Florida Regulations 69L-24.007: Pattern and Practice
Current as of: 2024 | Check for updates
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(1) A pattern or practice constitutes a willful violation if the regulated entity that committed the pattern or practice:
(a) Did so intentionally and with knowledge of the act’s unlawfulness or with disregard to the unlawfulness of the act; or
(b) Failed to comply with an order of the Department and the insurer has exhausted all appellate rights.
(2) The penalties assessed under subsection (1) of this rule shall be $20,000 for a single willful violation and not exceed an aggregate of $100,000 for all pattern or practice violations arising out of the same action.
(3)(a) The Department shall issue a non-willful violation for a pattern or practice of unreasonable claims handling for any monitoring, examining, or investigating review activity listed in subsection 69L-24.004(2), F.A.C. For each such non-willful violation, a penalty of $2,500 shall be assessed against the insurer by the Department, with such fines not exceeding an aggregate of $10,000 for all pattern or practice violations arising out of the same action. Any penalty imposed under this paragraph for a non-willful violation shall not duplicate a penalty imposed under another provision of Florida Statutes Chapter 440 or Department Rules governing Florida Workers’ Compensation law.
(b) The Department will calculate a regulated entity’s performance in order to determine if a non-willful violation will be assessed for a pattern or practice of unreasonable claims handling. If the performance falls below 90% compliance during an audit, examination or investigation, except as otherwise stated in Florida Statutes Chapter 440 and Department Rules, the Department shall assess a penalty pursuant to subsection (3), herein.
Rulemaking Authority 440.13, 440.185(9), (10), 440.20(6), 440.525(4), 440.591, 440.593(5) FS. Law Implemented 440.13(11), 440.185, 440.20(6), (8), 440.525, 440.593 FS. History-New 1-12-10.
Terms Used In Florida Regulations 69L-24.007
- Appellate: About appeals; an appellate court has the power to review the judgement of another lower court or tribunal.
(b) Failed to comply with an order of the Department and the insurer has exhausted all appellate rights.
(2) The penalties assessed under subsection (1) of this rule shall be $20,000 for a single willful violation and not exceed an aggregate of $100,000 for all pattern or practice violations arising out of the same action.
(3)(a) The Department shall issue a non-willful violation for a pattern or practice of unreasonable claims handling for any monitoring, examining, or investigating review activity listed in subsection 69L-24.004(2), F.A.C. For each such non-willful violation, a penalty of $2,500 shall be assessed against the insurer by the Department, with such fines not exceeding an aggregate of $10,000 for all pattern or practice violations arising out of the same action. Any penalty imposed under this paragraph for a non-willful violation shall not duplicate a penalty imposed under another provision of Florida Statutes Chapter 440 or Department Rules governing Florida Workers’ Compensation law.
(b) The Department will calculate a regulated entity’s performance in order to determine if a non-willful violation will be assessed for a pattern or practice of unreasonable claims handling. If the performance falls below 90% compliance during an audit, examination or investigation, except as otherwise stated in Florida Statutes Chapter 440 and Department Rules, the Department shall assess a penalty pursuant to subsection (3), herein.
Rulemaking Authority 440.13, 440.185(9), (10), 440.20(6), 440.525(4), 440.591, 440.593(5) FS. Law Implemented 440.13(11), 440.185, 440.20(6), (8), 440.525, 440.593 FS. History-New 1-12-10.