626.9541 Unfair methods of competition and unfair or deceptive acts or practices defined.—
(1) UNFAIR METHODS OF COMPETITION AND UNFAIR OR DECEPTIVE ACTS.—The following are defined as unfair methods of competition and unfair or deceptive acts or practices:
(a) Misrepresentations and false advertising of insurance policies.—Knowingly making, issuing, circulating, or causing to be made, issued, or circulated, any estimate, illustration, circular, statement, sales presentation, omission, comparison, or property and casualty certificate of insurance altered after being issued, which:
1. Misrepresents the benefits, advantages, conditions, or terms of any insurance policy.
2. Misrepresents the dividends or share of the surplus to be received on any insurance policy.
3. Makes any false or misleading statements as to the dividends or share of surplus previously paid on any insurance policy.
4. Is misleading, or is a misrepresentation, as to the financial condition of any person or as to the legal reserve system upon which any life insurer operates.
5. Uses any name or title of any insurance policy or class of insurance policies misrepresenting the true nature thereof.
6. Is a misrepresentation for the purpose of inducing, or tending to induce, the lapse, forfeiture, exchange, conversion, or surrender of any insurance policy.
7. Is a misrepresentation for the purpose of effecting a pledge or assignment of, or effecting a loan against, any insurance policy.
8. Misrepresents any insurance policy as being shares of stock or misrepresents ownership interest in the company.
9. Uses any advertisement that would mislead or otherwise cause a reasonable person to believe mistakenly that the state or the Federal Government is responsible for the insurance sales activities of any person or stands behind any person’s credit or that any person, the state, or the Federal Government guarantees any returns on insurance products or is a source of payment of any insurance obligation of or sold by any person.
10. Fails to disclose a third party that receives royalties, referral fees, or other remuneration for sponsorship, marketing, or use of third-party branding for a policy of health insurance as defined in s. 624.603.
(b) False information and advertising generally.—Knowingly making, publishing, disseminating, circulating, or placing before the public, or causing, directly or indirectly, to be made, published, disseminated, circulated, or placed before the public:
1. In a newspaper, magazine, or other publication,
2. In the form of a notice, circular, pamphlet, letter, or poster,
3. Over any radio or television station, or
4. In any other way,
an advertisement, announcement, or statement containing any assertion, representation, or statement with respect to the business of insurance, which is untrue, deceptive, or misleading.
(c) Defamation.—Knowingly making, publishing, disseminating, or circulating, directly or indirectly, or aiding, abetting, or encouraging the making, publishing, disseminating, or circulating of, any oral or written statement, or any pamphlet, circular, article, or literature, which is false or maliciously critical of, or derogatory to, any person and which is calculated to injure such person.
(d) Boycott, coercion, and intimidation.—Entering into any agreement to commit, or by any concerted action committing, any act of boycott, coercion, or intimidation resulting in, or tending to result in, unreasonable restraint of, or monopoly in, the business of insurance.
(e) False statements and entries.—
1. Knowingly:
a. Filing with any supervisory or other public official,
b. Making, publishing, disseminating, circulating,
c. Delivering to any person,
d. Placing before the public,
e. Causing, directly or indirectly, to be made, published, disseminated, circulated, delivered to any person, or placed before the public,
any false material statement.
2. Knowingly making any false entry of a material fact in any book, report, or statement of any person, or knowingly omitting to make a true entry of any material fact pertaining to the business of such person in any book, report, or statement of such person.
(f) Stock operations and advisory board contracts.—Issuing or delivering, promising to issue or deliver, or permitting agents, officers, or employees to issue or deliver, agency company stock or other capital stock, benefit certificates or shares in any common-law corporation, or securities or any special or advisory board contracts or other contracts of any kind promising returns or profits as an inducement to insurance.
(g) Unfair discrimination.—
1. Knowingly making or permitting unfair discrimination between individuals of the same actuarially supportable class and equal expectation of life, in the rates charged for a life insurance or annuity contract, in the dividends or other benefits payable thereon, or in any other term or condition of such contract.
2. Knowingly making or permitting unfair discrimination between individuals of the same actuarially supportable class, as determined at the time of initial issuance of the coverage, and essentially the same hazard, in the amount of premium, policy fees, or rates charged for a policy or contract of accident, disability, or health insurance, in the benefits payable thereunder, in the terms or conditions of such contract, or in any other manner.
3. For a health insurer, life insurer, disability insurer, property and casualty insurer, automobile insurer, or managed care provider to underwrite a policy, or refuse to issue, reissue, or renew a policy, refuse to pay a claim, cancel or otherwise terminate a policy, or increase rates based upon the fact that an insured or applicant who is also the proposed insured has made a claim or sought or should have sought medical or psychological treatment in the past for abuse, protection from abuse, or shelter from abuse, or that a claim was caused in the past by, or might occur as a result of, any future assault, battery, or sexual assault by a family or household member upon another family or household member as defined in s. 741.28. A health insurer, life insurer, disability insurer, or managed care provider may refuse to underwrite, issue, or renew a policy based on the applicant’s medical condition, but may not consider whether such condition was caused by an act of abuse. For purposes of this section, the term “abuse” means the occurrence of one or more of the following acts:
a. Attempting or committing assault, battery, sexual assault, or sexual battery;
b. Placing another in fear of imminent serious bodily injury by physical menace;
c. False imprisonment;
d. Physically or sexually abusing a minor child; or
e. An act of domestic violence as defined in s. 741.28.
This subparagraph does not prohibit a property and casualty insurer or an automobile insurer from excluding coverage for intentional acts by the insured if such exclusion is not an act of unfair discrimination as defined in this paragraph.
4. For a personal lines property or personal lines automobile insurer to:
a. Refuse to issue, reissue, or renew a policy; cancel or otherwise terminate a policy; or charge an unfairly discriminatory rate in this state based on the lawful use, possession, or ownership of a firearm or ammunition by the insurance applicant, insured, or a household member of the applicant or insured. This sub-subparagraph does not prevent an insurer from charging a supplemental premium that is not unfairly discriminatory for a separate rider voluntarily requested by the insurance applicant to insure a firearm or a firearm collection whose value exceeds the standard policy coverage.
b. Disclose the lawful ownership or possession of firearms of an insurance applicant, insured, or household member of the applicant or insured to a third party or an affiliated entity of the insurer unless the insurer discloses to the applicant or insured the specific need to disclose the information and the applicant or insured expressly consents to the disclosure, or the disclosure is necessary to quote or bind coverage, continue coverage, or adjust a claim. For purposes of underwriting and issuing insurance coverage, this sub-subparagraph does not prevent the sharing of information between an insurance company and its licensed insurance agent if a separate rider has been voluntarily requested by the policyholder or prospective policyholder to insure a firearm or a firearm collection whose value exceeds the standard policy coverage.
(h) Unlawful rebates.—
1. Except as otherwise expressly provided by law, or in an applicable filing with the office, knowingly:
a. Permitting, or offering to make, or making, any contract or agreement as to such contract other than as plainly expressed in the insurance contract issued thereon;
b. Paying, allowing, or giving, or offering to pay, allow, or give, directly or indirectly, as inducement to such insurance contract, any unlawful rebate of premiums payable on the contract, any special favor or advantage in the dividends or other benefits thereon, or any valuable consideration or inducement whatever not specified in the contract;
c. Giving, selling, or purchasing, or offering to give, sell, or purchase, as inducement to such insurance contract or in connection therewith, any stocks, bonds, or other securities of any insurance company or other corporation, association, or partnership, or any dividends or profits accrued thereon, or anything of value whatsoever not specified in the insurance contract.
2. Nothing in paragraph (g) or subparagraph 1. of this paragraph shall be construed as including within the definition of discrimination or unlawful rebates:
a. In the case of any contract of life insurance or life annuity, paying bonuses to all policyholders or otherwise abating their premiums in whole or in part out of surplus accumulated from nonparticipating insurance; provided that any such bonuses or abatement of premiums is fair and equitable to all policyholders and for the best interests of the company and its policyholders.
b. In the case of life insurance policies issued on the industrial debit plan, making allowance to policyholders who have continuously for a specified period made premium payments directly to an office of the insurer in an amount which fairly represents the saving in collection expenses.
c. Readjustment of the rate of premium for a group insurance policy based on the loss or expense thereunder, at the end of the first or any subsequent policy year of insurance thereunder, which may be made retroactive only for such policy year.
d. Issuance of life insurance policies or annuity contracts at rates less than the usual rates of premiums for such policies or contracts, as group insurance or employee insurance as defined in this code.
e. Issuing life or disability insurance policies on a salary savings, bank draft, preauthorized check, payroll deduction, or other similar plan at a reduced rate reasonably related to the savings made by the use of such plan.
3.a. No title insurer, or any member, employee, attorney, agent, or agency thereof, shall pay, allow, or give, or offer to pay, allow, or give, directly or indirectly, as inducement to title insurance, or after such insurance has been effected, any rebate or abatement of the premium or any other charge or fee, or provide any special favor or advantage, or any monetary consideration or inducement whatever.
b. Nothing in this subparagraph shall be construed as prohibiting the payment of fees to attorneys at law duly licensed to practice law in the courts of this state, for professional services, or as prohibiting the payment of earned portions of the premium to duly appointed agents or agencies who actually perform services for the title insurer. Nothing in this subparagraph shall be construed as prohibiting a rebate or abatement of an attorney fee charged for professional services, or that portion of the premium that is not required to be retained by the insurer pursuant to s. 627.782(1), or any other agent charge or fee to the person responsible for paying the premium, charge, or fee.
c. No insured named in a policy, or any other person directly or indirectly connected with the transaction involving the issuance of such policy, including, but not limited to, any mortgage broker, real estate broker, builder, or attorney, any employee, agent, agency, or representative thereof, or any other person whatsoever, shall knowingly receive or accept, directly or indirectly, any rebate or abatement of any portion of the title insurance premium or of any other charge or fee or any monetary consideration or inducement whatsoever, except as set forth in sub-subparagraph b.; provided, in no event shall any portion of the attorney fee, any portion of the premium that is not required to be retained by the insurer pursuant to s. 627.782(1), any agent charge or fee, or any other monetary consideration or inducement be paid directly or indirectly for the referral of title insurance business.
4.a. Paragraph (g) or subparagraph 1. may not be construed as including within the definition of unfair discrimination or unlawful rebates the offer or provision by a life or health insurer or a life or health agent of the life or health insurer, including by or through an employee, an affiliate, or a third-party representative, of a value-added product or service at no or reduced cost when such product or service is not specified in the life or health insurance policy, if the product or service relates to the insurance coverage and is primarily designed to do one or more of the following:
(I) Provide loss mitigation or loss control;
(II) Reduce claim costs or claim settlement costs;
(III) Provide education about liability risks or risk of loss to persons or property;
(IV) Monitor or assess risk, identify sources of risk, or develop strategies for eliminating or reducing risk;
(V) Enhance health;
(VI) Enhance financial wellness through items such as education or financial planning services;
(VII) Provide post-loss services;
(VIII) Incentivize behavioral changes to improve the health or reduce the risk of death or disability of a policyholder, potential policyholder, certificateholder, potential certificateholder, insured, potential insured, or applicant; or
(IX) Assist in the administration of employee or retiree benefit insurance coverage.
b. The cost to the life or health insurer or life or health agent offering the product or service to a customer must be reasonable in comparison to the customer’s premiums or life or health insurance coverage for the policy class.
c. If the life or health insurer or life or health agent is providing the product or service, the life or health insurer or life or health agent must ensure that the customer is provided with contact information to assist the customer with questions regarding the product or service.
d. The availability of the product or service must be based on documented objective evidence, and the product or service must be offered in a manner that is not unfairly discriminatory. The documented evidence must be maintained by the life or health insurer or life or health agent and produced upon request by the office or the department.
e. If a life or health insurer or life or health agent has a good faith belief, but does not have sufficient evidence to demonstrate, that the product or service meets any of the criteria in sub-sub-subparagraphs a.(I)-(IX), the life or health insurer or life or health agent may provide the product or service in a manner that is not unfairly discriminatory as part of a pilot or testing program for up to 1 year. The life or health insurer or life or health agent must notify the office or department, as applicable, of such pilot or testing program offered to consumers in this state before commencing the program. The life or health insurer or life or health agent may commence the program unless the office or department, as applicable, objects to the program within 21 days after receiving the notice.
f. A life or health insurer, life or health agent, or representative thereof may not offer or provide life or health insurance as an inducement to the purchase of another policy or otherwise use the words “free,” “no cost,” or similar words in an advertisement.
g. The commission may adopt rules to administer this subparagraph to ensure consumer protection. Such rules, consistent with applicable law, may address, among other issues, consumer data protections and privacy, consumer disclosure, and unfair discrimination.
(i) Unfair claim settlement practices.—
1. Attempting to settle claims on the basis of an application, when serving as a binder or intended to become a part of the policy, or any other material document which was altered without notice to, or knowledge or consent of, the insured;
2. A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy;
3. Committing or performing with such frequency as to indicate a general business practice any of the following:
a. Failing to adopt and implement standards for the proper investigation of claims;
b. Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue;
c. Failing to acknowledge and act promptly upon communications with respect to claims;
d. Denying claims without conducting reasonable investigations based upon available information;
e. Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed;
f. Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement;
g. Failing to promptly notify the insured of any additional information necessary for the processing of a claim;
h. Failing to clearly explain the nature of the requested information and the reasons why such information is necessary;
i. Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b). The office may order the insurer to pay restitution to a policyholder, medical provider, or other claimant, including interest at a rate consistent with the amount set forth in s. 55.03(1), for the time period within which an insurer fails to pay claims as required by law. Restitution is in addition to any other penalties allowed by law, including, but not limited to, the suspension of the insurer’s certificate of authority; or
j. Altering or amending an insurance adjuster’s report without:
(I) Providing a detailed explanation as to why any change that has the effect of reducing the estimate of the loss was made; and
(II) Including on the report or as an addendum to the report a detailed list of all changes made to the report and the identity of the person who ordered each change; or
(III) Retaining all versions of the report, and including within each such version, for each change made within such version of the report, the identity of each person who made or ordered such change; or
4. Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
(j) Failure to maintain complaint-handling procedures.—Failure of any person to maintain a complete record of all the complaints received since the date of the last examination. For purposes of this paragraph, “complaint” means any written communication primarily expressing a grievance.
(k) Misrepresentation in insurance applications.—
1. Knowingly making a false or fraudulent written or oral statement or representation on, or relative to, an application or negotiation for an insurance policy for the purpose of obtaining a fee, commission, money, or other benefit from any insurer, agent, broker, or individual.
2. Knowingly making a material omission in the comparison of a life, health, or Medicare supplement insurance replacement policy with the policy it replaces for the purpose of obtaining a fee, commission, money, or other benefit from any insurer, agent, broker, or individual. For the purposes of this subparagraph, a material omission includes the failure to advise the insured of the existence and operation of a preexisting condition clause in the replacement policy.
(l) Twisting.—Knowingly making any misleading representations or incomplete or fraudulent comparisons or fraudulent material omissions of or with respect to any insurance policies or insurers for the purpose of inducing, or tending to induce, any person to lapse, forfeit, surrender, terminate, retain, pledge, assign, borrow on, or convert any insurance policy or to take out a policy of insurance in another insurer.
(m) Advertising and promotional gifts and charitable contributions permitted.—
1. The provisions of paragraph (f), paragraph (g), or paragraph (h) do not prohibit a licensed insurer or its agent from:
a. Giving to insureds, prospective insureds, or others any article of merchandise, goods, wares, store gift cards, gift certificates, event tickets, anti-fraud or loss mitigation services, or other items having a total value of $100 or less per insured or prospective insured in any calendar year.
b. Making charitable contributions, as defined in s. 170(c) of the Internal Revenue Code, on behalf of insureds or prospective insureds, of up to $100 per insured or prospective insured in any calendar year.
2. The provisions of paragraph (f), paragraph (g), or paragraph (h) do not prohibit a title insurance agent or title insurance agency, as those terms are defined in s. 626.841, or a title insurer, as defined in s. 627.7711, from giving to insureds, prospective insureds, or others, for the purpose of advertising, any article of merchandise having a value of not more than $25. A person or entity governed by this subparagraph is not subject to subparagraph 1.
(n) Free insurance prohibited.—
1. Advertising, offering, or providing free insurance as an inducement to the purchase or sale of real or personal property or of services directly or indirectly connected with such real or personal property.
2. For the purposes of this paragraph, “free” insurance is:
a. Insurance for which no identifiable and additional charge is made to the purchaser of such real property, personal property, or services.
b. Insurance for which an identifiable or additional charge is made in an amount less than the cost of such insurance as to the seller or other person, other than the insurer, providing the same.
3. Subparagraphs 1. and 2. do not apply to:
a. Insurance of, loss of, or damage to the real or personal property involved in any such sale or services, under a policy covering the interests therein of the seller or vendor.
b. Blanket disability insurance as defined in s. 627.659.
c. Credit life insurance or credit disability insurance.
d. Any individual, isolated, nonrecurring unadvertised transaction not in the regular course of business.
e. Title insurance.
f. Any purchase agreement involving the purchase of a cemetery lot or lots in which, under stated conditions, any balance due is forgiven upon the death of the purchaser.
g. Life insurance, trip cancellation insurance, or lost baggage insurance offered by a travel agency as part of a travel package offered by and booked through the agency.
4. Using the word “free” or words which imply the provision of insurance without a cost to describe life or disability insurance, in connection with the advertising or offering for sale of any kind of goods, merchandise, or services.
(o) Illegal dealings in premiums; excess or reduced charges for insurance.—
1. Knowingly collecting any sum as a premium or charge for insurance, which is not then provided, or is not in due course to be provided, subject to acceptance of the risk by the insurer, by an insurance policy issued by an insurer as permitted by this code.
2. Knowingly collecting as a premium or charge for insurance any sum in excess of or less than the premium or charge applicable to such insurance, in accordance with the applicable classifications and rates as filed with and approved by the office, and as specified in the policy; or, in cases when classifications, premiums, or rates are not required by this code to be so filed and approved, premiums and charges collected from a Florida resident in excess of or less than those specified in the policy and as fixed by the insurer. Notwithstanding any other provision of law, this provision shall not be deemed to prohibit the charging and collection, by surplus lines agents licensed under part VIII of this chapter, of the amount of applicable state and federal taxes, or fees as authorized by s. 626.916(2), in addition to the premium required by the insurer or the charging and collection, by licensed agents, of the exact amount of any discount or other such fee charged by a credit card facility in connection with the use of a credit card, as authorized by subparagraph (q)3., in addition to the premium required by the insurer. This subparagraph shall not be construed to prohibit collection of a premium for a universal life or a variable or indeterminate value insurance policy made in accordance with the terms of the contract.
3.a. Imposing or requesting an additional premium for a policy of motor vehicle liability, personal injury protection, medical payment, or collision insurance or any combination thereof or refusing to renew the policy solely because the insured was involved in a motor vehicle accident unless the insurer’s file contains information from which the insurer in good faith determines that the insured was substantially at fault in the accident.
b. An insurer which imposes and collects such a surcharge or which refuses to renew such policy shall, in conjunction with the notice of premium due or notice of nonrenewal, notify the named insured that he or she is entitled to reimbursement of such amount or renewal of the policy under the conditions listed below and will subsequently reimburse him or her or renew the policy, if the named insured demonstrates that the operator involved in the accident was:
(I) Lawfully parked;
(II) Reimbursed by, or on behalf of, a person responsible for the accident or has a judgment against such person;
(III) Struck in the rear by another vehicle headed in the same direction and was not convicted of a moving traffic violation in connection with the accident;
(IV) Hit by a “hit-and-run” driver, if the accident was reported to the proper authorities within 24 hours after discovering the accident;
(V) Not convicted of a moving traffic violation in connection with the accident, but the operator of the other automobile involved in such accident was convicted of a moving traffic violation;
(VI) Finally adjudicated not to be liable by a court of competent jurisdiction;
(VII) In receipt of a traffic citation which was dismissed or nolle prossed; or
(VIII) Not at fault as evidenced by a written statement from the insured establishing facts demonstrating lack of fault which are not rebutted by information in the insurer’s file from which the insurer in good faith determines that the insured was substantially at fault.
c. In addition to the other provisions of this subparagraph, an insurer may not fail to renew a policy if the insured has had only one accident in which he or she was at fault within the current 3-year period. However, an insurer may nonrenew a policy for reasons other than accidents in accordance with s. 627.728. This subparagraph does not prohibit nonrenewal of a policy under which the insured has had three or more accidents, regardless of fault, during the most recent 3-year period.
4. Imposing or requesting an additional premium for, or refusing to renew, a policy for motor vehicle insurance solely because the insured committed a noncriminal traffic infraction as described in s. 318.14 unless the infraction is:
a. A second infraction committed within an 18-month period, or a third or subsequent infraction committed within a 36-month period.
b. A violation of s. 316.183, when such violation is a result of exceeding the lawful speed limit by more than 15 miles per hour.
5. Upon the request of the insured, the insurer and licensed agent shall supply to the insured the complete proof of fault or other criteria which justifies the additional charge or cancellation.
6. No insurer shall impose or request an additional premium for motor vehicle insurance, cancel or refuse to issue a policy, or refuse to renew a policy because the insured or the applicant is a handicapped or physically disabled person, so long as such handicap or physical disability does not substantially impair such person’s mechanically assisted driving ability.
7. No insurer may cancel or otherwise terminate any insurance contract or coverage, or require execution of a consent to rate endorsement, during the stated policy term for the purpose of offering to issue, or issuing, a similar or identical contract or coverage to the same insured with the same exposure at a higher premium rate or continuing an existing contract or coverage with the same exposure at an increased premium.
8. No insurer may issue a nonrenewal notice on any insurance contract or coverage, or require execution of a consent to rate endorsement, for the purpose of offering to issue, or issuing, a similar or identical contract or coverage to the same insured at a higher premium rate or continuing an existing contract or coverage at an increased premium without meeting any applicable notice requirements.
9. No insurer shall, with respect to premiums charged for motor vehicle insurance, unfairly discriminate solely on the basis of age, sex, marital status, or scholastic achievement.
10. Imposing or requesting an additional premium for motor vehicle comprehensive or uninsured motorist coverage solely because the insured was involved in a motor vehicle accident or was convicted of a moving traffic violation.
11. No insurer shall cancel or issue a nonrenewal notice on any insurance policy or contract without complying with any applicable cancellation or nonrenewal provision required under the Florida Insurance Code.
12. No insurer shall impose or request an additional premium, cancel a policy, or issue a nonrenewal notice on any insurance policy or contract because of any traffic infraction when adjudication has been withheld and no points have been assessed pursuant to s. 318.14(9) and (10). However, this subparagraph does not apply to traffic infractions involving accidents in which the insurer has incurred a loss due to the fault of the insured.
(p) Insurance cost specified in “price package”.—
1. When the premium or charge for insurance of or involving such property or merchandise is included in the overall purchase price or financing of the purchase of merchandise or property, the vendor or lender shall separately state and identify the amount charged and to be paid for the insurance, and the classifications, if any, upon which based; and the inclusion or exclusion of the cost of insurance in such purchase price or financing shall not increase, reduce, or otherwise affect any other factor involved in the cost of the merchandise, property, or financing as to the purchaser or borrower.
2. This paragraph does not apply to transactions which are subject to the provisions of part I of chapter 520, entitled “The Motor Vehicle Sales Finance Act.”
3. This paragraph does not apply to credit life or credit disability insurance which is in compliance with s. 627.681(4).
(q) Certain insurance transactions through credit card facilities prohibited.—
1. Except as provided in subparagraph 3., no person shall knowingly solicit or negotiate insurance; seek or accept applications for insurance; issue or deliver any policy; receive, collect, or transmit premiums, to or for an insurer; or otherwise transact insurance in this state, or relative to a subject of insurance resident, located, or to be performed in this state, through the arrangement or facilities of a credit card facility or organization, for the purpose of insuring credit card holders or prospective credit card holders. The term “credit card holder” as used in this paragraph means a person who may pay the charge for purchases or other transactions through the credit card facility or organization, whose credit with such facility or organization is evidenced by a credit card identifying such person as being one whose charges the credit card facility or organization will pay, and who is identified as such upon the credit card by name, account number, symbol, insignia, or other method or device of identification. This subparagraph does not apply as to health insurance or to credit life, credit disability, or credit property insurance.
2. If any person does or performs in this state any of the acts in violation of subparagraph 1. for or on behalf of an insurer or credit card facility, such insurer or credit card facility shall be deemed to be doing business in this state and, if an insurer, shall be subject to the same state, county, and municipal taxes as insurers that have been legally qualified and admitted to do business in this state by agents or otherwise are subject, the same to be assessed and collected against such insurers; and such person so doing or performing any of such acts is personally liable for all such taxes.
3. A licensed agent or insurer may solicit or negotiate insurance; seek or accept applications for insurance; issue or deliver any policy; receive, collect, or transmit premiums, to or for an insurer; or otherwise transact insurance in this state, or relative to a subject of insurance resident, located, or to be performed in this state, through the arrangement or facilities of a credit card facility or organization, for the purpose of insuring credit card holders or prospective credit card holders if:
a. The insurance or policy which is the subject of the transaction is noncancelable by any person other than the named insured, the policyholder, or the insurer;
b. Any refund of unearned premium is made to the credit card holder by mail or electronic transfer; and
c. The credit card transaction is authorized by the signature of the credit card holder or other person authorized to sign on the credit card account.
The conditions enumerated in sub-subparagraphs a.-c. do not apply to health insurance or to credit life, credit disability, or credit property insurance; and sub-subparagraph c. does not apply to property and casualty insurance if the transaction is authorized by the insured.
4. No person may use or disclose information resulting from the use of a credit card in conjunction with the purchase of insurance if such information is to the advantage of the credit card facility or an insurance agent, or is to the detriment of the insured or any other insurance agent; except that this provision does not prohibit a credit card facility from using or disclosing such information in a judicial proceeding or consistent with applicable law on credit reporting.
5. Such insurance may not be sold through a credit card facility in conjunction with membership in any automobile club. The term “automobile club” means a legal entity that, in consideration of dues, assessments, or periodic payments of money, promises its members or subscribers to assist them in matters relating to the ownership, operation, use, or maintenance of a motor vehicle; however, the term does not include persons, associations, or corporations that are organized and operated solely for the purpose of conducting, sponsoring, or sanctioning motor vehicle races, exhibitions, or contests upon racetracks, or upon race courses established and marked as such for the duration of such particular event. The words “motor vehicle” used herein shall be the same as defined in chapter 320.
(r) Interlocking ownership and management.—
1. Any domestic insurer may retain, invest in, or acquire the whole or any part of the capital stock of any other insurer or insurers, or have a common management with any other insurer or insurers, unless such retention, investment, acquisition, or common management is inconsistent with any other provision of this code, or unless by reason thereof the business of such insurers with the public is conducted in a manner which substantially lessens competition generally in the insurance business.
2. Any person otherwise qualified may be a director of two or more domestic insurers which are competitors, unless the effect thereof is substantially to lessen competition between insurers generally or materially tend to create a monopoly.
3. Any limitation contained in this paragraph does not apply to any person who is a director of two or more insurers under common control or management.
(s) Prohibited arrangements as to funerals.—
1. No life insurer shall designate in any life insurance policy the person to conduct the funeral of the insured, or organize, promote, or operate any enterprise or plan to enter into any contract with any insured under which the freedom of choice in the open market of the person having the legal right to such choice is restricted as to the purchase, arrangement, and conduct of a funeral service or any part thereof for any individual insured by the insurer. No life insurer shall designate in any life insurance policy the person to conduct the funeral of the insured as the owner of the policy.
2. No insurer shall contract or agree to furnish funeral merchandise or services in connection with the disposition of any person upon the death of any person insured by such insurer.
3. No insurer shall contract or agree with any funeral director or direct disposer to the effect that such funeral director or direct disposer shall conduct the funeral of any person insured by such insurer.
4. No insurer shall provide, in any insurance contract covering the life of any person in this state, for the payment of the proceeds or benefits thereof in other than legal tender of the United States and of this state, or for the withholding of such proceeds or benefits, all for the purpose of either directly or indirectly providing, inducing, or furthering any arrangement or agreement designed to require or induce the employment of a particular person to conduct the funeral of the insured.
(t) Certain life insurance relations with funeral directors prohibited.—
1. No life insurer shall permit any funeral director or direct disposer to act as its representative, adjuster, claim agent, special claim agent, or agent for such insurer in soliciting, negotiating, or effecting contracts of life insurance on any plan or of any nature issued by such insurer or in collecting premiums for holders of any such contracts except as prescribed in s. 626.785(3).
2. No life insurer shall:
a. Affix, or permit to be affixed, advertising matter of any kind or character of any licensed funeral director or direct disposer to such policies of insurance.
b. Circulate, or permit to be circulated, any such advertising matter with such insurance policies.
c. Attempt in any manner or form to influence policyholders of the insurer to employ the services of any particular licensed funeral director or direct disposer.
3. No such insurer shall maintain, or permit its agent to maintain, an office or place of business in the office, establishment, or place of business of any funeral director or direct disposer in this state.
(u) False claims; obtaining or retaining money dishonestly.—
1. Any agent, physician, claimant, or other person who causes to be presented to any insurer a false claim for payment, knowing the same to be false; or
2. Any agent, collector, or other person who represents any insurer or collects or does business without the authority of the insurer, secures cash advances by false statements, or fails to turn over when required, or satisfactorily account for, all collections of such insurer,
shall, in addition to the other penalties provided in this act, be guilty of a misdemeanor of the second degree and, upon conviction thereof, shall be subject to the penalties provided by s. 775.082 or s. 775.083.
(v) Proposal required.—If a person simultaneously holds a securities license and a life insurance license, he or she shall prepare and leave with each prospective buyer a written proposal, on or before delivery of any investment plan. “Investment plan” means a mutual funds program, and the proposal shall consist of a prospectus describing the investment feature and a full illustration of any life insurance feature. The proposal shall be prepared in duplicate, dated, and signed by the licensee. The original shall be left with the prospect, the duplicate shall be retained by the licensee for a period of not less than 3 years, and a copy shall be furnished to the department upon its request. In lieu of a duplicate copy, a receipt for standardized proposals filed with the department may be obtained and held by the licensee.
(w) Soliciting or accepting new or renewal insurance risks by insolvent or impaired insurer or receipt of certain bonuses by an officer or director of an insolvent insurer prohibited; penalty.—
1. Whether or not delinquency proceedings as to the insurer have been or are to be initiated, but while such insolvency or impairment exists, no director or officer of an insurer, except with the written permission of the office, shall authorize or permit the insurer to solicit or accept new or renewal insurance risks in this state after such director or officer knew, or reasonably should have known, that the insurer was insolvent or impaired.
2. Regardless of whether delinquency proceedings as to the insurer have been or are to be initiated, but while such insolvency or impairment exists, a director or an officer of an impaired insurer may not receive a bonus from such insurer, nor may such director or officer receive a bonus from a holding company or an affiliate that shares common ownership or control with such insurer.
3. As used in this paragraph, the term:
a. “Bonus” means a payment, in addition to an officer’s or a director’s usual compensation, which is in addition to any amounts contracted for or otherwise legally due.
b. “Impaired” includes impairment of capital or surplus, as defined in s. 631.011(12) and (13).
4. Any such director or officer, upon conviction of a violation of this paragraph, commits a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
(x) Refusal to insure.—In addition to other provisions of this code, the refusal to insure, or continue to insure, any individual or risk solely because of:
1. Race, color, creed, marital status, sex, or national origin;
2. The residence, age, or lawful occupation of the individual or the location of the risk, unless there is a reasonable relationship between the residence, age, or lawful occupation of the individual or the location of the risk and the coverage issued or to be issued;
3. The insured’s or applicant’s failure to agree to place collateral business with any insurer, unless the coverage applied for would provide liability coverage which is excess over that provided in policies maintained on property or motor vehicles;
4. The insured’s or applicant’s failure to purchase noninsurance services or commodities, including motor vehicle services as defined in s. 624.124 except for motor vehicle services purchased from a membership organization that, as of January 1, 2018, is affiliated with an admitted property and casualty insurer;
5. The fact that the insured or applicant is a public official; or
6. The fact that the insured or applicant had been previously refused insurance coverage by any insurer, when such refusal to insure or continue to insure for this reason occurs with such frequency as to indicate a general business practice.
(y) Powers of attorney.—Except as provided in s. 627.842(2):
1. Requiring, as a condition to the purchase or continuation of an insurance policy, that an applicant for insurance or an insured execute a power of attorney in favor of an insurance agent or agency or employee thereof; or
2. Presenting to the applicant or the insured, as a routine business practice, a form that authorizes the insurance agent or agency to sign the applicant’s or insured’s name on any insurance-related document or application for the purchase of motor vehicle services as described in s. 624.124. To be valid, a power of attorney must be an act or practice other than as described in this paragraph, must be a separate writing in a separate document, must be executed with the full knowledge and consent of the applicant or insured who grants the power of attorney, must be in the best interests of the insured or applicant, and a copy of the power of attorney must be provided to the applicant or insured at the time of the transaction.
(z) Sliding.—Sliding is the act or practice of any of the following:
1. Representing to the applicant that a specific ancillary coverage or product is required by law in conjunction with the purchase of insurance when such coverage or product is not required.
2. Representing to the applicant that a specific ancillary coverage or product is included in the policy applied for without an additional charge when such charge is required.
3. Charging an applicant for a specific ancillary coverage or product, in addition to the cost of the insurance coverage applied for, without the informed consent of the applicant.
4. Initiating, effectuating, binding, or otherwise issuing a policy of insurance without the prior informed consent of the owner of the property to be insured.
5. Mailing, transmitting, or otherwise submitting by any means an invoice for premium payment to a mortgagee or escrow agent, for the purpose of effectuating an insurance policy, without the prior informed consent of the owner of the property to be insured. However, this subparagraph does not apply in cases in which the mortgagee or escrow agent is renewing insurance or issuing collateral protection insurance, as defined in s. 624.6085, pursuant to the mortgage or other pertinent loan documents or communications regarding the property.
1. Churning is the practice whereby policy values in an existing life insurance policy or annuity contract, including, but not limited to, cash, loan values, or dividend values, and in any riders to that policy or contract, are directly or indirectly used to purchase another insurance policy or annuity contract with that same insurer for the purpose of earning additional premiums, fees, commissions, or other compensation:
a. Without an objectively reasonable basis for believing that the replacement or extraction will result in an actual and demonstrable benefit to the policyholder;
b. In a fashion that is fraudulent, deceptive, or otherwise misleading or that involves a deceptive omission;
c. When the applicant is not informed that the policy values including cash values, dividends, and other assets of the existing policy or contract will be reduced, forfeited, or used in the purchase of the replacing or additional policy or contract, if this is the case; or
d. Without informing the applicant that the replacing or additional policy or contract will not be a paid-up policy or that additional premiums will be due, if this is the case.
Churning by an insurer or an agent is an unfair method of competition and an unfair or deceptive act or practice.
2. Each insurer shall comply with sub-subparagraphs 1.c. and 1.d. by disclosing to the applicant at the time of the offer on a form designed and adopted by rule by the commission if, how, and the extent to which the policy or contract values (including cash value, dividends, and other assets) of a previously issued policy or contract will be used to purchase a replacing or additional policy or contract with the same insurer. The form must include disclosure of the premium, the death benefit of the proposed replacing or additional policy, and the date when the policy values of the existing policy or contract will be insufficient to pay the premiums of the replacing or additional policy or contract.
3. Each insurer shall adopt written procedures to reasonably avoid churning of policies or contracts that it has issued, and failure to adopt written procedures sufficient to reasonably avoid churning shall be an unfair method of competition and an unfair or deceptive act or practice.
(bb) Deceptive use of name.—Using the name or logo of a financial institution, as defined in s. 655.005(1), or its affiliates or subsidiaries when marketing or soliciting existing or prospective customers if such marketing materials are used without the written consent of the financial institution and in a manner that would lead a reasonable person to believe that the material or solicitation originated from, was endorsed by, or is related to or the responsibility of the financial institution or its affiliates or subsidiaries.
(cc) Unfair rate increases for persons in military service.—Charging an increased premium for reinstating a motor vehicle insurance policy that was canceled or suspended by the insured solely for the reason that he or she was transferred out of this state while serving in the United States Armed Forces or on active duty in the National Guard or United States Armed Forces Reserve. It is also an unfair practice for an insurer to charge an increased premium for a new motor vehicle insurance policy if the applicant for coverage or his or her covered dependents were previously insured with a different insurer and canceled that policy solely for the reason that he or she was transferred out of this state while serving in the United States Armed Forces or on active duty in the National Guard or United States Armed Forces Reserve. For purposes of determining premiums, an insurer shall consider such persons as having maintained continuous coverage.
(dd) Life insurance limitations based on past foreign travel experiences or future foreign travel plans.—
1. An insurer may not refuse life insurance to; refuse to continue the life insurance of; or limit the amount, extent, or kind of life insurance coverage available to an individual based solely on the individual’s past lawful foreign travel experiences.
2. An insurer may not refuse life insurance to; refuse to continue the life insurance of; or limit the amount, extent, or kind of life insurance coverage available to an individual based solely on the individual’s future lawful travel plans unless the insurer can demonstrate and the Office of Insurance Regulation determines that:
a. Individuals who travel are a separate actuarially supportable class whose risk of loss is different from those individuals who do not travel; and
b. Such risk classification is based upon sound actuarial principles and actual or reasonably anticipated experience that correlates to the risk of travel to a specific destination.
3. The commission may adopt rules pursuant to ss. 120.536(1) and 120.54 necessary to implement this paragraph and may provide for limited exceptions that are based upon national or international emergency conditions that affect the public health, safety, and welfare and that are consistent with public policy.
4. Each market conduct examination of a life insurer conducted pursuant to s. 624.3161 shall include a review of every application under which such insurer refused to issue life insurance; refused to continue life insurance; or limited the amount, extent, or kind of life insurance issued, based upon future lawful travel plans.
5. The administrative fines provided in s. 624.4211(2) and (3) shall be trebled for violations of this paragraph.
6. The Office of Insurance Regulation shall report to the President of the Senate and the Speaker of the House of Representatives by March 1, annually, on the implementation of this paragraph. The report shall include, but not be limited to, the number of applications under which life insurance was denied, continuance was refused, or coverage was limited based on future travel plans; the number of insurers taking such action; and the reason for taking each such action.
1(ee) Fraudulent signatures on an application or policy-related document.—Willfully submitting to an insurer on behalf of a consumer an insurance application or policy-related document bearing a false or fraudulent signature.
1(ff) Unlawful use of designations; misrepresentation of agent qualifications.—
1. A licensee may not, in any sales presentation or solicitation for insurance, use a designation or title in such a way as to falsely imply that the licensee:
a. Possesses special financial knowledge or has obtained specialized financial training; or
b. Is certified or qualified to provide specialized financial advice to senior citizens.
2. A licensee may not use terms such as “financial advisor” in such a way as to falsely imply that the licensee is licensed or qualified to discuss, sell, or recommend financial products other than insurance products.
3. A licensee may not, in any sales presentation or solicitation for insurance, falsely imply that he or she is qualified to discuss, recommend, or sell securities or other investment products in addition to insurance products.
4. A licensee who also holds a designation as a certified financial planner (CFP), chartered life underwriter (CLU), chartered financial consultant (ChFC), life underwriter training council fellow (LUTC), or the appropriate license to sell securities from the Financial Industry Regulatory Authority (FINRA) may inform the customer of those licenses or designations and make recommendations in accordance with those licenses or designations, and in so doing does not violate this paragraph.
(gg) Out-of-network reimbursement.—Willfully failing to comply with s. 627.64194 with such frequency as to indicate a general business practice.
(hh) Sales practices for pet wellness programs.—
1. A pet insurance agent may not market a wellness program as pet insurance.
2. If a wellness program is sold by a pet insurance agent:
a. The purchase of the wellness program may not be a prerequisite to the purchase of pet insurance;
b. The costs of the wellness program must be separate and identifiable from any pet insurance policy sold by the pet insurance agent;
c. The terms and conditions of the wellness program must be separate from any pet insurance policy sold by the agent;
d. The products or coverages available through the wellness program may not duplicate the products or coverages available through the pet insurance policy; and
e. The advertising of the wellness program must not be misleading.
(2) ALTERNATIVE RATES OF PAYMENT.—Nothing in this section shall be construed to prohibit an insurer or insurers from negotiating or entering into contracts with licensed health care providers for alternative rates of payment, or from limiting payments under policies pursuant to agreements with insureds, as long as the insurer offers the benefit of such alternative rates to insureds who select designated providers.
(3) INPATIENT FACILITY NETWORK.—This section may not be construed to prohibit a Medicare supplement insurer from granting a premium credit to insureds for using an in-network inpatient facility.
(4) PARTICIPATION IN A WELLNESS OR HEALTH IMPROVEMENT PROGRAM.—
(a) Authorization to offer rewards or incentives for participation.—An insurer issuing a group or individual health benefit plan may offer a voluntary wellness or health improvement program and may encourage or reward participation in the program by authorizing rewards or incentives, including, but not limited to, merchandise, gift cards, debit cards, premium discounts, contributions to a member’s health savings account, or modifications to copayment, deductible, or coinsurance amounts. Any advertisement of the program is not subject to the limitations set forth in paragraph (1)(m).
(b) Verification of medical condition by nonparticipants due to medical condition.—An insurer may require a member of a health benefit plan to provide verification, such as an affirming statement from the member’s physician, that the member’s medical condition makes it unreasonably difficult or inadvisable to participate in the wellness or health improvement program in order for that nonparticipant to receive the reward or incentive.
(c) Disclosure requirement.—A reward or incentive offered under this subsection shall be disclosed in the policy or certificate.
(d) Other incentives.—This subsection does not prohibit insurers from offering other incentives or rewards for adherence to a wellness or health improvement program if otherwise authorized by state or federal law.
(5) LOSS CONTROL AND LOSS MITIGATION.—This section does not prohibit an insurer or agent from offering or giving to an insured, for free or at a discounted price, services or other merchandise, goods, wares, or other items of value that relate to loss control or loss mitigation with respect to the risks covered under the policy.
1Note.—Section 12, ch. 2008-237, provides in part that “[e]ffective [June 30, 2008,] the Department of Financial Services may adopt rules to implement this act.”
...t. Specifically, to state a cause of action for certain unfair settlement practices in the insurance context, a complainant must show that the defendant committed or performed the act with "such frequency as to indicate a general business practice." § 626.9541(1)(i)3, Fla....
Cited 62 times | Published | Supreme Court of Florida | 2000 WL 232303
...1993, 124 L.Ed.2d 44 (1993); T.R. v. State, 677 So.2d 270, 271 (Fla.1996). At the time of its adoption in 1982, section 624.155(1)(a), Florida Statutes (Supp.1982), provided a civil remedy for any person damaged by an insurer's violation of any of the following provisions: 1. Section 626.9541(9), (15), or (24); 2....
...After entry of the arbitration order, Dadeland filed the instant action in the Fifteenth Judicial Circuit of Florida asserting that St. Paul had engaged in a bad-faith refusal to perform the duties required under the bond in contravention of sections 624.155(1)(b)(1) and 626.9541(1)(i) of the Florida Statutes (1995)....
...ourt: 1. IS THE OBLIGEE OF A SURETY CONTRACT CONSIDERED AN "INSURED" SUCH THAT THE OBLIGEE HAS THE RIGHT TO SUE THE SURETY FOR BAD-FAITH REFUSAL TO SETTLE CLAIMS UNDER § 624.155(1)(b)(1)? 2. IF SO, DOES THE LANGUAGE IN § 624.155(1)(b)(3) ELIMINATE § 626.9541's REQUIREMENT OF PROOF OF A GENERAL BUSINESS PRACTICE WHEN THE PLAINTIFF IS PURSUING A § 626.9541 CLAIM THROUGH THE RIGHT OF ACTION PROVIDED IN § 624.155? 3....
...[2] Having answered the first certified question, we now turn to the second question certified by the Eleventh Circuit whether the language in section 624.155 eliminates the requirement of proof of a general business practice when the plaintiff is pursuing a section 626.9541 claim *1232 through the right of action provided in section 624.155. Section 624.155(1) of the Florida Statutes, in its entirety, reads as follows: (1) Any person may bring a civil action against an insurer when such person is damaged: (a) By a violation of any of the following provisions by the insurer: 1. Section 626.9541(1)(i), (o), or (x); 2....
...(1999) (emphasis supplied). The circuit court's second certified question implicates the emphasized portion of this statutory provision, and asks whether it eliminates the requirement of proof of a general business practice when the plaintiff is pursuing a section 626.9541 claim through the right of action provided in section 624.155....
...Paul's assertion, that is not at all what the district court determined in Ticor. In addressing the plaintiff's claims under section 624.155 of the Florida Statutes, the Ticor court explicitly stated that section 624.155(1)(a)(1) "provides a civil remedy for violations of section 626.9541(1)(i) without proof that the insurer committed unfair or deceptive acts with such frequency as to constitute a general business practice....
...meaningless. See State v. Goode, 830 So.2d 817, 824 (Fla.2002). The only other provision referred to in section 624.155 which requires proof of conduct occurring with such frequency as to indicate a general business practice relates to violations of section 626.9541(1)(i), ( o ), and (x). Therefore, if we were to conclude that the paragraph at issue does not eliminate the requirement of section 626.9541 with regard to a general business practice in actions brought pursuant to section 624.155(1)(a), we would essentially be rendering the language absolutely meaningless as no other provision referred to in section 624.155 requires proof of a general business practice....
...le claims pursuant to section 624.155(1)(b)(1) of the Florida Statutes (1999); (2) the language of section 624.155(1)(b)(1) of the Florida Statutes (1999), eliminates the requirement of proof of a general business practice when a plaintiff pursues a section 626.9541 claim through the right of action provided by section 624.155(1)(b)(1); (3) an arbitration panel's findings that a surety's principal has breached its duty to the obligee and that the surety is obligated to the extent that its princi...
Cited 30 times | Published | Court of Appeals for the Eleventh Circuit
...asser medical insurance benefits under an employee benefit plan administered by the Union. Appellees asserted claims for breach of contract, fraud, and breach of fiduciary duty, as well as statutory claims under the Florida Insurance Code (Fla.Stat. § 626.9541 et seq.) and the Florida Consumer Protection Act (Fla.Stat....
...icient to support the award. 1 This argument does not join Burger's claim that he simply did without the medical care he needed. 2 The jury also awarded Burger $500 for unfair claim settlement practices by Time Insurance, pursuant to Florida Statute § 626.9541....
Cited 21 times | Published | District Court, M.D. Florida | 1996 WL 785444
...§ 624.155, and not under the common law. In Florida, first-party bad faith cases are actionable only under the statute. State Farm v. Laforet, 658 So.2d 55, 58-59 (Fla.1995). Talat argued that it had claimed not only under Fla.Stat.Ann. § 624.155(1)(b)(1), but also under Fla.Stat.Ann. § 626.9541(1)(i) and § 624.155(1)(a)(1) pertaining to unfair for deceptive acts....
Cited 18 times | Published | Florida 1st District Court of Appeal
...Department of Revenue, 273 So.2d 142, 144 (Fla. 1st DCA 1973). The next statute cited in the rule provides more guidance. Section 626.9611, Florida Statutes (1979), provides in part that in promulgating rules identifying specific practices which are prohibited by Section 626.9541, Florida Statutes (1979) (which defines unfair methods of competition and unfair or deceptive acts or practices and is part of the Unfair Insurance Trade Practices Act) the Department may not enact a rule which shall enlarge upon or extend the provisions of Section 626.9541. At the heart of this controversy is section 626.9541(15)(h), Florida Statutes (1979), one of the laws being implemented by Rule 4-43.03, which provides as follows: (h) No insurer shall, with respect to premiums charged for automobile insurance, unfairly discriminate solely on the basis of age, sex, marital status, or scholastic achievement....
...olely on these factors. Yet the Department, by promulgating Rule 4-43.03, imposed a total prohibition against the use of sex, marital status or scholastic achievement in the formulation of premiums or rate classifications. The legislative history of Section 626.9541(15)(h) irrefutably shows that the legislature expressly considered, but rejected, provisions which would prohibit the use of these factors as unfairly discriminatory. [5] This provides strong evidence that the legislature did not intend, by enactment of Section 626.9541(15)(h), to completely prohibit the use of these factors....
...Whatever the legislature does within its constitutional authority, no other department of the government may change, modify, alter, or amend. Thus we agree with the hearing officer's determination that Rule 4-43.03 extends, modifies and conflicts with Section 626.9541(15)(h), *912 and is therefore invalid under Section 120.54(2)(c)....
...male sex) but do not share the "average" driving characteristics of the group. [7] On the other hand, the insurance companies contend that "unfairly discriminatory" and "equitable" are technical words, with a particular meaning in the insurance industry, and that Section 626.9541(15)(h) must be construed with this meaning in mind....
...minatory," relevant to this proceeding. Historically, the Department has measured the equitableness of a rating factor by its predictive accuracy. Further, until the enactment of the challenged rule, the Department interpreted the insurance code and Section 626.9541(15)(h) [9] as permitting rate classification plans using sex, marital status and scholastic achievement criteria in their formulation....
...Instead, the Department urges that we should accept the rule because the record contains competent substantial evidence in support of the rule. Agrico Chemical Company v. State, Department of Environmental Regulation, 365 So.2d 759 (Fla. 1st DCA 1978). This argument ignores the fact that Rule 4-43.03 facially conflicts with Section 626.9541(15)(h)....
...Our concern is with the existence of statutory authority for Rule 4-43.03, or its absence. Department of Health and Rehabilitative Services v. Florida Psychiatric Society, Inc., 382 So.2d 1280 (Fla. 1st DCA 1980). Turning again to the statutes, we note that when the legislature enacted Section 626.9541(15)(h), it also reenacted Section 627.0651(3) through (8), which correspond with the Department's settled interpretation that rates "reflect equitably the difference in expected losses" if the rates reflect those differences as accurately as possible....
...SMITH, Jr., Chief Judge, dissenting. In my opinion Rule 4-43.03 permissibly exercises the responsibility placed in the *915 Department of Insurance by chapters 626 and 627, Florida Statutes (1979), to interpret and then implement the "unfair discrimination" prohibition expressed in section 626.9541(15)(h)....
...ation and the progressively deductive method of rulemaking. Here, Rule 4-43.03 represents, though characteristically of a rule it does not articulate as would an agency order, a permissible choice from among permissible conceptual interpretations of section 626.9541(15)(h). The permissible interpretations of § 626.9541(15)(h) By chapter 77-468, the Florida Insurance and Tort Reform Act of 1977, the legislature comprehensively enacted, reenacted, revised and reorganized numerous statutes pertaining to those subjects. Section 19 of the act added to section 626.9541(15), Florida Statutes (1976 Supp.) the new subsection (h) on which this controversy is centered: (h) No insurer shall, with respect to premiums charged for automobile insurance, unfairly discriminate solely on the basis of age, sex, marital status or scholastic achievement. *916 Section 626.9541(15)(h), Fla....
...Furthermore, if this new rulemaking required record justification in the form of new information or insights sufficient to "change the agency's mind," that is fully provided by the promulgating document itself. App., infra. But all this debate overlooks the critical fact that subsection (h) of section 626.9541(15) was newly enacted by chapter 77-468, section 19, effective Sept....
...The court's invalidating decision, reinstating the Department's "historic" policy, not only judges the policy of Rule 4-43.03 as though the rule were never promulgated; it also judges the fairness of discriminations based on gender, marital status and scholarship as though section 626.9541(15)(h), Florida Statutes (1977), were never enacted....
...ense that several of those arguments what the hearing officer thought after a seven-day trial, what the senate committee did to a substitute amendment, how the Department construed section 627.0651(6), nee 627.082(1)(e)3, before subsection (h) of 626.9541(15) became law are but servants to an underlying objection that would yet disapprove the rule *927 after all the lesser objections have been met and scattered....
...ng since the announcement of this decision throw new light upon the *939 question decided and, in my opinion, further demonstrate that the Department's decisive rulemaking is wholly valid. Had this question of the Department's regulatory power under section 626.9541(15)(h) arisen prior to the Administrative Procedure Act in 1974, the industry's most obvious point of attack would not have been upon the Department's rule barring as unfair the industry's discriminations based upon sex, marital stat...
...s motion, that our decision passes on a question of great public importance: Whether the Department of Insurance and the Insurance Commissioner, acting in their capacity as regulators of the insurance industry in this state, have the authority under section 626.9541(15)(h), Florida Statutes, to ban the use of sex, marital status, and scholastic achievement as classifications on which the insurance industry may base rates for private passenger automobile insurance....
...This rule was not challenged in this proceeding and therefore will not be addressed. [4] Rule 4-43.03 refers to rulemaking authority of the Department under Sections 624.308(1) and 626.9611, Florida Statutes (1979); and as the laws being implemented Sections 626.9541(15)(h), 627.031(1)(a), 627.062(1), and 627.0651, Florida Statutes (1979). [5] Senate Bill 1181, which amended Section 626.9541(15) by adding paragraph (h) was passed by voice vote of the Senate on May 18, 1977, 1977 Senate Journal 438....
...1977 House Journal 960. A conference committee appointed to resolve the differences between the House and Senate versions of CS/SB 1181 ultimately settled on the language in the Senate Bill which is identical to the language presently contained in Section 626.9541(15)(h). 1977 Senate Journal 857, 862, and 1977 House Journal 1229, 1234. The House and Senate approved the conference committee report and Section 626.9541(15)(h) ultimately became the law of this state....
...loss experience than the subgroup consisting of all unmarried policyholders. Further, there was testimony that there are differences in expected loss experience between those who qualify for scholastic achievement discount and those who do not. [9] Section 626.9541(15)(h) became effective September 1, 1977....
Cited 17 times | Published | Florida 1st District Court of Appeal | 1997 WL 108941
...surance contract, and section 626.9521, Florida Statutes (1989), which forbids knowingly making false statements in negotiating an insurance policy and knowingly misrepresenting the conditions or terms of any insurance policy to obtain a commission. § 626.9541(1)(a) and (k), Fla....
...sale of annuities. Second, we have concluded as a matter of law that no violation of section 626.611(9), Florida Statutes (1989), was proven. Third, both the final and recommended orders erroneously concluded that appellant had violated portions of section 626.9541, Florida Statutes (1989)....
...rnational Ship's rights, and (2) that St. Paul's acts reflect a general business practice. (Docket No. 130) In support of this contention, International Ship argues that St. Paul has violated Florida's Unfair Insurance Trade Practices Act, Fla.Stat. § 626.9541 et seq....
...o recover personal injury protection benefits, medical payments benefits, and uninsured motorist benefits under the policy. Subsequently, Inacio amended his complaint to add a claim for damages for State Farm's unfair trade practices in violation of section 626.9541, Florida Statutes (1987)....
Cited 15 times | Published | Supreme Court of Florida | 90 A.L.R. 4th 193
...Snyder, San Francisco, Cal., for Consumers Union of U.S., Inc., amicus curiae. OVERTON, Justice. This appeal from Dade County Consumer Advocate's Office v. Department of Insurance, 457 So.2d 495 (Fla. 1st DCA 1984), concerns the validity of sections 626.611(11) and 626.9541(1)(h)1, Florida Statutes *1033 (1983), [1] which prohibit insurance agents from accepting from their customers a commission lower than the commission set by the insurer....
...he district court in its opinion. Many of these arguments have been previously unsuccessfully made to uphold statutes or regulations limiting consumers' bargaining power for other services. For the reasons expressed, we find sections 626.611(11) and 626.9541(1)(h)1, Florida Statutes (1983), are unconstitutional under article I, section 9, of the Florida Constitution to the extent they prohibit insurance agents from rebating any portion of their commissions to their customers....
...y such person, if it finds that as to the applicant, licensee, or permittee any one or more of the following applicable grounds exist: ... . (11) Rebating, or attempt thereat, or unlawfully dividing or offering to divide his commission with another. Section 626.9541(1) reads, in pertinent part, as follows: UNFAIR METHODS OF COMPETITION AND UNFAIR OR DECEPTIVE ACTS....
...This appeal followed.
1
As is discussed subsequently, Florida’s Insurance Code allows an insured person to
bring an unfair trade action against an “insurer” when the insurer engages in unfair claim
settlement practices–that is, a violation of Fla. Stat. § 626.9541(1)(i)....
...Claim in connection with a § 624.155 Action
The district court also concluded that Dadeland did not present evidence to
establish that St. Paul’s alleged conduct constituted a general business practice. The
court stated that in order for a plaintiff to bring a § 626.9541(1)(i) action against an
insurer–through the conduit of § 624.155–a plaintiff was required to provide
evidence that the unfair settlement practice complained of was a “general business
practice.” R3-137 at 27. Because Dadeland had failed to allege a general business
practice on the part of St. Paul, the court construed Dadeland’s § 626.9541(1)(i)
claim as being waived.5
5
In order to understand the district court’s decision, some background as to Florida’s
statutory scheme is necessary....
... Because the Florida Supreme Court had not addressed whether § 624.155
eliminated the need for proof of a general business practice, we certified the
following question to the Florida Supreme Court:
DOES THE LANGUAGE IN § 624.155(1)(B)(3) ELIMINATE §
626.9541’s REQUIREMENT OF PROOF OF A GENERAL BUSINESS
PRACTICE WHEN THE PLAINTIFF IS PURSUING [AN UNFAIR
TRADE] CLAIM THROUGH THE RIGHT OF ACTION PROVIDED IN §
624.155?
Dadeland, 383 F.3d at 1277 (emphasis omitted)....
...siness practice was eliminated when an
unfair trade count was sought pursuant to § 624.155.
specifically requires proof of a “general business practice” on the part of the insurer to support
the plaintiff’s cause of action. See Fla Stat. § 626.9541(i)(3).
However, Florida’s insurance code, Fla. Stat. § 624.155(1)(a)(1), separately permits an
insured person to bring an action against an insurer for bad faith settlement practices, if the
insured person is “damaged . . . [b]y a violation of . . . section 626.9541(1)(i) ....
...only to subsection (b) of § 624.155–not to subsection (1)(a).
15
In light of the answer of the Florida Supreme Court, is clear that Dadeland
was not obligated to allege a general business practice in order to assert a §
626.9541 claim through the cause of action provided in § 624.155. The district
court erred in concluding otherwise, and in treating Dadeland’s § 626.9541 claim as
being waived....
...of Am., 979 F.2d 195, 198 (11th Cir.1992) (quoting Farlow v. Union Cent. Life Ins. Co., 874 F.2d 791, 795 (11th Cir.1989) abrogated on other grounds by Morstein v. Nat'l Ins. Servs., Inc., 93 F.3d 715 (11th Cir.1996)). Plaintiffs' negligence per se claim is based on Florida Statutes § 626.9541(1)(a)1 [6] and (b)4. [7] The Florida legislature provides for private causes of *1229 action under certain parts of § 626.9541: " Any person may bring a civil action against an insurer when such person is damaged: ... By a violation of any of the following provisions by the insurer: ... Section 626.9541(1)(i), (o), or (x) ..." Fla....
...the legislature has evidenced its desire that all persons be allowed to bring civil suit when they have been damaged by enumerated acts of the insurer."). But the Complaint does not allege violation of an enumerated act; rather, it alleges violation of § 626.9541(1)(a)1 and (b)4, neither of which is covered under § 624.155. See Compl. ¶ 87. If anything, the fact that § 624.155's list of enumerated acts explicitly lists three sections of § 626.9541(1) without including (a) or (b) evidences the legislature's intent not to create a private cause of action for those sections. Accordingly, Plaintiffs cannot use negligence per se to create a private cause of action for alleged violations of § 626.9541(1)(a)1 and (b)4 because the legislature has not demonstrated an intent to create a private cause of action under these sections. The negligence per se claim will therefore be dismissed with prejudice as to § 626.9541(1)(a)1 and (b)4....
...or causing to be made, issued, or circulated, any estimate, illustration, circular, statement, sales presentation, omission, or comparison which: ... [misrepresents the benefits, advantages, conditions, or terms of any insurance policy." Fla. Stat. § 626.9541(1)(a)1....
...nated, circulated, or placed before the public: ... an advertisement, announcement, or statement containing any assertion, representation, or statement with respect to the business of insurance, which is untrue, deceptive, or misleading." Fla. Stat. § 626.9541(1)(b)4.
...Conquest, 637 So.2d at 41-42 (footnote omitted). The district court affirmed the dismissals of counts II and III. Auto-Owners seeks review of the district court's reversal of the dismissal of count I, which pertains to sections 624.04, 624.155(1)(a)1., and 626.9541(1)(i)3....
...tells who may bring a civil action and sets forth Code violations that subject the insurer to suit. The section states, in part, that: (1) Any person may bring a civil action against an insurer when such person is damaged: (a) By a violation of any of the following provisions by the insurer: 1. Section 626.9541(1)(i), ( o ), or (x)... . Bonita Conquest alleged a cause of action under section 624.155(1)(a)1. based on her assertion that Auto-Owners violated section 626.9541(1)(i)3....
Cited 14 times | Published | Florida 3rd District Court of Appeal | 1989 WL 6168
...'s insurer. They cite for support the relevant sections of the statute which state: (1) Any person may bring a civil action against an insurer when such person is damaged: (a) By a violation of any of the following provisions by the insurer: *495 1. Section 626.9541(1)(i) ...; [1] (b) By the commission of any of the following acts by the insurer: 1....
...My view is to the contrary, see Blancher v. Metropolitan Dade County, 436 So.2d 1077 (Fla. 3d DCA 1983), and I would therefore order a new trial on this issue as well. NOTES [1] Plaintiffs' complaint alleged that Liberty Mutual had violated subsection (i)3a, c, and d of section 626.9541(i) which defines the following insurance company practices as unfair: (i) Unfair claim settlement practices....
...After the Prudential-Sheriff's Department payroll deduction agreement was in place, Prudential began selling individual insurance policies to Sheriff's Department employees. Plaintiff alleged that in August, 1991 he became aware that Prudential agents may have engaged in unfair trade practices in violation of section 626.9541, Florida Statutes (1991) by misrepresenting that the life insurance policies were retirement plans....
...ad-faith claim under section 624.155(1)(b)1. Section 624.155(1) reads in pertinent part: (1) Any person may bring a civil action against an insurer when such person is damaged: (a) By a violation of any of the following provisions by the insurer: 1. Section 626.9541(1)(i), ( o ), or (x); 2....
...uding “misrepresenting the ... conditions, or terms of any insurance policy” as well as “knowingly making ... any statement ... with respect to the business of insurance, which is untrue, deceptive, or misleading.” Fla. Stat. §§ 626.9521 , 626.9541....
...ed, or placed before the public ... In any other way an advertisement, announcement, or statement containing any assertion, representation, or statement with respect to the business of insurance, which is untrue, deceptive, or misleading. Fla. Stat. § 626.9541 (1)(a)(1) and (b). This lawsuit clearly does not concern Section 626.9541(1)(a)(1), because Plaintiffs do not allege that Public Storage misrepresented the actual terms of the PSTIP. There is no evidence that Plaintiffs did not receive the coverage they purchased or that Public Storage misrepresented the scope of the PSTIP coverage. There is a closer question as to Section 626.9541(1)(b), which broadly prohibits “untrue, deceptive, or misleading” statements with respect to the business of insurance....
...V, § 3(b)(5), Fla. Const. For reasons expressed below, we affirm the trial court's order declaring the statutes unconstitutional. MATERIAL FACTS S. Clark Butler, a builder and developer, challenges the constitutionality of sections 626.611(11), [1] 626.8437, [2] 626.9541(1)(h)3.a., [3] *1212 627.780, [4] 627.782 [5] and 627.783 [6] of the Florida Statutes (1997) and rule 4186.003(13)(a) *1213 of the Florida Administrative Code, [7] which prohibit title insurance agents from negotiating or rebating to their c...
...ty percent. See § 627.782(1). Butler seeks the right to negotiate the agent's share of the risk premium only. In pursuit of this end, Butler filed a complaint against the Department of Insurance seeking a declaratory judgment that sections 626.572, 626.9541(1)(h)3.a., and 626.611(11), Florida Statutes (1997), and rule 4-186.003(13) were unconstitutional as a violation of his substantive due process rights under article I, section 9 of the Florida Constitution....
...atory laws intended to curb *1220 such practices should not outweigh the public's right to effective bargaining power. We note, for example, that attorneys who perform title services appear to be expressly exempted from the anti-rebate provisions in section 626.9541 with regard to legal fees, see, e.g., § 626.9541(1)(h)3.a....
...r her share of the risk premium, to be unconstitutional. CONCLUSION In sum, we hold that the decision in Dade County applies to the statutes at issue in this case, [18] and in accordance with Dade County, we hold that sections 626.611(11), 626.8437, 626.9541(1)(h)3.a., 627.780, 627.782 and 627.783 of the Florida Statutes and rule 4-186.003(13)(a) of the Florida Administrative Code, to the extent they prohibit title insurance agents from rebating a portion of their risk premium, are unconstitutional under article I, section 9 of the Florida Constitution....
...e insurance agents. See id. § 626.8437(8) (prohibiting the "[u]nlawful rebating, or attempting to unlawfully rebate, or unlawfully dividing, or offering to unlawfully divide, title insurance premiums, fees, or charges with another, as prohibited by s. 626.9541(1)(h)3."). [3] Section 626.9541(1)(h)3.a., Florida Statutes (1997), proscribes rebating by title agents or insurers as an unfair method of competition....
...um, agent's commission, abstracting charges, title examination fee, and closing charges; however, nothing herein contained shall preclude an abatement in an attorney's fee charged for services rendered incident to the issuance of such insurance. Id. § 626.9541(1)(h)3.a....
...ve enactment. [12] That provision states: "No person shall be deprived of life, liberty or property without due process of law ..." Art. I, § 9, Fla. Const. [13] Specifically, the Consumer Advocate challenged the validity of section 626.611(11) and section 626.9541(1)(h)1, Florida Statutes (1983). Section 626.611(11) is the same statute challenged by Butler and states that the department may take disciplinary action against any agent who rebates or divides his or her commission with another. Section 626.9541(1)(h)1....
...Likewise, subsection (3) alters Florida's common law by providing for the recovery by the plaintiff of reasonable attorney's fees. In its motion to dismiss, United notes that, under subsection (1)(a), insurers may be held liable for certain "unfair claims settlement practices" described in Fla.Stat. 626.9541(1)(i)....
...rm "or". A claim of first party bad faith under (1)(b) may logically be seen as an alternative to any "unfair claims settlement" remedy provided for under (1)(a). The Court finds that United derives unwarranted implications from the incorporation of section 626.9541(1)(i) into section 624.155....
...[1] However, there is a statutory cause of action provided by section 624.155, Florida Statutes. [2] That statute provides: (1) Any person may bring a civil action against an insurer when such person is damaged: (a) By a violation of any of the following provisions by the insurer: 1. Section 626.9541(1)(i), ( o ), or (x); [wrongful refusal to settle] * * * * * * (b) By the commission of any of the following acts by the insurer: 1....
...Although, unfortunately, Plaintiffs' Complaint fails to state the specific subsections of Florida Statutes Section 624.155 upon which it is intending to rely, the allegations of the Complaint appear to attempt to state a claim under two subsections, namely: Section 624.155(1)(a)(1) (incorporating by reference Section 626.9541(1)(i) "Unfair Claim Settlement Practices"), which makes it illegal for an insurance company to fail to adopt and implement standards for the proper investigation of claims and denying claims without conducting reasonable investigatio...
Cited 9 times | Published | Florida 1st District Court of Appeal
...he provisions of Section 626.9702 for the insurer not to renew there must also be evidence revealing that the company's policyholder was to some extent at fault in causing the accident. This conclusion is made evident by reading the provisions of Section 626.9541(15)(c), Florida Statutes (1979), in pari materia with Section 626.9702(2). The former section was first enacted in 1976 as Section 626.954(15)(c) by Chapter 76-260, Section 9, Laws of Florida, effective June 28, 1976 (codified as Section 626.9541(15)(c), Florida Statutes (Supp....
...a policy solely because the insured was involved in an automobile accident, causing a loss to the insured's insurer under the policy, unless, among other things, "the insurer's file shall contain sufficient proof of fault... ." Reading further into Section 626.9541(15)(c), we are of the view that the statute clearly implies that a traffic citation should normally issue following an accident as a predicate to any assessment of fault in determining whether to renew a policy....
Cited 9 times | Published | Florida 4th District Court of Appeal | 1990 WL 175784
...Romer, 432 So.2d 66, 67 (Fla. 4th DCA 1983). Section 624.155, Florida Statutes (1985) provides: (1) Any person may bring a civil action against an insurer when such person is damaged: (a) By a violation of any of the following provisions by the insurer: 1. Section 626.9541(1)(i), ( o ), or (x); 2....
...Bonita Conquest contends the trial court erred in dismissing with prejudice her three-count complaint against Auto-Owners Insurance Company. We agree that counts II and III fail to state a cause of action and were properly dismissed; however, our interpretation of section 624.155, in combination with section 626.9541(1)(i), requires that we reverse the dismissal of count I and remand to the trial court....
...Thus, we conclude section 624.155(1)(b)1 provides no basis for this third-party claim and we affirm the trial court's dismissal with prejudice of count II. That leaves us with count I, which alleged a cause of action under section 624.155(1)(a)1 based on Auto-Owners' violation of section 626.9541(1)(i)3.a, c and d. Section 626.9541 is contained in the Unfair Insurance Trade Practices Act. Section 626.9541(1)(i) addresses unfair claim settlement practices and condemns an insurer for: 3....
...Failing to adopt and implement standards for the proper investigation of claims; * * * * * * c. Failing to acknowledge and act promptly upon communications with respect to claims; d. Denying claims without conducting reasonable investigations based upon available information. § 626.9541(1)(i)3.a, c and d....
...and these failures by Auto-Owners occurred with such frequency as to indicate a general business practice. She further alleged that as a result she suffered damages. We conclude Conquest stated a cause of action under the statute and find nothing in section 626.9541 that would restrict claims to insureds only....
...Appellant Kenneth Michael Whitaker challenges an order of the Department of Insurance which revokes his insurance licenses. Among the many issues he raises, Whitaker contends that the Department erred 1) in finding him guilty of failure to insure under section 626.9541(1)(x)4., Florida Statutes (Supp.1992), and 2) in finding that his conduct was detrimental to the public interest in violation of section 626.621(6), Florida Statutes (Supp.1992)....
...or threatening to cancel the "policy". The Insurance Commissioner filed a nine count administrative complaint charging Whitaker with 140 violations of Chapter 626, Florida Statutes. The hearing officer assigned to the case found eight violations of section 626.9541(1)(x)4., and eight violations of section 626.621(6)....
...She recommended that the Commissioner enter a final order suspending appellant's licenses for 13 months. The Insurance Commissioner adopted the hearing officer's findings of fact and conclusions with exceptions. The final order found four violations of section 626.9541(1)(x)4. (refusal to insure), three violations of section 626.9541(1)(z)3....
...nd fifteen violations of section 626.9521 (unfair method of competition or unfair and deceptive act or practice). The Commissioner rejected the 13 month suspension in favor of revocation of appellant's insurance licenses. The purported violations of section 626.9541(1)(x)4. will not withstand our construction of the statute. The violations of section 626.621(6) must also fall because that statute is unconstitutionally vague. Section 626.9541(1)(x)4., Florida Statutes (Supp.1992), provides: 626.9541 Unfair methods of competition and unfair or deceptive acts or practices defined. (1) UNFAIR METHODS OF COMPETITION AND UNFAIR OR DECEPTIVE ACTS.The following are defined as unfair methods of competition and unfair or deceptive acts or pr...
...The insured's or applicant's failure to purchase noninsurance services or commodities, including automobile services as defined in s. 624.124.... Appellant contends that the hearing officer and the Commissioner abused their discretion in interpreting section 626.9541(1)(x)4. to find "Respondent's refusal to finance insurance premiums is equivalent to a refusal to insure, as proscribed by section 626.9541(1)(x)4." Appellant argues, and we find, that the statute is clear on its face....
...Statutes providing for revocation or suspension of a license to practice are deemed penal in nature and must be strictly construed, with any ambiguity interpreted in favor of the licensee."). Had the Legislature intended to include "refusal to finance" under this section, it could easily have done so. Section 626.9541(1)(x)4., however, fails to give notice that the practice of conditioning premium financing upon purchase of an ancillary product is a prohibited act. See Yes Dear, Inc. v. Department of Revenue, 523 So.2d 1235 (Fla. 1st DCA 1988). The violations of section 626.9541(1)(x)4....
...We hold, therefore, that the language following the last "or" in section 626.621(6), Florida Statutes (Supp.1992), offends due process. We affirm the Commissioner's findings as to the other statutory violations except to the extent that some of those violations are based on violations of sections 626.9541(1)(x)4....
...everal other remedies. In the fourth count of the complaint Mainstream sought damages for alleged bad faith dealings by Hartford in violation of section 624.155(1)(b)(1), Florida Statutes (2002), and unfair claim settlement practices in violation of section 626.9541(1)(i), Florida Statutes (2002)....
...5th DCA 2003); American Bankers Ins. Co. of Fla. v. Wheeler, 711 So.2d 1347 (Fla. 5th DCA 1998). Accordingly, the trial court's order striking the paragraphs related to this cause of action was correct. [1] Section 624.155(1)(a) also creates a cause of action for an insured under section 626.9541(1)(i) for certain unfair methods of competition and unfair or deceptive acts or practices....
...hat Hartford misrepresented pertinent facts or policy provisions related to coverage. The issue before us, then, is whether Mainstream should be permitted to litigate these claims before coverage is determined, or whether the claims for violation of section 626.9541(1)(i) are also premature....
...( Id. ¶ 7.) Plaintiff initially filed a Complaint against Defendant Provident asserting five counts: (1) violation of § 624.155(1)(b)(1), Florida Statutes, (2008), due to Provident's failure to attempt in good faith to settle claims; (2) violation of § 626.9541(1)(e)(1), Florida Statutes, for the knowing making, dissemination, and delivery of false statements; (3) violation of § 626.9541(1)(i)(2), Florida Statutes, for making material misrepresentations to Plaintiff to effect settlement on less favorable terms than those provided in the policy; (4) violation of § 626.9541(1)(i)(3), Florida Statutes, due to Provident's general business practice of mishandling claims; and (5) breach of fiduciary duty....
...41, filed July 20, 2009, at 13-14, 2009 WL 2169850.) Plaintiff Hogan then filed an Amended Complaint against both Defendants Provident and Unum asserting eight counts: (1) violation of § 624.155(1)(b)(1), Florida Statutes, by Provident for failing to attempt in good faith to settle Plaintiff's claims; (2) violation of § 626.9541(1)(i)(2), Florida Statutes, by Provident for making material misrepresentations to Plaintiff to effect a settlement on less favorable terms than those provided in the policy; (3) violation of § 626.9541(1)(i)(3), Florida Statutes, by Provident for its general business practice of mishandling claims; (4) breach of fiduciary duty by Unum; (5) aiding and abetting Unum's breach of fiduciary duty by Provident; (6) common law fraud by Unum wit...
...ancial gain, not the merit of Hogan's claim, in denying benefits. Hogan also alleges how he was damaged by Provident's lack of good faith in settling his claims. ( Id. ¶ 31.) Thus, Hogan pleads sufficient facts on Count I. B. Count IIViolation of § 626.9541(1)(i)(2) by Defendant Provident Hogan contends in Count II that Provident made a material misrepresentation to him for the purpose of settling his claims on less favorable terms that those provided in his insurance contract in violation of § 626.9541(1)(i)(2), Florida Statutes (2009)....
...or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy. §§ 624.155(1)(a)(1), 626.9541(1)(i)(2), Fla....
...Integra Luxtec, Inc., 2009 WL 722320 at *2 (M.D.Fla. Mar. 18, 2009); Bailey v. Janssen Pharmaceutica, Inc., 2006 WL 3665417 at *7 (S.D.Fla. Nov. 14, 2006); Harrison Enterprises, Inc. v. Moran, 1999 WL 1211753 at *3 (S.D.Fla.1999). The misrepresentation required by § 626.9541(1)(i)(2) sounds in fraud because it must be made for the purpose and with the intent of effecting settlement of a claim on less favorable terms than those provided in the policy....
...of Am., Inc., 290 F.3d 1301, 1310 (11th Cir.2002). None of Hogan's allegations in Count II of the First Amended Complaint [3] satisfy the *1283 four elements in Clausen. Thus, Hogan's claim for misrepresentation is not pled pursuant to Rule 9(b) and must be dismissed. C. Count IIIViolation of § 626.9541(1)(i)(3) by Defendant Provident Hogan claims under Count III that Provident committed the following acts with such frequency as to indicate a general business practice in violation of § 626.9541(1)(i)(3), Florida Statutes (2009): a....
...olicy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement. (Doc. No. 42 ¶ 40.) These claims merely recite the statute, so Plaintiff must plead facts that plausibly establish these claims. §§ 626.9541(1)(i)(3)(a),(b),(d),(f), Fla. Stat.; Iqbal, 129 S.Ct. at 1949. Contrary to the language of § 626.9541(1)(i)(3), Hogan need not allege that these actions constitute a "general business practice" because the statute authorizing a private right of action for a violation of this section, § 624.155(1)(a)(1), Florida Statutes, eliminates that requirement. Dadeland Depot, Inc. v. St. Paul Fire and Marine Ins. Co., 945 So.2d 1216, 1232-33 (Fla.2006). First, Hogan claims a violation of § 626.9541(1)(i)(3)(a) by Provident for failing to adopt and implement standards for the proper investigation of claims....
...Hogan's medical condition, set goals for claims termination to obtain financial gain without respect to the merit of Hogan's claim, and terminated Hogan's benefits solely for financial reasons. (Doc. No. 42 ¶¶ 18, 19.) Hogan's claimed violation of § 626.9541(1)(i)(3)(b) for misrepresentation, however, is not pled with particularity pursuant to Rule 9(b) of the Federal Rules of Civil Procedure and must be dismissed because it is supported by the same allegations as the deficient claim of misrepresentation under Count II. (Doc. No. 42 at 8, 10); supra part I.B. Hogan's claim that Provident violated § 626.9541(1)(i)(3)(d) for denying claims without conducting reasonable investigations is plausibly established by allegations that Provident set targets and goals for claims termination without regard to the merits of Hogan's claim and terminated Hogan's benefits solely for financial reasons. (Doc. No. 42 ¶ 19.) Finally, Hogan claims that Provident violated § 626.9541(1)(i)(3)(f) by failing "to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to *1284 the facts or applicable law, for denial of a claim or for the offer of a compromise...
...ng which time Provident was allegedly engaging in a scheme to deny claims without respect to the merits of such claims solely for financial gain. (Doc. No. 42 ¶¶ 13, 18-20.) Thus, Hogan has sufficiently pled three of the four claimed violations of § 626.9541(1)(i)(3) under Count III....
...42 ¶¶ 73, 75.) Finally, Hogan alleges his damages caused by the acts underlying the conspiracy. ( Id. ¶ 76.) Thus, Hogan's claims of civil conspiracy against Unum to commit the unlawful acts alleged in Counts I and III [5] are sufficiently pled. Hogan's claim that *1286 Provident and Unum conspired to violate § 626.9541(1)(i)(2) [6] as alleged in Count II, however, must be dismissed because the misrepresentations underlying this claim are not pled with particularity pursuant to Rule 9(b) of the Federal Rules of Civil Procedure....
...Additionally, the statute proscribes the failure to adopt and implement standards for the proper investigation of claims and denying claims without conducting reasonable investigations based upon available information. Id. at § 624.155(1)(a)(1) (incorporating by reference Section 626.9541(1)(i) "Unfair Claim Settlement Practices")....
...A special verdict was returned against Defendant Continental on liability but with a finding of "zero" damages. Specifically, the jury determined that Continental did not attempt in good faith to settle Plaintiffs claim, § 624.155(1), and additionally found a violation of section 626.9541(1)(i) to the extent that Continental failed to promptly provide a reasonable explanation in writing of the basis in the insurance policy for denial of Plaintiffs' claim or for the offer of a compromise settlement....
...Following State Farm’s payment of the claim, Colella moved for partial summary judgment, contending that the payment of the proceeds and the letter conceding her entitlement to those benefits constituted a confession of judgment. Id. She further alleged a claim under section 626.9541(1), Florida Statutes (2006), or Florida’s Unfair Insurance Trade Practice Act, in which wrongfulness or bad faith is an issue....
...constitute per se negligence);' see Zarrella v. Pacific Life Ins. Co., 755 F.Supp.2d 1218, 1228-29 (S.D.Fla. Nov. 10, 2010) (“Plaintiffs cannot use negligence per se to create a private *1366 cause of action for alleged violations of [Fla. Stat.] § 626.9541(l)(a)l, and (b)4 because the legislature has not demonstrated an intent to create a private cause of action under these sections.”); cf....
...UW guilty. Specifically, the DOI held in the Final Order, 3. In accordance with the modified Conclusions of Law, Respondent is found guilty of the following violations as alleged in the Administrative Complaint: a) United Wisconsin violated Sections 626.9541(1)(g)2 and 627.6425, Florida Statutes, as alleged in Count V of the Administrative Complaint when in the year 2000 in connection with the renewal of the TNI association coverage it subjected individuals to rate increases which were not applicable to all members of the same class. In determining the legality of DOI's determination as to Count V we are asked to look at three issues: 1) Whether the Department proved that section 626.9541(1)(g)2., Florida Statutes, prohibits tier rating by out-of-state group health insurers; 2) whether the Department could base its finding of a violation as to Count V on section 627.6425, Florida Statutes, where this statute was neith...
...s tier rating by out-of-state group health insurers. We will address the first two issues, but because we find that DOI could not base a finding of guilt as to Count V on section 627.6425, Florida Statutes, we decline to address the third issue. [2] Section 626.9541 in pertinent part states, *420 (1) UNFAIR METHODS OF COMPETITION AND UNFAIR OR DECEPTIVE ACTS.The following are defined as unfair methods of competition and unfair or deceptive acts or practices: .......
...ance, in the benefits payable thereunder, in any of the terms or conditions of such contract, or in any other manner whatever. (Emphasis added). In Whitaker v. Department of Ins. and Treasurer, 680 So.2d 528 (Fla. 1st DCA 1996), this court held that section 626.9541 does not prohibit a practice which is not specifically delineated as "unfair" in the act or in the administrative code: Because the statute is penal in nature, it must be strictly construed with any doubt resolved in favor of the licensee....
...Statutes providing for revocation or suspension of a license to practice are deemed penal in nature and must be strictly construed, with any ambiguity interpreted in favor of the licensee."). Had the Legislature intended to include "refusal to finance" under this section, it could easily have done so. Section 626.9541(1)(x)4., however, fails to give notice that the practice of conditioning premium financing upon purchase of an ancillary product is a prohibited act. See Yes Dear, Inc. v. Department of Revenue, 523 So.2d 1235 (Fla. 1st DCA 1988). The violations of section 626.9541(1)(x)4....
...Several sections of the statutes regulating insurance expressly prohibit the use of claims experience or health status in determining whether to discontinue or renew health coverage. See, e.g., section 627.6425, Florida Statutes; section 626.6571, Florida Statutes; section 627.6699, Florida Statutes. [3] Section 626.9541(1)(g) does not contain the same *421 explicit language regarding renewals, health status, or claims history....
...1st DCA 1984), aff'd 492 So.2d 1032 (Fla.1986) (noting in dicta that allowing an agent to discount a portion of his commission to an individual purchaser without offering same to others would be considered an unfair method of competition or a deceptive act or practice under section 626.9541(1)(g))....
...Dino's opinion is not the only statutory interpretation within the Department. The foregoing findings are supported by competent substantial evidence. Thus, the ALJ determined that the Department failed to prove that the actuarially supportable class enumerated in section 626.9541(1)(g)2., Florida Statutes, was frozen at the time of the initiation of the policy, and therefore, no violation of the statute was proven....
... deceased. On the other hand, appellants contend that the attempted cancellation was void because it was in violation of a provision of Florida’s Unfair Insurance Trade Practices Act (UITPA), Fla.Stat. § 626.951 et seq., specifically, Fla.Stat. § 626.9541(24)(c) (1977)....
...lder against any individual insurer.” Id. Plaintiffs’ counsel argues that since Fla. Stat. § 626.9641 (2) applies only to “that section,” to-wit, § 626.9641, that the Coira decision does not control this action, which is based on Fla.Stat. § 626.9541(24)(c) (1977)....
...Rather, they argue that theirs is a common law action for breach of the underlying contract of insurance, which contract of insurance included the UITPA since it was in effect at the inception of the insurance contract. Plaintiffs’ argument is that the insurance contract, by the legal incorporation of Fla.Stat. § 626.9541(24)(c) prohibited the defendant from cancelling the insurance policy due to the insured’s failure to place “collateral business.” Plaintiffs’ argument, however, ignores the fact that the entire UITPA was incorporated into the insurance contract, including Fla.Stat....
...te. Rosenberg v. Ryder Leasing, Inc., 168 So.2d 678 (Fla. 3d D.C.A.1964); Girard Trust Co. v. Tampashores Development Co., 95 Fla. 1010, 1015-16 , 117 So. 786, 788 (1928). The specific provisions alleged to have been violated here are Fla.Stat. Sec. 626.9541(1)(a) and Fla.Stat. Sec. 626.9541(1)(i). Section 626.9541(1)(a) provides in pertinent part: 3 The following are defined as ......
...unfair or deceptive acts or practices: 4 (a) MISREPRESENTATIONS AND FALSE ADVERTISING OF INSURANCE POLICIES.--Knowingly making ... or causing to be made ... any ... statement ... which: 1. Misrepresents the benefits, advantages, conditions or terms of any insurance policy. 5 * * * 6 * * * Section 626.9541(1)(i) provides in part: 7 The following are defined as ......
...pertinent part as follows: 16 Further, Travelers has violated the Unfair Insurance Trade Practices Act Chapter 626, Florida Statute, Part VII (1980) as follows: (a) Travelers has engaged in unfair or deceptive acts or practices in violation of Sec. 626.9541(1)(a) by knowingly making statements to Plaintiffs and its attorneys misrepresenting the benefits, conditions and terms of Travelers policy, to wit: Travelers knowingly stated to Plaintiffs or their attorneys that the terms of the subject po...
...e extent of $100,000, when in fact the policy afforded benefits to the extent of $500,000 as alleged in paragraphs 4 & 5 above, a fact of which Travelers was aware. (b) Travelers has engaged in unfair claim settlement practices, in violation of Sec. 626.9541(9)(b) by making material misrepresentations to Plaintiffs as set out in subparagraph (a) above....
Cited 5 times | Published | Florida 1st District Court of Appeal | 1996 WL 587866
...We have on appeal a final order of the Circuit Court dismissing an amended complaint filed by appellant, S. Clark Butler. Butler, joined by the Florida Home Builder's Association, challenged the constitutionality of Rule 4-186.003(13)(a), Florida Administrative Code, and sections 626.9541(1)(h)3.a., 626.611(11) and 626.572, Florida Statutes (1993)....
...icus curiae. On June 30, 1995, Butler filed an amended complaint to reflect recent changes in the numbering and substance of Rule 4-186.003(11)(i). [1] Appellant also included in the amended complaint a challenge to the constitutionality of sections 626.9541(1)(h)3.a., 626.611(11), and 626.572, Florida Statutes (1993), citing basically the same reasons as those cited in challenging the rule. Section 626.9541(1)(h)3.a....
...After a hearing on October 23, 1995, the circuit court dismissed the amended complaint without prejudice for failure to exhaust administrative remedies. This appeal ensued. We find that this constitutional challenge focuses upon the facial validity of the anti-rebate statutory scheme as set forth in sections 626.9541(1)(h), 626.611(11) [4] and 626.572, Florida Statutes (1993) [5] and Rule 4-186.003(13)(a), Florida Administrative Code....
...NOTES [1] Recent amendments to Rule 4-186.003(11)(i) changed the number of the rule to 4-186.003(13)(a). The substance of the rule was changed as well, and now prohibits only "illegal" rebating or abating of risk premiums by title insurers or title insurance agents. See n. 3, infra. [2] Section 626.9541(1)(h)3.a....
...te, and not with rules that implement an allegedly unconstitutional statute. [7] The instant case is very similar to Dade County Consumer Advocate's Office, in which an action was brought challenging the constitutionality of sections 626.611(11) and 626.9541(1)(h)1, Florida Statutes (1983), which prohibit life insurance agents from negotiation with clients as to the amount of their commissions or offering to rebate portions thereof to clients....
...We did not go so far as to hold that State Farm had a duty to do so automatically, because the PIP statute, section 627.736(4), Florida Statutes (1975), made PIP coverage "primary," as did State Farm's policy. The statutory basis alleged in the insured's complaint is section 626.9541(1)(i) 2 and 3, Florida Statutes (1991) [2] , which subsection is titled "Unfair Claims Settlement Practices." Section 624.155 authorizes civil actions for violations of section 626.9541(1), but provides in subsection 624.155(4), with regard to punitive damages: No punitive damages shall be awarded under this section unless the acts giving rise to the violation occur with such frequency as to indicate a general busin...
...ida. QUESTION CERTIFIED. 1 . This argument does not join Burger's claim that he simply did without the medical care he needed. 2 . The jury also awarded Burger $500 for unfair claim settlement practices by Time Insurance, pursuant to Florida Statute § 626.9541....
...le under a title insurance policy to defendants University Creek, Inc. and Creek Plaza, Inc., d/b/a University Creek Associates (collectively: University Creek), and that it did not violate the Florida Unfair Insurance Trade Practices Act, Fla.Stat. § 626.9541(1)(i)(3)(c), (f)....
...Ticor's Claim for Declaration that It Did Not Violate the Florida Unfair Insurance Trade Practices Act 23. Under 28 U.S.C. § 2201 and Rule 57 of the Federal Rules of Civil Procedure, Ticor asks the Court to declare that it did not violate the Florida Unfair Insurance Trade Practices Act (the Act), Fla.Stat. § 626.9541(1)(i)(3)(c), (f)....
...bstantial controversy, between parties having adverse legal interests, of sufficient immediacy and reality to warrant the issuance of a declaratory judgment." The Court finds that the parties do not present a justiciable controversy under Fla. Stat. § 626.9541(1)(i)(3)(c), (f)....
...ect to claims, or fails promptly to provide explanations for denying claims. University Creek merely contends that Ticor failed to act promptly with regard to its own claim. Hence, the parties have no adverse legal interests with regard to Fla.Stat. § 626.9541(1)(i)(3)(c), (f)....
...26. Although University Creek cites section 624.155(1)(b)(1) in its complaint, both its pleadings and its proposed conclusions of law show that it also seeks to recover under section 624.155(1)(a)(1), which provides a civil remedy for violations of section 626.9541(1)(i) without proof that the insurer committed unfair or deceptive acts with such frequency as to constitute a general business practice. Specifically, University Creek seeks to recover damages under section 624.155(1)(a)(1) because Ticor allegedly violated section 626.9541(1)(i)(3)(c), (f)....
...I of its counterclaim, it would hold that University Creek could recover damages under Count II because Ticor violated section 624.155(1)(a)(1) by "[f]ailing to acknowledge and act promptly upon communications with respect to claims." See Fla.Stat. § 626.9541(1)(i)(3)(c)....
...by "[f]ailing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement." See Fla.Stat. § 626.9541(1)(i)(3)(f)....
...Accordingly, the Court will reserve jurisdiction to determine the amount of University Creek's attorneys' fees and costs upon further submissions of the parties, if they cannot stipulate to those amounts. Moreover, the Court finds that plaintiff Ticor Title Insurance Company's claim for a declaration that it did not violate section 626.9541(1)(i)(3)(c), (f) of the Florida Statutes presents no justiciable controversy....
Cited 5 times | Published | Florida 2nd District Court of Appeal | 1991 WL 38137
...ce. Ch. 76-260, § 9 Laws of Fla. Among other requirements, this enactment made it an unfair insurance practice for an insurance company to frequently misrepresent the "advantages" or the "dividends" associated with the company's insurance policies. § 626.9541(1), Fla....
...The referee found that respondent's actions violated section 626.9521, Florida Statutes (1995), proscribing "unfair method of competition or an unfair or deceptive act or practice involving the business of insurance," id., and several provisions of section 626.9541, which generally proscribes falsity in advertising and other publications, misrepresentations in solicitations (known as "twisting" in the industry), making unlawful rebates, and offering free insurance....
...An individual analysis is required. 9. The Florida Bar's Complaint incorporates the Department of Insurance Immediate Final Order wherein it is alleged that the AFBG and consequently Respondent, violated certain provisions of the insurance code, to wit: § 626.9521 and §§ 626.9541(1) a, b, e, h, l, and n of Florida Statutes, 1995....
...efendant profited from its bad faith claims handling practices or unfair insurance claims practices, including, but not limited to any interest or monies Defendant gained from such unlawful or illegitimate monies" under § 624.155 (Civil Remedy) and § 626.9541 (Unfair or Deceptive Acts or Practices Prohibited) Florida Statutes....
...the manner urged by Plaintiff. I am unwilling to do so. As a result, I find as a matter of law that Defendant was not acting in bad faith in its dealings with Plaintiff. As such, Plaintiff's claims for relief under Section 624.155 (Civil Remedy) and Section 626.9541 (Unfair or Deceptive Acts or Practices Prohibited) of the Florida Statutes are meritless and do not entitle Plaintiff to a jury trial....
Cited 4 times | Published | Florida 5th District Court of Appeal | 2008 WL 4889128
...352 (Fla. 9th Cir.Ct.2007). As discussed below, the trial court should have determined that Progressive was entitled to judgment as a matter of law. Subsection 627.736(6), Florida Statutes RMA relies on sections 627.736(6), 627.7401, 627.4137, and 626.9541, Florida Statutes....
...Paul Fire and Marine Ins. Co., 945 So.2d 1216, 1225 (Fla. 2006). In section 627.4137, the Legislature limited the statute to liability insurance coverage. Therefore, it does not impose a duty on a PIP insurer to produce the insurance information requested in this case. Section 626.9541, Florida Statutes RMA argues that section 626.9541, Florida Statutes, imposes a duty on Progressive to supply the requested documentation. Section 626.9541 addresses unfair competition and deceptive practices by insurance companies....
...2d DCA 2005) (internal citations omitted). In this case, RMA points to neither a contractual provision nor a statutory provision which requires production of the information. As in Snow, RMA cannot *1208 use the implied duty of good faith to create a duty which does not otherwise exist. Section 626.9541 also addresses unfair claims settlement procedures; it does not create a legal duty of pre-suit disclosure. Under Florida law, a party cannot pursue a cause of action for unfair settlement practices until the party has determined that it is entitled to recover under the insurance contract at issue. This Court has previously recognized that under section 626.9541, "a claim for bad faith ......
...business policies or claims practices until coverage has been determined. " Id. Until a party determines that coverage exists and the party is entitled to recover, the party cannot pursue a claim for unfair settlement. Obviously, a party cannot use section 626.9541 to investigate whether coverage exists because the provision's protection against unfair practices only applies to a party who is already attempting to recover insurance benefits and settle an existing claim....
...Appellant contends the Department erred in accepting the Administrative Law Judge's ("ALJ") finding that she sold ancillary insurance products without obtaining her customers' informed consent, a practice known as "sliding" and labeled an unfair or deceptive practice under section 626.9541(1)(z)3, Florida Statutes (2004)....
...es have fair notice of what conduct is proscribed. Id. (quoting Fla. Indus. Comm'n v. Manpower, Inc. of Miami, 91 So.2d 197, 199 (Fla.1956) and City of Miami Beach v. Galbut, 626 So.2d 192, 194 (Fla.1993)). The first statute at issue in this case is section 626.9541(1)(z), which defines "sliding" and categorizes it as an unfair method of competition or an unfair or deceptive act. An insurance agent can engage in sliding in three distinct ways. See § 626.9541(1)(z). The statutory definition of sliding relevant to this appeal is "[c]harging an applicant for a specific ancillary coverage or product, in addition to the cost of the insurance coverage applied for, without the informed consent of the applicant." § 626.9541(1)(z)3....
...The Second District's decision in Thomas v. State, Department of Insurance and Treasurer, 559 So.2d 419 (Fla. 2d DCA 1990), provides guidance as to the proper meaning of "informed consent" in the context before us, although it does not expressly construe the meaning of section 626.9541(1)(z)3....
...When the Thomases committed these violations of the insurance code, there was not yet a statutory definition or an express statutory prohibition of sliding. See id. (noting that the Department of Insurance had alleged the violations occurred in 1987); § 626.9541(1), Fla....
...ensure that she has received informed consent from her customers would be an extension of the statute by construction, which is improper. See Capital Nat'l Fin. Corp. v. Dep't of Ins. & Treasurer, 690 So.2d 1335, 1337 (Fla. 3d DCA 1997). As drafted, section 626.9541(1)(z)3 does not legislate how the informed consent must be gathered....
...) and (9). Instead, he simply found that the Department had not met its burden of proof with respect to the alleged violations of these statutory sections. In disagreeing with this finding, the Department opined that sliding, under the definition in section 626.9541(1)(z)3, is a per se violation of section 626.611(7)....
...s. While an instance of sliding may satisfy the demonstration prohibited under section 626.611(7), sliding is not a per se demonstration of unfitness or untrustworthiness. The instant case provides a good example of the fine-line distinction between section 626.9541(1)(z)3 and section 626.611(7)....
...dismissed by the Court's Order of October 5, 1987. [2] Section 624.155 provides in part: (1) Any person may bring a civil action against an insurer when such person is damaged: (a) By a violation of any of the following provisions by the insurer: 1. Section 626.9541(1)(i), ( o ), or (x); ......
...or (b) By the commission of any of the following acts by the insurer: 1. Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for his interests ... Section 626.9541(1)(i) provides in part: (1) Unfair methods of competition and unfair or deceptive acts.The following are defined as unfair methods of competition and unfair or deceptive acts or practices: ....
...is interests," in violation of section 624.155(1)(b)1, Florida Statutes (1997); and (2) Reliance engaged in unfair claim settlement practices, such as failing to investigate and act promptly on claims, as a general business practice, in violation of section 626.9541(1)(i)(3), Florida Statutes (1997)....
...[10] *1353 Based on the foregoing, the court holds that under the performance bond at issue, Ginn is not an "insured" and, therefore, cannot sue Reliance for bad faith under section 624.155(1)(b)1, Florida Statutes. Accordingly, summary judgment is appropriate on Count I. Section 626.9541(1)(i) Ginn's second count alleges that Reliance engaged in unfair claim settlement practices in violation of section 626.9541(1)(i), Florida Statutes, by failing to investigate and act promptly on the County's claims that Ginn had breached the construction contract, causing substantial financial hardship to Ginn. Section 626.9541(1)(i) is broader than section 624.155(1)(b) in that it permits actions against insurers by both insureds and third parties....
...2d DCA 1994) (relying on Robinson v. State Farm Fire & Cas. Co., 583 So.2d 1063 (Fla. 5th DCA 1991)). To prevail, the plaintiff must establish that the insurer committed unfair acts "with such frequency as to indicate a general business practice." § 626.9541(1)(i)(3), Fla.Stat....
...mages under section 624.155(4), Florida Statutes); Ticor Title Ins. Co. v. University Creek, Inc., 767 F.Supp. 1127, 1138 (M.D.Fla. *1354 1991) (plaintiff's claim itself was not sufficient to state a claim for unfair claim settlement practices under Section 626.9541(1)(i))....
...[11] A claim that an insurer has engaged in unfair claim settlement practices may be pursued through section 624.155(1)(a)1, Florida Statutes. [12] The court is unsure and has found no authority on whether "general business practice" means the same under sections 624.155(4) (punitive damages) and 626.9541(1)(i)(3) (unfair claim settlement practices), Florida Statutes....
...reasonable and necessary medical expenses and continually reimburses its insureds in amounts on less favorable terms than those required by section 627.736(1)(a) and its policy of insurance. In addition, the notice claimed that this conduct violated section 626.9541(1)(i)(2)....
...a motor vehicle as follows: (a) Medical benefits. Eighty percent of all reasonable expenses for medically necessary medical, surgical, X-ray, dental and rehabilitative services. . . . Scott alleged below that Progressive violated this section and section 626.9541(1)(i)2 which provides: (1) UNFAIR METHODS OF COMPETITION AND UNFAIR OR DECEPTIVE ACTS....
...Scott filed his bad faith/civil claim against Progressive under section 624.155, Florida Statutes, which provides in pertinent part: (1) Any person may bring a civil action against an insurer when such person is damaged: (a) By a violation of any of the following provisions by the insurer: 1. Section 626.9541(1)(i), ( o ), or (x); ....
...Because Lucente had not received a judgment against the insured, he did not have standing to sue State Farm. Therefore, the trial court properly granted the motion to dismiss. B. Section 624.155 Lucente also maintains that section 624.155 provides him with a right to sue State Farm for its failure to comply with section 626.9541(1)(i), Florida Statutes (1989). Section 624.155 provides in part: (1) Any person may bring a civil action against an insurer when such person is damaged: (a) By a violation of any of the following provisions by the insurer: 1. Section 626.9541(1)(i) [unfair claim settlement practices], ( o ) [illegal dealings in premiums; excess or reduced charges for insurance], or (x) [refusal to insure]......
Cited 4 times | Published | Florida 1st District Court of Appeal | 1991 WL 163060
...of fact and conclusions of law. The order summarized the precise charges against Dyer as follows: As to both counts I and II, Petitioner [Department of Insurance] specifically alleges that Respondent is guilty of: misrepresentation, (626.611(5) and 626.9541(1)(a); a demonstrated lack of fitness and trustworthiness to engage in the insurance business, (626.611(7); a demonstrated lack of general knowledge, (626.611(8); fraudulent or dishonest practices, (626.611(9); willful failure to comply with...
...n of the rule against "twisting", 626.621(5); engaging in unfair or deceptive methodology of competition or being a source of loss or injury to the public, (626.621(6) and 626.9521: knowingly making an untrue, deceptive or misleading advertisement, (626.9541(1)(b) and (1)(e)1; and improperly comparing his policies with those of another company, (Rule 4-4.003(2) F.A.C.)....
...Chappuis' representation of dental, vision and hearing coverage when he knew Mrs. Laws already wore a hearing aid, it also constituted willful misrepresentation or deception in violation of Section 626.611(5) and an unfair or deceptive practice under Sections 626.9541(1)(b) and (1)(e)1....
...nalty could be imposed. Yes Dear, Inc. v. Department of Revenue, 523 So.2d 1235 (Fla. 1st DCA 1988); Holmberg v. Department of Natural Resources, 503 So.2d 944 (Fla. 1st DCA 1987). As Dyer was found guilty of violating sections 626.611, 626.621, and 626.9541(1), Florida Statutes (1987), [1] these sections are necessarily the focus of this analysis....
...the exercise of its discretion found in these sections of the insurance code. The Department argues that the fines imposed against Dyer were not premised on violations of sections 626.611 and 626.621, but rather were premised on Dyer's violations of section 626.9541(1). Sections 626.9521 and 626.9541 are found in Part X of chapter 626, known as the "Unfair Insurance Trade Practices Act," and, the Department argues, additional penalties by administrative fine are authorized by section 626.9521 without regard to the limitations in section 626.681 because this latter section is in Part I of the chapter....
...cism of the attorney representing the Department, but only to express our concern and sympathize with him and the Department for having to attempt enforcement of such poorly drafted and confusing legislation. Nevertheless, even after traversing from section 626.9541 to section 626.9521 to section 627.381, thence back to section 624.4211 we have found that section 624.4211 only authorizes the imposition of a fine in lieu of suspension or revocation, the same as section 626.681....
...early contrary to the controlling statutes in light of his finding that Dyer had violated section 626.611. The Department was required to correct this error of law. Second, even if a fine could be validly assessed in lieu of suspension for violating section 626.9541(1), as argued by the Department, the final order erred in requiring that if the fine should not be paid within 30 days, Dyer's license would stand revoked....
...mstances for which such denial, suspension, revocation, or refusal is not mandatory under s. 626.211: * * * * * * (3) Violation of any lawful order or rule of the department. * * * * * * (5) Violation of the provision against twisting, as defined in s. 626.9541(1)(1)....
...ods of competition or in unfair or deceptive acts or practices, as prohibited under part X of this chapter, or having otherwise shown himself to be a source of injury or loss to the public or detrimental to the public interest. (Emphasis added). [5] Section 626.9541 defines "unfair or deceptive acts or practices." [6] Fines for nonwillful violations "shall not exceed $2,500 per violation" and not more than "$10,000 for all nonwillful violations arising out of the same action." Fines for "any kno...
...Those contract provisions give Allstate a right of subrogation and a right to take possession of covered, destroyed property. This Court will not create a contractual duty when the contract provisions do not indicate such a duty exists. [10] b. Duty by Statute Plaintiffs claim that Sections 624.155(1)(a)(1) and 626.9541(1)(i) give rise to a statutory duty for insurance companies to preserve evidence (Doc....
...Plaintiff's argument is without merit. Section 624.155(1)(a)(1) provides, in relevant part: [a]ny person may bring a civil action against an insurer when such person is damaged...[b]y a violation of any of the following provisions by the insurer: 1. Section 626.9541(1)(i), ( o ), or (x); .... Fla. Stat. Ann. § 624.155(1)(a)(1) (West 2002). *1311 Section 626.9541(1)(i) provides, in relevant part: [t]he following are defined as unfair methods of competition and unfair or deceptive acts or practices: ......
...[m]isrepresenting pertinent facts or insurance policy provisions relating to coverages at issue; c. [f]ailing to acknowledge and act promptly upon communications with respect to claims; d. [d]enying claims without conducting reasonable investigations based upon available information; .... Fla. Stat. Ann. § 626.9541(i)(3)(a)-(d) (West 2002) (emphasis in parts 3....
...to preserve potential evidence. Instead, the statutes allow an insured to maintain a civil action against the insured's insurance company for denying claims without conducting a reasonable investigation. See Fla. Stat. Ann. §§ 624.155(1)(a)(1) and 626.9541(1)(i) (West 2002)....
...n to the auditor in an effort to avoid paying the *3 premium increase that should have resulted from an accurate year-end audit. This court's opinion in Amos clearly reflects our concern that the conduct was morally improper. See id. at 1201 (citing § 626.9541, Fla....
...o a jury. First, we must discuss the statutory authority for the unfair insurance trade practices action. In 1982 the legislature provided for a civil remedy against an insurer for any person damaged by unfair claim settlement practices set forth in Section 626.9541(1)(i), Florida Statutes. Ch. 82-243, § 9, Laws of Fla. (codified at § 624.155, Fla. Stat.) Section 626.9541(1)(i), Florida Statutes (Supp....
...Failing to promptly notify the insured of any additional information necessary for the processing of a claim; or h. Failing to clearly explain the nature of the requested information and the reasons why such information is necessary. Jerue alleged in its complaint that INA violated Section 626.9541(1)(i) in that INA committed the following wrongful acts: (a) failed to acknowledge and act properly upon the claim submitted by the Plaintiff; (b) denied the claim without ever conducting a reasonable investigation based upon availab...
...stigation, and in failing to timely pay the benefits, Defendant breached these duties and thus, Plaintiff is entitled to exemplary damages. Compl. ¶ 37. Plaintiff asserts a cause of action under common law and under Fla. Stat. Ann. §§ 624.155 and 626.9541, for bad faith refusal to settle....
...Co., 174 F.3d 1207, 1214 (11th Cir.1999) (holding that plaintiff's claims for breach of contract and bad faith refusal to pay related to an ERISA covered plan and were preempted). Furthermore, Plaintiff's claims that Defendant violated Fla. Stat. §§ 624.155 and 626.9541 in not attempting to settle in good faith, arguably relate to the disability policy at issue and thus would fall within ERISA's preemption clause....
...s are not "essential elements ... [which] must each be satisfied," in order to find that a state statute regulates insurance and thus eludes preemption, but are only "considerations to be weighed." Id. Plaintiff further asserts that §§ 624.155 and 626.9541 are laws regulating insurance within the meaning of ERISA's saving clause, and thus are excepted from ERISA preemption....
...1999) (holding that state law causes of action are not permitted under UNUM ). Plaintiff himself acknowledges that the Supreme Court gave weight to the McCarran-Ferguson factors in its analysis. Plaintiff, furthermore, appears to ignore case law in the Eleventh Circuit which clearly demonstrates that §§ 624.155 and 626.9541 have been preempted by ERISA via the application of these factors under the McCarran-Ferguson analysis....
...Union Cent. Life Ins. Co., 1989 WL 62373, *2 (S.D.Fla. April 4, 1989) (holding that claim asserted pursuant to § 624.155 is preempted by ERISA); Kritzman v. UNUM Life Ins. Co., 928 F.Supp. 1165, 1167 (holding that ERISA preempts claim asserted pursuant to § 626.9541)....
...In 2002, well after State Farm closed out Shoemaker's claim, she filed a multi-count complaint against State Farm, alleging fraud and deceit in the claims handling process; violations of section 624.155, Florida Statutes (1991) (civil remedy statute); violations of section 626.9541, Florida Statutes (1991) (unfair claim settlement statute); and civil conspiracy....
...ad eleven days to file an amended complaint or the case would be considered dismissed (Doc. 22). Chilton filed an Amended Complaint on December 20, 1999 (Doc. 24). The Amended Complaint states only one claim an allegation that Prudential violated section 626.9541(1)( o )1., Florida Statutes (1998), part of the Unfair Insurance Trade Practices Act....
...trial.'" Lockett v. Wal-Mart Stores, Inc., 2000 WL 284295, *2 (S.D.Ala. Mar.8, 2000) (quoting Anderson, 477 U.S. at 249, 106 S.Ct. 2505). *677 B. The Merits of Prudential's Motion In his Amended Complaint, Chilton raises only one claim that under section 626.9541(1)( o )1., Florida Statutes (1998), [4] and the civil remedy provision, section 624.155, Florida Statutes (1998), [5] Prudential collected premium payments for a policy that was not delivered....
...ich regulates insurance, banking, or securities." 29 U.S.C. § 1144(b)(2)(A). In the instant case, reference to the ERISA plan already provided to Chilton is necessary to resolve the issue of whether another plan exists; accordingly, as applied here section 626.9541(1)( o )1., Florida Statutes, "relates to" an employee benefit plan and falls within the ERISA preemption clause in 29 U.S.C....
...Hence, Chilton's claim is within the ERISA preemption clause. The same "practical consequences" of litigating state law claims are present here. *679 Although Chilton's claim falls within ERISA's preemption clause, the claim might still be exempted from preemption by the savings clause if section 626.9541(1)( o )1....
...This Court agrees with the Bridges court that the Anschultz analysis of the McCarran-Ferguson factors remains good law even though the Supreme Court held in UNUM that not all three factors need be met. Applying the common sense test, the McCarran-Ferguson factors, and UNUM to the instant claims brought under section 626.9541(1)( o )1., Florida Statutes, this Court concludes that Chilton's claim is preempted by ERISA. From a common sense perspective, section 626.9541(1)( o )1....
...arguably regulates insurance because it is contained within the Florida Insurance Code and the subpart regarding "Unfair Insurance Trade Practices." Additionally, this section clearly applies only to the insurance industry and thus meets the third McCarran-Ferguson factor. Cf. Anschultz, 850 F.2d at 1468-1469. However, section 626.9541(1)( o )1....
...r the plan" and that the contract and tort claims failed to satisfy the first or second McCarran-Ferguson factors; such claims did not spread risk, did not define the terms of the relationship, and merely allowed for recovery of damages). Therefore, section 626.9541(1)( o )1., Florida Statutes, is not within ERISA's saving clause and Chilton's state law claim is preempted....
...urer-insured relationship, [the statute], unlike the notice-prejudice rule, creates a `supplemental' state law remedy that conflicts with ERISA § 502(a)'s exclusive remedy provision."). Even more so than the provisions at issue in Corporate Health, section 626.9541(1)( o )1., Florida Statutes, creates an "alternative mechanism" for seeking benefits under an employer-provided plan and therefore is not excluded from preemption by ERISA's savings clause....
...Chilton may not circumvent the ERISA civil enforcement scheme through creative pleading. Chilton's claim for a policy which allegedly was not provided is nothing more than alternative pleading seeking to establish the terms of a policy which Chilton obtained or allegedly obtained through his employer. IV. CONCLUSION In sum, section 626.9541(1)( o )1., Florida Statutes, does not regulate insurance under the common sense and McCarran-Ferguson framework....
...urer as permitted by this code. [5] This section provides in part: 624.155. Civil remedy (1) Any person may bring a civil action against an insurer when such person is damaged: (a) By a violation of any of the following provisions by the insurer: 1. Section 626.9541(1)(i), ( o ), or (x); * * * * * * (b) By the commission of any of the following acts by the insurer: 1....
Cited 3 times | Published | Florida 1st District Court of Appeal
...Hayes of Martin, Ade, Birchfield & Johnson, Jacksonville, for amicus curiae American Council of Life Ins., Inc. ERVIN, Chief Judge. Appellants, Dade County Consumer Advocate's Office and Walter Dartland, challenge the constitutionality of Sections 626.611(11) and 626.9541(1)(h)1, Florida Statutes (1983), [1] which prohibit insurance agents from negotiating with clients as to the amount of their commission, or offering *497 to rebate a portion thereof to the clients, alleging that they violate the due process clause, Article 1, Section 9, of the Florida Constitution....
...ected by modern courts. [6] In the absence of any apparent rational relation between the prohibition of rebates and some legitimate state purpose in safeguarding the public welfare, we conclude *499 the anti-rebate statutes, sections 626.611(11) and 626.9541(1)(h)1, constitute an unjustified exercise of the police power of this state, and are therefore violative of the due process clause, Article 1, Section 9, Florida Constitution....
...Disciplinary action for unlawful divisions is provided for in section 626.753(4) and section 626.611(13). Therefore, our decision does not affect proscribed activity otherwise provided in the Florida Statutes. Appellees similarly argue that the practical result of declaring section 626.9541(1)(h)1 unconstitutional would be far broader in scope than merely allowing an agent to discount a portion of his commission to an individual purchaser. For example, appellees first claim that if section 626.9541(1)(h)1a is struck down, that agent's misrepresentations would thereby be authorized. Appellees may have overlooked the fact that such misrepresentations are now prohibited in sections 626.9541(1)(a), (b) and (e) and 626.611(5). Another effect of invalidating section 626.9541(1)(h)1, appellees contend, is that an agent or insurer would be able to provide any valuable consideration or inducement not specified in the contract....
...individuals of the same actuarially supportable class and risk, this type of activity falls under the unfair discrimination provision of the same statute and thus would be considered an unfair method of competition or deceptive act or practice. See Section 626.9541(1)(g). Although section 626.9541(1)(h)1 may seem to cover a wide range of practices, its title is styled "Rebates" and simply applies to the variety of ways in which an agent may offer a rebate to a customer....
...[1] She then filed a three-count complaint against Auto-Owners seeking damages on three different theories. Two counts were dismissed and, after appeal, [2] the case proceeded to trial on her remaining claim that Auto-Owners violated the following provisions of section 626.9541(1)(I)(3) of the Unfair Insurance Trade Practices Act, Florida Statutes (1991): a....
Cited 3 times | Published | Florida 2nd District Court of Appeal | 1998 WL 210954
...se of avoiding or diminishing the amount of payment of any workers' compensation premiums. These sections were not in effect during the time frame of Amos's alleged offenses. The law which was in effect in the 1986-90 period of Amos's activities was section 626.9541, Florida Statutes (Supp.1986), which provided: 626.9541 Unfair methods of competition and unfair or deceptive acts or practices defined. (1) UNFAIR METHODS OF COMPETITION AND UNFAIR OR DECEPTIVE ACTS.The following are defined as unfair methods of competition and unfair or deceptive acts or practices: .......
...Estimate is defined in Websters Third New International Dictionary 778 (1986) as "a value judgment that is often valid, but incomplete, approximate or tentative." As such, they cannot form the subject of theft. Amos's practices were dishonest. He clearly violated section 626.9541 by making false statements on insurance applications, a second-degree misdemeanor, but did not violate section 812.014, the theft statute....
...assertions of bad faith in claims handling procedures under Florida Statutes § 624.155(1)(a)1. [1] As further support for the reasoning adopted above, it is noteworthy that both Section 624.155(1)(b)1 and Section 624.155(1)(a)1, which incorporates § 626.9541(1)(i), provide for causes of action arising from improper actions in the course of dealing with benefits claims. More specifically, both Sections address *1257 improper actions in the course of claim settlement practices. Indeed, Section 626.9541(1)(i) is entitled "Unfair Claim Settlement Practices," thus indicating greater similarity to Section 624.155(1)(b)1 than Plaintiff might argue. Accordingly, the Court finds that the reasoning of Blanchard v. State Farm Mutual Automobile Insurance Company, 575 So.2d 1289 (Fla.1991) is applicable not only to Florida Statutes § 624.155(1)(b)1, but to Florida Statutes § 626.9541(1)(i), via § 624.155(1)(a)1, as well....
...contract. DONE AND ORDERED. NOTES [1] Florida Statutes § 624.155(1)(a)(1) permits a party to bring a civil action against an insurer when that person is damaged due a violation of certain enumerated statutory provisionsincluding Florida Statutes § 626.9541(1)(i), which proscribes unfair claim settlement practices.
Cited 2 times | Published | Florida 4th District Court of Appeal | 1996 WL 267929
...Because we conclude that a direct action against State Farm was permissible, we reverse. Section 624.155 provides in part as follows: 624.155 civil remedy. (1) Any person may bring a civil action against an insurer when such person is damaged: (a) By a violation of any of the following provisions by the insurer: 1. Section 626.9541(1)(i), ( o ), or (x); 2....
...Clark asserts three claims under Florida law: (1) breach of the first disability policy by failing to timely pay benefits, Doc. 2 ¶¶ 22-25; (2) breach of the second disability policy by failing to timely pay benefits, Doc. 2 ¶¶ 26-29; and (3) negligent or intentional breach of statutory duties in Fla. Stat. § 626.9541 (defining unfair methods of competition and unfair or deceptive acts or practices by insurers) and other unspecified statutes by failing to timely pay benefits, investigate the claims, and communicate about the claims....
...If the legislature had intended that the statute prohibit such activity, it could have written the statute to so provide. See Whitaker v. Department of Ins., 680 So.2d 528, 531-532 (Fla. 1st DCA 1996). This construction is entirely consistent with the legislative prohibition of the practice of "sliding" as defined in section 626.9541(1)(z), Fla.Stat....
...to sell on credit."). These definitions do not limit the term to the charging of interest for borrowing money. [2] The Department has provided this court with legislative history which states that section 627.8405 was enacted to prevent "sliding." See § 626.9541(1)(z), Fla.Stat....
...ble under the 1998 Bond. [4] Subtracting the $25,000 deductible applicable under the terms of the 1998 Bond, the jury found Heritage entitled to recover $55,310 from National Union. [5] Heritage is now suing National Union under sections 624.155 and 626.9541(1)(i), Florida Statutes, to recover for damages sustained on account of National Union's alleged bad faith handling of Heritage's claim....
...According to Heritage, National Union refused in bad faith to investigate Heritage's claims and denied coverage, which ultimately caused Heritage to go out of business. Heritage is also suing National Union's corporate parent, AIG, under sections 624.155 and 626.9541(1)(i)....
...or denying summary judgment). ANALYSIS A. National Union's Motion for Summary Judgment In relevant part, section 624.155(1) provides that any person may bring a civil action against an insurer when such person is damaged by an insurer's violation of section 626.9541(1)(i) (dealing with unfair claims settlement practices), or where an insurer 1....
...Further, only one of those claimants, The Heritage Corporation of South Florida, has sued National Union for bad faith under section 624.155thus it is far from clear which claims in the CRN form the basis of this bad faith action. Moreover, the CRN quoted large portions of sections 624.155 and 626.9541(1)(i) but did not specify which subsections were at issue, or explain how National Union violated them....
...The court ultimately found the claimant's allegation that the defendant insurer "failed to conduct an adequate investigation" was insufficient to provide the insurer with an opportunity to cure. Id. Likewise, here Heritage's CRN provided so few details as to the alleged violations of sections 624.155 and 626.9541(1)(i) that it surely forced National Union to play a "guessing game" as to what, and how, to cure within 60 days....
...In Heritage's CRN, it stated: [N]otwithstanding the filing of Proofs of Claim, the first for $73,386.35 [resulting from employees' fraud and/or theft], and the second for sums of $3,801,976 [resulting from employees' fraud and/or theft], the Insurer, in violation of [sections 624.155 and 626.9541(1)(i)], took no action whatsoever to acknowledge, to conduct reasonable investigations, to deny or acknowledge coverage, or to attempt to settle the claims as it should have done, as a result of which the entire mortgage business operations of the Insured, which had prospered since 1963, were destroyed....
...However, Heritage has not brought forth evidence to show how its requested damages, which are presently claimed to be in excess of $4.5 million, could possibly be "reasonably foreseeable" from National Union's alleged violation of sections 624.155 and 626.9541(1)(i)that is, its alleged bad faith failure to investigate or to pay a $55,310 claim....
...# 1) against defendant OneBeacon, an insurance company doing business in the State of Florida with its principal place of business in Pennsylvania, asserting claims of: (1) "bad faith" failure to settle insurance claims pursuant to Florida Statutes § 624.155 (1999); (2) "unfair claims practices" pursuant to Fla. Stat. § 626.9541(1)(a) (1999); and (3) "unfair and deceptive trade practices" pursuant to FLA. STAT. § 626.9541(1)(i) (1999)....
...4.) With the underlying "breach of contract" *1316 case closed, plaintiffs have now filed a "bad faith" civil action against OneBeacon. IV. In their Complaint, plaintiffs claim that defendants violated Florida Statutes §§ 624.155(1)(b)(1), 624.155(1)(b)(3), 626.9541(1)(a) and 626.954(1)(i)....
..." Dadeland Depot, Inc. v. St. Paul Fire & Marine Ins. Co., 945 So.2d 1216, 1233 (Fla.2006). [2] "[B]oth the existence of liability and the extent of damages are elements of a statutory cause of action for bad faith [under FLA. STAT. §§ 624.155 and 626.9541] ..." Progressive Select Ins....
Cited 2 times | Published | District Court, M.D. Florida
...For example in Ardrey v. USAA Casualty Insurance Co. , No. 8:12-CV-08-T-24MAP, 2012 WL 831620 (M.D. Fla. Mar. 12, 2012), the plaintiff filed three deficient CRNs. Id. at *2-*4. In the first two, the plaintiff alleged that the insurer had violated Florida Statute § 626.9541(1)(i) by engaging in unfair settlement practices, but the plaintiff failed to specifically provide the subsections of § 626.9541(1)(i) the insurer allegedly violated or provide facts to indicate which subsections were violated, even though the plaintiff stated the specific subsections that the insured allegedly violated in the amended complaint....
...The court held that these deficient CRNs did not meet the notice requirements under § 624.155(3)(b) because the CRNs did not provide the specific subsections or facts describing the violation at issue. Id. at *3. The court also found Plaintiff's third CRN to be defective because it did not state that § 626.9541 had been violated....
...t against the insurer. Fla. Stat. § 624.155. Those unfair practices include the failure to "properly investigate" or "acknowledge" claims and the denial of a claim "without conducting a reasonable investigation of available information." Fla. Stat. § 626.9541....
...tion to dismiss. *275 Defendant contends that Plaintiff has failed to allege that it was damaged by Defendant's unfair claim practices. In its Amended Complaint, Plaintiff alleges that Defendant engaged in the practices discussed in §§ 624.155 and 626.9541, and that as a result of those practices, Plaintiff was damaged in the amount of $283,126.78....
Cited 1 times | Published | Court of Appeals for the Eleventh Circuit | 2007 WL 1075181
...repair inadequate work performed and having to present their claims to arbitration.
The Sureties removed the case to federal court.
The district court interpreted Dadeland’s claim as being both a claim for
bad-faith refusal to settle under Fla. Stat. §§ 624.155(1)(b)(1) and 626.9541(1)(a)
(1999), and a breach of contract claim for the Sureties’ failure to timely perform
their contractual duties....
...al business practice. In
order to fully explain this issue, some preliminary discussion of Florida’s statutory
scheme is necessary.
Dadeland’s complaint states that it is bringing its bad-faith claim under both
§ 624.155(1)(b)(1) and § 626.9541(1)(i).2 Section 626.9541(1)(i) explicitly
requires proof of a general business practice. However, the right of action to sue
based on a violation of § 626.9541(1)(i) is found in § 624.155(1)(a)(1), and §
624.155(1)(b)(3) states, “[n]otwithstanding the provisions of the above to the
contrary, a person pursuing a remedy under this section need not prove that such
act was committed or performed with such frequency as to indicate a general
business practice.”
Dadeland argues that this language applies to § 624.155 in its entirety
2
This particular issue appears to involve Dadeland’s claim under § 626.9541(1)(i) only.
The Sureties, in their brief, admit that claims brought under § 624.155(1)(b) do not require proof
of a general business practice.
10
because of the language “a person pursuing a remedy under this section.”
Moreover, Dadeland argues that § 626.9541 is the only statute incorporated into §
624.155 that requires proof of a general business practice and, thus, §
624.155(1)(b)(3) is meaningless if it does not apply to claims brought under §
626.9541 through § 624.155(1)(a). The Sureties, on the other hand, argue that the
language in § 624.155(1)(b)(3) applies only to subsection (b) of § 624.155 and
not to subsection (1)(a). Therefore, the Sureties contend that a claim brought under
§ 626.9541 through § 624.155(1)(a) still requires proof of a general business
practice.
Because this issue has not yet been addressed by the Florida courts, we also
certify the following question to the Supreme Court of Florida:
DOES THE LANGUAGE IN § 624.155(1)(b)(3) ELIMINATE
§ 626.9541's REQUIREMENT OF PROOF OF A GENERAL
BUSINESS PRACTICE WHEN THE PLAINTIFF IS PURSUING A
§ 626.9541 CLAIM THROUGH THE RIGHT OF ACTION
PROVIDED IN § 624.155?
Once we have established the requirements of the statute, we must then ask
what the effect of the arbitration proceeding was on Dadeland’s right to bring this
action....
...IS THE OBLIGEE OF A SURETY CONTRACT
CONSIDERED AN “INSURED” SUCH THAT THE
OBLIGEE HAS THE RIGHT TO SUE THE SURETY FOR
BAD-FAITH REFUSAL TO SETTLE CLAIMS UNDER §
624.155(1)(b)(1)?
2. IF SO, DOES THE LANGUAGE IN § 624.155(1)(b)(3)
ELIMINATE § 626.9541's REQUIREMENT OF PROOF OF A
GENERAL BUSINESS PRACTICE WHEN THE PLAINTIFF
IS PURSUING A § 626.9541 CLAIM THROUGH THE
RIGHT OF ACTION PROVIDED IN § 624.155?
3....
...s and Wilma. The claims proceeded to an appraisal. Sandalwood alleges that both Empire and its parent company, Zurich, acted in bad faith in processing Sandalwood's claims thereby violating Florida Statute §§ 624.155(1)(a)(1), 624.155(1)(b)(1) and 626.9541(1)(i)(3), all of which prohibit bad faith actions in claim settlement by insurers....
...laims handling personnel. Sandalwood alleges that by issuing a policy to Sandalwood, through Empire, Zurich is required to comply with the statutory duties of Florida Statute § 624.155 as well as the Unfair Claim Settlement Practices Act (Fla.Stat. § 626.9541)....
...r, statement, sales presentation, omission, comparison, or property and casualty certificate of insurance altered after being issued, which . . misrepresents" the benefits, advantages, conditions, or terms of any insurance policy.”- See Fla. Stat. § 626.9541 (l)(a)....
..., Pursuant to § 624.155, any person may bring a civil action against an insurer when that person *1360 is damaged by the insurer’s violation of certain-enumerated provisions of the Code. See Fla. Stat. § 624.155 (l)(a). While several subsections of § 626.9541 are among the enumerated provisions whose violation gives rise to a private right of action, § '626.9541(l)(a) is not....
...ng more than violations of § 624.155(1)(b), (2) Defendant knew that payment of Plaintiffs claim would have extinguished any cause of action under § 624.155, but it failed to take advantage of the sixty-day safe harbor to do so, and (3) evidence of § 626.9541(1)(i) violations are simply a way of demonstrating violations of § 624.155 that are an intrinsic part of demonstrating a(1)(b) violation. The facts are undisputed regarding the civil remedy notice ("CRN") provided by Plaintiff, and the Court agrees with Defendant that summary judgment is appropriate on the § 626.9541(1)(i) cause of action....
...and honestly toward its insured and with due regard for his or her interests." Section 624.155(1)(a) provides a right of action for an insurer's violation of certain enumerated provisions of Florida's Unfair Insurance Trade Practices Act (Fla. Stat. § 626.9541), including § 626.9541(1)(i)....
...ued." Id., citing Time Ins. Co. v. Burger, 712 So.2d 389, 393 (Fla.1998). In this case, Plaintiff failed to meet a condition precedent plainly set out in the statute because he failed to notify Defendant in the CRN that he was alleging violations of § 626.9541(1)(i)....
...ng the insured's claim. Plaintiff contends that Defendant knew that it had sixty days to pay the claim, but failed to avail itself of the statutory safe harbor. Moreover, Plaintiff argues that even if Plaintiff had included the statutory language of § 626.9541(1)(i), Defendant's coverage opinion would not have changed. Therefore, Plaintiff asserts that allowing it to proceed on the § 626.9541(1)(i) allegations would comport with the purpose of the civil remedy notice "to give the insurer one last chance to settle a claim with its insured and avoid unnecessary bad faith litigation"-because the CRN gave Defendant sufficient noti...
...Westfield Ins. Co., 862 So.2d 774, 779 (Fla. 5th DCA 2003). Plaintiffs CRN did not, however, sufficiently warn Defendant that a separate cause of action would be instituted against it for failure to cure the violations now alleged in Plaintiffs Complaint under § 626.9541(1)(i)....
...t's failure to adopt and implement standards, may be a way to show that Defendant did not, in good faith, attempt to settle the lawsuit, in violation of § 624.155(1)(b), Plaintiff cannot maintain a separate cause of action based upon a violation of § 626.9541(1)(i)....
...tes that the original CRN was filed on a form that included "check-off" boxes for each potential statutory violation, and that Plaintiff checked only the box that corresponded to a violation of § 624.155(1)(b)(1), and did not check the box labeled "626.9541(1)(i)". [7] Plaintiff also argues that § 626.9541(1)(i) is a method for demonstrating violations of § 624.155(1)(b) to the trier of fact....
...Plaintiff opposes the motion (Doc. 33). I. Background Plaintiff 316, Inc., has brought this diversity action against Defendant Maryland Casualty Company, alleging that Defendant has engaged in unfair methods of competition and unfair deceptive acts or practices under Fla. Stat. §§ 626.9541 and 624.155....
...Defendant's alternative request to bifurcate and stay the claim for punitive damages is DENIED AS MOOT. 4. Defendant's alternative request for a conference under Fed.R.Civ.P. 26(f) to address the sequencing of discovery relating to the claim for punitive damages is DENIED AS MOOT. NOTES [1] Fla. Stat. § 626.9541 defines unfair methods of competition and unfair or deceptive acts or practices....
...pursuant to the Civil Remedies Act rather than Florida common law. [5] Section 624.155(1)(a) permits a person to bring a civil action against an insurer when such person is damaged by a violation of any of the following provisions by the insurer: 1. Section 626.9541(1)(i), (o), or (x); 2....
...Measured against what the Court has now divined to be the law of Florida, the Court concludes that there is absolutely no evidence in the language of the UITPA that the Florida legislature intended to create a private cause of action against an insurance company or its agents for violating the specific sliding provisions of section 626.9541(1)(z)....
...he safety or welfare of the public as an entity, will not be construed as establishing civil liability) (citations omitted). *1218 More telling as to the Florida legislature's intent not to create a private right of action premised on a violation of section 626.9541(1)(z), is the fact that it expressly provided for a cause of action for violating other specific provisions of not only the UITPA but also of section 626.9541 itself. Section 624.155(1)(a)1-5 provides in pertinent part that [a]ny person may bring a civil action against an insurer when such person is damaged: By a violation of any of the following provisions by the insurer: Section 626.9541(1)(i), ( o ), or (x); Section 626.9551; Section 626.9705; Section 626.9706; Section 626.9707." Had the Florida legislature wished to include section 626.9541(1)(z) within the ambit of section 624.155(1)(a), it was free to do so....
...e a private right of action with regard to violations of specific provisions of the UITPA implies the legislature intended to exclude the pursuit of a private cause of action with regard to a violation of the other provisions of the UITPA, including section 626.9541(1)(z)....
...uded.") (citing Industrial Fire & Cas. Ins. Co. v. Kwechin, 447 So.2d 1337, 1339 (Fla.1983)). In light of the Court's conclusion that the Florida legislature did not intend to confer a private right of action on an individual claiming a violation of section 626.9541(1)(z) on the part of an insurance company, the Court's order dismissing Plaintiffs' third amended complaint is due to be modified to reflect that determination....
...As a further consequence of that conclusion, Plaintiffs' motion for rehearing and for leave to file a fourth amended complaint must be denied. To allow Plaintiffs to file the proposed fourth amended complaint, which is premised solely on alleged violations of section 626.9541(1)(z), would be an act of futility because the complaint would still be subject to dismissal....
...as allegedly violating Fla. Stat. §§ 624.155(1)(a)(1)
and 624.155(1)(b)(1). Section 624.155(1)(a)(1) provides, in relevant part, that “[a]ny person
may bring a civil action against an insurer when such person is damaged [b]y a violation of . . .
Section 626.9541(1)(i).” Section 626.9541(1)(i) prohibits
[c]ommitting or performing with such frequency as to indicate a general business
practice any of the following:
a....
...ction with a § 624.155 Action The district court also concluded that Dadeland did not present evidence to establish that St. Paul’s alleged conduct constituted a general business practice. The court stated that in order for a plaintiff to bring a § 626.9541(l)(i) action against an insurer—through the conduit of § 624.155—a plaintiff was required to provide evidence that the unfair settlement practice complained of was a “general business practice.” R3-137 at 27. Because Dadeland had failed to allege a general business practice on the part of St. Paul, the court construed Dadeland’s § 626.9541(l)(i) claim as being waived....
...5 Because the Florida Supreme Court had not addressed whether § 624.155 eliminated the need for proof of a general business practice, we certified the following question to the Florida Supreme Court: DOES THE LANGUAGE IN § 624.155(l)(b)(3) ELIMINATE § 626.9541’s REQUIREMENT OF PROOF OF A GENERAL BUSINESS PRACTICE WHEN THE PLAINTIFF IS PURSUING [AN UNFAIR TRADE] CLAIM THROUGH THE RIGHT OF ACTION PROVIDED IN § 624.155? Dadeland, 383 F.3d at 1277 (emphasis omitted)....
...ness practice was eliminated when an unfair trade count was sought pursuant to § 624.155. In light of the answer of the Florida Supreme Court, is clear that Dadeland was not obligated to allege a general busi *807 ness practice in order to assert a § 626.9541 claim through the cause of action provided in § 624.155. The district court erred in concluding otherwise, and in treating Dadeland’s § 626.9541 claim as being waived....
...opinion. 1 . As is discussed subsequently, Florida's Insurance Code allows an insured person to bring an unfair trade action against an "insurer” when the insurer engages in unfair claim settlement practices — that is, a violation of Fla. Stat. § 626.9541 (l)(i)....
...atutory scheme is necessary. With respect to insurance practices, Florida’s unfair trade statute specifically requires proof of a "general business practice” on the part of the insurer to support the plaintiff’s cause of action. See Fla. Stat. § 626.9541 (i)(3). However, Florida’s insurance code, Fla. Stat. § 624.155 (l)(a)(l), separately permits an insured person to bring an action against an insurer for bad faith settlement practices, if the insured person is "damaged ... [b]y a violation of ... section 626.9541(l)(i) ....
...Part X prohibits any "unfair method of competition or an unfair or deceptive act or practice involving the business of insurance." Penalties are prescribed for violations. Included among the prohibited acts of unfair and deceptive insurance practice is "twisting," which is sometimes called "rolling" in insurance matters. Section 626.9541(1)(a), Florida Statutes, states that the unfair and deceptive practice of "twisting" is: Knowingly making any misleading representations or incomplete or fraudulent comparisons or fraudulent material omissions of or with respect to a...
...purpose of inducing, or tending to induce, any person to lapse, forfeit, surrender, terminate, retain, or convert any insurance policy, or to take out a policy of insurance in another insurer. Specific Authority 624.308 FS. Law Implemented 626.797, 626.9541(12) FS....
...eir breach of
contract complaint.
After settling the underlying action, the Bartons filed a first-party bad-faith action
against Capitol, alleging that in handling the Bartons’ sinkhole claim, Capitol violated
sections 624.155(1)(b) and 626.9541(1)(i)3,4 Florida Statutes (2013), by, inter alia, failing
4 Section 626.9541(1)(i)3., Florida Statutes (2013), provides:
626.9541 Unfair methods of competition and unfair or
deceptive acts or practices defined.—
(1) Unfair methods of competition and unfair or
deceptive acts.—The following are de...
Cited 1 times | Published | Florida 1st District Court of Appeal
...tion of the final order by which the department determined that the agency involved herein had violated this statutory provision. We also conclude that federal statutes and regulations do not preempt the department's regulatory authority pursuant to section 626.9541, Florida Statutes....
...The department alleged various violations of chapters 624 and 626, Florida Statutes. It alleged that the appellants had formed an illegal association with Barnett Bank for the purpose of selling life insurance products in Florida, in violation of section 626.988(2). It also alleged that JMC had violated section 626.9541 by engaging in unfair or deceptive acts in the sale of life insurance products through Barnett Bank. At a 120.57(1) hearing, the hearing officer found violations of section 626.9541 in that the appellants had engaged in unfair and deceptive acts, and that James K....
...se that statute by its own terms was specifically aimed at agents and solicitors. The department entered a final order adopting all the hearing officer's findings of fact and most of his conclusions of law. The department concluded that JMC violated section 626.9541(1)(b), based on findings of the hearing officer that JMC failed to adequately *336 inform customers that they were not investing in a Barnett Bank account, but rather were buying an insurance product from insurance agents....
...The appellants contend that the federal laws and regulations which permit national banks to sell annuities preempt state laws which regulate third-party insurance agents who sell such annuities through a contract with a national bank. They specifically contend that such third-party agents may not be regulated pursuant to section 626.9541(1)(b), Florida Statutes....
...l annuities, either as an agent or through a third-party agent, as part of their authority to purchase and sell financial investment instruments. See NationsBank v. Variable Annuity Life Ins. Co., ___ U.S. ___, 115 S.Ct. 810, 130 L.Ed.2d 740 (1995). Section 626.9541 delineates unfair methods of competition and deceptive acts or practices in the insurance industry....
...1142 (1919). Indeed, the sole federal regulation in this area comes from an interagency statement published by the Comptroller of the Currency that is not inconsistent with the state law at issue in this case. Section 24 is not in irreconcilable conflict with section 626.9541(1)(b) such that compliance with both statutes is impossible. Section 24 empowers national banks to sell annuities, while section 626.9541(1)(b) ensures that such annuities are sold in a manner that is not unfair or deceptive....
...The McCarran-Ferguson Act reverses the normal rules of preemption by providing that state laws enacted "for the purpose of regulating the business of insurance" do not yield to conflicting federal statutes unless the federal statute itself "specifically relates to the business of insurance." See 15 U.S.C.A. § 1012(b). Section 626.9541(1)(b) clearly is a law enacted "for the purpose of regulating the business of insurance," and section 24 does not "specifically relate to the business of insurance." Section 24, which contains no reference to insurance or insurance practices, provides national banks with incidental powers....
...Florida's insurance code includes an Unfair Insurance Trade Practices Act ("UITPA") that proscribes the collection of premiums or charges in excess of those allowed under filed or approved rates, or in excess of premiums and charges specified in the policy. See Fla.Stat.Ann. § 626.9541(1)( o )....
...Count I of the amended complaint appears to be identical to the original complaint. It does not reflect the payments made in March and continues to allege that State Farm has refused to pay the claim. Count II attempts to allege a claim under Florida’s Unfair Insurance Trade Practices Act, section 626.9541(1), Florida Statutes (2006), and for “bad faith” under section 624.11, Florida Statutes (2006)....
...ary judgment. See Walters v. CSX
Transp., 778 So. 2d 396, 396 n.1 (Fla. 2d DCA 2001).
-2-
On January 8, 2018, the Homeowners filed a CRN alleging violations of
section 624.155(1)(b)(1) and section 626.9541(1)(i), Florida Statutes (2017)....
...under all the circumstances, it could and should have
done so, had it acted fairly and honestly toward its insured
and with due regard for her or his interests[.]
The statute also provides a civil remedy for violations of specific provisions of section
626.9541....
... argue, the statutory language "or the circumstances giving rise to the violation are
corrected" in section 624.155(3)(d) would apply to other violations not involving the
payment of benefits.
For instance, the Homeowners also alleged a violation of section
626.9541(1)(i)(3)(a) for "[f]ailing to adopt and implement standards for the proper
investigation of claims." The Homeowners requested that the Insurer create and
implement such standards as a remedy....
Published | Court of Appeals for the Eleventh Circuit
...statute. Rosenberg v. Ryder Leasing, Inc., 168 So.2d 678 (Fla. 3d D.C.A.1964); Girard Trust Co. v. Tampashores Development Co., 95 Fla. 1010, 1015-16 , 117 So. 786, 788 (1928). The specific provisions alleged to have been violated here are Fla.Stat. § 626.9541(1)(a) and Fla.Stat. § 626.9541(1)(i)....
...unfair or deceptive acts or practices: (a) MISREPRESENTATIONS AND FALSE ADVERTISING OF INSURANCE POLICIES. — Knowingly making ... or causing to be made ... any ... statement ... which: 1. Misrepresents *1052 the benefits, advantages, conditions or terms of any insurance policy. ****** Section 626.9541(l)(i) provides in part: The following are defined as ......
...intiff gave the insurance company notice of the claim pursuant to that statute. [7] The plaintiff argues further that the court should consider that the defendant's conduct constituted an unfair and deceptive trade practice prohibited by Fla. Stat., § 626.9541 (Doc....
...d and having to present their claims to arbitration. The Sureties removed the case to federal court. The district court interpreted Dade-land’s claim as being both a claim for bad-faith refusal to settle under Fla. Stat. §§ 624.155 (1)(b)(1) and 626.9541(1)(a) (1999), and a breach of contract claim for the Sureties’ failure to timely perform their contractual duties....
...red a general business practice. In order to fully explain this issue, some preliminary discussion of Florida’s statutory scheme is necessary. Dadeland’s complaint states that it is bringing its bad-faith claim under both § 624.155(1)(b)(1) and § 626.9541(l)(i). 2 Section 626.9541(1)(i) explicitly requires proof of a general business practice. However, the right of action to sue based on a violation of § 626.9541(1)(i) is found in § 624.155(1)(a)(1), and § 624.155(1)(b)(3) states, “[njotwithstanding the provisions of the above to the contrary, a person pursuing a remedy under this section need not prove that such act was committed or performed...
...such frequency as to indicate a general business practice.” Dadeland argues that this language applies to § 624.155 in its entirety because of the language “a person pursuing a remedy under this section.” Moreover, Dadeland *1277 argues that § 626.9541 is the only statute incorporated into § 624.155 that requires proof of a general business practice and, thus, § 624.155(l)(b)(8) is meaningless if it does not apply to claims brought under § 626.9541 through § 624.155(l)(a). The Sureties, on the other hand, argue that the language in § 624.155(l)(b)(3) applies only to subsection (b) of § 624.155 and not to subsection (l)(a). Therefore, the Sureties contend that a claim brought under § 626.9541 through § 624.155(l)(a) still requires proof of a general business practice. Because this issue has not yet been addressed by the Florida courts, we also certify the following question to the Supreme Court of Florida: DOES THE LANGUAGE IN § 624.155(l)(b)(3) ELIMINATE § 626.9541’s REQUIREMENT OF PROOF OF A GENERAL BUSINESS PRACTICE WHEN THE PLAINTIFF IS PURSUING A § 626.9541 CLAIM THROUGH THE RIGHT OF ACTION PROVIDED IN § 624.155? Once we have established the requirements of the statute, we must then ask what the effect of the arbitration proceeding was on Dadeland’s right to bring this action....
...: 1. IS THE OBLIGEE OF A SURETY CONTRACT CONSIDERED AN “INSURED” SUCH THAT THE OBLIGEE HAS THE RIGHT TO SUE THE SURETY FOR BAD-FAITH REFUSAL TO SETTLE CLAIMS UNDER § 624.155(l)(b)(l)? 2. IF SO, DOES THE LANGUAGE IN § 624.155(l)(b)(3) ELIMINATE § 626.9541’s REQUIREMENT OF PROOF OF A GENERAL BUSINESS PRACTICE WHEN THE PLAINTIFF IS PURSUING A § 626.9541 CLAIM THROUGH THE RIGHT OF ACTION PROVIDED IN § 624.155? 3....
...QUESTIONS .CERTIFIED.. . Although the district court did not make a determination on this issue, we address it here because it is a threshold issue and because Dadeland raises it in its brief. . This particular issue appears to involve Dadeland's claim under § 626.9541(1)(i) only....
...624.155, Florida Statutes. The Court agrees. Section 624.155 provides in relevant part: (1) Any person may bring a civil action against an insurer when such person is damaged: (a) By a violation of any of the following provisions by the insurer: 1. Section 626.9541(1)(i) ....
...tters or defects of title. The third issue was whether title insurance underwriters, agents, or branches are guilty of offering a special favor, advantage, or monetary consideration as an inducement to sell title insurance as prohibited by Fla.Stat. § 626.9541(8)(c)(1), when they offer immediate disbursement of real estate transaction proceeds without pursuing one of the three alternative disclosure and protection methods provided in the Attorney General's Declaratory Statement # 75-10031....
...Applicability of Talat Plaintiff argues that the Florida Supreme Court clearly limits its decision to actions brought under Fla.Stat. § 624.155(l)(b), and that, because plaintiff has alleged a cause of action under § 624.155(l)(a) for a violation of § 626.9541(l)(i); Talat is inapplicable....
...." Accepting the allegations of Ingraham's amended complaint in a light most favorable to him, see Abrams v. Gen. Ins. Co., 460 So.2d 572, 573 (Fla. 3d DCA 1984), Ingraham's bad faith cause of action is based upon allegations that Travelers violated section 626.9541(1)(i)3, Fla....
...The complaint included a request for attorney’s fees, which are recoverable by a prevailing insured in such a case pursuant to section 627.428, Florida Statutes (1985). On December 17, 1986, the complaint was amended to add a third count (which will be referred to as the bad faith claim) alleging violation of section 626.9541(l)(i)3., Florida Statutes (1985), for engaging in unfair claim settlement practices....
...nsurance regulations. ASIC contends that application of RICO would impair Florida’s regulations because the Florida Legislature has regulated insurance premiums under Fla. Stat. § 627.371 , prohibiting misrepresentations regarding policy terms in § 626.9541(l)(a), false statements relating to insurance in § 626.9541(l)(b) & (e), and “[i]llegal dealings in premiums” in § 626.9541(l)(o). The first group of regulations — Fla. Stat. §§ 627.371 , 626.9541(l)(a), (b), and (e) — do not provide for a private right of action against insurers who violate them....
...Accordingly, a RICO claim — even with its treble damages provision — challenging conduct the Florida Legislature has prohibited will not frustrate Florida’s interest in regulating that conduct, but will, in fact, further that interest. But Florida Statutes § 626.9541(l)(o) (titled “illegal dealings in premiums; excess or reduced charges for insurance”) does provide a private right of action— through Fla....
...rcumstances, it could and should have done so, had it acted fairly and honestly towards Lexington's insured and with due regard for his interest" (DE # 1 at ¶ 23). In addition, Plaintiff alleges that Lexington violated six subsections of Fla. Stat. § 626.9541(1)(i) by: a) Failing to adopt and implement standards for the proper investigation of claims; b) Failing to acknowledge and act promptly upon communications with respect to claims; c) Falling to promptly notify its insured of any addition...
...between its original payment and the appraisal award.
After the appraisal process concluded, Lloyd's of Shelton filed a bad
faith action against Progressive in the circuit court on March 10, 2020,
alleging statutory violations under sections 624.155(1)(b) and 626.9541,
Florida Statutes (2020)....
...applied its discounted pricing parameters[] without consideration of the
prevailing competitive price standards set forth in the insurance policy's
limitation of liability provision." This, the trial court explained, formed a
basis to conclude that Progressive had violated section 626.9541(1)(i)2,
which provides it is bad faith to make a material misrepresentation to an
insured for the purpose of effecting a settlement on less favorable terms
than those provided in the policy," and section 626.9541(1)(i)3.b, which
provides it is bad faith to misrepresent pertinent facts or policy
7
provisions relating to coverages at issue with such frequency as to
indicate a general business practice....
...The trial court found a basis to
conclude that Progressive's misrepresentation also constituted a second
bad faith violation because the letter did not provide a reasonable
explanation in writing for the basis in the policy for the offer to
compromise, in violation of section 626.9541(1)(i)3.f. The trial court
found that there was a basis to conclude Progressive committed a third
bad faith violation by failing to adopt or implement proper standards for
investigating claims, in violation of section 626.9541(1)(i)3.a, because
Progressive's standard "was not much more than the insured pressing a
prompt and being offered a 52% discount off of the NAGS benchmark
price or be 'steered' to a different repair shop." Finally, under the totality...
...Because the letter suggested that Lloyd's of Shelton had rejected
Progressive's price, the trial court found a basis to conclude that
Progressive had made a misrepresentation in violation of the bad faith
statute when it "create[d] a dispute where none exists." See
§ 626.9541(1)(i)2, (1)(i)3.b (listing certain misrepresentations as unfair
claim settlement practices that can give rise to a bad faith violation
under section 624.155(1))....
...Lloyd's of Shelton's services. But that is not a misrepresentation. And
even accepting for the sake of discussion that it could be characterized
as a misrepresentation, it could not be a "material misrepresentation" or
one of "pertinent facts." See § 626.9541(1)(i)2 (providing that an unfair
claim settlement practice occurs when an insurer makes a "material
misrepresentation to an insured . . . for the purpose and with the intent
of effecting settlement of such claim, loss, or damage under such
contract or policy on less favorable terms than those provided in, and
contemplated by, such contract or policy" (emphasis added));
§ 626.9541(1)(i)3.b ("Misrepresenting pertinent facts or insurance policy
provisions relating to coverages at issue." (emphasis added))....
..."
price Progressive had determined it would pay without considering the
policy's limitation of liability provision. To the extent the trial court
concluded that Progressive misrepresented that it had adjusted the loss
when in reality it had not, see § 626.9541(1)(i)2, (1)(i)3.b, that
conclusion is without an adequate record basis....
...3d at 1240.
The trial court also found a basis to conclude that Progressive's
pricing determination amounted to a failure to implement proper
standards for investigation of claims that was willful, wanton and
malicious or in reckless disregard of the insured's rights. See
§ 626.9541(1)(i)3.a (listing the "[f]ail[ure] to adopt and implement
standards for the proper investigation of claims" as an unfair claim
settlement practice that can give rise to a bad faith claim under section
624.155(1))....
...no
investigation.”
The trial court tried to distinguish this case from that of a bad faith case by
saying it was about negligence and omission. Indeed, negligence and omission
fall within the definition of “bad faith” or claims handling. Section 626.9541(1)(i),
Florida Statutes (2024), classifies “[f]ailing to acknowledge and act promptly
upon communications with respect to claims” and “[f]ailing to affirm or deny full
9
or partial coverage of claims ....
...On June 1, 2018, an appraisal award was entered in favor of Appellant
for an amount significantly greater than the payments previously tendered by
FedNat. Appellant filed a complaint against FedNat for violations of section
2
626.9541, Florida Statutes (2018), and in October 2021, he moved to amend
the complaint to add a claim for punitive damages....
...“The claimant may move to amend her or his
complaint to assert a claim for punitive damages as allowed by the rules of
civil procedure.” Id.; accord Fla. R. Civ. P. 1.190(f).
In his complaint, Appellant alleged violations of section
626.9541(1)(i)(3)(a) and (c)—failure to implement standards for proper
3
investigation of claims and failure to act promptly upon communications with
respect to claims....
...Accordingly, he must make a
reasonable showing by evidence in the record or by proffer that the alleged
violations constitute a general business practice and that the acts are in
reckless disregard for his rights as an insured.
In asserting that FedNat’s violations of section 626.9541(1)(i)(3)(a) and
(c) were a general business practice, Appellant primarily relies on the
deposition from FedNat’s vice president of claims, Brian Turnau, taken in
2018 during a separate unrelated case....
...Otherwise, the evidence established that the policies
5
and procedures for investigating and adjusting claims were contained in
FedNat’s claims manual. We conclude that, even if failing to have policies
that are specific to these types of claims violates section 626.9541(1)(i)(3), it
does not demonstrate that the acts giving rise to the violations occur with
such frequency as to establish a general business practice.
Accordingly, we agree with the trial court that Appellant has not made
a reasonable showing that FedNat’s alleged violations of section
626.9541(1)(i)(3)(a) and (c) occurred with such frequency as to indicate a
general business practice....
...ogram Agreement. Id. at ¶ 22; Mot. to Stay [DE 8], at Exh. 2 (Program Agreement, Art. IV). On March 24, 2005, Plaintiff filed this action against Defendant in this court. The Complaint [DE 1] sets forth two claims alleging a violation of Fla. Stat. § 626.9541( o )(2) (Count I) and breach of contract (Count II)....
...Eaton opines that certain provisions of the Program Agreement and the 2003 Addendum thereto appear to violate various sections of the Florida Unfair Insurance Trade Practices Act, Insurance Rating Law, and Workers' Compensation Law, and the regulations thereunder, including Fla. Stat. §§ 626.9541(1)(h), 627.062(1), 627.091, 627.191, 627.211, 627.410, 440.38, and 440.41....
...Financial Services, placing the insurer on notice of its bad faith conduct
and giving the insurer the opportunity to cure. The notice asserted the
insurer violated sections 624.155(1)(b)1. and 3., Florida Statutes (2020),
by failing to settle the claim properly and promptly, and section
626.9541(1)(i)3.a., Florida Statutes (2020), by failing to adopt and
implement standards for the proper investigation of claims.
After additional time passed, the homeowner invoked the policy’s
appraisal process....
...extra-contractual damages
against an insurer. See § 624.155(1)(a) (providing that “[a]ny person may bring a
civil action against an insurer when such person is damaged” by a violation by the
insurer of certain statutory provisions, including section 626.9541(1)(i), Florida
Statutes (2019), which prohibits unfair claim settlement practices);
§ 624.155(1)(b)1., Fla....
Published | Court of Appeals for the Eleventh Circuit
...th; did not conduct a proper investigation of the claim before refusing plaintiffs’ settlement offer; and in sum, employed a *849 course of dealing designed to hold on to its money as long as possible. . Additionally, the jury found a violation of § 626.9541(l)(i), to the extent that Continental failed promptly to provide a reasonable explanation in writing of the basis in the insurance policy for the denial of plaintiffs' claim, or for the offer of a compromise settlement....
...ayment be made by someone other than the agent, but we find no such exclusion in the statute. The only relevant provision is that the payment must be made in cash. It was. The insurance company also cites Sections 626.561, 626.611, 626.753, 626.794, 626.9541, 1 627.403, 627.453, 627.460, and 627.474, Florida Statutes (1981), for the propositions that the insured must pay the premium, or the agent cannot....
...Each case, as the Code of Professional Responsibility supposes, must be considered on its own merits. We find no error in the remaining points on appeal. REVERSED IN PART AND REMANDED WITH INSTRUCTIONS TO ENTER A FINAL JUDGMENT IN ACCORDANCE HEREWITH. HERSEY, J., concurs. ANSTEAD, C.J., specially concurs with opinion. . Section 626.9541 has been renumbered to Section 626.9541(l)(h), Florida Statutes (1983)....
Published | Court of Appeals for the Eleventh Circuit
...ailure to pay;
1
This argument does not join Burger's claim that he simply did without the medical care he
needed.
2
The jury also awarded Burger $500 for unfair claim settlement practices by Time Insurance,
pursuant to Florida Statute § 626.9541.
it did not alter case law which recognized mental anguish damages only in cases of intentional
infliction of emotional distress....
...between its original payment and the appraisal award.
After the appraisal process concluded, Lloyd's of Shelton filed a bad
faith action against Progressive in the circuit court on March 10, 2020,
alleging statutory violations under sections 624.155(1)(b) and 626.9541,
Florida Statutes (2020)....
...applied its discounted pricing parameters[] without consideration of the
prevailing competitive price standards set forth in the insurance policy's
limitation of liability provision." This, the trial court explained, formed a
basis to conclude that Progressive had violated section 626.9541(1)(i)2,
which provides it is bad faith to make a material misrepresentation to an
insured for the purpose of effecting a settlement on less favorable terms
than those provided in the policy," and section 626.9541(1)(i)3.b, which
provides it is bad faith to misrepresent pertinent facts or policy
7
provisions relating to coverages at issue with such frequency as to
indicate a general business practice....
...The trial court found a basis to
conclude that Progressive's misrepresentation also constituted a second
bad faith violation because the letter did not provide a reasonable
explanation in writing for the basis in the policy for the offer to
compromise, in violation of section 626.9541(1)(i)3.f. The trial court
found that there was a basis to conclude Progressive committed a third
bad faith violation by failing to adopt or implement proper standards for
investigating claims, in violation of section 626.9541(1)(i)3.a, because
Progressive's standard "was not much more than the insured pressing a
prompt and being offered a 52% discount off of the NAGS benchmark
price or be 'steered' to a different repair shop." Finally, under the totality...
...Because the letter suggested that Lloyd's of Shelton had rejected
Progressive's price, the trial court found a basis to conclude that
Progressive had made a misrepresentation in violation of the bad faith
statute when it "create[d] a dispute where none exists." See
§ 626.9541(1)(i)2, (1)(i)3.b (listing certain misrepresentations as unfair
claim settlement practices that can give rise to a bad faith violation
under section 624.155(1))....
...Lloyd's of Shelton's services. But that is not a misrepresentation. And
even accepting for the sake of discussion that it could be characterized
as a misrepresentation, it could not be a "material misrepresentation" or
one of "pertinent facts." See § 626.9541(1)(i)2 (providing that an unfair
claim settlement practice occurs when an insurer makes a "material
misrepresentation to an insured . . . for the purpose and with the intent
of effecting settlement of such claim, loss, or damage under such
contract or policy on less favorable terms than those provided in, and
contemplated by, such contract or policy" (emphasis added));
§ 626.9541(1)(i)3.b ("Misrepresenting pertinent facts or insurance policy
provisions relating to coverages at issue." (emphasis added))....
..."
price Progressive had determined it would pay without considering the
policy's limitation of liability provision. To the extent the trial court
concluded that Progressive misrepresented that it had adjusted the loss
when in reality it had not, see § 626.9541(1)(i)2, (1)(i)3.b, that
conclusion is without an adequate record basis....
...3d at 1240.
The trial court also found a basis to conclude that Progressive's
pricing determination amounted to a failure to implement proper
standards for investigation of claims that was willful, wanton and
malicious or in reckless disregard of the insured's rights. See
§ 626.9541(1)(i)3.a (listing the "[f]ail[ure] to adopt and implement
standards for the proper investigation of claims" as an unfair claim
settlement practice that can give rise to a bad faith claim under section
624.155(1))....
...ory claim. The Eleventh Circuit certified 5 questions to the Supreme Court of Florida, which had oral arguments on the questions on March 4, 2010, but has not issued a ruling on them. Chalfonte alleges in this *1303 case that QBE violated Fla. Stat. 626.9541(1) by not attempting in good faith to settle claims when it should have if it had acted fairly and honestly and in various other ways....
...on of the final order by which the department determined that the agency involved herein had violated this statutory provision. We also conclude that federal statutes and regulations do not preempt the department’s regulatory authority pursuant to section 626.9541, Florida Statutes....
...The department alleged various violations of chapters 624 and 626, Florida Statutes. It alleged that the appellants had formed an illegal association with Barnett Bank for the purpose of selling life insurance products in Florida, in violation of section 626.988(2). It also alleged that JMC had violated section 626.9541 by engaging in unfair or deceptive acts in the sale of life insurance products through Barnett Bank. At a 120.57(1) hearing, the hearing officer found violations of section 626.9541 in that the appellants had engaged in unfair and deceptive acts, and that James K....
...that statute by its own terms was specifically aimed at agents and solicitors. The department entered a final order adopting all the hearing officer’s findings of fact and most of his conclusions of law. The department concluded that JMC violated section 626.9541(l)(b), based on findings of the hearing officer that JMC failed to adequately *336 inform customers that they were not investing in a Barnett Bank account, but rather were buying an insurance product from insurance agents....
...The appellants contend that the federal laws and regulations which permit national banks to sell annuities preempt state laws which regulate third-party insurance agents who sell such annuities through a contract with a national bank. They specifically contend that such third-party agents may not be regulated pursuant to section 626.9541(l)(b), Florida Statutes....
...annuities, either as an agent or through a third-party agent, as part of their authority to purchase and sell financial investment in-, struments. See NationsBank v. Variable Annuity Life Ins. Co., — U.S. -, 115 S.Ct. 810 , 130 L.Ed.2d 740 (1995). Section 626.9541 delineates unfair methods of competition and deceptive acts or practices in the insurance industry....
...1142 (1919). Indeed, the sole federal regulation in this area comes from an interagency statement published by the Comptroller of the Currency that is not inconsistent with the state law at issue in this case. Section 24 is not in irreconcilable conflict with section 626.9541(1)(b) such that compliance with both statutes is impossible. Section 24 empowers national banks to sell annuities, while section 626.9541(1)(b) ensures that such annuities are sold in a manner that is not unfair or deceptive....
...hat state laws enacted “for the purpose of regulating the business of insurance” do not yield to conflicting federal statutes unless the federal statute itself “specifically relates to the business of insurance.” See 15 U.S.C.A. § 1012 (b). Section 626.9541(l)(b) clearly is a law enacted “for the purpose of regulating the business of insurance,” and section 24 does not “specifically relate to the business of insurance.” Section 24, which contains no reference to insurance or insurance practices, provides national banks with incidental powers....
...The amended
complaint re-asserted a declaratory judgment claim. The amended
complaint also asserted three new claims: (1) statutory violation of
insurance code sections 627.736(4)(f), Florida Statutes (2002); (2)
statutory violation of insurance code sections 627.736(6)(b) and 626.9541,
Florida Statutes (2002); and (3) statutory violations of insurance code
sections 627.736(11)(f) and 626.9541, Florida Statutes (2002).
In response, United filed its answer and affirmative defenses to the
amended complaint....
...Section 624.155 lists the exact
subsections within Florida’s Unfair Insurance Trade Practices Act that
support a civil remedy. See § 624.155(1)(a)1., Fla. Stat. (2002). The civil
remedy provision allows “any person” to bring a civil action against the
insurer for violating section 626.9541(1)(i), (o), or (x)—i.e., unfair claim
settlement practices, illegal dealings in premiums, and the refusal to
insure....
...insured was involved in an automobile accident unless the insurer has incurred a loss under its policy (other than with respect to uninsured mo *871 torist coverage) or unless the carrier’s file contains sufficient proof of fault for the accident. § 626.9541(l)(o )(3), Fla.Stat....
...In Sentry, the court held that the record did not contain sufficient proof of a relationship between the traffic violation and an increased risk of accident, or proof of fault regarding the traffic accident. Sentry’s decision not to renew thus violated sections 626.9541(l)(o )(3) and 626.9702(1). Sentry is distinguishable. Unlike the insurer in Sentry, State Farm did not violate any statute when it refused to renew Lid-sky’s insurance policy; the non-renewal was amply documented and was not based upon any factors prohibited by sections 626.9541(l)(o )(3), 626.9702(1), or 627.-728(4)(c)....
...Ass’n, 164
So. 3d 663, 667 (Fla. 2015). Section 624.155(1)(a)1. provides:
(1) Any person may bring a civil action against an insurer when such
person is damaged:
(a) By a violation of any of the following provisions by the insurer:
1. Section 626.9541(1)(i), (o), or (x)[.]
Section 626.9541(1)(i), Florida Statutes, in turn, includes a list of unfair
claim settlement practices that may, if properly pled, form the basis of a first-party
bad-faith cause of action....
...For example, allegations that the insurer “fail[ed] to
adopt and implement standards for the proper investigation of claims” and
“den[ied] claims without conducting reasonable investigations based upon
available information,” are elements in support of a party’s claim that the insurer
acted in bad-faith.8 §§ 626.9541(1)(i)(3)(a, d).
However, Citizens is entitled to sovereign immunity from these first-party
bad-faith allegations....
...judgment claims because whether Citizens “fairly” or “properly” investigated or
adjusted the Appellees’ insurance claims are issues that are only relevant in bad-
faith litigation, and Citizens is sovereignly immune from such litigation. See §§
624.155(1)(a)1., 626.9541(1)(i)(3)(a, d); Perdido Sun Condo....
...Ass’n, 164 So.
3d 663, 667 (Fla. 2015). Section 624.155(1)(a)1. provides:
(1) Any person may bring a civil action against an insurer when such
person is damaged:
(a) By a violation of any of the following provisions by the insurer:
1. Section 626.9541(1)(i), (o), or (x)[.]
Section 626.9541(1)(i), Florida Statutes, in turn, includes a list of unfair claim
settlement practices that may, if properly pled, form the basis of a first-party bad-
faith cause of action....
...laims” and “den[ied] claims
without conducting reasonable investigations based upon available information,” are
29
elements in support of a party’s claim that the insurer acted in bad-faith.8 §§
626.9541(1)(i)(3)(a, d).
However, Citizens is entitled to sovereign immunity from these first-party
bad-faith allegations....
...claims because whether Citizens “fairly” or “properly” investigated or adjusted the
Appellees’ insurance claims are issues that are only relevant in bad-faith litigation,
and Citizens is sovereignly immune from such litigation. See §§ 624.155(1)(a)1.,
626.9541(1)(i)(3)(a, d); Perdido Sun Condo....
This Florida statute resource is curated by Graham W. Syfert, Esq., a Jacksonville, Florida personal injury and workers' compensation attorney. For legal consultation, call 904-383-7448.
