Florida Senate - 2013 SB 1046
By Senator Brandes
22-00787A-13 20131046__
1 A bill to be entitled
2 An act relating to insurance; amending s. 215.555,
3 F.S.; deleting the future repeal of an exemption of
4 medical malpractice insurance premiums from emergency
5 assessments imposed to fund certain obligations,
6 costs, and expenses of the Florida Hurricane
7 Catastrophe Fund and the Florida Hurricane Catastrophe
8 Fund Finance Corporation; amending s. 316.646, F.S.;
9 authorizing a uniform motor vehicle proof-of-insurance
10 card to be in an electronic format; authorizing the
11 Department of Highway Safety and Motor Vehicles to
12 adopt rules; amending s. 320.02, F.S.; authorizing
13 insurers to furnish uniform proof-of-purchase cards in
14 an electronic format for use by insureds to prove the
15 purchase of required insurance coverage when
16 registering a motor vehicle; amending s. 624.413,
17 F.S.; revising a specified time period applicable to a
18 certified examination that must be filed by a foreign
19 or alien insurer applying for a certificate of
20 authority; amending s. 626.321, F.S.; providing that a
21 limited license to offer motor vehicle rental
22 insurance issued to a business that rents or leases
23 motor vehicles encompasses the employees of such
24 business; amending s. 626.601, F.S.; revising
25 terminology relating to investigations conducted by
26 the Department of Financial Services and the Office of
27 Insurance Regulation with respect to individuals and
28 entities involved in the insurance industry; amending
29 s. 626.9914, F.S.; conforming a provision to changes
30 made by the act; amending s. 626.99175, F.S.; deleting
31 provisions requiring registration of life expectancy
32 providers; deleting procedures, qualifying criteria,
33 and violations with respect thereto; amending ss.
34 626.9919, 626.992, 626.9925, and 626.99278, F.S.;
35 conforming provisions to changes made by the act;
36 amending s. 627.062, F.S.; requiring the Office of
37 Insurance Regulation to use certain models or averages
38 of certain models to estimate hurricane losses when
39 determining whether the rates in a rate filing are
40 excessive, inadequate, or unfairly discriminatory;
41 amending s. 627.0628, F.S.; increasing the length of
42 time during which an insurer must adhere to certain
43 findings made by the Commission on Hurricane Loss
44 Projection Methodology with respect to certain
45 methods, principles, standards, models, or output
46 ranges used in a rate finding; providing that the
47 requirement to adhere to such findings does not limit
48 an insurer from averaging together the results of
49 certain models or output ranges under specified
50 circumstances; amending s. 627.072, F.S.; authorizing
51 retrospective rating plans relating to workers’
52 compensation and employer’s liability insurance to
53 allow negotiations between certain employers and
54 insurers with respect to rating factors used to
55 calculate premiums; amending s. 627.281, F.S.;
56 conforming a cross-reference; repealing s. 627.3519,
57 F.S., relating to an annual report from the Financial
58 Services Commission to the Legislature of aggregate
59 net probable maximum losses, financing options, and
60 potential assessments of the Florida Hurricane
61 Catastrophe Fund and Citizens Property Insurance
62 Corporation; amending s. 627.4133, F.S.; deleting
63 provisions that require extended periods of prior
64 notice with respect to the nonrenewal, cancellation,
65 or termination of certain insurance policies;
66 prohibiting the cancellation of certain policies that
67 have been in effect for a specified amount of time
68 except under certain circumstances; amending s.
69 627.4137, F.S.; adding licensed company adjusters to
70 the list of persons who may respond to a claimant’s
71 written request for information relating to liability
72 insurance coverage; amending s. 627.421, F.S.;
73 authorizing the electronic delivery of certain
74 insurance documents; amending s. 627.43141, F.S.;
75 authorizing a notice of change in policy terms to be
76 sent in a separate mailing to an insured under certain
77 circumstances; requiring an insurer to provide such
78 notice to insured’s insurance agent; amending s.
79 627.701, F.S.; revising requirements to issue or renew
80 personal lines residential property insurance after a
81 certain date; amending s. 627.7015, F.S.; revising the
82 rulemaking authority of the department with respect to
83 qualifications and specified types of penalties
84 covered under the property insurance mediation
85 program; creating s. 627.70151, F.S.; providing
86 criteria for an insurer or policyholder to challenge
87 the impartiality of a loss appraisal umpire for
88 purposes of disqualifying such umpire; amending s.
89 627.706, F.S.; authorizing the inclusion of
90 deductibles applicable to sinkhole losses in property
91 insurance policies covering nonresidential buildings;
92 revising the definition of the term “neutral
93 evaluator”; amending s. 627.7074, F.S.; requiring the
94 department to adopt rules relating to certification of
95 neutral evaluators; amending s. 627.736, F.S.;
96 revising the time period for applicability of certain
97 Medicare fee schedules or payment limitations;
98 amending s. 627.745, F.S.; revising qualifications for
99 approval as a mediator by the department; providing
100 grounds for the department to deny an application or
101 revoke approval of a mediator or neutral evaluator;
102 authorizing the department to adopt rules; amending s.
103 627.952, F.S.; deleting a fidelity bond requirement
104 applicable to certain nonresident general lines agents
105 who are licensed as surplus lines agents in another
106 state; amending ss. 627.971 and 627.972, F.S.;
107 including licensed mutual insurers in financial
108 guaranty insurance corporations; amending s. 628.901,
109 F.S.; revising the definition of the term “qualifying
110 reinsurer parent company” to delete obsolete language;
111 amending s. 628.909, F.S.; providing for applicability
112 of certain provisions of the Insurance Code to
113 specified captive insurers; amending s. 634.406, F.S.;
114 revising criteria authorizing certain premiums of
115 certain service warranty associations to exceed their
116 specified net assets limitations; revising
117 requirements relating to contractual liability
118 policies that insure warranty associations; providing
119 an effective date.
120
121 Be It Enacted by the Legislature of the State of Florida:
122
123 Section 1. Paragraph (b) of subsection (6) of section
124 215.555, Florida Statutes, is amended to read:
125 215.555 Florida Hurricane Catastrophe Fund.—
126 (6) REVENUE BONDS.—
127 (b) Emergency assessments.—
128 1. If the board determines that the amount of revenue
129 produced under subsection (5) is insufficient to fund the
130 obligations, costs, and expenses of the fund and the
131 corporation, including repayment of revenue bonds and that
132 portion of the debt service coverage not met by reimbursement
133 premiums, the board shall direct the Office of Insurance
134 Regulation to levy, by order, an emergency assessment on direct
135 premiums for all property and casualty lines of business in this
136 state, including property and casualty business of surplus lines
137 insurers regulated under part VIII of chapter 626, but not
138 including any workers’ compensation premiums or medical
139 malpractice premiums. As used in this subsection, the term
140 “property and casualty business” includes all lines of business
141 identified on Form 2, Exhibit of Premiums and Losses, in the
142 annual statement required of authorized insurers by s. 624.424
143 and any rule adopted under this section, except for those lines
144 identified as accident and health insurance and except for
145 policies written under the National Flood Insurance Program. The
146 assessment shall be specified as a percentage of direct written
147 premium and is subject to annual adjustments by the board in
148 order to meet debt obligations. The same percentage shall apply
149 to all policies in lines of business subject to the assessment
150 issued or renewed during the 12-month period beginning on the
151 effective date of the assessment.
152 2. A premium is not subject to an annual assessment under
153 this paragraph in excess of 6 percent of premium with respect to
154 obligations arising out of losses attributable to any one
155 contract year, and a premium is not subject to an aggregate
156 annual assessment under this paragraph in excess of 10 percent
157 of premium. An annual assessment under this paragraph shall
158 continue as long as the revenue bonds issued with respect to
159 which the assessment was imposed are outstanding, including any
160 bonds the proceeds of which were used to refund the revenue
161 bonds, unless adequate provision has been made for the payment
162 of the bonds under the documents authorizing issuance of the
163 bonds.
164 3. Emergency assessments shall be collected from
165 policyholders. Emergency assessments shall be remitted by
166 insurers as a percentage of direct written premium for the
167 preceding calendar quarter as specified in the order from the
168 Office of Insurance Regulation. The office shall verify the
169 accurate and timely collection and remittance of emergency
170 assessments and shall report the information to the board in a
171 form and at a time specified by the board. Each insurer
172 collecting assessments shall provide the information with
173 respect to premiums and collections as may be required by the
174 office to enable the office to monitor and verify compliance
175 with this paragraph.
176 4. With respect to assessments of surplus lines premiums,
177 each surplus lines agent shall collect the assessment at the
178 same time as the agent collects the surplus lines tax required
179 by s. 626.932, and the surplus lines agent shall remit the
180 assessment to the Florida Surplus Lines Service Office created
181 by s. 626.921 at the same time as the agent remits the surplus
182 lines tax to the Florida Surplus Lines Service Office. The
183 emergency assessment on each insured procuring coverage and
184 filing under s. 626.938 shall be remitted by the insured to the
185 Florida Surplus Lines Service Office at the time the insured
186 pays the surplus lines tax to the Florida Surplus Lines Service
187 Office. The Florida Surplus Lines Service Office shall remit the
188 collected assessments to the fund or corporation as provided in
189 the order levied by the Office of Insurance Regulation. The
190 Florida Surplus Lines Service Office shall verify the proper
191 application of such emergency assessments and shall assist the
192 board in ensuring the accurate and timely collection and
193 remittance of assessments as required by the board. The Florida
194 Surplus Lines Service Office shall annually calculate the
195 aggregate written premium on property and casualty business,
196 other than workers’ compensation and medical malpractice,
197 procured through surplus lines agents and insureds procuring
198 coverage and filing under s. 626.938 and shall report the
199 information to the board in a form and at a time specified by
200 the board.
201 5. Any assessment authority not used for a particular
202 contract year may be used for a subsequent contract year. If,
203 for a subsequent contract year, the board determines that the
204 amount of revenue produced under subsection (5) is insufficient
205 to fund the obligations, costs, and expenses of the fund and the
206 corporation, including repayment of revenue bonds and that
207 portion of the debt service coverage not met by reimbursement
208 premiums, the board shall direct the Office of Insurance
209 Regulation to levy an emergency assessment up to an amount not
210 exceeding the amount of unused assessment authority from a
211 previous contract year or years, plus an additional 4 percent
212 provided that the assessments in the aggregate do not exceed the
213 limits specified in subparagraph 2.
214 6. The assessments otherwise payable to the corporation
215 under this paragraph shall be paid to the fund unless and until
216 the Office of Insurance Regulation and the Florida Surplus Lines
217 Service Office have received from the corporation and the fund a
218 notice, which shall be conclusive and upon which they may rely
219 without further inquiry, that the corporation has issued bonds
220 and the fund has no agreements in effect with local governments
221 under paragraph (c). On or after the date of the notice and
222 until the date the corporation has no bonds outstanding, the
223 fund shall have no right, title, or interest in or to the
224 assessments, except as provided in the fund’s agreement with the
225 corporation.
226 7. Emergency assessments are not premium and are not
227 subject to the premium tax, to the surplus lines tax, to any
228 fees, or to any commissions. An insurer is liable for all
229 assessments that it collects and must treat the failure of an
230 insured to pay an assessment as a failure to pay the premium. An
231 insurer is not liable for uncollectible assessments.
232 8. When an insurer is required to return an unearned
233 premium, it shall also return any collected assessment
234 attributable to the unearned premium. A credit adjustment to the
235 collected assessment may be made by the insurer with regard to
236 future remittances that are payable to the fund or corporation,
237 but the insurer is not entitled to a refund.
238 9. When a surplus lines insured or an insured who has
239 procured coverage and filed under s. 626.938 is entitled to the
240 return of an unearned premium, the Florida Surplus Lines Service
241 Office shall provide a credit or refund to the agent or such
242 insured for the collected assessment attributable to the
243 unearned premium before prior to remitting the emergency
244 assessment collected to the fund or corporation.
245 10. The exemption of medical malpractice insurance premiums
246 from emergency assessments under this paragraph is repealed May
247 31, 2013, and medical malpractice insurance premiums shall be
248 subject to emergency assessments attributable to loss events
249 occurring in the contract years commencing on June 1, 2013.
250 Section 2. Subsection (1) of section 316.646, Florida
251 Statutes, is amended, and subsection (5) is added to that
252 section, to read:
253 316.646 Security required; proof of security and display
254 thereof; dismissal of cases.—
255 (1) Any person required by s. 324.022 to maintain property
256 damage liability security, required by s. 324.023 to maintain
257 liability security for bodily injury or death, or required by s.
258 627.733 to maintain personal injury protection security on a
259 motor vehicle shall have in his or her immediate possession at
260 all times while operating such motor vehicle proper proof of
261 maintenance of the required security. Such proof shall be a
262 uniform proof-of-insurance card, in paper or electronic format,
263 in a form prescribed by the department, a valid insurance
264 policy, an insurance policy binder, a certificate of insurance,
265 or such other proof as may be prescribed by the department.
266 (5) The department may adopt rules to implement this
267 section.
268 Section 3. Paragraph (a) of subsection (5) of section
269 320.02, Florida Statutes, is amended to read:
270 320.02 Registration required; application for registration;
271 forms.—
272 (5)(a) Proof that personal injury protection benefits have
273 been purchased when required under s. 627.733, that property
274 damage liability coverage has been purchased as required under
275 s. 324.022, that bodily injury or death coverage has been
276 purchased if required under s. 324.023, and that combined bodily
277 liability insurance and property damage liability insurance have
278 been purchased when required under s. 627.7415 shall be provided
279 in the manner prescribed by law by the applicant at the time of
280 application for registration of any motor vehicle that is
281 subject to such requirements. The issuing agent shall refuse to
282 issue registration if such proof of purchase is not provided.
283 Insurers shall furnish uniform proof-of-purchase cards, in paper
284 or electronic format, in a form prescribed by the department and
285 shall include the name of the insured’s insurance company, the
286 coverage identification number, and the make, year, and vehicle
287 identification number of the vehicle insured. The card shall
288 contain a statement notifying the applicant of the penalty
289 specified in s. 316.646(4). The card or insurance policy,
290 insurance policy binder, or certificate of insurance or a
291 photocopy of any of these; an affidavit containing the name of
292 the insured’s insurance company, the insured’s policy number,
293 and the make and year of the vehicle insured; or such other
294 proof as may be prescribed by the department shall constitute
295 sufficient proof of purchase. If an affidavit is provided as
296 proof, it shall be in substantially the following form:
297
298 Under penalty of perjury, I ...(Name of insured)... do hereby
299 certify that I have ...(Personal Injury Protection, Property
300 Damage Liability, and, when required, Bodily Injury
301 Liability)... Insurance currently in effect with ...(Name of
302 insurance company)... under ...(policy number)... covering
303 ...(make, year, and vehicle identification number of
304 vehicle).... ...(Signature of Insured)...
305
306 Such affidavit shall include the following warning:
307
308 WARNING: GIVING FALSE INFORMATION IN ORDER TO OBTAIN A VEHICLE
309 REGISTRATION CERTIFICATE IS A CRIMINAL OFFENSE UNDER FLORIDA
310 LAW. ANYONE GIVING FALSE INFORMATION ON THIS AFFIDAVIT IS
311 SUBJECT TO PROSECUTION.
312
313 When an application is made through a licensed motor vehicle
314 dealer as required in s. 319.23, the original or a photostatic
315 copy of such card, insurance policy, insurance policy binder, or
316 certificate of insurance or the original affidavit from the
317 insured shall be forwarded by the dealer to the tax collector of
318 the county or the Department of Highway Safety and Motor
319 Vehicles for processing. By executing the aforesaid affidavit,
320 no licensed motor vehicle dealer will be liable in damages for
321 any inadequacy, insufficiency, or falsification of any statement
322 contained therein. A card shall also indicate the existence of
323 any bodily injury liability insurance voluntarily purchased.
324 Section 4. Paragraph (f) of subsection (1) of section
325 624.413, Florida Statutes, is amended to read:
326 624.413 Application for certificate of authority.—
327 (1) To apply for a certificate of authority, an insurer
328 shall file its application therefor with the office, upon a form
329 adopted by the commission and furnished by the office, showing
330 its name; location of its home office and, if an alien insurer,
331 its principal office in the United States; kinds of insurance to
332 be transacted; state or country of domicile; and such additional
333 information as the commission reasonably requires, together with
334 the following documents:
335 (f) If a foreign or alien insurer, a copy of the report of
336 the most recent examination of the insurer certified by the
337 public official having supervision of insurance in its state of
338 domicile or of entry into the United States. The end of the most
339 recent year covered by the examination must be within the 5-year
340 3-year period preceding the date of application. In lieu of the
341 certified examination report, the office may accept an audited
342 certified public accountant’s report prepared on a basis
343 consistent with the insurance laws of the insurer’s state of
344 domicile, certified by the public official having supervision of
345 insurance in its state of domicile or of entry into the United
346 States.
347 Section 5. Paragraph (d) of subsection (1) of section
348 626.321, Florida Statutes, is amended to read:
349 626.321 Limited licenses.—
350 (1) The department shall issue to a qualified applicant a
351 license as agent authorized to transact a limited class of
352 business in any of the following categories of limited lines
353 insurance:
354 (d) Motor vehicle rental insurance.—
355 1. License covering only insurance of the risks set forth
356 in this paragraph when offered, sold, or solicited with and
357 incidental to the rental or lease of a motor vehicle and which
358 applies only to the motor vehicle that is the subject of the
359 lease or rental agreement and the occupants of the motor
360 vehicle:
361 a. Excess motor vehicle liability insurance providing
362 coverage in excess of the standard liability limits provided by
363 the lessor in the lessor’s lease to a person renting or leasing
364 a motor vehicle from the licensee’s employer for liability
365 arising in connection with the negligent operation of the leased
366 or rented motor vehicle.
367 b. Insurance covering the liability of the lessee to the
368 lessor for damage to the leased or rented motor vehicle.
369 c. Insurance covering the loss of or damage to baggage,
370 personal effects, or travel documents of a person renting or
371 leasing a motor vehicle.
372 d. Insurance covering accidental personal injury or death
373 of the lessee and any passenger who is riding or driving with
374 the covered lessee in the leased or rented motor vehicle.
375 2. Insurance under a motor vehicle rental insurance license
376 may be issued only if the lease or rental agreement is for no
377 more than 60 days, the lessee is not provided coverage for more
378 than 60 consecutive days per lease period, and the lessee is
379 given written notice that his or her personal insurance policy
380 providing coverage on an owned motor vehicle may provide
381 coverage of such risks and that the purchase of the insurance is
382 not required in connection with the lease or rental of a motor
383 vehicle. If the lease is extended beyond 60 days, the coverage
384 may be extended one time only for a period not to exceed an
385 additional 60 days. Insurance may be provided to the lessee as
386 an additional insured on a policy issued to the licensee’s
387 employer.
388 3. The license may be issued only to the full-time salaried
389 employee of a licensed general lines agent or to a business
390 entity that offers motor vehicles for rent or lease if insurance
391 sales activities authorized by the license are in connection
392 with and incidental to the rental or lease of a motor vehicle.
393 a. A license issued to a business entity that offers motor
394 vehicles for rent or lease encompasses each office, branch
395 office, employee, or place of business making use of the
396 entity’s business name in order to offer, solicit, and sell
397 insurance pursuant to this paragraph.
398 b. The application for licensure must list the name,
399 address, and phone number for each office, branch office, or
400 place of business that is to be covered by the license. The
401 licensee shall notify the department of the name, address, and
402 phone number of any new location that is to be covered by the
403 license before the new office, branch office, or place of
404 business engages in the sale of insurance pursuant to this
405 paragraph. The licensee must notify the department within 30
406 days after closing or terminating an office, branch office, or
407 place of business. Upon receipt of the notice, the department
408 shall delete the office, branch office, or place of business
409 from the license.
410 c. A licensed and appointed entity is directly responsible
411 and accountable for all acts of the licensee’s employees.
412 Section 6. Section 626.601, Florida Statutes, is amended to
413 read:
414 626.601 Improper conduct; inquiry; fingerprinting.—
415 (1) The department or office may, upon its own motion or
416 upon a written complaint signed by any interested person and
417 filed with the department or office, inquire into any alleged
418 improper conduct of any licensed, approved, or certified
419 insurance agency, agent, adjuster, service representative,
420 managing general agent, customer representative, title insurance
421 agent, title insurance agency, mediator, neutral evaluator,
422 continuing education course provider, instructor, school
423 official, or monitor group under this code. The department or
424 office may thereafter initiate an investigation of any such
425 individual or entity licensee if it has reasonable cause to
426 believe that the individual or entity licensee has violated any
427 provision of the insurance code. During the course of its
428 investigation, the department or office shall contact the
429 individual or entity licensee being investigated unless it
430 determines that contacting such individual or entity person
431 could jeopardize the successful completion of the investigation
432 or cause injury to the public.
433 (2) In the investigation by the department or office of the
434 alleged misconduct, the individual or entity licensee shall,
435 whenever so required by the department or office, cause the
436 individual’s or entity’s his or her books and records to be open
437 for inspection for the purpose of such inquiries.
438 (3) The complaints against any individual or entity
439 licensee may be informally alleged and need not be in any such
440 language as is necessary to charge a crime on an indictment or
441 information.
442 (4) The expense for any hearings or investigations under
443 this law, as well as the fees and mileage of witnesses, may be
444 paid out of the appropriate fund.
445 (5) If the department or office, after investigation, has
446 reason to believe that an individual or entity a licensee may
447 have been found guilty of or pleaded guilty or nolo contendere
448 to a felony or a crime related to the business of insurance in
449 this or any other state or jurisdiction, the department or
450 office may require the individual licensee to file with the
451 department or office a complete set of his or her fingerprints,
452 which shall be accompanied by the fingerprint processing fee set
453 forth in s. 624.501. The fingerprints shall be taken by an
454 authorized law enforcement agency or other department-approved
455 entity.
456 (6) The complaint and any information obtained pursuant to
457 the investigation by the department or office are confidential
458 and are exempt from the provisions of s. 119.07, unless the
459 department or office files a formal administrative complaint,
460 emergency order, or consent order against the individual or
461 entity licensee. Nothing in This subsection does not shall be
462 construed to prevent the department or office from disclosing
463 the complaint or such information as it deems necessary to
464 conduct the investigation, to update the complainant as to the
465 status and outcome of the complaint, or to share such
466 information with any law enforcement agency.
467 Section 7. Paragraphs (i), (j), and (k) of subsection (1)
468 of section 626.9914, Florida Statutes, are amended to read:
469 626.9914 Suspension, revocation, denial, or nonrenewal of
470 viatical settlement provider license; grounds; administrative
471 fine.—
472 (1) The office shall suspend, revoke, deny, or refuse to
473 renew the license of any viatical settlement provider if the
474 office finds that the licensee:
475 (i) Employs any person who materially influences the
476 licensee’s conduct and who fails to meet the requirements of
477 this act; or
478 (j) No longer meets the requirements for initial licensure;
479 or
480 (k) Obtains or utilizes life expectancies from life
481 expectancy providers who are not registered with the office
482 pursuant to this act.
483 Section 8. Section 626.99175, Florida Statutes, is amended
484 to read:
485 626.99175 Life expectancy providers; registration required;
486 denial, suspension, revocation.—
487 (1) After July 1, 2006, a person may not perform the
488 functions of a life expectancy provider without first having
489 registered as a life expectancy provider, except as provided in
490 subsection (6).
491 (2) Application for registration as a life expectancy
492 provider must be made to the office by the applicant on a form
493 prescribed by the office, under oath and signed by the
494 applicant. The application must be accompanied by a fee of $500.
495 (3) A completed application shall be evidenced on a form
496 and in a manner prescribed by the office and shall require the
497 registered life expectancy provider to update such information
498 and renew such registration as required by the office.
499 (4) In the application, the applicant must provide all of
500 the following:
501 (a) The full name, age, residence address, and business
502 address, and all occupations engaged in by the applicant during
503 the 5 years preceding the date of the application.
504 (b) A copy of the applicant’s basic organizational
505 documents, if any, including the articles of incorporation,
506 articles of association, partnership agreement, trust agreement,
507 or other similar documents, together with all amendments to such
508 documents.
509 (c) Copies of all bylaws, rules, regulations, or similar
510 documents regulating the conduct of the applicant’s internal
511 affairs.
512 (d) A list showing the name, business and residence
513 addresses, and official position of each individual who is
514 responsible for conduct of the applicant’s affairs, including,
515 but not limited to, any member of the board of directors, board
516 of trustees, executive committee, or other governing board or
517 committee and any other person or entity owning or having the
518 right to acquire 10 percent or more of the voting securities of
519 the applicant, and any person performing life expectancies by
520 the applicant.
521 (e) A sworn biographical statement on forms supplied by the
522 office with respect to each individual identified under
523 paragraph (d), including whether such individual has been
524 associated with any other life expectancy provider or has
525 performed any services for a person in the business of viatical
526 settlements.
527 (f) A sworn statement of any criminal and civil actions
528 pending or final against the registrant or any individual
529 identified under paragraph (d).
530 (g) A general description of the following policies and
531 procedures covering all life expectancy determination criteria
532 and protocols:
533 1. The plan or plans of policies and procedures used to
534 determine life expectancies.
535 2. A description of the training, including continuing
536 training, of the individuals who determine life expectancies.
537 3. A description of how the life expectancy provider
538 updates its manuals, underwriting guides, mortality tables, and
539 other reference works and ensures that the provider bases its
540 determination of life expectancies on current data.
541 (h) A plan for assuring confidentiality of personal,
542 medical, and financial information in accordance with federal
543 and state laws.
544 (i) An anti-fraud plan as required pursuant to s.
545 626.99278.
546 (j) A list of any agreements, contracts, or any other
547 arrangement to provide life expectancies to a viatical
548 settlement provider, viatical settlement broker, or any other
549 person in the business of viatical settlements in connection
550 with any viatical settlement contract or viatical settlement
551 investment.
552 (5) As part of the application, and on or before March 1 of
553 every 3 years thereafter, a registered life expectancy provider
554 shall file with the office an audit of all life expectancies by
555 the life expectancy provider for the 5 calendar years
556 immediately preceding such audit, which audit shall be conducted
557 and certified by a nationally recognized actuarial firm and
558 shall include only the following:
559 (a) A mortality table.
560 (b) The number, percentage, and an actual-to-expected ratio
561 of life expectancies in the following categories: life
562 expectancies of less than 24 months, life expectancies of 25
563 months to 48 months, life expectancies of 49 months to 72
564 months, life expectancies of 73 months to 108 months, life
565 expectancies of 109 months to 144 months, life expectancies of
566 145 months to 180 months, and life expectancies of more than 180
567 months.
568 (6) A No viatical settlement broker, viatical settlement
569 provider, or insurance agent in the business of viatical
570 settlements in this state may not shall directly or indirectly
571 own or be an officer, director, or employee of a life expectancy
572 provider.
573 (7) Each registered life expectancy provider shall provide
574 the office, as applicable, at least 30 days’ advance notice of
575 any change in the registrant’s name, residence address,
576 principal business address, or mailing address.
577 (8) A person required to be registered by this section
578 shall for 5 years retain copies of all life expectancies and
579 supporting documents and medical records unless those personal
580 medical records are subject to different retention or
581 destruction requirements of a federal or state personal health
582 information law.
583 (9) An application for life expectancy provider
584 registration shall be approved or denied by the commissioner
585 within 60 calendar days following receipt of a completed
586 application by the commissioner. The office shall notify the
587 applicant that the application is complete. A completed
588 application that is not approved or denied in 60 calendar days
589 following its receipt shall be deemed approved.
590 (10) The office may, in its discretion, deny the
591 application for a life expectancy provider registration or
592 suspend, revoke, or refuse to renew or continue the registration
593 of a life expectancy provider if the office finds:
594 (a) Any cause for which registration could have been
595 refused had it then existed and been known to the office;
596 (b) A violation of any provision of this code or of any
597 other law applicable to the applicant or registrant;
598 (c) A violation of any lawful order or rule of the
599 department, commission, or office; or
600 (d) That the applicant or registrant:
601 1. Has been found guilty of or pled guilty or nolo
602 contendere to a felony or a crime punishable by imprisonment of
603 1 year or more under the law of the United States of America or
604 of any state thereof or under the law of any other country;
605 2. Has knowingly and willfully aided, assisted, procured,
606 advised, or abetted any person in the violation of a provision
607 of the insurance code or any order or rule of the department,
608 commission, or office;
609 3. Has knowingly and with intent to defraud, provided a
610 life expectancy that does not conform to an applicant’s or
611 registrant’s general practice;
612 4. Does not have a good business reputation or does not
613 have experience, training, or education that qualifies the
614 applicant or registrant to conduct the business of a life
615 expectancy provider; or
616 5. Has demonstrated a lack of fitness or trustworthiness to
617 engage in the business of issuing life expectancies.
618 (11) The office may, in lieu of or in addition to any
619 suspension or revocation, assess an administrative fine not to
620 exceed $2,500 for each nonwillful violation or $10,000 for each
621 willful violation by a registered life expectancy provider. The
622 office may also place a registered life expectancy provider on
623 probation for a period not to exceed 2 years.
624 (12) It is a violation of this section for a person to
625 represent, orally or in writing, that a life expectancy
626 provider’s registration pursuant to this act is in any way a
627 recommendation or approval of the entity or means that the
628 qualifications or abilities have in any way been approved of.
629 (13) The Financial Services Commission may, by rule,
630 require that all or part of the statements or filings required
631 under this section be submitted by electronic means and in a
632 computer-readable format specified by the commission.
633 Section 9. Section 626.9919, Florida Statutes, is amended
634 to read:
635 626.9919 Notice of change of licensee or registrant’s
636 address or name.—Each viatical settlement provider licensee and
637 registered life expectancy provider must provide the office at
638 least 30 days’ advance notice of any change in the licensee’s or
639 registrant’s name, residence address, principal business
640 address, or mailing address.
641 Section 10. Section 626.992, Florida Statutes, is amended
642 to read:
643 626.992 Use of licensed viatical settlement providers and,
644 viatical settlement brokers, and registered life expectancy
645 providers required.—
646 (1) A licensed viatical settlement provider may not use any
647 person to perform the functions of a viatical settlement broker
648 as defined in this act unless such person holds a current, valid
649 life agent license and has appointed himself or herself in
650 conformance with this chapter.
651 (2) A viatical settlement broker may not use any person to
652 perform the functions of a viatical settlement provider as
653 defined in this act unless such person holds a current, valid
654 license as a viatical settlement provider.
655 (3) After July 1, 2006, a person may not operate as a life
656 expectancy provider unless such person is registered as a life
657 expectancy provider pursuant to this act.
658 (4) After July 1, 2006, a viatical settlement provider,
659 viatical settlement broker, or any other person in the business
660 of viatical settlements may not obtain life expectancies from a
661 person who is not registered as a life expectancy provider
662 pursuant to this act.
663 Section 11. Section 626.9925, Florida Statutes, is amended
664 to read:
665 626.9925 Rules.—The commission may adopt rules to
666 administer this act, including rules establishing standards for
667 evaluating advertising by licensees; rules providing for the
668 collection of data, for disclosures to viators, and for the
669 reporting of life expectancies, and for the registration of life
670 expectancy providers; and rules defining terms used in this act
671 and prescribing recordkeeping requirements relating to executed
672 viatical settlement contracts.
673 Section 12. Section 626.99278, Florida Statutes, is amended
674 to read:
675 626.99278 Viatical provider anti-fraud plan.—Every licensed
676 viatical settlement provider and registered life expectancy
677 provider must adopt an anti-fraud plan and file it with the
678 Division of Insurance Fraud of the department. Each anti-fraud
679 plan shall include:
680 (1) A description of the procedures for detecting and
681 investigating possible fraudulent acts and procedures for
682 resolving material inconsistencies between medical records and
683 insurance applications.
684 (2) A description of the procedures for the mandatory
685 reporting of possible fraudulent insurance acts and prohibited
686 practices set forth in s. 626.99275 to the Division of Insurance
687 Fraud of the department.
688 (3) A description of the plan for anti-fraud education and
689 training of its underwriters or other personnel.
690 (4) A written description or chart outlining the
691 organizational arrangement of the anti-fraud personnel who are
692 responsible for the investigation and reporting of possible
693 fraudulent insurance acts and for the investigation of
694 unresolved material inconsistencies between medical records and
695 insurance applications.
696 (5) For viatical settlement providers, a description of the
697 procedures used to perform initial and continuing review of the
698 accuracy of life expectancies used in connection with a viatical
699 settlement contract or viatical settlement investment.
700 Section 13. Paragraph (b) of subsection (2) of section
701 627.062, Florida Statutes, is amended to read:
702 627.062 Rate standards.—
703 (2) As to all such classes of insurance:
704 (b) Upon receiving a rate filing, the office shall review
705 the filing to determine if a rate is excessive, inadequate, or
706 unfairly discriminatory. In making that determination, the
707 office shall, in accordance with generally accepted and
708 reasonable actuarial techniques, consider the following factors:
709 1. Past and prospective loss experience within and without
710 this state.
711 2. Past and prospective expenses.
712 3. The degree of competition among insurers for the risk
713 insured.
714 4. Investment income reasonably expected by the insurer,
715 consistent with the insurer’s investment practices, from
716 investable premiums anticipated in the filing, plus any other
717 expected income from currently invested assets representing the
718 amount expected on unearned premium reserves and loss reserves.
719 The commission may adopt rules using reasonable techniques of
720 actuarial science and economics to specify the manner in which
721 insurers calculate investment income attributable to classes of
722 insurance written in this state and the manner in which
723 investment income is used to calculate insurance rates. Such
724 manner must contemplate allowances for an underwriting profit
725 factor and full consideration of investment income which produce
726 a reasonable rate of return; however, investment income from
727 invested surplus may not be considered.
728 5. The reasonableness of the judgment reflected in the
729 filing.
730 6. Dividends, savings, or unabsorbed premium deposits
731 allowed or returned to Florida policyholders, members, or
732 subscribers.
733 7. The adequacy of loss reserves.
734 8. The cost of reinsurance. The office may not disapprove a
735 rate as excessive solely due to the insurer having obtained
736 catastrophic reinsurance to cover the insurer’s estimated 250
737 year probable maximum loss or any lower level of loss.
738 9. Trend factors, including trends in actual losses per
739 insured unit for the insurer making the filing.
740 10. Conflagration and catastrophe hazards, if applicable.
741 11. Projected hurricane losses, if applicable, which must
742 be estimated using a model or method, or models or an average or
743 weighted average of models, independently found to be acceptable
744 or reliable by the Florida Commission on Hurricane Loss
745 Projection Methodology, and as further provided in s. 627.0628.
746 12. A reasonable margin for underwriting profit and
747 contingencies.
748 13. The cost of medical services, if applicable.
749 14. Other relevant factors that affect the frequency or
750 severity of claims or expenses.
751 Section 14. Paragraph (d) of subsection (3) of section
752 627.0628, Florida Statutes, is amended to read:
753 627.0628 Florida Commission on Hurricane Loss Projection
754 Methodology; public records exemption; public meetings
755 exemption.—
756 (3) ADOPTION AND EFFECT OF STANDARDS AND GUIDELINES.—
757 (d) With respect to a rate filing under s. 627.062, an
758 insurer shall employ and may not modify or adjust actuarial
759 methods, principles, standards, models, or output ranges found
760 by the commission to be accurate or reliable in determining
761 hurricane loss factors for use in a rate filing under s.
762 627.062. An insurer shall employ and may not modify or adjust
763 models found by the commission to be accurate or reliable in
764 determining probable maximum loss levels pursuant to paragraph
765 (b) with respect to a rate filing under s. 627.062 made more
766 than 120 60 days after the commission has made such findings.
767 This paragraph does not prohibit an insurer from averaging
768 together the model results or output ranges or using weighted
769 averages for the purposes of a rate filing under s. 627.062.
770 Section 15. Present subsections (2), (3), and (4) of
771 section 627.072, Florida Statutes, are renumbered as subsections
772 (3), (4), and (5), respectively, and a new subsection (2) is
773 added to that section, to read:
774 627.072 Making and use of rates.—
775 (2) A retrospective rating plan may contain a provision
776 that allows negotiation between the employer and the insurer to
777 determine the retrospective rating factors used to calculate the
778 premium for employers having exposure in more than one state and
779 an estimated annual countrywide standard premium of $1 million
780 or more for workers’ compensation.
781 Section 16. Subsection (2) of section 627.281, Florida
782 Statutes, is amended to read:
783 627.281 Appeal from rating organization; workers’
784 compensation and employer’s liability insurance filings.—
785 (2) If such appeal is based upon the failure of the rating
786 organization to make a filing on behalf of such member or
787 subscriber which is based on a system of expense provisions
788 which differs, in accordance with the right granted in s.
789 627.072(3) 627.072(2), from the system of expense provisions
790 included in a filing made by the rating organization, the office
791 shall, if it grants the appeal, order the rating organization to
792 make the requested filing for use by the appellant. In deciding
793 such appeal, the office shall apply the applicable standards set
794 forth in ss. 627.062 and 627.072.
795 Section 17. Section 627.3519, Florida Statutes, is
796 repealed.
797 Section 18. Paragraph (b) of subsection (2) of section
798 627.4133, Florida Statutes, is amended to read:
799 627.4133 Notice of cancellation, nonrenewal, or renewal
800 premium.—
801 (2) With respect to any personal lines or commercial
802 residential property insurance policy, including, but not
803 limited to, any homeowner’s, mobile home owner’s, farmowner’s,
804 condominium association, condominium unit owner’s, apartment
805 building, or other policy covering a residential structure or
806 its contents:
807 (b) The insurer shall give the first-named insured written
808 notice of nonrenewal, cancellation, or termination at least 100
809 days before the effective date of the nonrenewal, cancellation,
810 or termination. However, the insurer shall give at least 100
811 days’ written notice, or written notice by June 1, whichever is
812 earlier, for any nonrenewal, cancellation, or termination that
813 would be effective between June 1 and November 30. The notice
814 must include the reason or reasons for the nonrenewal,
815 cancellation, or termination, except that:
816 1. The insurer shall give the first-named insured written
817 notice of nonrenewal, cancellation, or termination at least 120
818 days prior to the effective date of the nonrenewal,
819 cancellation, or termination for a first-named insured whose
820 residential structure has been insured by that insurer or an
821 affiliated insurer for at least a 5-year period immediately
822 prior to the date of the written notice.
823 1.2. If cancellation is for nonpayment of premium, at least
824 10 days’ written notice of cancellation accompanied by the
825 reason therefor must be given. As used in this subparagraph, the
826 term “nonpayment of premium” means failure of the named insured
827 to discharge when due her or his obligations for in connection
828 with the payment of premiums on a policy or any installment of
829 such premium, whether the premium is payable directly to the
830 insurer or its agent or indirectly under any premium finance
831 plan or extension of credit, or failure to maintain membership
832 in an organization if such membership is a condition precedent
833 to insurance coverage. The term also means the failure of a
834 financial institution to honor an insurance applicant’s check
835 after delivery to a licensed agent for payment of a premium,
836 even if the agent has previously delivered or transferred the
837 premium to the insurer. If a dishonored check represents the
838 initial premium payment, the contract and all contractual
839 obligations are void ab initio unless the nonpayment is cured
840 within the earlier of 5 days after actual notice by certified
841 mail is received by the applicant or 15 days after notice is
842 sent to the applicant by certified mail or registered mail., and
843 If the contract is void, any premium received by the insurer
844 from a third party must be refunded to that party in full.
845 2.3. If such cancellation or termination occurs during the
846 first 90 days the insurance is in force and the insurance is
847 canceled or terminated for reasons other than nonpayment of
848 premium, at least 20 days’ written notice of cancellation or
849 termination accompanied by the reason therefor must be given
850 unless there has been a material misstatement or
851 misrepresentation or failure to comply with the underwriting
852 requirements established by the insurer.
853 3. After the policy has been in effect for 90 days, the
854 policy may not be canceled by the insurer unless there has been
855 a material misstatement, a nonpayment of premium, a failure to
856 comply with underwriting requirements established by the insurer
857 within 90 days after the date of effectuation of coverage, or a
858 substantial change in the risk covered by the policy or if the
859 cancellation is for all insureds under such policies for a given
860 class of insureds. This subparagraph does not apply to
861 individually rated risks having a policy term of less than 90
862 days.
863 4. The requirement for providing written notice by June 1
864 of any nonrenewal that would be effective between June 1 and
865 November 30 does not apply to the following situations, but the
866 insurer remains subject to the requirement to provide such
867 notice at least 100 days before the effective date of
868 nonrenewal:
869 a. A policy that is nonrenewed due to a revision in the
870 coverage for sinkhole losses and catastrophic ground cover
871 collapse pursuant to s. 627.706.
872 4.b. A policy that is nonrenewed by Citizens Property
873 Insurance Corporation, pursuant to s. 627.351(6), for a policy
874 that has been assumed by an authorized insurer offering
875 replacement coverage to the policyholder is exempt from the
876 notice requirements of paragraph (a) and this paragraph. In such
877 cases, the corporation must give the named insured written
878 notice of nonrenewal at least 45 days before the effective date
879 of the nonrenewal.
880
881 After the policy has been in effect for 90 days, the policy may
882 not be canceled by the insurer unless there has been a material
883 misstatement, a nonpayment of premium, a failure to comply with
884 underwriting requirements established by the insurer within 90
885 days after the date of effectuation of coverage, or a
886 substantial change in the risk covered by the policy or if the
887 cancellation is for all insureds under such policies for a given
888 class of insureds. This paragraph does not apply to individually
889 rated risks having a policy term of less than 90 days.
890 5. Notwithstanding any other provision of law, an insurer
891 may cancel or nonrenew a property insurance policy after at
892 least 45 days’ notice if the office finds that the early
893 cancellation of some or all of the insurer’s policies is
894 necessary to protect the best interests of the public or
895 policyholders and the office approves the insurer’s plan for
896 early cancellation or nonrenewal of some or all of its policies.
897 The office may base such finding upon the financial condition of
898 the insurer, lack of adequate reinsurance coverage for hurricane
899 risk, or other relevant factors. The office may condition its
900 finding on the consent of the insurer to be placed under
901 administrative supervision pursuant to s. 624.81 or to the
902 appointment of a receiver under chapter 631.
903 6. A policy covering both a home and motor vehicle may be
904 nonrenewed for any reason applicable to either the property or
905 motor vehicle insurance after providing 90 days’ notice.
906 Section 19. Subsection (1) of section 627.4137, Florida
907 Statutes, is amended to read:
908 627.4137 Disclosure of certain information required.—
909 (1) Each insurer that provides which does or may provide
910 liability insurance coverage to pay all or a portion of any
911 claim that which might be made shall provide, within 30 days
912 after of the written request of the claimant, a statement, under
913 oath, of a corporate officer or the insurer’s claims manager, or
914 superintendent, or licensed company adjuster setting forth the
915 following information with regard to each known policy of
916 insurance, including excess or umbrella insurance:
917 (a) The name of the insurer.
918 (b) The name of each insured.
919 (c) The limits of the liability coverage.
920 (d) A statement of any policy or coverage defense that the
921 which such insurer reasonably believes is available to the such
922 insurer at the time of filing such statement.
923 (e) A copy of the policy.
924
925 In addition, the insured, or her or his insurance agent, upon
926 written request of the claimant or the claimant’s attorney,
927 shall disclose the name and coverage of each known insurer to
928 the claimant and shall forward such request for information as
929 required by this subsection to all affected insurers. The
930 insurer shall then supply the information required in this
931 subsection to the claimant within 30 days after of receipt of
932 such request.
933 Section 20. Subsection (1) of section 627.421, Florida
934 Statutes, is amended to read:
935 627.421 Delivery of policy.—
936 (1) Subject to the insurer’s requirement as to payment of
937 premium, every policy shall be mailed or delivered to the
938 insured or to the person entitled thereto not later than 60 days
939 after the effectuation of coverage. Notwithstanding any other
940 provision of law, an insurer may allow a policyholder to elect
941 delivery of the policy documents, including, but not limited to,
942 policies, endorsements, notices, or documents, by electronic
943 means in lieu of delivery by mail.
944 Section 21. Subsection (2) of section 627.43141, Florida
945 Statutes, is amended to read:
946 627.43141 Notice of change in policy terms.—
947 (2) A renewal policy may contain a change in policy terms.
948 If a renewal policy contains does contain such change, the
949 insurer must give the named insured written notice of the
950 change, which may either must be enclosed along with the written
951 notice of renewal premium required by ss. 627.4133 and 627.728
952 or sent in a separate notice that complies with the nonrenewal
953 mailing time requirement for that particular line of business.
954 The insurer must also provide or make available electronically
955 to the insured’s insurance agent such notice before or at the
956 same time notice is given to the insured. Such notice shall be
957 entitled “Notice of Change in Policy Terms.”
958 Section 22. Subsection (7) of section 627.701, Florida
959 Statutes, is amended to read:
960 627.701 Liability of insureds; coinsurance; deductibles.—
961 (7) Before Prior to issuing a personal lines residential
962 property insurance policy on or after January 1, 2014 April 1,
963 1997, or before prior to the first renewal of a residential
964 property insurance policy on or after January 1, 2014 April 1,
965 1997, the insurer must offer a deductible equal to $500, or
966 equal to 1 percent of the policy dwelling limits if such amount
967 is not less than $500, applicable to losses from perils other
968 than hurricane. The insurer must provide the policyholder with
969 notice of the availability of the deductible specified in this
970 subsection in a form approved by the office at least once every
971 3 years. The failure to provide such notice constitutes a
972 violation of this code but does not affect the coverage provided
973 under the policy. An insurer may require a higher deductible
974 only as part of a deductible program lawfully in effect on June
975 1, 1996, or as part of a similar deductible program.
976 Section 23. Paragraph (b) of subsection (4) of section
977 627.7015, Florida Statutes, is amended to read:
978 627.7015 Alternative procedure for resolution of disputed
979 property insurance claims.—
980 (4) The department shall adopt by rule a property insurance
981 mediation program to be administered by the department or its
982 designee. The department may also adopt special rules which are
983 applicable in cases of an emergency within the state. The rules
984 shall be modeled after practices and procedures set forth in
985 mediation rules of procedure adopted by the Supreme Court. The
986 rules shall provide for:
987 (b) Qualifications, denial of application, suspension,
988 revocation, and other penalties for of mediators as provided in
989 s. 627.745 and in the Florida Rules of Certified and Court
990 Appointed Mediators, and for such other individuals as are
991 qualified by education, training, or experience as the
992 department determines to be appropriate.
993 Section 24. Section 627.70151, Florida Statutes, is created
994 to read:
995 627.70151 Appraisal; conflicts of interest.—An insurer that
996 offers residential coverage, as defined in s. 627.4025, or a
997 policyholder that uses an appraisal clause in the property
998 insurance contract to establish a process of estimating or
999 evaluating the amount of the loss through the use of an
1000 impartial umpire may challenge the umpire’s impartiality and
1001 disqualify the proposed umpire only if:
1002 (1) A familial relationship within the third degree exists
1003 between the umpire and any party or a representative of any
1004 party;
1005 (2) The umpire has previously represented any party or a
1006 representative of any party in a professional capacity in the
1007 same or a substantially related matter;
1008 (3) The umpire has represented another person in a
1009 professional capacity on the same or a substantially related
1010 matter, including the claim, on the same property, or on an
1011 adjacent property and that other person’s interests are
1012 materially adverse to the interests of any party; or
1013 (4) The umpire has worked as an employer or employee of any
1014 party within the preceding 5 years.
1015 Section 25. Subsection (1) and paragraph (c) of subsection
1016 (2) of section 627.706, Florida Statutes, are amended to read:
1017 627.706 Sinkhole insurance; catastrophic ground cover
1018 collapse; definitions.—
1019 (1)(a) Every insurer authorized to transact property
1020 insurance in this state must provide coverage for a catastrophic
1021 ground cover collapse.
1022 (b) The insurer shall make available, for an appropriate
1023 additional premium, coverage for sinkhole losses on any
1024 structure, including the contents of personal property contained
1025 therein, to the extent provided in the form to which the
1026 coverage attaches. The insurer may require an inspection of the
1027 property before issuance of sinkhole loss coverage. A policy for
1028 residential property insurance may include a deductible amount
1029 applicable to sinkhole losses equal to 1 percent, 2 percent, 5
1030 percent, or 10 percent of the policy’s covered building policy
1031 dwelling limits, with appropriate premium discounts offered with
1032 each deductible amount.
1033 (c) The insurer may restrict catastrophic ground cover
1034 collapse and sinkhole loss coverage to the principal building,
1035 as defined in the applicable policy.
1036 (2) As used in ss. 627.706-627.7074, and as used in
1037 connection with any policy providing coverage for a catastrophic
1038 ground cover collapse or for sinkhole losses, the term:
1039 (c) “Neutral evaluator” means a professional engineer or a
1040 professional geologist who has completed a course of study in
1041 alternative dispute resolution designed or approved by the
1042 department for use in the neutral evaluation process, and who is
1043 determined by the department to be fair and impartial, and who
1044 is not otherwise ineligible for certification as provided in s.
1045 627.7074.
1046 Section 26. Subsection (1) of section 627.7074, Florida
1047 Statutes, is amended to read:
1048 627.7074 Alternative procedure for resolution of disputed
1049 sinkhole insurance claims.—
1050 (1) The department shall:
1051 (a) Certify and maintain a list of persons who are neutral
1052 evaluators.
1053 (b) Adopt rules for certifying, denying certification,
1054 suspending certification, and revoking certification as a
1055 neutral evaluator, in keeping with qualifications specified in
1056 this section and ss. 627.706 and 627.745(4).
1057 (c)(b) Prepare a consumer information pamphlet for
1058 distribution by insurers to policyholders which clearly
1059 describes the neutral evaluation process and includes
1060 information necessary for the policyholder to request a neutral
1061 evaluation.
1062 Section 27. Paragraph (a) of subsection (5) of section
1063 627.736, Florida Statutes, is amended to read:
1064 627.736 Required personal injury protection benefits;
1065 exclusions; priority; claims.—
1066 (5) CHARGES FOR TREATMENT OF INJURED PERSONS.—
1067 (a) A physician, hospital, clinic, or other person or
1068 institution lawfully rendering treatment to an injured person
1069 for a bodily injury covered by personal injury protection
1070 insurance may charge the insurer and injured party only a
1071 reasonable amount pursuant to this section for the services and
1072 supplies rendered, and the insurer providing such coverage may
1073 pay for such charges directly to such person or institution
1074 lawfully rendering such treatment if the insured receiving such
1075 treatment or his or her guardian has countersigned the properly
1076 completed invoice, bill, or claim form approved by the office
1077 upon which such charges are to be paid for as having actually
1078 been rendered, to the best knowledge of the insured or his or
1079 her guardian. However, such a charge may not exceed the amount
1080 the person or institution customarily charges for like services
1081 or supplies. In determining whether a charge for a particular
1082 service, treatment, or otherwise is reasonable, consideration
1083 may be given to evidence of usual and customary charges and
1084 payments accepted by the provider involved in the dispute,
1085 reimbursement levels in the community and various federal and
1086 state medical fee schedules applicable to motor vehicle and
1087 other insurance coverages, and other information relevant to the
1088 reasonableness of the reimbursement for the service, treatment,
1089 or supply.
1090 1. The insurer may limit reimbursement to 80 percent of the
1091 following schedule of maximum charges:
1092 a. For emergency transport and treatment by providers
1093 licensed under chapter 401, 200 percent of Medicare.
1094 b. For emergency services and care provided by a hospital
1095 licensed under chapter 395, 75 percent of the hospital’s usual
1096 and customary charges.
1097 c. For emergency services and care as defined by s. 395.002
1098 provided in a facility licensed under chapter 395 rendered by a
1099 physician or dentist, and related hospital inpatient services
1100 rendered by a physician or dentist, the usual and customary
1101 charges in the community.
1102 d. For hospital inpatient services, other than emergency
1103 services and care, 200 percent of the Medicare Part A
1104 prospective payment applicable to the specific hospital
1105 providing the inpatient services.
1106 e. For hospital outpatient services, other than emergency
1107 services and care, 200 percent of the Medicare Part A Ambulatory
1108 Payment Classification for the specific hospital providing the
1109 outpatient services.
1110 f. For all other medical services, supplies, and care, 200
1111 percent of the allowable amount under:
1112 (I) The participating physicians fee schedule of Medicare
1113 Part B, except as provided in sub-sub-subparagraphs (II) and
1114 (III).
1115 (II) Medicare Part B, in the case of services, supplies,
1116 and care provided by ambulatory surgical centers and clinical
1117 laboratories.
1118 (III) The Durable Medical Equipment Prosthetics/Orthotics
1119 and Supplies fee schedule of Medicare Part B, in the case of
1120 durable medical equipment.
1121
1122 However, if such services, supplies, or care is not reimbursable
1123 under Medicare Part B, as provided in this sub-subparagraph, the
1124 insurer may limit reimbursement to 80 percent of the maximum
1125 reimbursable allowance under workers’ compensation, as
1126 determined under s. 440.13 and rules adopted thereunder which
1127 are in effect at the time such services, supplies, or care is
1128 provided. Services, supplies, or care that is not reimbursable
1129 under Medicare or workers’ compensation is not required to be
1130 reimbursed by the insurer.
1131 2. For purposes of subparagraph 1., the applicable fee
1132 schedule or payment limitation under Medicare is the fee
1133 schedule or payment limitation in effect on March 1 of the year
1134 in which the services, supplies, or care is rendered and for the
1135 area in which such services, supplies, or care is rendered, and
1136 the applicable fee schedule or payment limitation applies until
1137 March 1 of the following throughout the remainder of that year,
1138 notwithstanding any subsequent change made to the fee schedule
1139 or payment limitation, except that it may not be less than the
1140 allowable amount under the applicable schedule of Medicare Part
1141 B for 2007 for medical services, supplies, and care subject to
1142 Medicare Part B.
1143 3. Subparagraph 1. does not allow the insurer to apply any
1144 limitation on the number of treatments or other utilization
1145 limits that apply under Medicare or workers’ compensation. An
1146 insurer that applies the allowable payment limitations of
1147 subparagraph 1. must reimburse a provider who lawfully provided
1148 care or treatment under the scope of his or her license,
1149 regardless of whether such provider is entitled to reimbursement
1150 under Medicare due to restrictions or limitations on the types
1151 or discipline of health care providers who may be reimbursed for
1152 particular procedures or procedure codes. However, subparagraph
1153 1. does not prohibit an insurer from using the Medicare coding
1154 policies and payment methodologies of the federal Centers for
1155 Medicare and Medicaid Services, including applicable modifiers,
1156 to determine the appropriate amount of reimbursement for medical
1157 services, supplies, or care if the coding policy or payment
1158 methodology does not constitute a utilization limit.
1159 4. If an insurer limits payment as authorized by
1160 subparagraph 1., the person providing such services, supplies,
1161 or care may not bill or attempt to collect from the insured any
1162 amount in excess of such limits, except for amounts that are not
1163 covered by the insured’s personal injury protection coverage due
1164 to the coinsurance amount or maximum policy limits.
1165 5. Effective July 1, 2012, an insurer may limit payment as
1166 authorized by this paragraph only if the insurance policy
1167 includes a notice at the time of issuance or renewal that the
1168 insurer may limit payment pursuant to the schedule of charges
1169 specified in this paragraph. A policy form approved by the
1170 office satisfies this requirement. If a provider submits a
1171 charge for an amount less than the amount allowed under
1172 subparagraph 1., the insurer may pay the amount of the charge
1173 submitted.
1174 Section 28. Subsection (3) of section 627.745, Florida
1175 Statutes, is amended, present subsections (4) and (5) of that
1176 section are renumbered as subsections (5) and (6), respectively,
1177 and a new subsection (4) is added to that section, to read:
1178 627.745 Mediation of claims.—
1179 (3)(a) The department shall approve mediators to conduct
1180 mediations pursuant to this section. All mediators must file an
1181 application under oath for approval as a mediator.
1182 (b) To qualify for approval as a mediator, an individual a
1183 person must meet one of the following qualifications:
1184 1. Possess an active certification as a Florida Circuit
1185 Court Mediator. A Florida Circuit Court Mediator in a lapsed,
1186 suspended, or decertified status is not eligible to participate
1187 in the mediation program a masters or doctorate degree in
1188 psychology, counseling, business, accounting, or economics, be a
1189 member of The Florida Bar, be licensed as a certified public
1190 accountant, or demonstrate that the applicant for approval has
1191 been actively engaged as a qualified mediator for at least 4
1192 years prior to July 1, 1990.
1193 2. Be an approved department mediator as of July 1, 2013,
1194 and have conducted at least one mediation on behalf of the
1195 department within 4 years immediately preceding that the date
1196 the application for approval is filed with the department, have
1197 completed a minimum of a 40-hour training program approved by
1198 the department and successfully passed a final examination
1199 included in the training program and approved by the department.
1200 The training program shall include and address all of the
1201 following:
1202 a. Mediation theory.
1203 b. Mediation process and techniques.
1204 c. Standards of conduct for mediators.
1205 d. Conflict management and intervention skills.
1206 e. Insurance nomenclature.
1207 (4) The department shall deny an application, or revoke its
1208 approval of a mediator or neutral evaluator to serve in such
1209 capacity, if the department finds that any of the following
1210 grounds exist:
1211 (a) Lack of one or more of the qualifications specified in
1212 this section for approval or certification.
1213 (b) Material misstatement, misrepresentation, or fraud in
1214 obtaining or attempting to obtain the approval or certification.
1215 (c) Demonstrated lack of fitness or trustworthiness to act
1216 as a mediator or neutral evaluator.
1217 (d) Fraudulent or dishonest practices in the conduct of
1218 mediation or neutral evaluation or in the conduct of business in
1219 the financial services industry.
1220 (e) Violation of any provision of this code or of a lawful
1221 order or rule of the department or aiding, instructing, or
1222 encouraging another party in committing such a violation.
1223
1224 The department may adopt rules to administer this subsection.
1225 Section 29. Paragraph (b) of subsection (1) of section
1226 627.952, Florida Statutes, is amended to read:
1227 627.952 Risk retention and purchasing group agents.—
1228 (1) Any person offering, soliciting, selling, purchasing,
1229 administering, or otherwise servicing insurance contracts,
1230 certificates, or agreements for any purchasing group or risk
1231 retention group to any resident of this state, either directly
1232 or indirectly, by the use of mail, advertising, or other means
1233 of communication, shall obtain a license and appointment to act
1234 as a resident general lines agent, if a resident of this state,
1235 or a nonresident general lines agent if not a resident. Any such
1236 person shall be subject to all requirements of the Florida
1237 Insurance Code.
1238 (b) Any person required to be licensed and appointed under
1239 this subsection, in order to place business through Florida
1240 eligible surplus lines carriers, must, if a resident of this
1241 state, be licensed and appointed as a surplus lines agent. If
1242 not a resident of this state, such person must be licensed and
1243 appointed as a surplus lines agent in her or his state of
1244 residence and file and maintain a fidelity bond in favor of the
1245 people of the State of Florida executed by a surety company
1246 admitted in this state and payable to the State of Florida;
1247 however, such nonresident is limited to the provision of
1248 insurance for purchasing groups. The bond must be continuous in
1249 form and in the amount of not less than $50,000, aggregate
1250 liability. The bond must remain in force and effect until the
1251 surety is released from liability by the department or until the
1252 bond is canceled by the surety. The surety may cancel the bond
1253 and be released from further liability upon 30 days’ prior
1254 written notice to the department. The cancellation does not
1255 affect any liability incurred or accrued before the termination
1256 of the 30-day period. Upon receipt of a notice of cancellation,
1257 the department shall immediately notify the agent.
1258 Section 30. Subsection (6) of section 627.971, Florida
1259 Statutes, is amended to read:
1260 627.971 Definitions.—As used in this part:
1261 (6) “Financial guaranty insurance corporation” means a
1262 stock or mutual insurer licensed to transact financial guaranty
1263 insurance business in this state.
1264 Section 31. Subsection (1) of section 627.972, Florida
1265 Statutes, is amended to read:
1266 627.972 Organization; financial requirements.—
1267 (1) A financial guaranty insurance corporation must be
1268 organized and licensed in the manner prescribed in this code for
1269 stock or mutual property and casualty insurers except that:
1270 (a) A corporation organized to transact financial guaranty
1271 insurance may, subject to the provisions of this code, be
1272 licensed to transact:
1273 1. Residual value insurance, as defined by s. 624.6081;
1274 2. Surety insurance, as defined by s. 624.606;
1275 3. Credit insurance, as defined by s. 624.605(1)(i); and
1276 4. Mortgage guaranty insurance as defined in s. 635.011,
1277 provided that the provisions of chapter 635 are met.
1278 (b)1. Before Prior to the issuance of a license, a
1279 corporation must submit to the office for approval, a plan of
1280 operation detailing:
1281 a. The types and projected diversification of guaranties to
1282 be issued;
1283 b. The underwriting procedures to be followed;
1284 c. The managerial oversight methods;
1285 d. The investment policies; and
1286 e. Any other matters prescribed by the office;
1287 2. An insurer which is writing only the types of insurance
1288 allowed under this part on July 1, 1988, and otherwise meets the
1289 requirements of this part, is exempt from the requirements of
1290 this paragraph.
1291 (c) An insurer transacting financial guaranty insurance is
1292 subject to all provisions of this code that are applicable to
1293 property and casualty insurers to the extent that those
1294 provisions are not inconsistent with this part.
1295 (d) The investments of an insurer transacting financial
1296 guaranty insurance in any entity insured by the corporation may
1297 not exceed 2 percent of its admitted assets as of the end of the
1298 prior calendar year.
1299 (e) An insurer transacting financial guaranty insurance may
1300 only assume those lines of insurance for which it is licensed to
1301 write direct business.
1302 Section 32. Subsection (13) of section 628.901, Florida
1303 Statutes, is amended to read:
1304 628.901 Definitions.—As used in this part, the term:
1305 (13) “Qualifying reinsurer parent company” means a
1306 reinsurer that which currently holds a certificate of authority
1307 or a, letter of eligibility or is an accredited or a
1308 satisfactory non-approved reinsurer in this state possessing a
1309 consolidated GAAP net worth of at least $500 million and a
1310 consolidated debt to total capital ratio of not greater than
1311 0.50.
1312 Section 33. Paragraph (a) of subsection (2) and paragraph
1313 (a) of subsection (3) of section 628.909, Florida Statutes, are
1314 amended to read:
1315 628.909 Applicability of other laws.—
1316 (2) The following provisions of the Florida Insurance Code
1317 apply to captive insurers who are not industrial insured captive
1318 insurers to the extent that such provisions are not inconsistent
1319 with this part:
1320 (a) Chapter 624, except for ss. 624.407, 624.408, 624.4085,
1321 624.40851, 624.4095, 624.411, 624.425, and 624.426.
1322 (3) The following provisions of the Florida Insurance Code
1323 apply to industrial insured captive insurers to the extent that
1324 such provisions are not inconsistent with this part:
1325 (a) Chapter 624, except for ss. 624.407, 624.408, 624.4085,
1326 624.40851, 624.4095, 624.411, 624.425, 624.426, and 624.609(1).
1327 Section 34. Present subsection (8) of section 634.406,
1328 Florida Statutes, is renumbered as subsection (7), and present
1329 subsections (6) and (7) of that section are amended, to read:
1330 634.406 Financial requirements.—
1331 (6) An association that which holds a license under this
1332 part and which does not hold any other license under this
1333 chapter may allow its premiums written under this part to exceed
1334 the ratio to net assets limitations of this section if the
1335 association meets all of the following:
1336 (a) Maintains net assets of at least $750,000.
1337 (b) Utilizes a contractual liability insurance policy
1338 approved by the office which:
1339 1. Reimburses the service warranty association for 100
1340 percent of its claims liability and is issued by an insurer that
1341 maintains a policyholder surplus of at least $100 million; or
1342 2. Complies with the requirements of subsection (3) and is
1343 issued by an insurer that maintains a policyholder surplus of at
1344 least $200 million.
1345 (c) The insurer issuing the contractual liability insurance
1346 policy:
1347 1. Maintains a policyholder surplus of at least $100
1348 million.
1349 1.2. Is rated “A” or higher by A.M. Best Company or an
1350 equivalent rating by another national rating service acceptable
1351 to the office.
1352 3. Is in no way affiliated with the warranty association.
1353 2.4. In conjunction with the warranty association’s filing
1354 of the quarterly and annual reports, provides, on a form
1355 prescribed by the commission, a statement certifying the gross
1356 written premiums in force reported by the warranty association
1357 and a statement that all of the warranty association’s gross
1358 written premium in force is covered under the contractual
1359 liability policy, whether or not it has been reported.
1360 (7) A contractual liability policy must insure 100 percent
1361 of an association’s claims exposure under all of the
1362 association’s service warranty contracts, wherever written,
1363 unless all of the following are satisfied:
1364 (a) The contractual liability policy contains a clause that
1365 specifically names the service warranty contract holders as sole
1366 beneficiaries of the contractual liability policy and claims are
1367 paid directly to the person making a claim under the contract;
1368 (b) The contractual liability policy meets all other
1369 requirements of this part, including subsection (3) of this
1370 section, which are not inconsistent with this subsection;
1371 (c) The association has been in existence for at least 5
1372 years or the association is a wholly owned subsidiary of a
1373 corporation that has been in existence and has been licensed as
1374 a service warranty association in the state for at least 5
1375 years, and:
1376 1. Is listed and traded on a recognized stock exchange; is
1377 listed in NASDAQ (National Association of Security Dealers
1378 Automated Quotation system) and publicly traded in the over-the
1379 counter securities market; is required to file either of Form
1380 10-K, Form 100, or Form 20-G with the United States Securities
1381 and Exchange Commission; or has American Depository Receipts
1382 listed on a recognized stock exchange and publicly traded or is
1383 the wholly owned subsidiary of a corporation that is listed and
1384 traded on a recognized stock exchange; is listed in NASDAQ
1385 (National Association of Security Dealers Automated Quotation
1386 system) and publicly traded in the over-the-counter securities
1387 market; is required to file Form 10-K, Form 100, or Form 20-G
1388 with the United States Securities and Exchange Commission; or
1389 has American Depository Receipts listed on a recognized stock
1390 exchange and is publicly traded;
1391 2. Maintains outstanding debt obligations, if any, rated in
1392 the top four rating categories by a recognized rating service;
1393 3. Has and maintains at all times a minimum net worth of
1394 not less than $10 million as evidenced by audited financial
1395 statements prepared by an independent certified public
1396 accountant in accordance with generally accepted accounting
1397 principles and submitted to the office annually; and
1398 4. Is authorized to do business in this state; and
1399 (d) The insurer issuing the contractual liability policy:
1400 1. Maintains and has maintained for the preceding 5 years,
1401 policyholder surplus of at least $100 million and is rated “A”
1402 or higher by A.M. Best Company or has an equivalent rating by
1403 another rating company acceptable to the office;
1404 2. Holds a certificate of authority to do business in this
1405 state and is approved to write this type of coverage; and
1406 3. Acknowledges to the office quarterly that it insures all
1407 of the association’s claims exposure under contracts delivered
1408 in this state.
1409
1410 If all the preceding conditions are satisfied, then the scope of
1411 coverage under a contractual liability policy shall not be
1412 required to exceed an association’s claims exposure under
1413 service warranty contracts delivered in this state.
1414 Section 35. This act shall take effect upon becoming a law.