Other unfair practices
Here are some more things that can get an agent in trouble...
False statements and entries. This includes filing any false material statement with any supervisory official and knowingly making false entries or leaving out material facts in reports.
Failure to maintain compliant-handling procedures. Complaints are written communication that primarily express a grievance and insurance companies are required to keep records of them since the date of the last market conduct examination.
Advertising gifts permitted. An insurer or agent may give to insureds, prospective insureds, and others, for the purpose of advertising, any article of merchandise having a value of not more than $100.
Life insurance limitations based on past foreign travel experiences or future foreign travel plans. Past lawful foreign travel experiences are not allowed to effect issuance of life insurance, nor is it allowed to limit the amount or type of life insurance coverage available to an individual unless the insurance company can prove to the OIR that it is actuarially supported.
Loan or extension of credit; voluntary selection of insurer. No lender may require, as a condition to lending money or extension of credit, that the person purchase a policy through a particular insurer, agent, or broker. (This is considered coercion as discussed earlier.)
Unfair claims practices
Unfair claims practices include several things, including but not limited to the following:
- Using an application or any other material document that was altered without the knowledge or consent of the insured during the claim settlement
- Not adopting standards for the proper investigation of claims
- Not acting promptly on claims
- Failing to affirm or deny full or partial coverage of claims upon the written request of the insured within 30 days after proof-of-loss statements have been completed
- Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement
- Not promptly notifying the insured of any additional information necessary for the processing of a claim
Fraud
Fraud is an intentionally deceptive act, and anyone who intentionally submits false material facts to an insurance company commits a fraudulent act. This was originally discussed at the end of chapter 3. Remember that the contestable period allows the insurance company to void the policy and return premiums within the first two years.
Fraudulent signatures on an application or policy-related document
Willfully submitting fraudulent signatures on an application or other policy-related document is a third-degree felony.
Proof of loss; fraud statement
All proof-of-loss paperwork must prominently display the following statement:
"Pursuant to subsection 817.234, Florida Statutes, any person who, with the intent to injure, defraud, or deceive any insurer or insured, prepares, presents, or causes to be presented a proof of loss or estimate of cost or repair of damaged property in support of a claim under an insurance policy knowing that the proof of loss or estimate of claim or repairs contains any false, incomplete, or misleading information concerning any fact or thing material to the claim commits a felony of the third degree."