I. STATE APPELLATE DECISIONS

  1. FLORIDA
  • Smith v. Time Customer Services (Fla 1st DCA). Workers’ Compensation. Judge of Compensation Claims (JCC) erred by entering summary final judgment in favor of the Employer/Carrier (E/C) based on a finding of res judicata because a genuine issue of material fact remained unresolved as to Claimant’s petition for benefits (PFB). Summary judgment reversed on appeal and remanded for final evidentiary hearing. The PFB was for a particular type of mattress for a work-related lumbar spine condition, prescribed by Claimant’s physician after the E/C previously agreed to provide Claimant with an unspecified type of mattress and the Claimant had thereupon voluntarily dismissed his earlier claim for the mattress. The appeals court held that the subsequent prescription and the Claimant’s subsequent PFB base involved "potentially a different benefit from the one agreed to by the E/C” and held that, where several claims due at different times arise out of the same transaction, a judgment as to one or more of such claims will not bar a subsequent action on claims becoming due thereafter.
  1. GEORGIA
  • Parsons v. State Farm Mutual Automobile Insurance Company (Ga App. A12A1839). Uninsured/underinsured Coverage/automobile insurance. Summary judgment in favor of insurer reversed. Genuine issue exists regarding location of driver’s primary residence to determine whether his vehicle was “uninsured motor vehicle” under relative’s uninsured/underinsured automobile insurance policy.

II. FEDERAL APPELLATE DECISIONS

  • Cynergy, LLC v. First American Title Insurance Company (11th Circuit, Ga). Title insurance. Title insurance policy, which excluded losses arising from “defects, liens, encumbrances, adverse claims or other matters . . . created, suffered, assumed or agreed to by the insured claimant,” did not cover damages for lack of ingress-egress to parcel of land, since undisputed facts showed the plaintiff’s insured predecessor in interest had made the acquisition loan with full knowledge of the parcel’s landlocked condition and plaintiff assumed the predecessor’s position knowing of that as well.
  • Duckworth v. AllianzLife Insurance Company of North America, et al. (11th Circuit, Ga). Long term disability insurance. Disability policy provided that benefits payable would be offset by “disability or retirement benefits under the United States Social Security Act, The Canada Pension Plan, The Quebec Pension Plan, or any similar plan or act” received by the insured. Applying Georgia law, the appeals court held that the claimant’s benefits under the Railroad Retirement Act fall within the policy’s offset provision.
  • Mann, et al.v.Unum Life Insurance Company of America (11th Circuit, Fla). Long term care insurance. Class action; removal to federal court under Class Action Fairness Act (CAFA). Insurer did not satisfy CAFA’s jurisdictional amount requirement for removal by relying on estimated future losses the insurer would experience on renewal of the class’s long term care policies at premium rates capped by Florida law because, for purposes of CAFA minimum jurisdictional amount, the value of injunctive or declaratory relief is the monetary value “that would flow to the plaintiffs if the injunction were granted,” not the value of the defendant’s costs. Case ordered remanded to Florida state court.
  • State Farm Mutual Automobile Insurance Company v. Coker, et al. (11th Circuit, Fla). Liability insurance. Insured’s attorney’s fees under section 627.428, Florida Statutes. Insurer sued its insured (Coker) for declaratory judgment that insurer had no duty to defend or indemnify Coker in an underlying negligence suit. The underlying suit was dismissed for fraud on the court in which it was pending. Insurer then filed a suggestion of mootness in the coverage action, and the district court dismissed the coverage action as moot. Coker then sought attorney’s fees against the insurer under section 627.428, Florida Statutes. The appeals court held Coker was not entitled to recover fees under that statute for defending against the coverage action because the insurer’s suggestion of mootness was not the equivalent of a confession of judgment in the coverage action by the insurer.

III. ADMINISTRATIVE LAW/AGENCY DECISIONS

  1. FLORIDA

Failure to Disclose Prior Administrative Action

  • In the Matter of Alpagos Insurance; In the Matter of Atlantic Financial Services; In the Matter of Laura Patricia Robles.

Failure to Disclose Prior Criminal History

  • In the Matter of Timothy Earl Bryson. Final Order. Applicant denied resident customer representative insurance and permanent bar from licensure as nonresident independent property and casualty insurance adjuster and independent motor vehicle physical damage insurance adjuster due to prior federal felony convictions for odometer tampering and conspiracy to violate laws of the United States. Department concluded that crime of odometer tampering fell within the purview of section 626.207(3), Fla. Stat., which permanently bars an applicant from licensure when his or her criminal history includes a felony involving fraud.
  • In the Matter of Michael Cosimo Pepe. Final Order. Applicant denied insurance agent license and 15 year qualification from applying for licensure imposed due to prior criminal history.
  • In the Matter of Etiame Caridid Ramjohn. Final Order. Applicant’s customer service representative license denied and permanent bar for licensure under Florida Insurance Code imposed due to prior criminal history involving felony crimes of moral turpitude.

Misrepresentation

  • In the Matter of George P. Harris. Consent Order. Insurance agent license surrendered and 2 year bar from reapplying for licensure. Department alleged agent misappropriated premium funds collected in the normal course of business belonging to an insurer, failed to forward signed applications and premium to an insurer, conducted business without a valid appointment, failed to maintain a business location which is identifiable and accessible to the public, and failed to submit a change of business address to the Department.

Failure to Timely Renew Insurance Agency Licenses

  • In the Matter of Ed Jacobs Insurance; In the Matter of Cheryl Karr, Inc; In the Matter of Pablo Beach Insurance Group, LLC; In the Matter of Twin Ports Insurance.

Title Insurance

  • In the Matter of Arthur Glen Smith. Consent Order. Title agent discipline. Department alleged that title agent failed to issue title insurance through a licensed and appointed title agency. Discipline imposed: 1 year probation and fine.
  1. GEORGIA
  • DIRECTIVE 13-EXAM-1. All insurers covering property risks in Georgia are required to provide the Office of the Insurance Commissioner the following information for all claims that relate to losses deemed from severe storms that occurred on January 30, 2013: 1) total number of claims reported; 2) total number of open claims; 3) total number of closed claims; 4) total amount of claim paid; and, 5) total amount of incurred losses (including a reasonable estimate for incurred but not reported losses). An initial report of this information is due no later than 12 p.m. on February 5, 2013. In addition, each insurer shall provide updated reports of the requested information once a week starting February 12, 2013 and continuing until April 23, 2013, for a total of 12 weekly reports. Insurers with zero claims may submit only the initial report provided that reporting is resumed if claims are subsequently filed. All data submissions shall be collected electronically via the Department’s company portal. The company portal can be accessed at https://www.oci.ga.gov/SecApps/PortalLogin.aspx.

License Reinstatement Orders

IV. NOTICES OF ADMINISTRATIVE RULEMAKING PROCEEDINGS

  1. FLORIDA
  • Rule 59G-4.110, F.A.C. – Medicaid. The purpose of the proposed amendment to Rule 59G-4.110 is to incorporate by reference the revised Florida Medicaid Hearing Services Coverage and Limitations Handbook, October 2012. With this amendment, the submission of prior authorization requests for the repair and maintenance of the external components of cochlear and BAHA implant will be reassigned to the manufacturer/provider and no longer required of the clinicians. This will eliminate the need for clinicians to purchase the repairs and components from the enrolled manufacturer and then obtain reimbursement from Medicaid. It will also result in policy clarifications for providers and will direct them to other information resources on the Medicaid Web site. A hearing will be held on February 21, 2013, 11:00 a.m. - 12:00 p.m., Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room B, Tallahassee, FL.
  • Rule 59G-4.205, F.A.C. – Medicaid. The purpose of new Rule 59G-4.205 is to incorporate by reference the new Florida Medicaid Practitioner Services Coverage and Limitations Handbook, December 2012. A hearing will be held on March 7, 2013, 3:30 p.m. - 4:30 p.m., Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room A, Tallahassee, FL.
  • Rule 69O-149.003, F.A.C. – Rate Filing Procedures. The Final Public Hearing on the adoption of proposed amendments to Rule 69O-149.003, Florida Administrative Code, published on July 20, 2012 in Vol. 38, No. 29, of the Florida Administrative Register, has been changed from February 7, 2013 to March 4, 2013, 9:00 a.m., during a regular meeting of the Financial Services Commission, Cabinet Meeting Room, Lower Level, The Capitol, Tallahassee, FL.
  1. GEORGIA
  • Notice of Amendments to Regulations 120-2-3-.39, 120-2-3-.25, 120-2-3-.06, 120-2-3-.16 and Public Hearing. The proposed changes to Regulations 120-2-3-.39 seek to incorporate statutory changes made to Title 33, Chapter 23, including changing terminology “portable electronics” for “communications equipment’ and to clarify that the limited license described in the regulation is required only for principal or home offices, but not each business location. The proposed changes to Regulations 120-2-3-.25 and 120-2-3-.06 are being offered consistent with the direction from the Risk Management Agency of the U.S. Department of Agriculture. The proposed change to Regulation 120-2-3-.16 would allow for the automatic assessment of a $150.00 penalty for the untimely filing of license renewals. The text of the proposed regulations is available here. A public hearing is scheduled March 12, 2013, 9:00 a.m., Hearing Room, Office of the Insurance Commissioner, 7th Floor, Floyd Building, Two Martin Luther King, Jr., Drive, Atlanta, GA. Written comments may be submitted by 4:30 p.m., March 8 2013, to Vince Wiegand, Administrative Procedure Division, Office of Commissioner of Insurance, 1016 West Tower, Floyd Buildings, Two Martin Luther King, Jr. Drive, Atlanta, GA.

V. MEETING NOTICES OF INTEREST/MISCELLANEOUS