Florida Senate - 2017 SB 1582
By Senator Bradley
5-00827B-17 20171582__
1 A bill to be entitled
2 An act relating to workers’ compensation insurance;
3 amending s. 440.02, F.S.; redefining the term
4 “specificity”; amending s. 440.102, F.S.; conforming a
5 cross-reference; amending s. 440.105, F.S.; deleting a
6 prohibition against receiving certain fees,
7 consideration, or gratuities under certain
8 circumstances; amending s. 440.13, F.S.; defining the
9 term “business day”; specifying certain timeframes in
10 terms of business days, rather than days; requiring
11 carriers to authorize or decline, rather than respond
12 to, certain requests for authorization within a
13 specified time; revising construction; revising a
14 specified interval for certain notices furnished by
15 treating physicians to employers or carriers; amending
16 s. 440.15, F.S.; revising the maximum period of
17 specified temporary disability benefits; amending s.
18 440.192, F.S.; revising conditions under which the
19 Office of the Judges of Compensation Claims must
20 dismiss petitions for benefits; revising requirements
21 for such petitions; revising construction relating to
22 dismissals of petitions or portions thereof; requiring
23 judges of compensation claims to enter orders on
24 certain motions to dismiss within specified
25 timeframes; amending s. 440.34, F.S.; requiring judges
26 of compensation claims to consider specified factors
27 in increasing or decreasing attorney fees; specifying
28 a basis for a maximum hourly rate for attorney fees;
29 deleting a provision authorizing such judges to
30 approve alternative attorney fees under certain
31 circumstances; conforming cross-references; amending
32 s. 624.482, F.S.; conforming a provision to changes
33 made by the act; amending s. 627.041, F.S.; redefining
34 terms; amending s. 627.0612, F.S.; adding prospective
35 loss costs to a list of reviewable matters in certain
36 proceedings by appellate courts; amending s. 627.062,
37 F.S.; requiring insurers and rating organizations to
38 establish and use prospective loss costs for a
39 specified purpose; requiring copies of prospective
40 loss costs to be filed with the Office of Insurance
41 Regulation; amending s. 627.072, F.S.; deleting a
42 specified methodology that may be used by the office
43 in rate determinations; amending s. 627.091, F.S.;
44 defining terms; requiring insurers writing workers’
45 compensation and employer’s liability insurances to
46 independently and individually file their proposed
47 final rates; specifying requirements for such filings;
48 deleting a requirement that such filings contain
49 certain information; revising requirements for
50 supporting information required to be furnished to the
51 office under certain circumstances; deleting a
52 specified method for insurers to satisfy filing
53 obligations; specifying requirements for a licensed
54 rating organization that elects to develop and file
55 certain reference filings and certain other
56 information; authorizing insurers to use supplementary
57 rating information approved by the office; revising
58 applicability of public meetings and records
59 requirements to certain meetings of recognized rating
60 organization committees; amending s. 627.093, F.S.;
61 revising applicability of public meetings and records
62 requirements to prospective loss cost filings or
63 appeals; amending s. 627.101, F.S.; conforming a
64 provision to changes made by the act; amending s.
65 627.211, F.S.; deleting provisions relating to
66 deviations; revising requirements for the office’s
67 annual report to the Legislature relating to the
68 workers’ compensation insurance market; creating s.
69 627.2151, F.S.; defining the term “defense and cost
70 containment expenses” or “DCCE”; requiring insurer
71 groups or insurers writing workers’ compensation
72 insurance to file specified schedules with the office
73 at specified intervals; providing construction
74 relating to excessive DCCE; requiring the office to
75 order returns of excess amounts of DCCE, subject to
76 certain hearing requirements; providing requirements
77 for, and an exception from, the return of excessive
78 DCCE amounts; providing construction; amending s.
79 627.291, F.S.; providing applicability of certain
80 disclosure and hearing requirements for rating
81 organizations filing prospective loss costs; amending
82 s. 627.318, F.S.; providing applicability of certain
83 recordkeeping requirements for rating organizations or
84 insurers filing or using prospective loss costs,
85 respectively; amending s. 627.361, F.S.; providing
86 applicability of a prohibition against false or
87 misleading information relating to prospective loss
88 costs; amending s. 627.371, F.S.; providing
89 applicability of certain hearing procedures and
90 requirements relating to the application, making, or
91 use of prospective loss costs; providing an effective
92 date.
93
94 Be It Enacted by the Legislature of the State of Florida:
95
96 Section 1. Subsection (40) of section 440.02, Florida
97 Statutes, is amended to read:
98 440.02 Definitions.—When used in this chapter, unless the
99 context clearly requires otherwise, the following terms shall
100 have the following meanings:
101 (40) “Specificity” means information on the petition for
102 benefits sufficient to put the employer or carrier on notice of
103 the exact statutory classification and outstanding time period
104 for each requested benefit, the specific amount of each
105 requested benefit, the calculation used for computing the
106 requested benefit, of benefits being requested and includes a
107 detailed explanation of any benefits received that should be
108 increased, decreased, changed, or otherwise modified. If the
109 petition is for medical benefits, the information must shall
110 include specific details as to why such benefits are being
111 requested, why such benefits are medically necessary, and why
112 current treatment, if any, is not sufficient. Any petition
113 requesting alternate or other medical care, including, but not
114 limited to, petitions requesting psychiatric or psychological
115 treatment, must specifically identify the physician, as defined
116 in s. 440.13(1), who is recommending such treatment. A copy of a
117 report from such physician making the recommendation for
118 alternate or other medical care must shall also be attached to
119 the petition. A judge of compensation claims may shall not order
120 such treatment if a physician is not recommending such
121 treatment.
122 Section 2. Paragraph (p) of subsection (5) of section
123 440.102, Florida Statutes, is amended to read:
124 440.102 Drug-free workplace program requirements.—The
125 following provisions apply to a drug-free workplace program
126 implemented pursuant to law or to rules adopted by the Agency
127 for Health Care Administration:
128 (5) PROCEDURES AND EMPLOYEE PROTECTION.—All specimen
129 collection and testing for drugs under this section shall be
130 performed in accordance with the following procedures:
131 (p) All authorized remedial treatment, care, and attendance
132 provided by a health care provider to an injured employee before
133 medical and indemnity benefits are denied under this section
134 must be paid for by the carrier or self-insurer. However, the
135 carrier or self-insurer must have given reasonable notice to all
136 affected health care providers that payment for treatment, care,
137 and attendance provided to the employee after a future date
138 certain will be denied. A health care provider, as defined in s.
139 440.13(1) s. 440.13(1)(g), that refuses, without good cause, to
140 continue treatment, care, and attendance before the provider
141 receives notice of benefit denial commits a misdemeanor of the
142 second degree, punishable as provided in s. 775.082 or s.
143 775.083.
144 Section 3. Paragraph (c) of subsection (3) of section
145 440.105, Florida Statutes, is amended to read:
146 440.105 Prohibited activities; reports; penalties;
147 limitations.—
148 (3) Whoever violates any provision of this subsection
149 commits a misdemeanor of the first degree, punishable as
150 provided in s. 775.082 or s. 775.083.
151 (c) It is unlawful for any attorney or other person, in his
152 or her individual capacity or in his or her capacity as a public
153 or private employee, or for any firm, corporation, partnership,
154 or association to receive any fee or other consideration or any
155 gratuity from a person on account of services rendered for a
156 person in connection with any proceedings arising under this
157 chapter, unless such fee, consideration, or gratuity is approved
158 by a judge of compensation claims or by the Deputy Chief Judge
159 of Compensation Claims.
160 Section 4. Present paragraphs (c) through (s) of subsection
161 (1) of section 440.13, Florida Statutes, are redesignated as
162 paragraphs (d) through (t), respectively, and a new paragraph
163 (c) is added to that subsection, and paragraph (f) of subsection
164 (2), paragraphs (d) and (i) of subsection (3), paragraph (a) of
165 subsection (4), paragraphs (a) and (c) of subsection (5), and
166 paragraphs (c) and (d) of subsection (9) of that section are
167 amended, to read:
168 440.13 Medical services and supplies; penalty for
169 violations; limitations.—
170 (1) DEFINITIONS.—As used in this section, the term:
171 (c) “Business day” means Monday through Friday, excluding
172 the following holidays: New Year’s Day, Birthday of Dr. Martin
173 Luther King, Jr., Memorial Day, Independence Day, Labor Day,
174 Veterans’ Day, Thanksgiving Day and the Friday after
175 Thanksgiving, and Christmas Day. If any of the holidays falls on
176 Saturday or Sunday, the term does not include the day on Monday
177 through Friday on which the holiday is observed.
178 (2) MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.—
179 (f) Upon the written request of the employee, the carrier
180 shall give the employee the opportunity for one change of
181 physician during the course of treatment for any one accident.
182 Upon the granting of a change of physician, the originally
183 authorized physician in the same specialty as the changed
184 physician shall become deauthorized upon written notification by
185 the employer or carrier. The carrier shall authorize an
186 alternative physician who shall not be professionally affiliated
187 with the previous physician within 5 business days after receipt
188 of the request. If the carrier fails to provide a change of
189 physician as requested by the employee, the employee may select
190 the physician and such physician shall be considered authorized
191 if the treatment being provided is compensable and medically
192 necessary.
193
194 Failure of the carrier to timely comply with this subsection
195 shall be a violation of this chapter and the carrier shall be
196 subject to penalties as provided for in s. 440.525.
197 (3) PROVIDER ELIGIBILITY; AUTHORIZATION.—
198 (d) A carrier must respond, by telephone or in writing,
199 must authorize or decline to a request for authorization from an
200 authorized health care provider by the close of the third
201 business day after receipt of the request. A carrier authorizes
202 the request if it who fails to respond to a written request for
203 authorization for referral for medical treatment by the close of
204 the third business day after receipt of the request consents to
205 the medical necessity for such treatment. All such requests must
206 be made to the carrier. Notice to the carrier does not include
207 notice to the employer.
208 (i) Notwithstanding paragraph (d), a claim for specialist
209 consultations, surgical operations, physiotherapeutic or
210 occupational therapy procedures, X-ray examinations, or special
211 diagnostic laboratory tests that cost more than $1,000 and other
212 specialty services that the department identifies by rule is not
213 valid and reimbursable unless the services have been expressly
214 authorized by the carrier, unless the carrier has failed to
215 respond within 10 business days to a written request for
216 authorization, or unless emergency care is required. The insurer
217 shall authorize such consultation or procedure unless the health
218 care provider or facility is not authorized, unless such
219 treatment is not in accordance with practice parameters and
220 protocols of treatment established in this chapter, or unless a
221 judge of compensation claims has determined that the
222 consultation or procedure is not medically necessary, not in
223 accordance with the practice parameters and protocols of
224 treatment established in this chapter, or otherwise not
225 compensable under this chapter. Authorization of a treatment
226 plan does not constitute express authorization for purposes of
227 this section, except to the extent the carrier provides
228 otherwise in its authorization procedures. This paragraph does
229 not limit the carrier’s obligation to identify and disallow
230 overutilization or billing errors.
231 (4) NOTICE OF TREATMENT TO CARRIER; FILING WITH
232 DEPARTMENT.—
233 (a) Any health care provider providing necessary remedial
234 treatment, care, or attendance to any injured worker shall
235 submit treatment reports to the carrier in a format prescribed
236 by the department. A claim for medical or surgical treatment is
237 not valid or enforceable against such employer or employee,
238 unless, by the close of the third business day following the
239 first treatment, the physician providing the treatment furnishes
240 to the employer or carrier a preliminary notice of the injury
241 and treatment in a format prescribed by the department and,
242 within 15 business days thereafter, furnishes to the employer or
243 carrier a complete report, and subsequent thereto furnishes
244 progress reports, if requested by the employer or insurance
245 carrier, at intervals of not less than 15 business days 3 weeks
246 apart or at less frequent intervals if requested in a format
247 prescribed by the department.
248 (5) INDEPENDENT MEDICAL EXAMINATIONS.—
249 (a) In any dispute concerning overutilization, medical
250 benefits, compensability, or disability under this chapter, the
251 carrier or the employee may select an independent medical
252 examiner. If the parties agree, the examiner may be a health
253 care provider treating or providing other care to the employee.
254 An independent medical examiner may not render an opinion
255 outside his or her area of expertise, as demonstrated by
256 licensure and applicable practice parameters. The employer and
257 employee shall be entitled to only one independent medical
258 examination per accident and not one independent medical
259 examination per medical specialty. The party requesting and
260 selecting the independent medical examination shall be
261 responsible for all expenses associated with said examination,
262 including, but not limited to, medically necessary diagnostic
263 testing performed and physician or medical care provider fees
264 for the evaluation. The party selecting the independent medical
265 examination shall identify the choice of the independent medical
266 examiner to all other parties within 15 business days after the
267 date the independent medical examination is to take place.
268 Failure to timely provide such notification shall preclude the
269 requesting party from submitting the findings of such
270 independent medical examiner in a proceeding before a judge of
271 compensation claims. The independent medical examiner may not
272 provide followup care if such recommendation for care is found
273 to be medically necessary. If the employee prevails in a medical
274 dispute as determined in an order by a judge of compensation
275 claims or if benefits are paid or treatment provided after the
276 employee has obtained an independent medical examination based
277 upon the examiner’s findings, the costs of such examination
278 shall be paid by the employer or carrier.
279 (c) The carrier may, at its election, contact the claimant
280 directly to schedule a reasonable time for an independent
281 medical examination. The carrier must confirm the scheduling
282 agreement in writing with the claimant and the claimant’s
283 counsel, if any, at least 7 business days before the date upon
284 which the independent medical examination is scheduled to occur.
285 An attorney representing a claimant is not authorized to
286 schedule the self-insured employer’s or carrier’s independent
287 medical evaluations under this subsection. Neither the self
288 insured employer nor the carrier shall be responsible for
289 scheduling any independent medical examination other than an
290 employer or carrier independent medical examination.
291 (9) EXPERT MEDICAL ADVISORS.—
292 (c) If there is disagreement in the opinions of the health
293 care providers, if two health care providers disagree on medical
294 evidence supporting the employee’s complaints or the need for
295 additional medical treatment, or if two health care providers
296 disagree that the employee is able to return to work, the
297 department may, and the judge of compensation claims shall, upon
298 his or her own motion or within 15 business days after receipt
299 of a written request by either the injured employee, the
300 employer, or the carrier, order the injured employee to be
301 evaluated by an expert medical advisor. The injured employee and
302 the employer or carrier may agree on the health care provider to
303 serve as an expert medical advisor. If the parties do not agree,
304 the judge of compensation claims shall select an expert medical
305 advisor from the department’s list of certified expert medical
306 advisors. If a certified medical advisor within the relevant
307 medical specialty is unavailable, the judge of compensation
308 claims shall appoint any otherwise qualified health care
309 provider to serve as an expert medical advisor without obtaining
310 the department’s certification. The opinion of the expert
311 medical advisor is presumed to be correct unless there is clear
312 and convincing evidence to the contrary as determined by the
313 judge of compensation claims. The expert medical advisor
314 appointed to conduct the evaluation shall have free and complete
315 access to the medical records of the employee. An employee who
316 fails to report to and cooperate with such evaluation forfeits
317 entitlement to compensation during the period of failure to
318 report or cooperate.
319 (d) The expert medical advisor must complete his or her
320 evaluation and issue his or her report to the department or to
321 the judge of compensation claims within 15 business days after
322 receipt of all medical records. The expert medical advisor must
323 furnish a copy of the report to the carrier and to the employee.
324 Section 5. Paragraph (a) of subsection (2) and paragraph
325 (e) of subsection (4) of section 440.15, Florida Statutes, are
326 amended to read:
327 440.15 Compensation for disability.—Compensation for
328 disability shall be paid to the employee, subject to the limits
329 provided in s. 440.12(2), as follows:
330 (2) TEMPORARY TOTAL DISABILITY.—
331 (a) Subject to subsection (7), in case of disability total
332 in character but temporary in quality, 66 2/3 or 66.67 percent
333 of the average weekly wages shall be paid to the employee during
334 the continuance thereof, not to exceed 260 104 weeks except as
335 provided in this subsection, s. 440.12(1), and s. 440.14(3).
336 Once the employee reaches the maximum number of weeks allowed,
337 or the employee reaches the date of maximum medical improvement,
338 whichever occurs earlier, temporary disability benefits shall
339 cease and the injured worker’s permanent impairment shall be
340 determined.
341 (4) TEMPORARY PARTIAL DISABILITY.—
342 (e) Such benefits shall be paid during the continuance of
343 such disability, not to exceed a period of 260 104 weeks, as
344 provided by this subsection and subsection (2). Once the injured
345 employee reaches the maximum number of weeks, temporary
346 disability benefits cease and the injured worker’s permanent
347 impairment must be determined. If the employee is terminated
348 from postinjury employment based on the employee’s misconduct,
349 temporary partial disability benefits are not payable as
350 provided for in this section. The department shall by rule
351 specify forms and procedures governing the method and time for
352 payment of temporary disability benefits for dates of accidents
353 before January 1, 1994, and for dates of accidents on or after
354 January 1, 1994.
355 Section 6. Subsections (2) and (5) of section 440.192,
356 Florida Statutes, are amended to read:
357 440.192 Procedure for resolving benefit disputes.—
358 (2) Upon receipt, the Office of the Judges of Compensation
359 Claims shall review each petition and shall dismiss each
360 petition or any portion of such a petition that does not on its
361 face meet the requirements of this section and the definition of
362 specificity under s. 440.02, and specifically identify or
363 itemize the following:
364 (a) The name, address, and telephone number, and social
365 security number of the employee.
366 (b) The name, address, and telephone number of the
367 employer.
368 (c) A detailed description of the injury and cause of the
369 injury, including the Florida county or, if outside of Florida,
370 the state location of the occurrence and the date or dates of
371 the accident.
372 (d) A detailed description of the employee’s job, work
373 responsibilities, and work the employee was performing when the
374 injury occurred.
375 (e) The specific time period for which compensation and the
376 specific classification of compensation were not timely
377 provided.
378 (f) The specific date of maximum medical improvement,
379 character of disability, and specific statement of all benefits
380 or compensation that the employee is seeking. A claim for
381 permanent benefits must include the specific date of maximum
382 medical improvement and the specific date that such permanent
383 benefits are claimed to begin.
384 (g) All specific travel costs to which the employee
385 believes she or he is entitled, including dates of travel and
386 purpose of travel, means of transportation, and mileage and
387 including the date the request for mileage was filed with the
388 carrier and a copy of the request filed with the carrier.
389 (h) A specific listing of all medical charges alleged
390 unpaid, including the name and address of the medical provider,
391 the amounts due, and the specific dates of treatment.
392 (i) The type or nature of treatment care or attendance
393 sought and the justification for such treatment. If the employee
394 is under the care of a physician for an injury identified under
395 paragraph (c), a copy of the physician’s request, authorization,
396 or recommendation for treatment, care, or attendance must
397 accompany the petition.
398 (j) The specific amount of compensation claimed to be
399 accurate and the methodology claimed to accurately calculate the
400 average weekly wage, if the average weekly wage calculated by
401 the employer or carrier is disputed. If the petition does not
402 include a claim under this paragraph, the average weekly wage
403 and corresponding compensation calculated by the employer or
404 carrier are presumed to be accurate.
405 (k)(j) A specific explanation of any other disputed issue
406 that a judge of compensation claims will be called to rule upon.
407
408 The dismissal of any petition or portion of such a petition
409 under this subsection section is without prejudice and does not
410 require a hearing.
411 (5)(a) All motions to dismiss must state with particularity
412 the basis for the motion. The judge of compensation claims shall
413 enter an order upon such motions without hearing, unless good
414 cause for hearing is shown. Dismissal of any petition or portion
415 of a petition under this subsection is without prejudice.
416 (b) Upon motion that a petition or portion of a petition be
417 dismissed for lack of specificity, the judge of compensation
418 claims shall enter an order on the motion, unless stipulated in
419 writing by the parties, within 10 days after the motion is filed
420 or, if good cause for hearing is shown, within 20 days after
421 hearing on the motion. When any petition or portion of a
422 petition is dismissed for lack of specificity under this
423 subsection, the claimant must be allowed 20 days after the date
424 of the order of dismissal in which to file an amended petition.
425 Any grounds for dismissal for lack of specificity under this
426 section which are not asserted within 30 days after receipt of
427 the petition for benefits are thereby waived.
428 Section 7. Section 440.34, Florida Statutes, is amended to
429 read:
430 440.34 Attorney Attorney’s fees; costs.—
431 (1)(a) A fee, gratuity, or other consideration may not be
432 paid for a claimant in connection with any proceedings arising
433 under this chapter, unless approved by the judge of compensation
434 claims or court having jurisdiction over such proceedings. Any
435 attorney fees attorney’s fee approved by a judge of compensation
436 claims for benefits secured on behalf of a claimant must equal
437 to 20 percent of the first $5,000 of the amount of the benefits
438 secured, 15 percent of the next $5,000 of the amount of the
439 benefits secured, 10 percent of the remaining amount of the
440 benefits secured to be provided during the first 10 years after
441 the date the claim is filed, and 5 percent of the benefits
442 secured after 10 years.
443 (b) However, the judge of compensation claims shall
444 consider the following factors in each case and may increase or
445 decrease the attorney fees, based on a maximum hourly rate of
446 $250 per hour, if in his or her judgment he or she expressly
447 finds that the circumstances of the particular case warrant such
448 action:
449 1. The time and labor required, the novelty and difficulty
450 of the questions involved, and the skill requisite to perform
451 the legal service properly.
452 2. The fee customarily charged in the locality for similar
453 legal services.
454 3. The amount involved in the controversy and the benefits
455 resulting to the claimant.
456 4. The time limitation imposed by the claimant or the
457 circumstances.
458 5. The experience, reputation, and ability of the attorney
459 or attorneys performing services.
460 6. The contingency or certainty of a fee.
461 (c) The judge of compensation claims shall not approve a
462 compensation order, a joint stipulation for lump-sum settlement,
463 a stipulation or agreement between a claimant and his or her
464 attorney, or any other agreement related to benefits under this
465 chapter which provides for attorney fees an attorney’s fee in
466 excess of the amount permitted by this section. The judge of
467 compensation claims is not required to approve any retainer
468 agreement between the claimant and his or her attorney. The
469 retainer agreement as to fees and costs may not be for
470 compensation in excess of the amount allowed under this
471 subsection or subsection (7).
472 (2) In awarding a claimant’s attorney fees attorney’s fee,
473 the judge of compensation claims shall consider only those
474 benefits secured by the attorney. An attorney is not entitled to
475 attorney attorney’s fees for representation in any issue that
476 was ripe, due, and owing and that reasonably could have been
477 addressed, but was not addressed, during the pendency of other
478 issues for the same injury. The amount, statutory basis, and
479 type of benefits obtained through legal representation shall be
480 listed on all attorney attorney’s fees awarded by the judge of
481 compensation claims. For purposes of this section, the term
482 “benefits secured” does not include future medical benefits to
483 be provided on any date more than 5 years after the date the
484 claim is filed. In the event an offer to settle an issue pending
485 before a judge of compensation claims, including attorney
486 attorney’s fees as provided for in this section, is communicated
487 in writing to the claimant or the claimant’s attorney at least
488 30 days prior to the trial date on such issue, for purposes of
489 calculating the amount of attorney attorney’s fees to be taxed
490 against the employer or carrier, the term “benefits secured”
491 shall be deemed to include only that amount awarded to the
492 claimant above the amount specified in the offer to settle. If
493 multiple issues are pending before the judge of compensation
494 claims, said offer of settlement shall address each issue
495 pending and shall state explicitly whether or not the offer on
496 each issue is severable. The written offer shall also
497 unequivocally state whether or not it includes medical witness
498 fees and expenses and all other costs associated with the claim.
499 (3) If any party should prevail in any proceedings before a
500 judge of compensation claims or court, there shall be taxed
501 against the nonprevailing party the reasonable costs of such
502 proceedings, not to include attorney attorney’s fees. A claimant
503 is responsible for the payment of her or his own attorney
504 attorney’s fees, except that a claimant is entitled to recover
505 attorney fees an attorney’s fee in an amount equal to the amount
506 provided for in subsection (1) or subsection (7) from a carrier
507 or employer:
508 (a) Against whom she or he successfully asserts a petition
509 for medical benefits only, if the claimant has not filed or is
510 not entitled to file at such time a claim for disability,
511 permanent impairment, wage-loss, or death benefits, arising out
512 of the same accident;
513 (b) In any case in which the employer or carrier files a
514 response to petition denying benefits with the Office of the
515 Judges of Compensation Claims and the injured person has
516 employed an attorney in the successful prosecution of the
517 petition;
518 (c) In a proceeding in which a carrier or employer denies
519 that an accident occurred for which compensation benefits are
520 payable, and the claimant prevails on the issue of
521 compensability; or
522 (d) In cases where the claimant successfully prevails in
523 proceedings filed under s. 440.24 or s. 440.28.
524
525 Regardless of the date benefits were initially requested,
526 attorney attorney’s fees shall not attach under this subsection
527 until 30 days after the date the carrier or employer, if self
528 insured, receives the petition.
529 (4) In such cases in which the claimant is responsible for
530 the payment of her or his own attorney attorney’s fees, such
531 fees are a lien upon compensation payable to the claimant,
532 notwithstanding s. 440.22.
533 (5) If any proceedings are had for review of any claim,
534 award, or compensation order before any court, the court may
535 award the injured employee or dependent attorney fees an
536 attorney’s fee to be paid by the employer or carrier, in its
537 discretion, which shall be paid as the court may direct.
538 (6) A judge of compensation claims may not enter an order
539 approving the contents of a retainer agreement that permits
540 placing any portion of the employee’s compensation into an
541 escrow account until benefits have been secured.
542 (7) If an attorney’s fee is owed under paragraph (3)(a),
543 the judge of compensation claims may approve an alternative
544 attorney’s fee not to exceed $1,500 only once per accident,
545 based on a maximum hourly rate of $150 per hour, if the judge of
546 compensation claims expressly finds that the attorney’s fee
547 amount provided for in subsection (1), based on benefits
548 secured, fails to fairly compensate the attorney for disputed
549 medical-only claims as provided in paragraph (3)(a) and the
550 circumstances of the particular case warrant such action.
551 Section 8. Subsection (10) of section 624.482, Florida
552 Statutes, is amended to read:
553 624.482 Making and use of rates.—
554 (10) Any self-insurance fund that writes workers’
555 compensation insurance and employer’s liability insurance is
556 subject to, and shall make all rate filings for workers’
557 compensation insurance and employer’s liability insurance in
558 accordance with, ss. 627.091, 627.101, 627.111, 627.141,
559 627.151, 627.171, and 627.191, and 627.211.
560 Section 9. Subsections (3), (4), and (6) of section
561 627.041, Florida Statutes, are amended to read:
562 627.041 Definitions.—As used in this part:
563 (3) “Rating organization” means every person, other than an
564 authorized insurer, whether located within or outside this
565 state, who has as his or her object or purpose the making of
566 prospective loss costs, rates, rating plans, or rating systems.
567 Two or more authorized insurers that act in concert for the
568 purpose of making prospective loss costs, rates, rating plans,
569 or rating systems, and that do not operate within the specific
570 authorizations contained in ss. 627.311, 627.314(2), (4), and
571 627.351, shall be deemed to be a rating organization. No single
572 insurer shall be deemed to be a rating organization.
573 (4) “Advisory organization” means every group, association,
574 or other organization of insurers, whether located within or
575 outside this state, which prepares policy forms or makes
576 underwriting rules incident to but not including the making of
577 prospective loss costs, rates, rating plans, or rating systems
578 or which collects and furnishes to authorized insurers or rating
579 organizations loss or expense statistics or other statistical
580 information and data and acts in an advisory, as distinguished
581 from a ratemaking, capacity.
582 (6) “Subscriber” means an insurer which is furnished at its
583 request:
584 (a) With prospective loss costs, rates, and rating manuals
585 by a rating organization of which it is not a member; or
586 (b) With advisory services by an advisory organization of
587 which it is not a member.
588 Section 10. Subsection (1) of section 627.0612, Florida
589 Statutes, is amended to read:
590 627.0612 Administrative proceedings in rating
591 determinations.—
592 (1) In any proceeding to determine whether prospective loss
593 costs, rates, rating plans, or other matters governed by this
594 part comply with the law, the appellate court shall set aside a
595 final order of the office if the office has violated s.
596 120.57(1)(k) by substituting its findings of fact for findings
597 of an administrative law judge which were supported by competent
598 substantial evidence.
599 Section 11. Paragraph (a) of subsection (2) of section
600 627.062, Florida Statutes, is amended to read:
601 627.062 Rate standards.—
602 (2) As to all such classes of insurance:
603 (a) Insurers or rating organizations shall establish and
604 use prospective loss costs, rates, rating schedules, or rating
605 manuals that allow the insurer a reasonable rate of return on
606 the classes of insurance written in this state. A copy of
607 prospective loss costs, rates, rating schedules, rating manuals,
608 premium credits or discount schedules, and surcharge schedules,
609 and changes thereto, must be filed with the office under one of
610 the following procedures:
611 1. If the filing is made at least 90 days before the
612 proposed effective date and is not implemented during the
613 office’s review of the filing and any proceeding and judicial
614 review, such filing is considered a “file and use” filing. In
615 such case, the office shall finalize its review by issuance of a
616 notice of intent to approve or a notice of intent to disapprove
617 within 90 days after receipt of the filing. The notice of intent
618 to approve and the notice of intent to disapprove constitute
619 agency action for purposes of the Administrative Procedure Act.
620 Requests for supporting information, requests for mathematical
621 or mechanical corrections, or notification to the insurer by the
622 office of its preliminary findings does not toll the 90-day
623 period during any such proceedings and subsequent judicial
624 review. The rate shall be deemed approved if the office does not
625 issue a notice of intent to approve or a notice of intent to
626 disapprove within 90 days after receipt of the filing.
627 2. If the filing is not made in accordance with
628 subparagraph 1., such filing must be made as soon as
629 practicable, but within 30 days after the effective date, and is
630 considered a “use and file” filing. An insurer making a “use and
631 file” filing is potentially subject to an order by the office to
632 return to policyholders those portions of rates found to be
633 excessive, as provided in paragraph (h).
634 3. For all property insurance filings made or submitted
635 after January 25, 2007, but before May 1, 2012, an insurer
636 seeking a rate that is greater than the rate most recently
637 approved by the office shall make a “file and use” filing. For
638 purposes of this subparagraph, motor vehicle collision and
639 comprehensive coverages are not considered property coverages.
640
641 The provisions of this subsection do not apply to workers’
642 compensation, employer’s liability insurance, and motor vehicle
643 insurance.
644 Section 12. Subsection (5) of section 627.072, Florida
645 Statutes, is amended to read:
646 627.072 Making and use of rates.—
647 (5)(a) In the case of workers’ compensation and employer’s
648 liability insurance, the office shall consider utilizing the
649 following methodology in rate determinations: Premiums,
650 expenses, and expected claim costs would be discounted to a
651 common point of time, such as the initial point of a policy
652 year, in the determination of rates; the cash-flow pattern of
653 premiums, expenses, and claim costs would be determined
654 initially by using data from 8 to 10 of the largest insurers
655 writing workers’ compensation insurance in the state; such
656 insurers may be selected for their statistical ability to report
657 the data on an accident-year basis and in accordance with
658 subparagraphs (b)1., 2., and 3., for at least 2 1/2 years; such
659 a cash-flow pattern would be modified when necessary in
660 accordance with the data and whenever a radical change in the
661 payout pattern is expected in the policy year under
662 consideration.
663 (b) If the methodology set forth in paragraph (a) is
664 utilized, to facilitate the determination of such a cash-flow
665 pattern methodology:
666 1. Each insurer shall include in its statistical reporting
667 to the rating bureau and the office the accident year by
668 calendar quarter data for paid-claim costs;
669 2. Each insurer shall submit financial reports to the
670 rating bureau and the office which shall include total incurred
671 claim amounts and paid-claim amounts by policy year and by
672 injury types as of December 31 of each calendar year; and
673 3. Each insurer shall submit to the rating bureau and the
674 office paid-premium data on an individual risk basis in which
675 risks are to be subdivided by premium size as follows:
676
677 Number of Risks in
678 Premium Range Standard Premium Size
679
680 ...(to be filled in by carrier)... $300—999
681 ...(to be filled in by carrier)... 1,000—4,999
682 ...(to be filled in by carrier)... 5,000—49,999
683 ...(to be filled in by carrier)... 50,000—99,999
684 ...(to be filled in by carrier)... 100,000 or more
685 Total:
686 Section 13. Section 627.091, Florida Statutes, is amended
687 to read:
688 627.091 Rate filings; workers’ compensation and employer’s
689 liability insurances.—
690 (1) As used in this section, the term:
691 (a) “Expenses” means the portion of a rate which is
692 attributable to acquisition, field supervision, collection
693 expenses, taxes, assessments, and general expenses.
694 (b) “Loss cost modifier” means an adjustment to, or a
695 deviation from, the approved prospective loss costs filed by a
696 licensed rating organization.
697 (c) “Loss cost multiplier” means the profit and expense
698 factor, expressed as a single nonintegral number to be applied
699 to the prospective loss costs other than loss adjustment
700 expenses, which is associated with writing workers’ compensation
701 and employer’s liability insurance and which is approved by the
702 office in making rates for each classification of risks used by
703 that insurer.
704 (d) “Prospective loss costs” means the portion of a rate
705 which reflects historical industry average aggregate losses and
706 loss adjustment expenses projected through development to their
707 ultimate value and through trending to a future point in time.
708 The term does not include provisions for profit or expenses
709 other than loss adjustment expense.
710 (2)(1) As to workers’ compensation and employer’s liability
711 insurances, every insurer shall file with the office every
712 manual of classifications, rules, and rates, every rating plan,
713 and every modification of any of the foregoing which it proposes
714 to use. Each insurer shall independently and individually file
715 with the office the final rates it proposes to use. An insurer
716 may satisfy this filing requirement by adopting the office’s
717 approved loss costs and otherwise complying with this part. Each
718 insurer shall file data in accordance with the uniform
719 statistical plan approved by the office. Every filing under this
720 subsection:
721 (a) Must state the proposed effective date and must be made
722 at least 30 days before such proposed effective date;
723 (b) Must indicate the character and extent of the coverage
724 contemplated;
725 (c) May use the approved prospective loss costs filed by a
726 licensed rating organization in combination with the insurer’s
727 own approved loss cost multiplier and loss cost modifier;
728 (d) May include deductible provisions in its manual of
729 classifications, rules, and rates. All deductibles must be in a
730 form and manner that is consistent with the underlying purpose
731 of chapter 440;
732 (e) May use variable or fixed expense loads or a
733 combination thereof, and may vary the expense, profit, or
734 contingency provisions by class or group of classes, if the
735 insurer files supporting data justifying such variations; and
736 (f) May include a schedule of proposed premium discounts,
737 credits, and surcharges. The office may not approve discounts,
738 credits, and surcharges unless they are based on objective
739 criteria that bear a reasonable relationship to the expected
740 loss, expense, or profit experience of an individual
741 policyholder or a class of policyholders Every insurer is
742 authorized to include deductible provisions in its manual of
743 classifications, rules, and rates. Such deductibles shall in all
744 cases be in a form and manner which is consistent with the
745 underlying purpose of chapter 440.
746 (3)(2) Every such filing shall state the proposed effective
747 date thereof, and shall indicate the character and extent of the
748 coverage contemplated. When a prospective loss cost, loss cost
749 multiplier, or loss cost modifier filing is not accompanied by
750 the information upon which the insurer or rating organization
751 supports the filing and the office does not have sufficient
752 information to determine whether the filing meets the applicable
753 requirements of this part, the office it shall within 15 days
754 after the date of filing require the insurer or rating
755 organization to furnish the information upon which it supports
756 the filing. The information furnished in support of a filing may
757 include:
758 (a) The experience or judgment of the insurer or rating
759 organization making the filing;
760 (b) The Its interpretation of any statistical data which
761 the insurer or rating organization making the filing it relies
762 upon;
763 (c) The experience of other insurers or rating
764 organizations; or
765 (d) Any other factors which the insurer or rating
766 organization making the filing deems relevant.
767 (4)(3) A filing and any supporting information are shall be
768 open to public inspection as provided in s. 119.07(1).
769 (4) An insurer may satisfy its obligation to make such
770 filings by becoming a member of, or a subscriber to, a licensed
771 rating organization which makes such filings and by authorizing
772 the office to accept such filings in its behalf; but nothing
773 contained in this chapter shall be construed as requiring any
774 insurer to become a member or a subscriber to any rating
775 organization.
776 (5) A licensed rating organization may develop and file for
777 approval with the office reference filings containing
778 prospective loss costs and the underlying loss data, and other
779 supporting statistical and actuarial information. A rating
780 organization may not develop or file final rates or multipliers
781 for expenses, profit, or contingencies. After a loss cost
782 reference filing is filed with the office and is approved, the
783 rating organization must provide its member subscribers with a
784 copy of the approved reference filing.
785 (6) A rating organization may file supplementary rating
786 information that includes policywriting rules, rating plan
787 classification codes and descriptions, experience modification
788 plans, and rules that include factors or relativities, such as
789 increased limits factors, classification relativities, or
790 similar factors, but that exclude minimum premiums. An insurer
791 may use supplementary rating information approved by the office.
792 (7)(5) Pursuant to the provisions of s. 624.3161, the
793 office may examine the underlying statistical data used in such
794 filings.
795 (8)(6) Whenever the committee of a recognized rating
796 organization with authority to file prospective loss costs for
797 use by insurers in determining responsibility for workers’
798 compensation and employer’s liability insurance rates in this
799 state meets to discuss the necessity for, or a request for,
800 Florida rate increases or decreases in prospective loss costs in
801 this state, the determination of prospective loss costs in this
802 state Florida rates, the prospective loss costs rates to be
803 requested in this state, and any other matters pertaining
804 specifically and directly to prospective loss costs in this
805 state such Florida rates, such meetings shall be held in this
806 state and are shall be subject to s. 286.011. The committee of
807 such a rating organization shall provide at least 3 weeks’ prior
808 notice of such meetings to the office and shall provide at least
809 14 days’ prior notice of such meetings to the public by
810 publication in the Florida Administrative Register.
811 Section 14. Section 627.093, Florida Statutes, is amended
812 to read:
813 627.093 Application of s. 286.011 to workers’ compensation
814 and employer’s liability insurances.—Section 286.011 shall be
815 applicable to every prospective loss cost and rate filing,
816 approval or disapproval of filing, rating deviation from filing,
817 or appeal from any of these regarding workers’ compensation and
818 employer’s liability insurances.
819 Section 15. Subsection (1) of section 627.101, Florida
820 Statutes, is amended to read:
821 627.101 When filing becomes effective; workers’
822 compensation and employer’s liability insurances.—
823 (1) The office shall review all required filings as to
824 workers’ compensation and employer’s liability insurances as
825 soon as reasonably possible after they have been made in order
826 to determine whether they meet the applicable requirements of
827 this part. If the office determines that part of a required rate
828 filing does not meet the applicable requirements of this part,
829 it may reject so much of the filing as does not meet these
830 requirements, and approve the remainder of the filing.
831 Section 16. Section 627.211, Florida Statutes, is amended
832 to read:
833 627.211 Annual report by the office on the workers’
834 compensation insurance market Deviations; workers’ compensation
835 and employer’s liability insurances.—
836 (1) Every member or subscriber to a rating organization
837 shall, as to workers’ compensation or employer’s liability
838 insurance, adhere to the filings made on its behalf by such
839 organization; except that any such insurer may make written
840 application to the office for permission to file a uniform
841 percentage decrease or increase to be applied to the premiums
842 produced by the rating system so filed for a kind of insurance,
843 for a class of insurance which is found by the office to be a
844 proper rating unit for the application of such uniform
845 percentage decrease or increase, or for a subdivision of
846 workers’ compensation or employer’s liability insurance:
847 (a) Comprised of a group of manual classifications which is
848 treated as a separate unit for ratemaking purposes; or
849 (b) For which separate expense provisions are included in
850 the filings of the rating organization.
851
852 Such application shall specify the basis for the modification
853 and shall be accompanied by the data upon which the applicant
854 relies. A copy of the application and data shall be sent
855 simultaneously to the rating organization.
856 (2) Every member or subscriber to a rating organization
857 may, as to workers’ compensation and employer’s liability
858 insurance, file a plan or plans to use deviations that vary
859 according to factors present in each insured’s individual risk.
860 The insurer that files for the deviations provided in this
861 subsection shall file the qualifications for the plans,
862 schedules of rating factors, and the maximum deviation factors
863 which shall be subject to the approval of the office pursuant to
864 s. 627.091. The actual deviation which shall be used for each
865 insured that qualifies under this subsection may not exceed the
866 maximum filed deviation under that plan and shall be based on
867 the merits of each insured’s individual risk as determined by
868 using schedules of rating factors which shall be applied
869 uniformly. Insurers shall maintain statistical data in
870 accordance with the schedule of rating factors. Such data shall
871 be available to support the continued use of such varying
872 deviations.
873 (3) In considering an application for the deviation, the
874 office shall give consideration to the applicable principles for
875 ratemaking as set forth in ss. 627.062 and 627.072 and the
876 financial condition of the insurer. In evaluating the financial
877 condition of the insurer, the office may consider: (1) the
878 insurer’s audited financial statements and whether the
879 statements provide unqualified opinions or contain significant
880 qualifications or “subject to” provisions; (2) any independent
881 or other actuarial certification of loss reserves; (3) whether
882 workers’ compensation and employer’s liability reserves are
883 above the midpoint or best estimate of the actuary’s reserve
884 range estimate; (4) the adequacy of the proposed rate; (5)
885 historical experience demonstrating the profitability of the
886 insurer; (6) the existence of excess or other reinsurance that
887 contains a sufficiently low attachment point and maximums that
888 provide adequate protection to the insurer; and (7) other
889 factors considered relevant to the financial condition of the
890 insurer by the office. The office shall approve the deviation if
891 it finds it to be justified, it would not endanger the financial
892 condition of the insurer, and it would not constitute predatory
893 pricing. The office shall disapprove the deviation if it finds
894 that the resulting premiums would be excessive, inadequate, or
895 unfairly discriminatory, would endanger the financial condition
896 of the insurer, or would result in predatory pricing. The
897 insurer may not use a deviation unless the deviation is
898 specifically approved by the office. An insurer may apply the
899 premiums approved pursuant to s. 627.091 or its uniform
900 deviation approved pursuant to this section to a particular
901 insured according to underwriting guidelines filed with and
902 approved by the office, such approval to be based on ss. 627.062
903 and 627.072.
904 (4) Each deviation permitted to be filed shall be effective
905 for a period of 1 year unless terminated, extended, or modified
906 with the approval of the office. If at any time after a
907 deviation has been approved the office finds that the deviation
908 no longer meets the requirements of this code, it shall notify
909 the insurer in what respects it finds that the deviation fails
910 to meet such requirements and specify when, within a reasonable
911 period thereafter, the deviation shall be deemed no longer
912 effective. The notice shall not affect any insurance contract or
913 policy made or issued prior to the expiration of the period set
914 forth in the notice.
915 (5) For purposes of this section, the office, when
916 considering the experience of any insurer, shall consider the
917 experience of any predecessor insurer when the business and the
918 liabilities of the predecessor insurer were assumed by the
919 insurer pursuant to an order of the office which approves the
920 assumption of the business and the liabilities.
921 (6) The office shall submit an annual report to the
922 President of the Senate and the Speaker of the House of
923 Representatives by January 15 of each year which evaluates
924 insurance company solvency and competition in the workers’
925 compensation insurance market in this state. The report must
926 contain an analysis of the availability and affordability of
927 workers’ compensation coverage and whether the current market
928 structure, conduct, and performance are conducive to
929 competition, based upon economic analysis and tests. The report
930 must also contain an analysis of each insurer’s capital compared
931 to minimum risk-based capital. The purpose of this report is to
932 aid the Legislature in determining whether changes to the
933 workers’ compensation rating laws are warranted. The report must
934 also document that the office has complied with the provisions
935 of s. 627.096 which require the office to investigate and study
936 all workers’ compensation insurers in the state and to study the
937 data, statistics, schedules, or other information as it finds
938 necessary to assist in its review of workers’ compensation rate
939 filings.
940 Section 17. Section 627.2151, Florida Statutes, is created
941 to read:
942 627.2151 Workers’ compensation excessive defense and cost
943 containment expenses.—
944 (1) As used in this section, the term “defense and cost
945 containment expenses” or “DCCE” includes the following Florida
946 expenses of an insurer group or insurer writing workers’
947 compensation insurance:
948 (a) Insurance company attorney fees;
949 (b) Expert witnesses;
950 (c) Medical examinations and autopsies;
951 (d) Medical fee review panels;
952 (e) Bill auditing;
953 (f) Treatment utilization reviews;
954 (g) Preferred provider network expenses; and
955 (h) Vocational rehabilitation.
956 (2) Each insurer group or insurer writing workers’
957 compensation insurance shall file with the office a schedule of
958 Florida defense and cost containment expenses and total Florida
959 incurred losses for each of the 3 years before the most recent
960 accident year. The DCCE and incurred losses must be valued as of
961 December 31 of the first year following the latest accident year
962 to be reported, developed to an ultimate basis, and at two 12
963 month intervals thereafter, each developed to an ultimate basis,
964 so that a total of three evaluations will be provided for each
965 accident year. The first year reported shall be accident year
966 2018, so that the reporting of 3 accident years under this
967 evaluation will not take place until accident years 2019 and
968 2020 have become available.
969 (3) Excessive DCCE occurs when the Florida defense and cost
970 containment expenses for workers’ compensation exceed 15 percent
971 of Florida workers’ compensation incurred losses by the insurer
972 or insurer group for the 3 most recent calendar years for which
973 data is to be filed under this section.
974 (4) If the insurer or insurer group realizes excessive
975 DCCE, the office must order a return of the excess amounts after
976 affording the insurer or insurer group an opportunity for a
977 hearing and otherwise complying with the requirements of chapter
978 120. Excessive DCCE amounts must be returned in all instances
979 unless the insurer or insurer group affirmatively demonstrates
980 to the office that the refund of the excessive DCCE amounts will
981 render a member of the insurer group financially impaired or
982 will render it insolvent under provisions of the Florida
983 Insurance Code.
984 (5) Any excess DCCE amount must be returned to
985 policyholders in the form of a cash refund or credit toward the
986 future purchase of insurance. The refund or credit must be made
987 on a pro rata basis in relation to the final compilation year
988 earned premiums to the policyholders of record of the insurer or
989 insurer group on December 31 of the final compilation year. Cash
990 refunds and data in required reports to the office may be
991 rounded to the nearest dollar and must be consistently applied.
992 (6)(a) Refunds must be completed in one of the following
993 ways:
994 1. A cash refund must be completed within 60 days after
995 entry of a final order indicating that excessive DCCE has been
996 realized.
997 2. A credit to renewal policies must be applied to policy
998 renewal premium notices that are forwarded to insureds more than
999 60 calendar days after entry of a final order indicating that
1000 excessive DCCE has been realized. If the insured thereafter
1001 cancels a policy or otherwise allows the policy to terminate,
1002 the insurer or insurer group must make a cash refund not later
1003 than 60 days after coverage termination.
1004 (b) Upon completion of the renewal credits or refunds, the
1005 insurer or insurer group shall immediately certify having made
1006 the refunds to the office.
1007 (7) Any refund or renewal credit made pursuant to this
1008 section is treated as a policyholder dividend applicable to the
1009 year immediately succeeding the compilation period giving rise
1010 to the refund or credit, for purposes of reporting under this
1011 section for subsequent years.
1012 Section 18. Section 627.291, Florida Statutes, is amended
1013 to read:
1014 627.291 Information to be furnished insureds; appeal by
1015 insureds; workers’ compensation and employer’s liability
1016 insurances.—
1017 (1) As to workers’ compensation and employer’s liability
1018 insurances, every rating organization filing prospective loss
1019 costs and every insurer which makes its own rates shall, within
1020 a reasonable time after receiving written request therefor and
1021 upon payment of such reasonable charge as it may make, furnish
1022 to any insured affected by a rate made by it, or to the
1023 authorized representative of such insured, all pertinent
1024 information as to such rate.
1025 (2) As to workers’ compensation and employer’s liability
1026 insurances, every rating organization filing prospective loss
1027 costs and every insurer which makes its own rates shall provide
1028 within this state reasonable means whereby any person aggrieved
1029 by the application of its rating system may be heard, in person
1030 or by his or her authorized representative, on his or her
1031 written request to review the manner in which such rating system
1032 has been applied in connection with the insurance afforded him
1033 or her. If the rating organization filing prospective loss costs
1034 or the insurer making its own rates fails to grant or rejects
1035 such request within 30 days after it is made, the applicant may
1036 proceed in the same manner as if his or her application had been
1037 rejected. Any party affected by the action of such rating
1038 organization filing prospective loss costs or insurer making its
1039 own rates on such request may, within 30 days after written
1040 notice of such action, appeal to the office, which may affirm or
1041 reverse such action.
1042 Section 19. Section 627.318, Florida Statutes, is amended
1043 to read:
1044 627.318 Records.—Every insurer, rating organization filing
1045 prospective loss costs, and advisory organization and every
1046 group, association, or other organization of insurers which
1047 engages in joint underwriting or joint reinsurance shall
1048 maintain reasonable records, of the type and kind reasonably
1049 adapted to its method of operation, of its experience or the
1050 experience of its members and of the data, statistics, or
1051 information collected or used by it in connection with the
1052 prospective loss costs, rates, rating plans, rating systems,
1053 underwriting rules, policy or bond forms, surveys, or
1054 inspections made or used by it, so that such records will be
1055 available at all reasonable times to enable the office to
1056 determine whether such organization, insurer, group, or
1057 association, and, in the case of an insurer or rating
1058 organization, every prospective loss cost, rate, rating plan,
1059 and rating system made or used by it, complies with the
1060 provisions of this part applicable to it. The maintenance of
1061 such records in the office of a licensed rating organization of
1062 which an insurer is a member or subscriber will be sufficient
1063 compliance with this section for any such insurer maintaining
1064 membership or subscribership in such organization, to the extent
1065 that the insurer uses the prospective loss costs, rates, rating
1066 plans, rating systems, or underwriting rules of such
1067 organization. Such records shall be maintained in an office
1068 within this state or shall be made available for examination or
1069 inspection within this state by the department at any time upon
1070 reasonable notice.
1071 Section 20. Section 627.361, Florida Statutes, is amended
1072 to read:
1073 627.361 False or misleading information.—No person shall
1074 willfully withhold information from or knowingly give false or
1075 misleading information to the office, any statistical agency
1076 designated by the office, any rating organization, or any
1077 insurer, which will affect the prospective loss costs, rates, or
1078 premiums chargeable under this part.
1079 Section 21. Subsections (1) and (2) of section 627.371,
1080 Florida Statutes, are amended to read:
1081 627.371 Hearings.—
1082 (1) Any person aggrieved by any rate charged, rating plan,
1083 rating system, or underwriting rule followed or adopted by an
1084 insurer, and any person aggrieved by any rating plan, rating
1085 system, or underwriting rule followed or adopted by a rating
1086 organization, may herself or himself or by her or his authorized
1087 representative make written request of the insurer or rating
1088 organization to review the manner in which the prospective loss
1089 cost, rate, plan, system, or rule has been applied with respect
1090 to insurance afforded her or him. If the request is not granted
1091 within 30 days after it is made, the requester may treat it as
1092 rejected. Any person aggrieved by the refusal of an insurer or
1093 rating organization to grant the review requested, or by the
1094 failure or refusal to grant all or part of the relief requested,
1095 may file a written complaint with the office, specifying the
1096 grounds relied upon. If the office has already disposed of the
1097 issue as raised by a similar complaint or believes that probable
1098 cause for the complaint does not exist or that the complaint is
1099 not made in good faith, it shall so notify the complainant.
1100 Otherwise, and if it also finds that the complaint charges a
1101 violation of this chapter and that the complainant would be
1102 aggrieved if the violation is proven, it shall proceed as
1103 provided in subsection (2).
1104 (2) If after examination of an insurer, rating
1105 organization, advisory organization, or group, association, or
1106 other organization of insurers which engages in joint
1107 underwriting or joint reinsurance, upon the basis of other
1108 information, or upon sufficient complaint as provided in
1109 subsection (1), the office has good cause to believe that such
1110 insurer, organization, group, or association, or any prospective
1111 loss cost, rate, rating plan, or rating system made or used by
1112 any such insurer or rating organization, does not comply with
1113 the requirements and standards of this part applicable to it, it
1114 shall, unless it has good cause to believe such noncompliance is
1115 willful, give notice in writing to such insurer, organization,
1116 group, or association stating therein in what manner and to what
1117 extent noncompliance is alleged to exist and specifying therein
1118 a reasonable time, not less than 10 days thereafter, in which
1119 the noncompliance may be corrected, including any premium
1120 adjustment.
1121 Section 22. This act shall take effect July 1, 2017.