I. STATE APPELLATE DECISIONS
- Ake v. U.S. Sugar and Gallagher Bassett Services, Inc. (Fla. 1st DCA). Workers’ compensation; timeliness of appeal. Claimant’s Notice of Appeal filed February 7, 2013 challenging a “final evidentiary order” entered February 6, 2012 dismissing with prejudice his claims for permanent total disability (PTD) dismissed as untimely. The February 6, 2012, order was a final appealable order under Florida Rule of Appellate Procedure 9.180(b)(1), which order was not appealed within 30 days of rendition. In the context of a workers’ compensation case, an order that decides all issues then ripe for adjudication is considered to be a “final order”, even if the order does not represent an end to all judicial labor in the case, and even where additional claims not then ripe for adjudication remain pending. The Judge of Compensation Claims (JCC), by finally ruling on the PTD benefits in the February 2012 order, and by not ruling on unmediated claims for temporary disability benefits (TDB) and directing that such claims proceed to mediation (an unmet condition precedent to the conduction of a merit hearing on the claims), entered an order that finally adjudicated all claims ripe for adjudication, reserving upon those claims not ripe for adjudication.
- Boston v. Publix Super Markets, Inc. et al. (Fla. 4th DCA). Worker's compensation immunity. Appeal by decedent’s estate of trial court’s final summary judgment in favor of Employer and Employee. Employer entitled to immunity under section 440.11, Fla. Stat. because Employer’s conduct was not virtually certain to produce injury or death, thus failing to meet the statutory exception to immunity. However, as to the Employee, material issues of fact remained as to whether Employee was grossly negligent, an exception to employee statutory immunity under section 440.11(1), Fla. Stat. Summary judgment in favor of Employee reversed and remanded for further proceedings on the claim of gross negligence.
- Citizens v. Zunjic (Fla. 3d DCA). Homeowners’ insurance; appraisal. Trial court order compelling insurer to appraisal improper. Insurance policy appraisal clause required, as a condition precedent, that the parties enter into a written agreement setting forth the terms of the appraisal. Insured failed to respond to insurer concerning proposed appraisal agreement and never executed an appraisal agreement. Florida law does not require an insurer to participate in appraisal absent a written agreement between the two parties. What is appraised and whether a party can be compelled to appraisal depend on the contract provisions.
- Gira v. Wolfe (Fla. 2d DCA). Automobile insurance; settlement. Auto insurance; settlement; conditions of claimant’s offer. Where claimant’s offer of settlement to insurer was conditioned on disclosure of the name and coverage of each known insurer by the insured and her insurance agent, but insured did not provide such information before the deadline for the insurer to accept claimant’s offer expired, no enforceable settlement agreement was formed.
- Phillips-Huter v. Amstaff HR (Fla. 1st DCA). Workers' compensation. Order of Judge of Compensation Claims (JCC) denying entitlement to permanent total disability (PTD) benefits reversed. The JCC erred in applying section 440.093, Fla. Stat., to this case because section 440.093, Fla. Stat., presents the test for compensability of psychiatric injuries, and, here the Employer/Carrier did not challenge compensability of Claimant’s psychiatric injury.
- Universal Property and Casualty Insurance Company v. Johnson (Fla. 1st DCA). Homeowners’ insurance; misrepresentation. Trial court erred in granting summary judgment which found that based on the policy language, the insurer was required to prove at trial that the insured’s misrepresentation concerning her criminal history was intentional and that the insurer was entitled to rescind the insurance contract based only upon the commission of an intentional misrepresentation which was material to the acceptance of the risk. The First District Court of Appeal found that the insurance policy at issue did not impose a more stringent standard for voiding a policy that provided by section 627.409, Fla. Stat. Under the policy at issue and under section 627.409(1), Fla. Stat., a misrepresentation need not be fraudulently or knowingly made but need only affect the insurer’s risk or be a fact, which, if known, would have caused the insurer not to issue the policy or not issue it in so large an amount.
- St. Paul Fire and Marine Insurance Company v. Hughes (Ga. Ct. of App., 2nd Division). Commercial excess and umbrella insurance. Trial court properly denied insurer’s cross-motion for summary judgment that Indiana law applied and properly granted insured’s employee’s motion for partial summary on limited issue whether insurance policy (Policy) provides UM coverage. At the time of the accident, Georgia’s Uninsured Motorist Statute applied to excess and umbrella insurance and required that any motor vehicle liability policy issued or delivered by an insurer licensed in Georgia upon any motor vehicle then principally garaged or principally used in Georgia contain an endorsement or provisions providing the insured Uninsured Motorist coverage. The insured was licensed in Georgia, the vehicle involved in the accident was principally garaged in Georgia, and there was no written rejection of UM benefits for the Policy. Furthermore, the Policy’s UM exclusion was void because it conflicted with the plain terms of O.C.G.A. § 33-7-1.
II. FEDERAL APPELLATE DECISIONS
- No opinions reported.
III. ADMINISTRATIVE LAW/AGENCY DECISIONS
- Florida Office of Insurance Regulation Issues Order Seeking to Suspend AGIC, Inc. The Order asserts that AGIC is in an unsound financial condition. AGIC has 21 days from the date of receipt of the Order to request a hearing.
- No Georgia agency decisions reported.
IV. NOTICES OF ADMINISTRATIVE RULEMAKING PROCEEDINGS
- Rule No 59G-4.015, F.A.C. - Ambulance Transportation Services. Notice of Change published.
- Rule 59G-4.085, F.A.C. – Medicaid Early Intervention Services Coverage and Limitation Handbook. The Agency scheduled a public meeting on May 16, 2013, from 2:00 p.m. to 4:00 p.m., Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room D, Tallahassee, FL, to discuss the existing August 2007 version of the Florida Medicaid Early Intervention Services Coverage and Limitations Handbook located on the Medicaid fiscal agent’s Web site at www.mymedicaid-florida.com. Select Public Information for Providers, then Provider Support, and then Provider Handbooks.
- Rule 59G-4.130, F.A.C. – Medicaid Home Health Services. Notice of Change published.
- Rule 59G-4.205, F.A.C. – Medicaid Practitioner Services. Notice of Change published.
- Rule 59G-4.320, F.A.C. – Medicaid Therapy Services. Notice of Additional Hearing on May 13, 2013, 3:00 p.m. - 4:00 p.m., Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room D, Tallahassee, FL.
- Rule 59G-5.020, F.A.C. – Medicaid Provider Requirements. Notice of Change published regarding the Florida Medicaid Provider General Handbook, June 2012.
- Rule 59G-7.007, F.A.C. – Medicaid. The purpose of new rule 59G-7.007 is to implement the Health Insurance Premium Payment Program to reimburse recipients for premiums paid to employer health coverage plans. If requested in writing and not deemed unnecessary by the agency head, a rule development workshop will be noticed in the next available Florida Administrative Register.
- Rule 61G7-5.005 – Board of Employee Leasing Companies; Deficiency in Tangible Accounting and Accounting Net Worth; Guaranty Form Acceptable to Board; Sufficient Evidence of Guarantor's Adequate Resources. The Board proposes the rule amendment to update incorporated materials in the rule. If a hearing is requested regarding the proposed rule, it will be noticed in the Florida Administrative Register. If requested in writing and not deemed unnecessary by the agency head, a rule development workshop will be noticed in the next available Florida Administrative Register.
- Rule 61G7-10.002, F.A.C. – Board of Employee Leasing Companies; Reporting of Change of Status Required; Effect on Licensees; Change of Licensee Name. Notice of Change published in response to written comments submitted by the staff of the Joint Administrative Procedures Committee concerning the proposed rule.
- Rule 69B-221.075, F.A.C. – Bail Bonds; Power of Attorney; Penal Sum of Bonds; Not Applicable to Automobile Clubs. Section 648.43, Fla. Stat., requires every insurer engaged in the writing of bail bonds through bail bond agents in the State of Florida to submit and have approved by the Department a sample power of attorney, which will be the only form of power of attorney the insurer will issue to bail bond agents in this State. The proposed rule sets forth the information a sample power of attorney must contain in order to be approved by the Department. The proposed amendment will allow insurance companies to continue using their existing forms as long as the items required for approval are included on the form. If requested in writing and not deemed unnecessary by the agency head, a rule development workshop will be held on May 23, 2013, 10:00 a.m., Room 139, Larson Bldg., 200 E. Gaines St., Tallahassee, FL.
- Rule 69B-221.051, F.A.C. – Bail Bonds; Actively Engaged in Business; Place Suitably Designated; Accessible to Public. Notice of Change/Withdrawal.
- Rule 69B-221.155, F.A.C. – Bail Bonds; Temporary Permit. Section 648.285(2), Fla. Stat., provides that if the owner of a bail bond agency dies or becomes mentally incapacitated, a personal representative or legal guardian may be issued a temporary permit to manage the affairs of the bail bond agency. The application for a temporary permit must be made by the personal representative or legal guardian upon statements and affidavits filed with the Department on forms prescribed and furnished by it. If requested in writing and not deemed unnecessary by the agency head, a rule development workshop will be held on May 23, 2013, 1:00 p.m., Room 139, Larson Bldg., 200 E. Gaines St., Tallahassee, FL
- Rules 69B-228.180 and 69B-228.220, F.A.C. - Forms, Licensee Compliance; Requirements; Penalties for Non-Compliance. Notice of Change/Withdrawal.
- Proposed Regulation Chapter 120-2-103 – Certificates of Insurance. The purpose of the proposed rule is to implement recent changes to the Insurance Code aimed at ensuring that property and casualty certificates of insurance accurately reflect underlying policies. Following a public hearing and receipt of written comments, the Georgia Office of the Commissioner of Insurance entered an Order adopting amendments to Proposed Regulation Chapter 120-2-103, effective May 22, 2013. Click here for a copy of the adopted rule.
V. MEETING NOTICES OF INTEREST/MISCELLANEOUS
- Agency for Health Care Administration/Medicaid Public Hearing. May 15, 2013, 2:00 p.m.; and May 28, 2013, 1:00 p.m., Medicaid Area Office 6, 6800 Dale Mabry Hwy, Suite 220, Tampa, FL 33614. May 29, 2013 as a webinar, Agency for Health Care Administration Headquarters, 2727 Mahan Drive, Bldg. 3, Tallahassee, FL. The Agency for Health Care Administration seeks to renew the federal waiver authority to continue to provide Medicaid eligibility to the MEDS-AD group. A link to the public notice document concerning this renewal request, instructions for how to submit comments, and a link to the Federal Centers for Medicaid and Medicare Services may be found at http://ahca.myflorida.com/Medicaid/index.shtml . All interested stakeholders will be able to provide comments for 30 days, from May 1 through May 30, 2013. The Agency will post all comments received for public review. For a copy of the agenda for these meetings, or any person requiring special accommodations to participate in either meeting, contact Marie Donnelly at Marie.Donnelly@ahca.myflorida.com , or (850) 412-4149.
- Agency Health Care Administration Meeting - Medicaid; Preferred Drug List. June 21, 2013, 1:00 - 5:00 p.m., Tampa Airport Marriott, Tampa International Airport, Tampa, FL. The purpose of the meeting is to discuss recommendations for drugs to be included on the Preferred Drug List. Members of the public who wish to speak at this meeting must contact Vern Hamilton at (850) 412-4154.
- Board of Employee Leasing Companies Probable Cause Panel Meeting. June 5, 2013, 8:30 a.m., The Bohemian Hotel Celebration 700 Bloom Street Celebration, FL.
- Board of Employee Leasing Companies Board Meetings. June 5, 2013,11:00 a.m. or soon thereafter and June 6, 2013, 9:00 a.m. or soon thereafter, The Bohemian Hotel Celebration 700 Bloom Street Celebration, FL.
- Citizens Property Insurance Corporation Depopulation Committee Meeting. May 29, 2013 1:00 p.m. (EDT), Knott Building, 402 S. Monroe Street, Webster Hall Room 212 Tallahassee, FL.
- Florida Office of Insurance Regulation Announces Public Hearing – American Security Insurance Company. The Florida Office of Insurance Regulation (OIR) will conduct a public hearing on May 13, 2013, 1:00 p.m., Senate Office Building, Room 301 (adjacent to the Capitol), Florida Capitol Complex, Tallahassee, FL, to review the proposed rate filing for American Security Insurance Company’s property collateral protection program/lender-placed insurance. American Security Company’s proposed statewide average rate change is 0% for its property collateral protection program. The proposed rate would become effective August 1, 2013 for any new and renewal business. The proposed rate change is not uniform and some areas of the state are subject to higher rates. Click here for a copy of the agenda.
- Florida Office of Insurance Regulation Announces Public Hearing – Fidelity National Property & Casualty Insurance Company. The Florida Office of Insurance Regulation (OIR) will conduct a public hearing on May 30, 2013, 9:00 a.m., Larson Building, Room 116, 200 E. Gaines Street, Tallahassee, FL, to review the proposed rate filing for Fidelity National Property & Casualty Insurance Company’s (Fidelity) for its homeowners program. Fidelity has requested an average statewide rate change of 28.1% effective August 1, 2013 for new business and September 25, 2013 for renewal business. The requested rate change is not uniform. Some areas are subject to higher rates.
- Health Information Exchange Coordinating Committee Meeting. May 17, 2013, 10:00 a.m., Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room A, Tallahassee, FL. The Health Information Exchange Coordinating Committee will review and discuss strategies to increase electronic health record adoption and health information exchange in Florida.
- Florida Office of Insurance Regulation Launches New “I-File Forms and Rates Filing Search” System. This system provides public access to filings collected from Florida’s licensed Life & Health and Property & Casualty insurers.
- Florida Department of Financial Services Publishes Annual Report of Florida Insurance Examinations of Life including Variable Annuity, Health, Personal Lines, and General Lines Examinations for Calendar Year 2012. The report was prepared according to the provisions of section 626.2415, Fla. Stat., and is published annually using data from Pearson VUE, the current contracted testing vendor. The purpose of this report is to aid the Department in improving the quality and fairness of the insurance examinations. The demographic information contained in this report was voluntarily submitted by examinees for the Life & Variable Annuity, Life, Health & Variable Annuity, Health, General Lines, and Personal Lines insurance agent licenses.
- Georgia Office of the Commissioner of Insurance to Hold 12th Annual Hurricane Preparedness Expo on June 15, 2013 in Savannah, GA.
- Georgia Office of the Commissioner of Insurance Urges Georgians to Consider Travel Insurance to Protect Against Possible Vacation Losses.