Current through Reg. 50, No. 187; September 24, 2024
(1) This
rule implements the publication requirements of Section
624.313, F.S., which requires
the Office to publish complaint ratios for the 10 largest insurers or insurer
groups by line of insurance and each insurer or insurer group that has 1
percent or more of a line of insurance in this state. This rule does not apply
to private passenger automobile insurance coverages. This rule also identifies
the procedures by which insurer complaint ratios, herein referred to as
complaint indexes, are calculated. Insurer Complaint indexes can be used by the
Office to identify insurers with questionable claims handling practices and
allow the Office to take appropriate regulatory action to avoid an interruption
in services to the insurance consumer. The insurance consumer will be able to
compare insurers by line of insurance to assist in the purchase of
insurance.
(2) Definitions. The
following words and phrases, when used in this rule shall have the following
meanings, except where the context clearly indicates a different meaning:
(a) "Bureau" means the Bureau of Consumer
Assistance, a bureau within the Division of Insurance Consumer
Services.
(b) "Complaint" for
purposes of the complaint index, means any written communication, by an insured
or named beneficiary, primarily expressing a grievance or dissatisfaction over
which the Office has regulatory authority. Complaints which will not be used to
calculate the complaint index include complaints against an incorrect entity;
complaints against companies providing administrative services for self-funded
benefit plans; complaints regarding properly filed or approved rates; suspected
fraudulent claim complaints; and complaints which are duplicative, harassing or
frivolous.
(c) "Complaint Index"
means an index derived by dividing the complaint share by the market share for
a specific insurer by line of insurance.
(d) "Complaint Share" means the percentage of
complaints received by the Office relevant to an insurer for any given line of
insurance when compared to the total complaints received by the Office for that
line of insurance.
(e) "Office"
means the Office of Insurance Regulation.
(f) "Direct Written Premium" means a
consideration paid, or to be paid, to the insurer for the issuance and delivery
of any binder or policy of insurance or annuity written directly to the
consumer.
(g) "Division" means the
Division of Insurance Consumer Services, a division within the Department of
Financial Services.
(h) "Insurer"
includes every individual, company, association, organization, partnership,
syndicate, business trust, corporation or legal entity engaged as indemnitor,
surety or contractor, holding a certificate of authority issued by the Office,
which is authorized to enter into contracts of insurance or annuity.
(i) "Line of Insurance" means the
subclassifications of kinds of insurance which are required to be annually
reported on the standardized Annual Statement adopted by the Office.
(j) "Market Share" means the percentage of
the direct written premiums when compared to the total direct written premiums
in the State of Florida for a given line of insurance.
(3) Computing the Complaint Index.
(a) All direct written premiums for the
reporting period will be compared to determine the market share of insurance
business for each insurer by line of insurance.
(b) Insurer complaint information for the
reporting period will be obtained from the Division for all insurers.
1. Complaint information will be subdivided
by line of insurance for each insurer.
2. The complaint share will be determined for
each insurer by line of insurance based on complaints received by the
Office.
(c) An insurer
complaint index, for each insurer, will be calculated by dividing the complaint
share by line of insurance by the market share of direct written premium for
that line of insurance.
1. A complaint index
of 1.00 will indicate that the insurer has received a proportionate number of
complaints as compared to the market share of direct written premium for a
particular line of insurance.
2. A
complaint index of less than 1.00 will indicate that the insurer has a
complaint share that is less than their market share of direct written premium
for that particular line of insurance.
3. A complaint index of more than 1.00 will
indicate that the insurer has a complaint share that is more than their market
share of direct written premium for that line of
insurance.
(4)
Complaint Indexes. Complaint indexes by line of insurance will be published by
the Office annually as required by Section
624.313, F.S., and may be
published at such other times as the Office deems appropriate. The Office shall
make available to insurers, upon written request, a copy of the index prior to
publication. If the insurer disagrees with the index, the insurer shall provide
the Office with written supporting documentation within 15 days of receipt of
the index.
Rulemaking Authority 624.308 FS. Law Implemented
624.307(1), 624.313, 624.4241 FS.
New 8-3-93, Formerly
4-142.002.
