Volume 6, No. 7 - July 2017

Case Notes

Bureau of Investigation

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 Investigative and Forensic Services for criminal investigation.

Case: This investigation was opened when the Department was notified a personal lines agent's appointment with an insurer was terminated for cause. Information obtain by investigators determined the agent attempted to add comprehensive and collision coverage to her automobile policy on the same day she was involved in an auto crash. The agent also suggested the other driver do the same, and attempted to coordinate changing the date of the accident with the other driver for claim purposes. In a transcript obtained by investigators from the insurer, the agent admitted to adding the coverage to her policy after the crash. In an interview with investigators, the agent confirmed she added the coverage after the crash occurred.
Disposition: License suspended for 15 months.

Case: An investigation was opened on a general lines agent based on an agency referral alleging misappropriation of policy funds. The agent provided copies of homeowners and flood insurance “policies” to a consumer that contained fraudulent dates and policy numbers. Over a period of three years, the agent collected more than $32,000 in premium for the policies, but never submitted the premiums to the insurers. The diversion of the premium funds and failure to place insurance put the owners of the waterfront property at enormous financial risk for years.
Disposition:  License suspended for 18 months followed by two years' probation.

Case: An investigation against a life, health, variable annuity and general lines agent was opened after investigators conducted a revocation follow-up on another licensee. Investigators gathered evidence and determined the subject had allowed the revoked agent to work in his agency.

Investigators conducted agency inspections, obtained consumer affidavits as well as insurer documentation to establish the revoked agent was actively employed by the subject. Under the agent's supervision, the revoked agent provided homeowner’s insurance quotes, explained coverages and even sold policies to consumers despite being revoked and banned from employment in the insurance business.
Disposition: License suspended six months.

Case: The case was based on a referral from the Division of Forensic Services, Bureau of Insurance Fraud indicating the agent submitted a fraudulent Errors & Omissions (E & O) policy to an insurer. The case investigator contacted the insurance agency that supposedly issued the E&O policy. The company confirmed that the original policy issued was not renewed, and the declaration page was deemed fraudulent. During the course of the investigation, it was discovered the agent also presented the false document to another insurer. Investigators met with the agent who could not produce proof of premium payment for the E&O policy for any time period.
Disposition: License suspended for 12 months. The suspended agent was later arrested by the Division of Investigative and Forensic Services, Bureau of Insurance Fraud, (DIFS) and charged with two counts of Insurance/false/misleading statement/supporting documents, one count of Forgery, two counts of Uttering Forged Instruments and one count of Grand theft, 3rd Degree.

Case: The subject of this investigation, a life, health and variable annuity agent was terminated for cause by an insurer for submitting applications and related documents containing false and fraudulent information. Investigators obtained documentation from the insurer and interviewed both consumers, who revealed they had not applied for insurance.
Disposition: License suspended for six months; restitution to affected insurers ordered.