Florida/Georgia Personal Injury & Workers Compensation

...[7] We also do not reach the issue of whether the entire amount of PIP coverage would be invalidated based on any fraudulent submission of a PIP bill because that issue is not before us. We recognize, of course, that this State strongly discourages insurance fraud. See, e.g, § 626.989, Fla. Stat. (1997) (recognizing and empowering the Division of Insurance Fraud); § 626.9891, Fla....

...Davidson, Florida Department of Insurance, Tallahassee, for Appellee. VAN NORTWICK, J. Accelerated Benefits Corp. (ABC) challenges a final order of the Department of Insurance which revoked ABC's license to operate as a viatical settlement provider. ABC argues that the statute which it was charged with violating, section 626.989(6), Florida Statutes (2000), is unconstitutionally vague on its face and as applied....

...ment that they did have certain medical condition directly contrary to each viator's representations on a life insurance application. Given this knowledge on the part of ABC, the Department submitted that ABC was obliged to make a report pursuant to section 626.989(6)....

...period [of the policy], and also paid the viator's premiums in the interim. The ALJ recommended that appellant's license be revoked. The Department agreed and issued a final order so providing. ABC now seeks reversal of the final order, arguing that section 626.989(6) is unconstitutionally vague because it requires a party to divine the intent of a third party. Section 626.989(6) provides in pertinent part: Any professional practitioner licensed or regulated by the Department of Business and Professional Regulation, except as otherwise provided by law, any medical review committee as defined in s....

..., such exactly replicates the everyday experience of our criminal courts. We see no reason why a public employee should be entitled to a greater degree of protection than a criminal defendant. Goin, 658 So.2d at 1136. Here, the legislature has drawn section 626.989(6) more narrowly than the statute *121 considered in Barker and Goin. Section 626.989(6) did not require appellant to determine the intent of the viators to commit a crime. Section 626.989(6) requires only that the regulated party have knowledge of an act which would constitute a violation, if committed with the requisite intent. A party alleged to have violated section 626.989(6) can defend against such an allegation by offering evidence that it did not have knowledge of the commission of an offense under the code....

...That the issue of knowledge may require an inference from circumstantial evidence is a matter affecting the weight of the evidence, not the constitutionality of a statute. Because we have no difficulty in concluding that appellant's conduct falls within the ambit of section 626.989(6), we need not address the myriad of possible applications of this statute....

...This was an action for malicious prosecution against USF & G and its superintendent of claims, George Woodward. USF & G and Woodward answered Pearce's malicious prosecution claim by denying its allegations and as an affirmative defense alleged their immunity from suit for malicious prosecution, pursuant to section 626.989, Florida Statutes (1981)....

...observed from claims files handled by Pearce indications of possible claims fraud; that USF & G informed the Division of Insurance Fraud of what it had discovered, and, as requested, furnished further information; that this conduct is called for by section 626.989(5), Florida Statutes; that the Division of Insurance Fraud investigated the suspicious-appearing claims and determined there had been fraud; that some of the participants confessed and one or more implicated Pearce; that on the basis...

...formation against Pearce and others; that Woodward testified for the state at trial; and that Pearce was ultimately acquitted of the criminal charges, and subsequently initiated his present subject claim. The issue is whether the immunity granted by section 626.989(6), Florida Statutes (1981), extends to the conduct of the appellees that was the foundation of appellant's claim. We conclude that it does. Section 626.989(5), Florida Statutes (1981), requires an insurance company to notify the Division of Insurance, on the prescribed Florida Department of Insurance form, of any fraudulent claim it believes is being made, and to supply the Department with such additional relevant information as it may require. Section 626.989(6), Florida Statutes (1981), immunizes the insurer and its employees and agents from liability for libel "or otherwise," for complying with the statute or furnishing the Division with other information it requires under authority granted it in the statute....

...izes appellees from an action for malicious prosecution, rather than as showing an element of malicious prosecution to be lacking. There appears to be no case law to instruct us on the extent of the immunity furnished insurers and their employees by section 626.989(6). We think comparison of that section with the protection afforded merchants or their employees and law enforcement authorities by section 812.015(3), Florida Statutes, may help us determine the scope of the immunity under section 626.989(6)....

...anner and duration of the detention. It has been determined that the protection of section 812.015 does not extend to claims of malicious prosecution. Weissman, 396 So.2d at 1167. A comparison of the operative language of section 812.015 and that of section 626.989 reveals much. Section 812.015 speaks specifically to civil or criminal liability for "false arrest, false imprisonment, or unlawful detention." § 812.015(3)(c). Section 626.989(6), on the other hand, speaks to "civil liability for libel or otherwise." Section 812.015 creates an immunity for the persons specified, if they have conformed with the stated requirements, from both civil and criminal prosecution for three stated torts and crimes. Section 626.989(6) immunizes specified persons, if they have done what the section requires or what the Insurance Fraud Division requires pursuant to its authority under the statute, only *753 from civil actions, but these actions are identified as "...

...Moreover, Saenz had submitted receipts for the rental of two storage units following the hurricane, and Goldsmith learned that one of these units' had been rented eight months prior to the hurricane. By the end of December, 1993, Saenz had yet to submit her renovation receipts and Goldsmith, pursuant to section 626.989(6), Florida Statutes, referred Saenz’s claim to the Department of Insurance, Division of In- *66 suranee Fraud (“DIF”)....

...They also filed a motion for summary judgment for the malicious prosecution and negligent hiring claims. Following a hearing, the court granted the motion for summary judgment and entered final summary judgment, finding as a matter of law that State Farm and Goldsmith were immune from liability under Florida Statute 626.989, the Insurance Fraud Statute....

...The court also found that State Farm and Goldsmith were entitled to judgment on the claim for malicious prosecution, because Saenz “failed to present evidence” that the defendants instituted or continued a criminal prosecution. This appeal followed. Section 626.989 provides insurers and their employees immunity from civil actions, absent fraud or bad faith, arising out of the furnishing of information required by the statute....

...For any information relating to suspected fraudulent insurance acts furnished to or received from other persons subject to the provisions of this chapter; or 3. For any such information furnished in reports to the department, division, or the National Association of Insurance Commissioners. § 626.989(4)(c), Fla....

...Term 2002)(“Since plaintiff *68 has not presented evidentiary proof of fraud or bad faith in either the allegations of the complaint or in papers opposing [summary judgment], the Court grants ... summary judgment[.]”). See also Pearce v. U.S. Fid. & Guar. Co., 476 So.2d 750, 752-53 (Fla. 4th DCA 1985)(“Section [626.989(4)(c) ] immunizes specified persons, if they have done what the section requires or what the Insurance Fraud Division requires pursuant to its authority under the statute ......

...Accordingly, dismissal was proper. Affirmed. . Saenz contends that she provided Goldsmith with a summary of her expenses. Goldsmith, however, claims that he told Saenz that State Farm required documentation reflecting the renovations, not an unverified summary. . Section 626.989(6) provides in pertinent part that: any insurer, agent, or other person licensed under the code, or an employee thereof, having knowledge or who believes that a fraudulent insurance act or any other act or practice which, upon conviction, constitutes a felony or a misdemeanor under the code, or under s. 817.234, is being or has been committed shall send to the Division of Insurance Fraud a report or information pertinent to such knowledge or belief and such additional information relative thereto as the department may require. § 626.989(6), Fla....

...assistance program); § 415.1113(10), Fla. Stat. (2013) (providing information to a central abuse hotline); § 429.28(7), Fla. Stat. (2013) (describing services and conditions in assisted care facilities); § 560.123(3)(d), Fla. Stat. (2013) (filing a report on money laundering); § 626.989(4)(c), Fla....

prohibition in s. 5(a), Art. II, State Const. Section 626.989(7), F.S. (1990 Supp.), authorizes investigators

Section 790.25(4), Florida Statutes (1993). 4 Section 626.989(7), Florida Statutes (1983). 5 Id. 6 Supra

statute which it was charged with violating, section 626.989(6), Florida Statutes (2000), is unconstitutionally

...Supplemental information furnished with your request indicates that the Department of Insurance has attempted during the past several legislative sessions to obtain legislative authorization for the Division of Insurance Fraud investigators to carry firearms in the performance of their duties as provided in s 626.989 , F.S....

...These materials suggest that in view of the definition of "law enforcement officer" contained in s 790.001 (8)(a), F.S., and the provisions of s 790.25 (3)(d) and (4), F.S., such legislative authorization is not needed, and further suggest that the cited statutes, all of which antedate the enactment of present s 626.989 (7), F.S., by s 2 of Ch. 78-258, Laws of Florida, make s 626.989 (7) subservient thereto or supersede any law in conflict therewith. Section 626.989 (7), F.S., brought into the statutes by s 2, Ch....

...These provisions do not operate to make or denominate such investigators "peace officers" or "law enforcement officers;" they only make the laws applicable to arrests by peace officers applicable also to division investigators. The last sentence of s 626.989 (7) specifically provides that the division investigators "empowered to make arrests under this section shall not be empowered to carry firearms or other weapons in the performance of their duties." Since they are not empowered to carry firea...

...This office is without power to authorize or sanction the division investigators' exercise of the power to carry firearms or other weapons in the performance of their duties in disregard of the specific legislative direction contained in the last sentence of s 626.989 (7), F.S., which withholds such power from such investigators. Nor does this office possess the power to decree by executive edict or effect an implied modification or repeal of s 626.989 (7) due to the provisions of ss 790.001 (8)(a), 790.051 , and 790.25 (3)(d) and (4), F.S. Absent a judicial determination that the cited provisions of Ch. 790 , F.S., operate to effect an implied modification or repeal of s 626.989 (7), or part thereof, the latter may be effectively amended or repealed only by the Legislature. As noted above, the cited provisions of Ch. 790 , F.S., antedate the enactment of s 626.989 (7), F.S. If any irreconcilable conflict exists between s 626.989 (7) and the cited provisions of Ch....

...vail to the extent of any such conflict. See, e.g., Albury v. City of Jacksonville, 295 So.2d 297 (Fla. 1974); De Coningh v. City of Daytona Beach, 103 So.2d 233 (1 D.C.A.Fla., 1958); Overstreet v. Ty-Tan, Inc., 48 So.2d 158 (Fla. 1950). Moreover, s 626.989 (7) deals particularly and specifically with the Division of Insurance Fraud's investigative powers and the powers of its investigators while Ch....

...of New York v. Bedingfield, 60 So.2d 489 (Fla. 1952); Liggett Drug Co. v. Gay, 29 So.2d 623 (Fla. 1947). Accordingly, unless and until legislatively provided or judicially determined otherwise, it is my opinion that under the distinct and specific terms of s 626.989 (7), F.S., which particularly pertains to and provides that investigators of the Division of Insurance Fraud of the Department of Insurance are not empowered to carry firearms or other weapons in the performance of their duties, such division...

...cquitted of charges of making a false statement in support of an insurance claim and grand theft arising from statements Frazier made to Hanover in connection with an insurance claim. Hanover and Arline responded, asserting immunity from suit under section 626.989(4)(c), Florida Statutes (2011), which provides immunity from civil liability to persons furnishing information related to suspected fraudulent insurance acts....

...required to establish and maintain an "anti-fraud investigative unit" or division, commonly called a special investigations unit (SIU), to investigate and report possible fraudulent insurance acts by insureds or by persons making claims against policies held by insureds. See § 626.9891(1).2 If an insurer has knowledge or believes that a fraudulent insurance act that would be a felony or misdemeanor has been committed, it must send a report to the Division of Investigative and Forensic Services ("DIFS"), a unit of the De...

...ey have pursued in this appeal as well. We need not reach the issue because our determination that Hanover and Arline had immunity from suit is dispositive. 2 In the current version of the statute, this provision appears in subsection (2). See § 626.9891(2), Fla. Stat. (2023). 2 Services, detailing the information it has giving rise to its suspicion. See § 626.989(6).3 This reporting is mandatory....

...violation. Id. If the state attorney does not begin a prosecution within sixty days after receiving the report, or if it declines to prosecute, it must inform DIFS of the reasons. Id. As part of this legislatively mandated anti-fraud program, section 626.989(4)(c) provides insurers and their employees immunity from civil actions, absent fraud or bad faith, arising out of the furnishing of the information required by the statute: (c) In the absence of fraud or bad faith, a person is...

...For any information relating to suspected fraudulent insurance acts or persons suspected of engaging in such acts furnished to or received from other persons subject to the provisions of this chapter; 3 In the current version of the statute, subsection (6) is divided into parts (a)–(c). See § 626.989(6)(a)–(c), Fla....

...toll plaza, he concluded that the damage to the passenger side of Grant's car was not caused by the collision with Williams.6 Thus, he concluded Grant should have filed two claims with Hanover, not one, and been subject to two deductibles. As required by section 626.989(6), Arline filed a report with DIFS, noting in the report that it was a supplement or duplicate of the report Williams had filed several months earlier. As part its investigation, DIFS's investigator, Tom Eberhart, interviewed Wi...

...this action for malicious prosecution against Hanover and Arline.7 On appeal, Hanover and Arline argue the trial court erred in denying their claims of immunity because all Arline did was investigate and report the suspected fraud as he was statutorily required to do. See §§ 626.989, 626.9891....

...caused by the collision with Williams. Because this information gave Arline a basis to believe that Frazier had made a false statement in connection with Grant's claim, pursuant to the anti-fraud statute he was required to supply the information he had gathered to DIFS. See § 626.989(6). Absent fraud or bad faith, section 626.989(4)(c) immunizes insurers and their employees if they have done what is required by the anti-fraud statute....

...cquitted of charges of making a false statement in support of an insurance claim and grand theft arising from statements Frazier made to Hanover in connection with an insurance claim. Hanover and Arline responded, asserting immunity from suit under section 626.989(4)(c), Florida Statutes (2011), which provides immunity from civil liability to persons furnishing information related to suspected fraudulent insurance acts....

...required to establish and maintain an "anti-fraud investigative unit" or division, commonly called a special investigations unit (SIU), to investigate and report possible fraudulent insurance acts by insureds or by persons making claims against policies held by insureds. See § 626.9891(1).2 If an insurer has knowledge or believes that a fraudulent insurance act that would be a felony or misdemeanor has been committed, it must send a report to the Division of Investigative and 1 Hanover and Arline also unsuccessf...

...ey have pursued in this appeal as well. We need not reach the issue because our determination that Hanover and Arline had immunity from suit is dispositive. 2 In the current version of the statute, this provision appears in subsection (2). See § 626.9891(2), Fla. Stat. (2023). 2 Forensic Services ("DIFS"), a unit of the Department of Financial Services, detailing the information it has giving rise to its suspicion. See § 626.989(6).3 This reporting is mandatory....

...violation. Id. If the state attorney does not begin a prosecution within sixty days after receiving the report, or if it declines to prosecute, it must inform DIFS of the reasons. Id. As part of this legislatively mandated anti-fraud program, section 626.989(4)(c) provides insurers and their employees immunity from civil actions, absent fraud or bad faith, arising out of the furnishing of the information required by the statute: (c) In the absence of fraud or bad faith, a person is...

...agents, or employees; 2. For any information relating to suspected fraudulent insurance acts or persons suspected of engaging in such acts 3 In the current version of the statute, subsection (6) is divided into parts (a)–(c). See § 626.989(6)(a)–(c), Fla....

...toll plaza, he concluded that the damage to the passenger side of Grant's car was not caused by the collision with Williams.6 Thus, he concluded Grant should have filed two claims with Hanover, not one, and been subject to two deductibles. As required by section 626.989(6), Arline filed a report with DIFS, noting in the report that it was a supplement or duplicate of the report Williams had filed several months earlier. As part its investigation, DIFS's investigator, Tom Eberhart, interviewed Wi...

...this action for malicious prosecution against Hanover and Arline.7 On appeal, Hanover and Arline argue the trial court erred in denying their claims of immunity because all Arline did was investigate and report the suspected fraud as he was statutorily required to do. See §§ 626.989, 626.9891....

...caused by the collision with Williams. Because this information gave Arline a basis to believe that Frazier had made a false statement in connection with Grant's claim, pursuant to the anti-fraud statute he was required to supply the information he had gathered to DIFS. See § 626.989(6). 7 The charges against Grant were dropped before trial. 7  Absent fraud or bad faith, section 626.989(4)(c) immunizes insurers and their employees if they have done what is required by the anti-fraud statute....