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Department Home | Agent and Agency Home | Insurance Insights Home

  Vol. 10, No. 2 - Fall 2021

Case Notes


Case: Florida Statutes s.626.112(7)(a) requires that an individual, firm, partnership, corporation, association, or other entity shall not operate as an insurance agency under its name or a trade name unless it has first obtained an insurance agency license from the Department.

An investigation was opened after to determine whether an entity was operating without the required license in Florida after the applicant failed to complete the application process.

Investigators contacted an insurer the agency's principal was appointed by and obtained evidence confirming the agency had sold multiple policies to Florida consumers while the agency was unlicensed.

Disposition:
Fined $1,000 and required to obtain an insurance agency license.


Case: The Department received an insurer complaint alleging a health agent submitted fraudulent supplemental health benefit applications allegedly sold to employers who could not offer health benefits to their employees.

The complaint alleged the agent opened new business accounts for two businesses and enrolled a total of 35 "employees" under those accounts. Investigators were able to verify accurate identifying information for only one employee.

Investigators interviewed the agent who admitted the two business accounts were owned by her family members.

The agent received $23,455 in advanced commissions from the sales. The insurer terminated the agent, who owes the full amount of advanced commissions paid to her due to non-payment of premium for the products fraudulently "sold".

Disposition: Suspended for 18 months.


Case: Investigators scheduled a bail bond agency inspection but found the bail bond agent was not in his office during the required, posted business Monday through Friday business hours.

The Department made several attempts to complete the inspection, but the bail bond agent was not at the office when investigators arrived on several occasions. Investigators finally made contact with the bail bond agent and the inspection was completed. The inspection found the bail bond agent failed to keep a daily bond register of written bail bonds and failed to keep individual files for each defendant.

Disposition: Fined $2,500 and placed on probation for one year.


Case: The Department received an insurer's appointment termination for cause of a life, health,variable annuity and general lines agent.

Detailed information about the cause for the termination was received along with documentation to support the insurance company's action.

Investigators discovered the agent used a consumer's credit card to pay personal expenses totaling almost $2,000.The consumer stated he gave his credit card information to the agent to pay his insurance premium. The consumer subsequently discovered charges on his statement that he did not authorize. The consumer discovered the charges and was able to have the charges reversed.

Disposition: License suspended for six months.


Case: The investigation of an agency that specialized in workers' compensation sales sales led to an investigation of a general lines agency.

Investigators obtained an affidavit from the affected consumer, conducted agency inspections and procured extensive documentation from the insurance company and the agency’s bank.

The consumer met with an unlicensed individual who sold him a workers' compensation policy. The unlicensed individual explained the coverage and engaged in a substantive discussion of the consumer's insurance needs.

When the insurance application was submitted to the insurance company, it was signed by the subject of the investigation who worked at a different agency, located in another city. The subject signed the application attesting he met with the insured when, in fact, he had not. The subject later admitted he never met the insured and did not know him. To compound matters, the insured was overcharged $13,215 for premium by the unlicensed individual and the policy was mishandled. The agency sent the consumer a refund check for the premium overcharge after investigators visited the agency.

The subject was charged with aiding and abetting an unlicensed person.

Disposition:
Fined $4,000.


Case: This case was opened after a field investigation on another licensee revealed a life, health, variable annuity and customer representative was marketing insurance using the name of an unlicensed entity.

The investigation revealed the subject solicited insurance products she was not properly licensed or appointed to sell and was sending email solicitations to consumers for referrals offering a $500 gift card raffle for consumers who filled out a survey.

The subject admitted to investigators she was marketing insurance products as an unlicensed agency. The subject agreed to stop the email campaign, take down the unlicensed agency's Facebook page, and correct the unlicensed agency's website. The subject was given 10 days to comply and was told investigators would follow up on her compliance with their instructions. The subject failed to comply with the Department's guidance.

Disposition: $2500 fine and probation for one year.


Case: The Department received a complaint from an insurer against a life, variable annuity and health insurance agent alleging the agent used theft and fraud to qualify for a production-based contest sponsored by the insurance company.

The complaint said the agent used the same checking account on multiple applications for different insureds and different premium payors.

Investigators obtained multiple affidavits from Florida consumers stating they did not authorize the agent to use their bank account information on any other application other than their own.
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In addition, the agent met with consumers and agreed to obtain health insurance coverage through one insurer, but the applications were submitted to another insurance company without the knowledge and consent of the applicants, so the agent could qualify for the contest.

Disposition: License revoked. The agent was later arrested by the Division of Investigative and Forensic Services and charged with organized scheme to defraud, false and fraudulent insurance applications, criminal use of personal identifying information, and grand theft, all 3rd degree felonies. If convicted, the agent faces up to 40 years in prison.




 

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