Florida Senate - 2025 SB 1428
By Senator DiCeglie
18-01081A-25 20251428__
1 A bill to be entitled
2 An act relating to consumer protection in insurance
3 matters; amending s. 626.854, F.S.; requiring public
4 adjusters, public adjuster apprentices, and public
5 adjusting firms to provide a specified response within
6 a specified timeframe after receiving a request for
7 claim status from a claimant, an insured, or a
8 designated representative; requiring such adjusters,
9 apprentices, and firms to retain a copy of such
10 response; creating s. 627.4815, F.S.; defining terms;
11 requiring that universal life insurance policies
12 include a provision requiring a certain annual report;
13 specifying requirements for the annual report;
14 providing applicability; amending s. 627.6515, F.S.;
15 revising applicability relating to group health
16 insurance policies; creating s. 627.7293, F.S.;
17 requiring certain automobile insurers, under certain
18 circumstances, to provide a specified statement in a
19 certain manner; requiring the automobile insurer to
20 obtain express consent before submitting specified
21 claims; providing applicability; creating s. 627.7431,
22 F.S.; defining terms; requiring insurers to pay or
23 deny certain claims within a specified timeframe;
24 providing an exception; requiring insurers to provide
25 certain explanations to policyholders under certain
26 circumstances; specifying that certain payments bear
27 specified interest; specifying when the interest
28 begins to accrue; providing construction; requiring
29 the insured to select the manner of receiving
30 prejudgment interest under certain circumstances;
31 specifying that the failure to comply with certain
32 provisions does not form the basis of a private cause
33 of action; providing applicability; specifying that
34 certain requirements are tolled under certain
35 circumstances; providing an effective date.
36
37 Be It Enacted by the Legislature of the State of Florida:
38
39 Section 1. Subsection (24) is added to section 626.854,
40 Florida Statutes, to read:
41 626.854 “Public adjuster” defined; prohibitions.—The
42 Legislature finds that it is necessary for the protection of the
43 public to regulate public insurance adjusters and to prevent the
44 unauthorized practice of law.
45 (24) A public adjuster, public adjuster apprentice, or
46 public adjusting firm must provide a specific response to a
47 written or electronic request for claim status from a claimant,
48 an insured, or the person’s designated representative within 14
49 days after receiving the request. The public adjuster, public
50 adjuster apprentice, or public adjusting firm must retain a copy
51 of its response for its records.
52 Section 2. Section 627.4815, Florida Statutes, is created
53 to read:
54 627.4815 Universal life policies.—
55 (1) As used in this section, the term:
56 (a) “Cash surrender value” means the net cash surrender
57 value plus any amounts outstanding as policy loans.
58 (b) “Fixed premium universal life insurance policy” means a
59 universal life insurance policy other than a flexible premium
60 universal life insurance policy.
61 (c) “Flexible premium universal life insurance policy”
62 means a universal life insurance policy that permits the
63 policyowner to vary, independently of each other, the amount or
64 timing of one or more premium payments or the amount of
65 insurance.
66 (d) “Net cash surrender value” means the maximum amount
67 payable to the policyowner upon surrender.
68 (e) “Policy value” means the value of any individual life
69 insurance policy, rider, group master policy, or individual
70 certificate. The term includes separately identified interest
71 credits, except those related to dividend accumulations, premium
72 deposit funds, or other supplementary accounts, and mortality
73 and expense charges.
74 (f) “Universal life insurance policy” means any individual
75 life insurance policy, rider, group master policy, or individual
76 certificate that includes separately identified interest credits
77 and mortality and expense charges. A universal life insurance
78 policy may also include other types of credits and charges. The
79 term does not apply to policies, riders, group master policies,
80 or individual certificates in connection with dividend
81 accumulations, premium deposit funds, or other supplementary
82 accounts.
83 (2) A universal life insurance policy issued in this state
84 must include a provision requiring the policyowner to receive,
85 at no cost, an annual report on the policy’s status. The report
86 must be sent within 3 months after the end of the reporting
87 period. The report must include all of the following:
88 (a) The beginning and end of the current reporting period.
89 (b) The policy value at the end of the previous reporting
90 period and at the end of the current reporting period.
91 (c) The total amounts that have been credited or debited to
92 the policy value during the current reporting period, identified
93 by type.
94 (d) The current death benefit at the end of the current
95 reporting period on each life covered by the policy.
96 (e) The net cash surrender value of the policy as of the
97 end of the current reporting period.
98 (f) The amount of outstanding loans, if any, as of the end
99 of the current reporting period.
100 (g) For fixed premium policies, if, assuming guaranteed
101 interest, mortality and expense loads, and continued scheduled
102 premium payment, the policy’s net cash surrender value is such
103 that it would not maintain insurance in force until the end of
104 the next reporting period, a notice to that effect.
105 (h) For flexible premium policies, if, assuming guaranteed
106 interest and mortality and expense loads, the policy’s net cash
107 surrender value will not maintain insurance in force until the
108 end of the next reporting period unless further premium payments
109 are made, a notice to that effect.
110 (i) For fixed premium or flexible premium policies, if,
111 assuming guaranteed interest and mortality and expense loads,
112 the policy’s net cash surrender value will not maintain
113 insurance in force until maturity of the contract, the projected
114 date on which policy values will be insufficient to continue
115 coverage in force.
116 (3) This section applies to all universal life insurance
117 policies except variable contracts as defined in s. 627.8015.
118 Section 3. Subsection (2) of section 627.6515, Florida
119 Statutes, is amended to read:
120 627.6515 Out-of-state groups.—
121 (2) Except as otherwise provided in this part, this part
122 does not apply to a group health insurance policy issued or
123 delivered outside this state under which a resident of this
124 state is provided coverage if:
125 (a) The policy is issued to an employee group the
126 composition of which is substantially as described in s.
127 627.653; a labor union group or association group the
128 composition of which is substantially as described in s.
129 627.654; an additional group the composition of which is
130 substantially as described in s. 627.656; a group insured under
131 a blanket health policy when the composition of the group is
132 substantially in compliance with s. 627.659; a group insured
133 under a franchise health policy when the composition of the
134 group is substantially in compliance with s. 627.663; an
135 association group to cover persons associated in any other
136 common group, which common group is formed primarily for
137 purposes other than providing insurance; a group that is
138 established primarily for the purpose of providing group
139 insurance, provided the benefits are reasonable in relation to
140 the premiums charged thereunder and the issuance of the group
141 policy has resulted, or will result, in economies of
142 administration; or a group of insurance agents of an insurer,
143 which insurer is the policyholder;
144 (b) Certificates evidencing coverage under the policy are
145 issued to residents of this state and contain in contrasting
146 color and not less than 10-point type the following statement:
147 “The benefits of the policy providing your coverage are governed
148 primarily by the law of a state other than Florida”; and
149 (c) The policy provides the benefits specified in ss.
150 627.419, 627.6562, 627.6574, 627.6575, 627.6579, 627.6612,
151 627.66121, 627.66122, 627.6613, 627.667, 627.6675, 627.6691, and
152 627.66911, and complies with the requirements of s. 627.66996.
153 (d) Applications for certificates of coverage offered to
154 residents of this state must contain, in contrasting color and
155 not less than 12-point type, the following statement on the same
156 page as the applicant’s signature:
157
158 “This policy is primarily governed by the laws of
159 ...(insert state where the master policy is filed)....
160 As a result, all of the rating laws applicable to
161 policies filed in this state do not apply to this
162 coverage, which may result in increases in your
163 premium at renewal that would not be permissible under
164 a Florida-approved policy. Any purchase of individual
165 health insurance should be considered carefully, as
166 future medical conditions may make it impossible to
167 qualify for another individual health policy. For
168 information concerning individual health coverage
169 under a Florida-approved policy, consult your agent or
170 the Florida Department of Financial Services.”
171
172 This paragraph applies only to group certificates providing
173 health insurance coverage which require individualized
174 underwriting to determine coverage eligibility for an individual
175 or premium rates to be charged to an individual except for the
176 following:
177 1. Policies issued to provide coverage to groups of persons
178 all of whom are in the same or functionally related licensed
179 professions, and providing coverage only to such licensed
180 professionals, their employees, or their dependents;
181 2. Policies providing coverage to small employers as
182 defined by s. 627.6699. Such policies shall be subject to, and
183 governed by, the provisions of s. 627.6699;
184 3. Policies issued to a bona fide association, as defined
185 by s. 627.6571(5), provided that there is a person or board
186 acting as a fiduciary for the benefit of the members, and such
187 association is not owned, controlled by, or otherwise associated
188 with the insurance company; or
189 4. Any accidental death, accidental death and
190 dismemberment, accident-only, vision-only, dental-only, hospital
191 indemnity-only, hospital accident-only, cancer, specified
192 disease, Medicare supplement, products that supplement Medicare,
193 long-term care, or disability income insurance, or similar
194 supplemental plans provided under a separate policy,
195 certificate, or contract of insurance, which cannot duplicate
196 coverage under an underlying health plan, coinsurance, or
197 deductibles or coverage issued as a supplement to workers’
198 compensation or similar insurance, or automobile medical-payment
199 insurance.
200 Section 4. Section 627.7293, Florida Statutes, is created
201 to read:
202 627.7293 Towing and labor coverage requirements.—
203 (1) An automobile insurer that provides towing and labor
204 coverage as a filed claim shall provide the following language
205 or substantially similar language on any web or electronic
206 platform through which a towing or labor claim is made or
207 verbally stated to the claimant if the claim is being made over
208 the phone:
209
210 Your auto insurance policy provides coverage for
211 towing and labor. Use of this coverage requires a
212 filing of a claim. Such claim filing will remain in
213 your claims’ history for use of future underwriting of
214 any initial or renewal offer made by this insurer or
215 any other insurer.
216
217 (2) The automobile insurer shall obtain the claimant’s
218 express consent before submitting a claim filed under the towing
219 and labor coverage.
220 (3) This disclosure requirement provided under subsection
221 (1) does not apply if the towing and labor claim is filed as
222 part of a crash-related damage claim.
223 Section 5. Section 627.7431, Florida Statutes, is created
224 to read:
225 627.7431 Payment of first-party claim.—
226 (1) For purposes of this section, the term:
227 (a) “Claim” means any first-party claim under an insurance
228 policy providing coverage for a private passenger motor vehicle
229 as defined in s. 627.732.
230 (b) “Factors beyond the control of the insurer” means:
231 1. Any of the following events that is the basis for the
232 office issuing an order finding that such event renders all or
233 specified motor vehicle insurers reasonably unable to meet the
234 requirements of this section in specified locations and ordering
235 that such insurer or insurers may have additional time, not
236 exceeding 30 days, as specified by the office, to comply with
237 the requirements of this section: a state of emergency declared
238 by the Governor under s. 252.36, a breach of security that must
239 be reported under s. 501.171(3), or an information technology
240 issue.
241 2. Actions by the policyholder or the policyholder’s
242 representative which constitute fraud, lack of cooperation, or
243 intentional misrepresentation regarding the claim for which
244 benefits are owed, when such actions reasonably prevent the
245 insurer from complying with any requirement of this section.
246 3. Actions by any repair company which constitute fraud,
247 lack of cooperation, or intentional misrepresentation regarding
248 the claim for which benefits are owed, when such actions
249 reasonably prevent the insurer from complying with any
250 requirement of this section.
251 4. Inaccessibility to or delay in the arrival of parts
252 necessary for the repair of the vehicle.
253 (2) Within 60 days after an insurer receives notice of an
254 initial, reopened, or supplemental first-party physical damage
255 insurance claim from a policyholder, the insurer shall pay or
256 deny such claim or a portion of the claim unless the failure to
257 pay is caused by factors beyond the control of the insurer. The
258 insurer shall provide a reasonable explanation in writing to the
259 policyholder of the basis in the insurance policy, in relation
260 to the facts or applicable law, for the payment, denial, or
261 partial denial of a claim. If the insurer’s claim payment is
262 less than that specified in any insurer’s detailed estimate of
263 the amount of the loss, the insurer must provide a reasonable
264 explanation in writing of the difference to the policyholder.
265 Any payment of an initial or supplemental claim or portion of
266 such claim made 60 days after the insurer receives notice of the
267 claim, or made after the expiration of any additional timeframe
268 provided to pay or deny a claim or a portion of a claim made
269 pursuant to an order of the office finding factors beyond the
270 control of the insurer, whichever is later, bears interest at
271 the rate set forth in s. 55.03. Interest begins to accrue from
272 the date the insurer receives notice of the claim. This
273 subsection may not be waived, voided, or nullified by the terms
274 of the insurance policy. If there is a right to prejudgment
275 interest, the insured must select whether to receive prejudgment
276 interest or interest under this subsection. Interest is payable
277 when the claim or portion of the claim is paid. Failure to
278 comply with this subsection constitutes a violation of this
279 code. However, failure to comply with this subsection does not
280 form the sole basis for a private cause of action.
281 (3) This section applies to surplus lines insurers and
282 surplus lines insurance authorized under ss. 626.913-626.937
283 providing personal automobile coverage.
284 (4) This section does not apply to any of the following
285 claims:
286 (a) Any claims covered under an insurance policy providing
287 coverage for commercial motor vehicles as defined in s. 627.732.
288 (b) Any portion of a claim covered under an insurance
289 policy covering private passenger motor vehicles if the portion
290 of the claim is based on coverage for:
291 1. Personal injury protection;
292 2. Property damage liability;
293 3. Bodily injury;
294 4. Uninsured motorists or underinsured motorists; or
295 5. Medical payments.
296 (5) The requirements of this section are tolled:
297 (a) During the pendency of any mediation proceeding under
298 s. 627.745 or any alternative dispute resolution proceeding
299 provided for in the insurance contract. The tolling period ends
300 upon the end of the mediation or alternative dispute resolution
301 proceeding.
302 (b) Upon the failure of a policyholder or a representative
303 of the policyholder to provide material claims information
304 requested by the insurer within 10 days after the request was
305 received. The tolling period ends upon the insurer’s receipt of
306 the requested information. Tolling under this paragraph applies
307 only to requests sent by the insurer to the policyholder or to a
308 representative of the policyholder at least 15 days before the
309 insurer is required to pay or deny the claim or a portion of the
310 claim under subsection (2).
311 Section 6. This act shall take effect July 1, 2025.