The following are instances in which licensees or other persons violated the Florida Insurance Code and the administrative action the Department has taken against them. Note: All administrative investigations are subject to referral to the Division of Insurance Fraud for criminal investigation.
Case: A case was opened based on an
anonymous tip from the Division of Investigative and Forensic Services alleging
a general lines agent was issuing fraudulent Certificates of Insurance (COI). An
agency inspection was performed and several files were randomly selected and
reviewed. The investigator contacted the insurance companies named in the COIs,
which confirmed the COI’s were issued by the agent when no coverage was in
effect. However, when the investigator contacted consumers regarding the COIs,
the consumers advised the investigator they were no longer insured with the
agency and had taken their business elsewhere. The investigation revealed the
agent had issued COIs for consumers at renewal without confirming they wanted to
renew their policy. The agent did not collect any premiums prior to issuing the
COIs and did not benefit financially.
Disposition: License suspended for six months followed by one year's probation.
Case: An investigative
case was opened on a life, health and variable annuity agent based on a referral
from the Division of Investigative and Forensic Services alleging the agent was
involved in a scheme of forgery, rebating, misrepresentation, and providing
false underwriting information. During the course of the investigation, evidence
was obtained that proved the agent submitted applications for coverage and
altered the terms of the coverage which the insurer did not authorize. The
applications also contained falsified signatures of the applicants.
Disposition:License suspended for 12 months.
Case: A case was opened after
investigators receive an allegation of fraud from two health insurers,
indicating suspected fraud by a life, health and variable annuity agent. The
insurance companies conducted internal investigations and found 1,300 suspicious
enrollments by the agent for fully subsidized government health exchange plans
without the insureds' knowledge or consent.
Investigators requested documentation from the companies
including the agent's agreement and production runs. The investigators' review
of the agent’s production report and related applications found many insured
addresses were not valid addresses according to the United States Postal
Service. One group of irregularities found indicated the agent used a single
address on 27 separate applications.
Disposition: License revoked.
Case: Investigators received a complaint from
our Division of Consumer Services alleging that an agency owner licensed as a
life, health, variable annuity and general lines agent was allowing an
unlicensed person to transact insurance. Investigators found the unlicensed
employee's Customer Representative's license had expired because he was never
properly appointed. The unlicensed employee purchased the agency but never
applied for a general lines license. Investigators determined that the licensed
agent was only coming into the agency briefly during the day, allowing the
unlicensed owner to operate the agency in his absence, and that the agency phone
was forwarded to the unlicensed owner's home phone line when the agency was
closed. Although the general lines agent sold the agency to the unlicensed
person, he continued to act as the agent in charge as all of the agency's
insurer appointments were in his name.
Disposition: Agent's license suspended for 12 months, agency license suspended for three months.
Case: The source of this complaint was a referral from the Division of Investigative and Forensic Services. The complaint alleged that a life, health, variable annuity and general lines agent fraudulently submitted more than 15 bogus certificates of insurance for workers compensation insurance. Investigators obtained statements from consumers and insurance carrier documentation, and also interviewed the subject of the investigation.
Investigators proved the agent failed to place workers compensation coverage for a business that applied for coverage, and disseminated multiple invalid certificates to a number of unsuspecting municipal government entities throughout Palm Beach County and the Treasure Coast. The certificates contained numerous misrepresentations including fabricated insurance company names and policy numbers.
The agent was arrested by the Division of Investigative and Forensic Services
and charged with 16 counts of uttering a forged instrument.
Disposition: Permanently barred from the insurance business in Florida.
Case: An investigation was opened on a life,
health and annuity agent after Investigators received information from an
insurer alleging the agent altered applications and related documents for a life
insurance policy. Investigators met with the affected consumer, who advised she
received a statement of policy values from the agent that reflected
approximately $100,000 in her policy, but she was suspicious because the
printing on the statement didn't line up. The insured contacted the insurer, and
found her policy value was only $4,700.
Disposition: Fined $3,000, suspended six months.