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Inicio del Departamento | Inicio de Agentes y Agencias | Inicio de Insurance Insights

  Vol. 9, No. 4 - December 2020

Notas de Casos


Case: The Bureau of Investigation received an insurer's notice of the termination for cause alleging a life insurance agent had committed fraudulent, illegal and dishonest acts. The insurer alleged the agent knowingly, with intent to defraud the insurer, submitted an application to insure a deceased person.

During the course of the investigation, evidence obtained confirmed the agent made fraudulent representations on the application. The agent also impersonated the deceased applicant-insured to confirm the false medical history represented on the application during a telephone interview with the insurer's representative.

Disposition:
Suspended for three months, fined $1,500, and ordered to pay administrative costs of $2,000.


Case: A case was opened when a property and casualty agent filed a complaint against a customer representative. The agent alleged that while conducting a background check during the hiring process, she discovered the subject had placed ads on social media falsely representing herself as a licensed general lines agent offering homeowners, auto and commercial insurance products to the public. The ads also indicated the subject was operating an insurance agency at her residence. The hiring agent also noted the subject had been appointed and unappointed nine times in the last eight months which she felt was very unusual.

During the course of the investigation, evidence proved the subject unlawfully advertised as a general lines agent offering insurance products on social media. Customer representatives are prohibited from soliciting to the insurance buying public, or holding themselves out to the public as a general lines agent. The subject did not hold an agency license for the entity advertised. When questioned by investigators, the subject admitted she did not apply for or possess an agency license, but had thought about opening one.

Disposition: Fined $1,500 and placed on probation for one year.


Case: The Department received a consumer complaint alleging a general lines agent accepted a premium payment to add commercial equipment to an existing policy, which did not exist. The equipment was financed and was required to include physical damage coverage. The subject issued a Certificate of Coverage for the equipment and provided it to the consumer and the finance company. The equipment was damaged in a fire and the insurance company informed the consumer that there was no coverage, and the claim was denied.

Evidence obtained included documentation received from the insurance company, copies of the consumer's premium payment, as well as copies of documents from the named agent. This evidence showed the policy had not been renewed prior to the equipment being added, although the premium had been paid. In addition, the equipment was not eligible to be added to the consumer's General Liability policy and should have been insured on a separate Inland Marine policy.

A second consumer was identified who paid the agent premium for her homeowner's policy. The agent did not submit the application and premium to the insurance company and a policy was never issued.

Disposition: Suspended for three months and fined $2,000.


Case: A life insurance agent was alleged to have named herself and members of her family as the beneficiaries of several life insurance policies. The Florida Statutes prohibit a licensee from naming themselves or family members as beneficiaries of any life insurance policy without a demonstrated insurable interest in the life of the insured.

Statements were obtained from several of the involved insureds. The insurer's representative provided an affidavit along with extensive documentation of the information maintained by the insurer.

The insurer's documents indicated the agent had designated both herself and her family members as beneficiaries on numerous applications. To conceal her actions, the subject made a series of false representations on the applications. Many of the insureds were indigent, suffered from mental illness, and had no knowledge of the applications or the insurance policies issued.

Disposition: License revoked.


Case: A health insurance agency hired a third-party administrator (TPA) and allowed it to offer coupons for discounted insurance rates on its website. A review of the website found coupons offering several unlawful inducements to purchase insurance including 50% off insurance premiums, "10% off", $10 off "sign-up", and "special offers". When a consumer clicked on a coupon, the website routed the user to the agency's website, suggesting the reader "quote and save today".

Disposition:
The agency was fined $1,000.


 

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