Titular de Insurance Insights
Volume 6, No. 3 - March 2017

Notas de Casos

Oficina de Investigaciones

The following are instances in which licensees or other persons violated the Florida Insurance Code and the administrative action the Department has taken against them. Note: All administrative investigations are subject to referral to the División de Servicios Forenses y de Investigación for criminal investigation.

Case: An investigation was opened on the agent in charge of a life, health, annuity and general lines agency after a consumer complained to the Department she had received a life insurance policy she did not apply for. The customer received a life insurance policy in the mail after speaking to a customer representative at the agency by phone. The consumer never authorized anyone to initiate a policy on her behalf and never met the agent in charge. The agent stated she knew the customer representative completed the life insurance application on the consumer. Customer representatives are prohibited from transacting life insurance business.
Disposition: The agent in charge was fined $2,500 and placed on probation for one year.

Case: According to an insurance company appointment termination, a life, health and annuity agent intentionally made fraudulent statements on employee group insurance applications submitted to the insurer. Investigators confirmed the agent added individuals to the group plan that were not employed by the group policyholder. An audit of the group's application records revealed the individuals added to the group plan as employees did not reside at the addresses on their applications, and could not be contacted at the phone numbers or email addresses on the applications.
Disposition: License suspended for nine months.

Case: An investigation was opened based on review of an internet advertisement by a Public Adjuster. The ad did not include the full name and license number of the designated primary adjuster. Investigators discovered the adjuster was operating from a residence. The adjuster failed to maintain a place of business accessible to the public and failed to maintain records as required, and failed to notify the Department of an address change within 30 days as required by statute.
Disposition: Fined $3,500.

Case: A case was opened on a general lines agent when investigators learned the agent was knowingly allowing a revoked customer representative (CR) to continue to transact insurance. The CR was working alone from the offices of an automobile dealer. The completed applications would be brought by the CR to the general lines agency for the general lines agent to sign as the writing agent. Investigators determined 133 applications had been processed in this manner. Our investigation confirmed the CR had continued to receive wages from the general lines agency in violation of the Order of Revocation issued. An inspection of agency documents verified the applications in question were transacted by the CR and the subject was listed as the agent of record for the polices with the companies issuing the policies.

The customer representative was arrested by the Division of Investigative & Forensic Services, Bureau of Insurance Fraud for transacting insurance business while revoked.

Our research uncovered other customer representatives in the agency who were not properly appointed by the agent or the agency. The Department alleged the subject of the investigation assisted and allowed a revoked customer representative to transact insurance business, failed to appoint and properly supervise customer representatives and failed to submit a designation of supervising agent form for the customer representatives working in her agency.
Disposition: The agent was fined $7,500 and placed on probation for one year.

Case: The original source of this complaint was a consumer affidavit obtained by the Bureau of Investigation in another matter. The subject of the investigation is an unlicensed individual, and the owner of a roofing and general contracting firm. Statements obtained by investigators and documentation from insurance companies indicated the unlicensed subject offered free public adjuster services and had obtained authorization from numerous clients to assist with their claim resolution. The business owner was found to have advertised "free hurricane mediation" without the license or skills required of a mediator.
Disposition: The owner of the business was ordered to Cease and Desist from acting as a public adjuster without a license. The individual is subject to arrest on felony charges if he is again found to portray himself as a public adjuster to the public.

Case: Investigators opened a case on a non-resident general lines agent after regulatory monitoring found enforcement action was taken against the agent in his home state. The action alleged the agent failed to procure proper insurance for a commercial business client, which violated certain sections of that State’s laws. He was fined $5,000 and placed on probation for one year in his home state. A search of our Department records and the NAIC database revealed the agent failed to report this action to the Department as required by Florida law.
Disposition: Fined $1,500 and placed on probation for one year.