Fla. Admin. Code Ann. R. 69L-24.007 - Pattern and Practice
Current through Reg. 47, No. 249; December 28, 2021
(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
Chapter 440, Florida Statutes 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
Chapter 440, Florida Statutes and Department Rules, the Department shall assess
a penalty pursuant to subsection (3) herein.
Notes
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