Law & Ethics Update

Failure to Maintain Complaint-Handling Procedures §626.9541(j)


It is a violation of the Insurance Code for anyone to fail to maintain a complete record of all the complaints received since the date of the last examination. For purposes of this paragraph, “complaint” means any written communication primarily expressing a grievance. This includes correspondence received by email.

 

Misrepresentation in Insurance Applications §626.9541(k)

 

· Knowingly making a false or fraudulent written or oral statement, representation on, or relative to, an application or negotiation for an insurance policy for the purpose of obtaining a fee, commission, money, or other benefit from any insurer, agent, broker, or individual.

· Knowingly making a material omission in the comparison of a life, health, or Medicare supplement insurance replacement policy with the policy it replaces, for the purpose of obtaining a fee, commission, money, or other benefit from an insurer, agent, broker, or individual.

 

 

Free Insurance Prohibited §626.9541(n)


You might consider this title self-explanatory. Free insurance is insurance for which the purchaser of real property, personal property, or services pays no identifiable charge.

Insurance, for which an identifiable or additional charge is paid in an amount less than the cost of the insurance, would be categorized as
prohibited free insurance. Using the word free or words that imply insurance without a cost to describe life insurance in advertising is also prohibited.

 

 

Illegal Dealings in Premiums; Excess or Reduced Charges for Insurance §626.9541(o)

 

· Once a premium payment reaches your hands, you need to submit it on behalf of the client, immediately and in the manner it was paid.

· Don’t impose or request an additional premium for a policy of motor vehicle liability, personal injury protection, medical payment, collision insurance or any combination of these. You cannot refuse to renew a policy solely because the insured was involved in a motor vehicle accident, unless the insurer’s file contains information from which the insurer, in good faith, determines the insured was substantially at fault in an accident.

· Anyone otherwise qualified can be a director of two or more domestic competing insurers, unless the effect is to lessen competition to generally or materially create a monopoly.

· This does not apply to those who are directors of two or more insurers under common control or management.

 

 

Interlocking Ownership and Management §626.9541(r)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Prohibited Arrangements as to Funerals §626.9541(s)

 

· A life insurer cannot designate who will conduct an insured’s funeral. The insurer cannot organize, promote, or operate any enterprise, or plan to enter into any contract, with any insured, under which the freedom of choice in the open market of the person is restricted as to the purchase, arrangement, and conduct of a funeral service for any insured by the insurer.An insurer cannot contract or agree to furnish funeral merchandise or services in connection with the disposition of an insured at death.

· An insurer cannot contract or agree with any funeral director (or direct disposer) promising a funeral director consent to conduct the funerals of insureds of the insurer.

· An insurer will provide, in any insurance contract covering the life of a Florida resident, for the payment of proceeds or benefits in U.S. dollars. The insured will not withhold proceeds or benefits for the purpose of providing, inducing, or furthering an arrangement or agreement designed to require the employment of a particular person to conduct the funeral.

 

 

Inpatient Facility Network §626.9541(3)


Inpatient Facility Network should not be construed to prohibit a Medicare supplement insurer from granting a premium credit to insureds for using an in-network inpatient facility.

 

 

Participation in a Wellness or Health Improvement Program §626.9541(4)


Authorization to offer rewards or incentives for participation: An insurer issuing a group or individual health benefit plan may offer a voluntary wellness or health improvement program and may encourage or reward participation in the program by authorizing rewards or incentives, such as merchandise, gift cards, debit cards, premium discounts, contributions to a member’s health savings account, or modifications to copayment, deductible, or coinsurance amounts.

Verification of medical condition by nonparticipants due to medical condition: An insurer may require a member of a health benefit plan to provide verification, such as an affirming statement from the member’s physician, that the member’s medical condition makes it unreasonably difficult or inadvisable to participate in the wellness or health improvement program in order for that nonparticipant to receive the reward or incentive.
Disclosure requirement: A reward or incentive offered must be disclosed in the policy or certificate.

Other incentives do not prohibit insurers from offering rewards for adherence to a wellness or health improvement program if otherwise authorized by state or federal law.

 

 

Favored Agent or Insurer; Coercion of Debtors §626.9551


No person may: 

 

· Require, as a condition precedent or subsequent to the lending of money or extension of credit or renewal, that the person to whom money or credit is extended, or whose obligation the creditor is to finance, negotiate any policy or contract of insurance through a particular insurer, group of insurers, agent, broker, or group of agents or brokers.

· Reject an insurance policy solely because the policy has been issued or underwritten by a person not associated with a financial institution, subsidiary or affiliate, when the insurance is required in connection with a loan or extension of credit; or unreasonably disapprove the insurance policy provided by a borrower for the protection of the property securing the credit or lien. This disapproval is deemed unreasonable if it is not based solely on uniformly applies reasonable standards, relating to the extent of coverage required by the lender extending credit and the financial soundness and services of an insurer. Standards cannot discriminate  against any particular type of insurer, nor can standards call for the disapproval of an insurance policy because the policy contains coverage in addition to that required.

· Require any borrower, mortgagor, purchaser, insurer, broker, or agent to pay a separate charge in connection with the handling of an insurance policy required in connection with a loan or other extension of credit, or pay a separate charge to substitute the insurance policy of one insurer for another, unless the charge would be required if the person were providing the insurance.

· Provide to others or use insurance information required to be disclosed by a customer to a financial institution, subsidiary or affiliate, in connection with the extension of credit for the purpose of soliciting the sale of insurance, unless the customer has given express written consent or the opportunity to object to use of the information. Insurance information means information concerning premiums, terms, and conditions of insurance coverage, insurance claims, and insurance history provided by a customer. The opportunity to object to the use of insurance information must be in writing and clearly and conspicuously made.

 


Any person offering the sale of insurance at the time of and in connection with an extension of credit or the sale or lease of goods or services must disclose, in writing, the choice of an insurance provider will not affect the decision regarding the extension of credit, sale, lease of goods or services, except that reasonable requirements may be imposed. And there’s more:  

· Federally or state-insured depository institutions and credit unions must make clear and conspicuous written disclosure prior to the sale of any insurance policy that policies ARE NOT deposits, are not insured by the FDIC or any other entity, are not guaranteed by the insured depository institution or any person soliciting the purchase or selling the policy; that the financial institution is not obligated to provide benefits under the insurance contract; and, where appropriate, that the policy involves investment risk, including potential loss of principal.

· All documents constituting policies of insurance must be separate and cannot be combined with or part of, other documents. A person may not include the expense of insurance premiums in a primary credit transaction without the express written consent of the customer.

A loan officer of a financial institution involved in the application, solicitation, or closing of a loan transaction cannot solicit or sell insurance in connection with the loan, but may refer the customer to an insurance agent who is not involved in the application, solicitation, or closing of the same loan transaction.


Power of Department and Office §626.9561

 

The department and office each have power, within their respective regulatory jurisdictions, to examine and investigate the affairs of every person involved in the business of insurance in order to determine whether any person has been or is engaged in any unfair method of competition or in any unfair or deceptive act or practice and each has the powers and duties specified in Defined Practices; Hearings, Witnesses, Appearances, Production of Books and Service of Process.

 

 

Defined Practices; Hearings, Witnesses, Appearances, Production of Books and Service of Process §626.9571

Whenever the department or office has reason to believe a person in Florida has engaged, or is engaging, in an unfair method of competition, unfair or deceptive act, practice, or is engaging in the business of insurance without being properly licensed as required, and that a proceeding would be in the best interest of the public, it will conduct a hearing in accordance with the Administrative Procedures Act.

The department or office, a duly empowered hearing officer, or an administrative law judge will, during the conduct of a hearing, have the powers enumerated in
Decisions Which Affect Substantial Interest (§120.569). Penalties for failure to comply with a subpoena or an order directing discovery are limited to fines up to $1,000 per violation.

Statements of charges, notices, and orders under this Act may be served by anyone duly authorized by the department or office, either in the manner provided by law for service of process in civil actions or by certifying and mailing a copy to the person affected by the statement, notice, order, or other process at his, her, or its residence or principal office (place of business). The verified return by the person providing service sets out the manner of service. The return postcard receipt for service by mail will also substantiate proof of service.



Illegal Dealings in Premiums; Excess Charges for Insurance §626.9702


Any person or organization that violates a provision of
Illegal Dealings in Premiums or Excess Charges for Insurance is subject to: 

 

· Suspension of any license or authority of any rating organization or insurer that fails to comply with an order of the office within the time stated by the order, or extension of the order.

· The office cannot suspend the license or authority of any rating organization or insurer for failure to comply with an order until the time prescribed for an appeal has expired, or,

· If an appeal has been taken, until the order has been affirmed.

· The office may determine when a suspension of license or authority will become effective and it will remain in effect for the period fixed by it, unless it modifies or rescinds the suspension, or until the order, upon which the suspension is based, is modified, rescinded, or reversed.

 

Life or Disability Insurance; Illegal Dealings §626.9705


No life or disability insurer can refuse to renew, sell, or issue a life or disability insurance policy,

· Establish or charge a premium or rate to an applicant or a prospective policyholder, or

· Establish or charge an unfair, discriminatory premium or rate to such person

à Based solely on the grounds that the applicant or policyholder suffers from a severe disability.

 

Severe Disability means:

· A spinal cord disease or injury resulting in permanent and total disability

· Amputation of any extremity that requires prosthesis

· Permanent visual acuity of 20/200 or worse in the better eye with the best correction

à A peripheral field that the widest diameter of the field subtends an angular distance no greater than 20 degrees, or

· Neurosensory deafness

Nothing should be construed as requiring an insurer to provide insurance coverage against a severe disability that the applicant or policyholder has already sustained.


Life Insurance; Discrimination on Basis of Sickle-Cell Trait Prohibited §626.9706


Insurers authorized to transact insurance in Florida cannot refuse to issue and deliver a policy of life insurance solely because the person to be insured has the sickle-cell trait.

 

No life insurance policy issued and delivered in Florida can carry a higher premium rate or charge solely because the person to be insured has the sickle-cell trait. [See also §626.9707, Disability Insurance; Discrimination of Basis of Sickle-Cell Trait Prohibited]

 

 

Life Insurance Solicitation §626.99


The purpose of statute §626.99,
Insurance Field Representatives and Operations; Life Insurance Solicitation, requires insurers to provide purchasers of life insurance:  

· Information that will improve the buyer’s ability to select the most appropriate plan of life insurance

· Improve the buyer’s understanding of the basic features of the policy purchased or under consideration

· Improve the ability of the buyer to evaluate the relative costs of similar plans of life insurance

 

Statute does not prohibit an insurer from using additional material, if not a violation of any statute or regulation.

Except as exempted, this statute applies to any solicitation, negotiation, or procurement of life insurance occurring in Florida. It also applies to any issuer of life insurance contracts, including a fraternal benefit society.

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