, or under the law of any other country without regard to whether a judgment of conviction has been entered by the court having jurisdiction of the case. See s. 626.451(7), Estatutos de la Florida

Información sobre Navegadores e Inscripción

There is Florida law regarding the registering and regulation of the “Navigator” position created by federal health care reform. The law states:

  • Individuals acting as a "navigator" under the Patient Protection and Affordable Care Act (PPACA), commonly known as the Affordable Care Act or ACA, are required to be registered with the Florida Department of Financial Services (DFS).
  • Para registrarse como navegador, el individuo debe:
    • Ser una persona naturalizada de al menos 18 años de edad;
    • Ser ciudadano de los Estados Unidos o extranjero legal que posea autorización para trabajar otorgada por la Oficina de Ciudadanía y Servicios Migratorios de los Estados Unidos;
    • Enviar la solicitud de registro al responder todas las preguntas y pagar los cargos para completar la solicitud en línea;
    • Provide official certification that he or she has successfully completed all required training by the federal government and has been certified by them as a Marketplace Navigator for the 2017 enrollment period. The certificate of completion that states it is "not an official certification record" is not sufficient. Please provide the official certificate that has the navigator's unique ID number assigned by the Department of Health and Human Services (HHS) and the organization they are employed;
    • Enviar las huellas dactilares para verificación de antecedentes penales (certain crimes may disqualify an applicant from registration).
  • Al navegador se le prohíbe:
    • Solicitar, negociar o vender seguros de salud;
    • Recomendar la compra de un plan de salud particular o manifestar que un determinado plan de salud es preferible a otro;
    • Recomendar o ayudar a cancelar la cobertura de seguro comprada fuera del Intercambio;
    • Recibir compensación o algún tipo de valor por parte de una aseguradora, plan de salud, empresa o consumidor que estuviera relacionada con la realización de actividades como navegador, que no sean aquellas del Intercambio o de una entidad o individuo que haya recibido una subvención para navegador según la PPACA.
  • Grounds for suspension or revocation of registration and authorizes DFS to impose an administrative fine in lieu of, or in addition to suspension or revocation.
  • Any person who acts as a navigator without registration is subject to an administrative penalty not to exceed $1,500.
    Navigators are required to adhere to strict security and privacy standards – including how to safeguard a consumer’s personal information. They are required to complete training by the federal government to be certified, will take additional federal training throughout the year, and will renew their federal certification yearly. All types of enrollment assisters – including Certified Application Counselors and agents/brokers – are required to complete specific training and are subject to federal criminal penalties for violations of privacy or fraud statutes, on top of any relevant state law penalties.

Aquellos interesados en convertirse en Navegadores deben  contactar a las entidades que recibieron las subvenciones para Navegadores del Departamento de Salud y Servicios Humanos (HHS) para potenciales oportunidades laborales. Los Navegadores no son contratados en forma directa por el gobierno federal ni por el Mercado.

El currículum de capacitación para Navegadores está disponible en el sitio web del Mercado, http://marketplace.cms.gov. Tenga en cuenta que por completar el currículum de navegador federal, un individuo no califica automáticamente para convertirse en navegador.

Los Consejeros de Inscripción Certificados del Mercado no deben registrarse como navegadores del Departamento de Servicios Financieros (DFS) de la Florida, ya que no son regulados por el DFS. Si usted es un Consejero de Inscripción certificado del Mercado, no se inscriba como navegador de la Florida.

If you are already registered in Florida as a navigator, you do not need to re-apply, re-qualify, or re-register with the DFS. Please be sure to check your registration status via your MyProfile account. You only need to email your Marketplace Navigator certificate for the 2017 enrollment period to the Department.

Información de Contacto para Servicios Humanos y de Salud

Si usted desea acceder a información del Gobierno Federal, tal como información relacionada con el Mercado de Seguros del Gobierno Federal o el Intercambio de Seguros de Salud, visite el sitio web en http://www.healthcare.gov.

Federally-Facilitated Marketplace (FFM) Agent/Broker Training

Annual FFM Registration Requirements

All agents and brokers participating in the FFM must complete registration on the CMS Enterprise Portal at https://portal.cms.gov (i.e., create an FFM user account, select the agent/broker role, and complete identity proofing) if they have not done so previously.

To continue participation in the Federally-facilitated Individual Marketplace each year, agents and brokers must also complete a Marketplace Learning Management System (MLMS) profile, complete the required training and exams, and execute the Individual Marketplace Agreements (i.e., General and Privacy & Security Agreement). To begin this process, agents and brokers must log in to the CMS Enterprise Portal at https://portal.cms.gov with their existing credentials.

To continue participation in the Federally-facilitated SHOP Marketplace each year, agents and brokers must also complete an MLMS profile and execute the FF-SHOP Agreement, and are strongly encouraged to complete the associated training and exams.  To begin this process, agents and brokers must log in to the CMS Enterprise Portal at https://portal.cms.gov with their existing credentials.

For plan year 2017, agents and brokers can complete the CMS-developed training on the MLMS or through a CMS-approved vendor. Agents and brokers will access both the CMS-developed training and CMS-approved vendor training via the CMS Enterprise Portal. For more information, click aquí.

¿Tiene Preguntas?

Mire la información que nuestra División de Servicio al Consumidor tiene en su sitio web en: http://www.MyFloridaCFO.com/Division/Consumers/HealthReform.htm.

Por favor haga clic aquí para ver una lista actual de los navegadores registrados.


Información sobre Cumplimiento

Department licensees and consumers can access compliance information at the Division of Insurance Agent and Agency Services' web page Información sobre Cumplimiento. Additional information is available by type of license at our Preguntas Frecuentes web page.