ENROLLED
       2022 Legislature                                         SB 7016
       
       
       
       
       
       
                                                             20227016er
    1  
    2         An act relating to a review under the Open Government
    3         Sunset Review Act; amending s. 626.9891, F.S., which
    4         provides an exemption from public records requirements
    5         for certain information submitted by insurers to the
    6         Department of Financial Services; removing the
    7         scheduled repeal of the exemption; providing an
    8         effective date.
    9          
   10  Be It Enacted by the Legislature of the State of Florida:
   11  
   12         Section 1. Section 626.9891, Florida Statutes, is amended
   13  to read:
   14         626.9891 Insurer anti-fraud investigative units; reporting
   15  requirements; penalties for noncompliance.—
   16         (1) As used in this section, the term:
   17         (a) “Anti-fraud investigative unit” means the designated
   18  anti-fraud unit or division, or contractor authorized under
   19  subparagraph (2)(a)2.
   20         (b) “Designated anti-fraud unit or division” includes a
   21  distinct unit or division or a unit or division made up of
   22  employees whose principal responsibilities are the investigation
   23  and disposition of claims who are also assigned investigation of
   24  fraud.
   25         (2) By December 31, 2017, every insurer admitted to do
   26  business in this state shall:
   27         (a)1. Establish and maintain a designated anti-fraud unit
   28  or division within the company to investigate and report
   29  possible fraudulent insurance acts by insureds or by persons
   30  making claims for services or repairs against policies held by
   31  insureds; or
   32         2. Contract with others to investigate and report possible
   33  fraudulent insurance acts by insureds or by persons making
   34  claims for services or repairs against policies held by
   35  insureds.
   36         (b) Adopt an anti-fraud plan.
   37         (c) Designate at least one employee with primary
   38  responsibility for implementing the requirements of this
   39  section.
   40         (d) Electronically file with the Division of Investigative
   41  and Forensic Services of the department, and annually
   42  thereafter, a detailed description of the designated anti-fraud
   43  unit or division or a copy of the contract executed under
   44  subparagraph (a)2., as applicable, a copy of the anti-fraud
   45  plan, and the name of the employee designated under paragraph
   46  (c).
   47  
   48  An insurer must include the additional cost incurred in creating
   49  a distinct unit or division, hiring additional employees, or
   50  contracting with another entity to fulfill the requirements of
   51  this section, as an administrative expense for ratemaking
   52  purposes.
   53         (3) Each anti-fraud plan must include:
   54         (a) An acknowledgment that the insurer has established
   55  procedures for detecting and investigating possible fraudulent
   56  insurance acts relating to the different types of insurance by
   57  that insurer;
   58         (b) An acknowledgment that the insurer has established
   59  procedures for the mandatory reporting of possible fraudulent
   60  insurance acts to the Division of Investigative and Forensic
   61  Services of the department;
   62         (c) An acknowledgment that the insurer provides the anti
   63  fraud education and training required by this section to the
   64  anti-fraud investigative unit;
   65         (d) A description of the required anti-fraud education and
   66  training;
   67         (e) A description or chart of the insurer’s anti-fraud
   68  investigative unit, including the position titles and
   69  descriptions of staffing; and
   70         (f) The rationale for the level of staffing and resources
   71  being provided for the anti-fraud investigative unit which may
   72  include objective criteria, such as the number of policies
   73  written, the number of claims received on an annual basis, the
   74  volume of suspected fraudulent claims detected on an annual
   75  basis, an assessment of the optimal caseload that one
   76  investigator can handle on an annual basis, and other factors.
   77         (4) By December 31, 2018, each insurer shall provide staff
   78  of the anti-fraud investigative unit at least 2 hours of initial
   79  anti-fraud training that is designed to assist in identifying
   80  and evaluating instances of suspected fraudulent insurance acts
   81  in underwriting or claims activities. Annually thereafter, an
   82  insurer shall provide such employees a 1-hour course that
   83  addresses detection, referral, investigation, and reporting of
   84  possible fraudulent insurance acts for the types of insurance
   85  lines written by the insurer.
   86         (5) Each insurer is required to report data related to
   87  fraud for each identified line of business written by the
   88  insurer during the prior calendar year. The data shall be
   89  reported to the department by March 1, 2019, and annually
   90  thereafter, and must include, at a minimum:
   91         (a) The number of policies in effect;
   92         (b) The amount of premiums written for policies;
   93         (c) The number of claims received;
   94         (d) The number of claims referred to the anti-fraud
   95  investigative unit;
   96         (e) The number of other insurance fraud matters referred to
   97  the anti-fraud investigative unit that were not claim related;
   98         (f) The number of claims investigated or accepted by the
   99  anti-fraud investigative unit;
  100         (g) The number of other insurance fraud matters
  101  investigated or accepted by the anti-fraud investigative unit
  102  that were not claim related;
  103         (h) The number of cases referred to the Division of
  104  Investigative and Forensic Services;
  105         (i) The number of cases referred to other law enforcement
  106  agencies;
  107         (j) The number of cases referred to other entities; and
  108         (k) The estimated dollar amount or range of damages on
  109  cases referred to the Division of Investigative and Forensic
  110  Services or other agencies.
  111         (6) In addition to providing information required under
  112  subsections (2), (4), and (5), each insurer writing workers’
  113  compensation insurance shall also report the following
  114  information to the department, on or before March 1, 2019, and
  115  annually thereafter:
  116         (a) The estimated dollar amount of losses attributable to
  117  workers’ compensation fraud delineated by the type of fraud,
  118  including claimant, employer, provider, agent, or other type.
  119         (b) The estimated dollar amount of recoveries attributable
  120  to workers’ compensation fraud delineated by the type of fraud,
  121  including claimant, employer, provider, agent, or other type.
  122         (c) The number of cases referred to the Division of
  123  Investigative and Forensic Services, delineated by the type of
  124  fraud, including claimant, employer, provider, agent, or other
  125  type.
  126         (7) An insurer who obtains a certificate of authority has 6
  127  months in which to comply with subsection (2), and one calendar
  128  year thereafter, to comply with subsections (4), (5), and (6).
  129         (8) If an insurer fails or otherwise refuses to comply with
  130  the provisions of this section, the department, office, or
  131  commission may:
  132         (a) Impose an administrative fine of not more than $2,000
  133  per day for such failure until the department, office, or
  134  commission deems the insurer to be in compliance;
  135         (b) Impose an administrative fine for failure by an insurer
  136  to implement or follow the provisions of an anti-fraud plan or
  137  anti-fraud investigative unit description; or
  138         (c) Impose the provisions of both paragraphs (a) and (b).
  139         (9) On or before December 31, 2018, the Division of
  140  Investigative and Forensic Services shall create a report
  141  detailing best practices for the detection, investigation,
  142  prevention, and reporting of insurance fraud and other
  143  fraudulent insurance acts. The report must be updated as
  144  necessary but at least every 2 years. The report must provide:
  145         (a) Information on the best practices for the establishment
  146  of anti-fraud investigative units within insurers;
  147         (b) Information on the best practices and methods for
  148  detecting and investigating insurance fraud and other fraudulent
  149  insurance acts;
  150         (c) Information on appropriate anti-fraud education and
  151  training of insurer personnel;
  152         (d) Information on the best practices for reporting
  153  insurance fraud and other fraudulent insurance acts to the
  154  Division of Investigative and Forensic Services and to other law
  155  enforcement agencies;
  156         (e) Information regarding the appropriate level of staffing
  157  and resources for anti-fraud investigative units within
  158  insurers;
  159         (f) Information detailing statistics and data relating to
  160  insurance fraud which insurers should maintain; and
  161         (g) Other information as determined by the Division of
  162  Investigative and Forensic Services.
  163         (10) The department may adopt rules to administer this
  164  section, except that it shall adopt rules to administer
  165  subsection (5).
  166         (11)(a) The information submitted to the department
  167  pursuant to paragraphs (3)(d), (e), and (f) and paragraphs
  168  (5)(d), (e), (f), (g), and (k) is exempt from s. 119.07(1) and
  169  s. 24(a), Art. I of the State Constitution.
  170         (b) This subsection is subject to the Open Government
  171  Sunset Review Act in accordance with s. 119.15 and shall stand
  172  repealed on October 2, 2022, unless reviewed and saved from
  173  repeal through reenactment by the Legislature.
  174         (c) This exemption applies to records held before, on, or
  175  after the effective date of this act.
  176         Section 2. This act shall take effect October 1, 2022.