Florida Senate - 2009                                     SB 962
       
       
       
       By Senator Gaetz
       
       
       
       
       4-00960-09                                             2009962__
    1                        A bill to be entitled                      
    2         An act relating to insurance; amending s. 626.9541,
    3         F.S.; providing that it is an unfair claim settlement
    4         practice for an insurer to fail to adopt and implement
    5         standards for the proper adjustment of claims with
    6         such frequency as to indicate a general business
    7         practice; providing an effective date.
    8         
    9  Be It Enacted by the Legislature of the State of Florida:
   10         
   11         Section 1. Paragraph (i) of subsection (1) of section
   12  626.9541, Florida Statutes, is amended to read:
   13         626.9541 Unfair methods of competition and unfair or
   14  deceptive acts or practices defined.—
   15         (1) UNFAIR METHODS OF COMPETITION AND UNFAIR OR DECEPTIVE
   16  ACTS.—The following are defined as unfair methods of competition
   17  and unfair or deceptive acts or practices:
   18         (i) Unfair claim settlement practices.—
   19         1. Attempting to settle claims on the basis of an
   20  application, when serving as a binder or intended to become a
   21  part of the policy, or any other material document which was
   22  altered without notice to, or knowledge or consent of, the
   23  insured;
   24         2. A material misrepresentation made to an insured or any
   25  other person having an interest in the proceeds payable under
   26  such contract or policy, for the purpose and with the intent of
   27  effecting settlement of such claims, loss, or damage under such
   28  contract or policy on less favorable terms than those provided
   29  in, and contemplated by, such contract or policy; or
   30         3. Committing or performing with such frequency as to
   31  indicate a general business practice any of the following:
   32         a. Failing to adopt and implement standards for the proper
   33  investigation and adjustment of claims;
   34         b. Misrepresenting pertinent facts or insurance policy
   35  provisions relating to coverages at issue;
   36         c. Failing to acknowledge and act promptly upon
   37  communications with respect to claims;
   38         d. Denying claims without conducting reasonable
   39  investigations based upon available information;
   40         e. Failing to affirm or deny full or partial coverage of
   41  claims, and, as to partial coverage, the dollar amount or extent
   42  of coverage, or failing to provide a written statement that the
   43  claim is being investigated, upon the written request of the
   44  insured within 30 days after proof-of-loss statements have been
   45  completed;
   46         f. Failing to promptly provide a reasonable explanation in
   47  writing to the insured of the basis in the insurance policy, in
   48  relation to the facts or applicable law, for denial of a claim
   49  or for the offer of a compromise settlement;
   50         g. Failing to promptly notify the insured of any additional
   51  information necessary for the processing of a claim; or
   52         h. Failing to clearly explain the nature of the requested
   53  information and the reasons why such information is necessary.
   54         4. Failing to pay undisputed amounts of partial or full
   55  benefits owed under first-party property insurance policies
   56  within 90 days after an insurer receives notice of a residential
   57  property insurance claim, determines the amounts of partial or
   58  full benefits, and agrees to coverage, unless payment of the
   59  undisputed benefits is prevented by an act of God, prevented by
   60  the impossibility of performance, or due to actions by the
   61  insured or claimant that constitute fraud, lack of cooperation,
   62  or intentional misrepresentation regarding the claim for which
   63  benefits are owed.
   64         Section 2. This act shall take effect July 1, 2009.