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

  Vol. 9, No. 1 - February 2020

Notas de Casos


Case: The Department received multiple complaints about a general lines agency and two of its agents. Investigations into the activities of all three licensees were conducted.

Investigators became aware of a court order indicating the licensees collectively owed a premium finance company more than $700,000 and it was alleged the funds were paid to the agency by the premium finance company for insureds that did not exist.

The unpaid premium finance company payments resulted in numerous complaints including:

An out of state insurance agency alleged it had placed and made premium payments on several policies through the subject which were cancelled for non-payment of premium. The subject agency's checks issued to the premium finance company were returned unpaid, causing the cancellation of three consumers' policies for non-payment of the premiums due.

A condominium association reported it made a $9,300 down payment for coverage and elected to finance the remaining $110,000 in premium. The policy lapsed for non-payment of premium leaving the property unprotected for nine months before the problem was detected. In this case, the funds provided by the original premium finance company were paid by the agency to a different premium finance company. The agency's check to the premium finance company was returned by its bank and the condo association's policy was cancelled.

Another condominium association provided investigators with a copy of a lawsuit filed against it by the premium finance company for unpaid premium finance payments. The condominium association provided investigators with proof they had made the full payment of premium to the agency for all invoiced payments. They also provided a copy of the fraudulent premium finance agreement created by the agency. The association did file a complaint with their local law enforcement agency, too.

A consumer who had been a client of the agency for 15 years, learned of issues with the renewals and payments made on the coverages maintained for several rental properties, including general liability and umbrella policies. The customer found her payments were mishandled and one policy was not renewed. The actions of the agency and agents left the consumer's properties unprotected for more than six months.

Disposition: The agent in charge, who was also the agency owner, was permanently barred. The licenses of the second agent and the agency were revoked.

The Department's Division of Investigative & Forensic Services, Bureau of Insurance Fraud charged the agent/owner of the agency, with Grand Theft, Uttering Forged Instruments and Organized Fraud, The subject is currently awaiting their criminal trial on 42 felony charges.


Case: The Department received a complaint from a licensee who stated he had hired a life insurance agent to solicit and sell life insurance from his agency. Subsequently it was discovered the agent had submitted multiple applications that listed the same address and phone number for the insured which actually belonged to the agent.

The Department reviewed copies of numerous applications and other documentation from the insurance companies. Consumers were contacted and several sworn statements obtained that said the information on the application was not correct or they had no knowledge of the agent and did not authorize or sign the application.

An investigative case file was submitted to the Department’s Legal Processing Unit with allegations of misrepresentation on life insurance applications, submitting applications to an insurer without the knowledge or consent of the insured, unlawfully withholding of premiums due an insurer and demonstrating a lack of fitness and trustworthiness to engage in the business of insurance.

The agent entered into a Settlement Stipulation for Consent Order surrendering his license to the Department, with the same force and effect as a revocation. The agent is prohibited from engaging in any transaction for which a license is required and is prohibited from directly or indirectly owing, controlling, or being employed in any manner by any insurance agency, adjuster or adjusting firm.

Disposition: License administratively surrendered.


Case: The Department received a complaint from an insurance company that an agent was terminated after submitting three applications for life insurance without the knowledge or consent of the insureds.

Department Investigators obtained documentation from the involved insurer. One consumer called the insurer when she noticed an unauthorized withdrawal from her bank account and was told an application in her name had been submitted to the company. In her statement, the consumer said she never met the subject and did not sign the application.

Investigators alleged the agent had made false statements on insurance applications, submitted those applications to an insurer without the knowledge or consent of the proposed insureds, which demonstrated a lack of fitness and trustworthiness to engage in the business of insurance by doing so.

Disposition: Permanently barred.


 

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