Case Notes - Fall 2022
Case: This case was opened after our Division of Consumer Services referred a complaint from a consumer who alleged a health insurance agent enrolled her into a health insurance policy without her knowledge or consent and then renewed the fraudulent policy a year later.
Investigators spoke to the agent and sent multiple written requests for copies of his records related to the alleged conduct. The agent agreed to produce the records then advised investigators that he could not fulfill the request for records and stopped responding to the Department. Enforcement action was taken against the agent for failing to provide records to the Department during the course of an investigation as required under s. 624.318(2), F.S.
Disposition: License suspended 90 days. The former agent will be required to reapply for a license. However, the license may not be reinstated if the circumstances that caused the suspension still exist or are likely to recur.
Case: A case was opened on an insurance agency based on a referral from the Department's Division of Consumer Services related to a denied auto insurance claim.
The insured requested the removal of a vehicle from the auto policy, but the agency removed a different vehicle from coverage. Investigators confirmed the vehicle in question was removed from the policy by the agency without the insured's knowledge or consent. The agency was not able to convince the insurance carrier to cover the consumer’s claim, so they made the consumer whole.
Disposition:
The agency's agent in charge was fined $3,500 and placed on probation for one year.
Case: The Bureau of Investigation opened an investigation on a health and general lines agent based on a referral from an entity that is integrated with www.Healthcare.gov. The complaint alleged the agent named herself as the enrolling agent of record for approximately 500 health insurance policies issued through the Federally Facilitated Marketplace (FFM). The agent did not have lawful authority to make the changes, which were made without the knowledge and consent of the insureds.
Investigators obtained extensive insurer documentation, and consumer-insured affidavits as well as interviewing the subject. Not only were the insureds deceived by the subject's actions, but so were the legitimate agents of record for the
policies. The agent of record replacements created a major disruption in the lives of the insureds and a loss of income to the agents who were replaced.
Disposition: License revoked.
Case: The Bureau of Investigation opened investigations on two agents based on a referral from the Department’s Division of Consumer Services. An agent who worked briefly at the same agency as the agents alleged they stole her identity to write more than 750 Accidental Death & Dismemberment (AD&D) policies using her name and license number without her knowledge and consent.
Investigators obtained extensive insurer documentation, bank records, and affidavits from consumers and insurance company personnel. During the course of the investigation, numerous insureds reported they were not aware AD&D policies were issued for them.
The scheme unraveled when the victimized agent received a 1099 tax form indicating she had earned $153,000
in commissions which she never received, making her liable for taxes on the commissions.
Disposition: Both agents were suspended for 24 months and ordered to pay $100,000 in shared restitution to the victimized agent.
Case: Investigators opened case on a public adjuster after his surety bond was cancelled, which is a requirement to maintain his license type. The investigator contacted the public adjuster to advise him a new bond was required and must be submitted
to the Bureau of Licensing within 31 days. The public adjuster failed to submit the new bond.
Disposition: Suspended for 90 days or until the former adjuster complies with the bond requirement.
