Bill Text: FL S1582 | 2017 | Regular Session | Comm Sub
Bill Title: Workers' Compensation Insurance
Spectrum: Bipartisan Bill
Status: (Failed) 2017-05-05 - Laid on Table [S1582 Detail]
Download: Florida-2017-S1582-Comm_Sub.html
Florida Senate - 2017 CS for SB 1582
By the Committee on Appropriations; and Senator Bradley
576-03782-17 20171582c1
1 A bill to be entitled
2 An act relating to workers’ compensation insurance;
3 amending s. 440.02, F.S.; redefining the term
4 “specificity”; amending s. 440.105, F.S.; revising a
5 prohibition against receiving certain fees,
6 consideration, or gratuities under certain
7 circumstances; amending s. 440.13, F.S.; specifying
8 certain timeframes in terms of business days, rather
9 than days; requiring carriers to authorize or deny,
10 rather than respond to, certain requests for
11 authorization within a specified timeframe; revising
12 construction; revising a specified interval for
13 certain notices furnished by treating physicians to
14 employers or carriers; amending s. 440.15, F.S.;
15 revising the maximum period of specified temporary
16 disability benefits; amending s. 440.151, F.S.;
17 providing that specified cancers of firefighters are
18 deemed occupational diseases arising out of work
19 performed in the course and scope of employment;
20 amending s. 440.192, F.S.; revising conditions under
21 which the Office of the Judges of Compensation Claims
22 must dismiss petitions for benefits; revising
23 requirements for such petitions; revising construction
24 relating to dismissals of petitions or portions of
25 such petitions; requiring judges of compensation
26 claims to enter orders on certain motions to dismiss
27 within specified timeframes; amending s. 440.34, F.S.;
28 prohibiting the payment of certain consideration by
29 carriers or employers, rather than prohibiting such
30 payment for claimants, in connection with certain
31 proceedings under certain circumstances; requiring
32 judges of compensation claims to consider specified
33 factors in increasing or decreasing attorney fees;
34 specifying a maximum hourly rate for attorney fees;
35 revising provisions that prohibit such judges from
36 approving certain agreements and that limit attorney
37 fees in retainer agreements; providing construction;
38 deleting a provision authorizing such judges to
39 approve alternative attorney fees under certain
40 circumstances; conforming a cross-reference; amending
41 s. 624.482, F.S.; conforming a provision to changes
42 made by the act; amending s. 627.041, F.S.; redefining
43 terms; amending s. 627.0612, F.S.; adding prospective
44 loss costs to a list of reviewable matters in certain
45 proceedings by appellate courts; amending s. 627.062,
46 F.S.; prohibiting loss costs for specified classes of
47 insurance from being excessive, inadequate, or
48 unfairly discriminatory; amending s. 627.0645, F.S.;
49 deleting an annual base rate filing requirement
50 exception relating to workers’ compensation and
51 employer’s liability insurance for certain rating
52 organizations; amending s. 627.072, F.S.; requiring
53 certain factors to be used in determining and fixing
54 loss costs; deleting a specified methodology that may
55 be used by the Office of Insurance Regulation in rate
56 determinations; amending s. 627.091, F.S.; defining
57 terms; requiring insurers or insurer groups writing
58 workers’ compensation and employer’s liability
59 insurances to independently and individually file
60 their proposed final rates; specifying requirements
61 for such filings; deleting a requirement that such
62 filings contain certain information; revising
63 requirements for supporting information required to be
64 furnished to the office under certain circumstances;
65 deleting a specified method for insurers to satisfy
66 filing obligations; specifying requirements for a
67 licensed rating organization that elects to develop
68 and file certain reference filings and certain other
69 information; authorizing insurers to use supplementary
70 rating information approved by the office; revising
71 applicability of public meetings and records
72 requirements to certain meetings of recognized rating
73 organization committees; requiring certain insurer
74 groups to file underwriting rules not contained in
75 rating manuals; amending s. 627.093, F.S.; revising
76 applicability of public meetings and records
77 requirements to prospective loss cost filings or
78 appeals; amending s. 627.101, F.S.; conforming a
79 provision to changes made by the act; amending s.
80 627.211, F.S.; deleting provisions relating to
81 deviations; requiring that the office’s annual report
82 to the Legislature relating to the workers’
83 compensation insurance market evaluate insurance
84 company solvency; creating s. 627.2151, F.S.; defining
85 the term “defense and cost containment expenses” or
86 “DCCE”; requiring insurer groups or insurers writing
87 workers’ compensation insurance to file specified
88 schedules with the office at specified intervals;
89 providing construction relating to excessive DCCE;
90 requiring the office to order returns of excess
91 amounts of DCCE, subject to certain hearing
92 requirements; providing requirements for, and an
93 exception from, the return of excessive DCCE amounts;
94 providing construction; amending s. 627.291, F.S.;
95 providing applicability of certain disclosure and
96 hearing requirements for rating organizations filing
97 prospective loss costs; amending s. 627.318, F.S.;
98 providing applicability of certain recordkeeping
99 requirements for rating organizations or insurers
100 filing or using prospective loss costs, respectively;
101 amending s. 627.361, F.S.; providing applicability of
102 a prohibition against false or misleading information
103 relating to prospective loss costs; amending s.
104 627.371, F.S.; providing applicability of certain
105 hearing procedures and requirements relating to the
106 application, making, or use of prospective loss costs;
107 providing appropriations; providing effective dates.
108
109 Be It Enacted by the Legislature of the State of Florida:
110
111 Section 1. Subsection (40) of section 440.02, Florida
112 Statutes, is amended to read:
113 440.02 Definitions.—When used in this chapter, unless the
114 context clearly requires otherwise, the following terms shall
115 have the following meanings:
116 (40) “Specificity” means information on the petition for
117 benefits sufficient to put the employer or carrier on notice of
118 the exact statutory classification and outstanding time period
119 for each requested benefit, the specific amount of each
120 requested benefit, the calculation used for computing the
121 requested benefit, of benefits being requested and includes a
122 detailed explanation of any benefits received that should be
123 increased, decreased, changed, or otherwise modified. If the
124 petition is for medical benefits, the information must shall
125 include specific details as to why such benefits are being
126 requested, why such benefits are medically necessary, and why
127 current treatment, if any, is not sufficient. Any petition
128 requesting alternate or other medical care, including, but not
129 limited to, petitions requesting psychiatric or psychological
130 treatment, must specifically identify the physician, as defined
131 in s. 440.13(1), who is recommending such treatment. A copy of a
132 report from such physician making the recommendation for
133 alternate or other medical care must shall also be attached to
134 the petition. A judge of compensation claims may shall not order
135 such treatment if a physician is not recommending such
136 treatment.
137 Section 2. Paragraph (c) of subsection (3) of section
138 440.105, Florida Statutes, is amended to read:
139 440.105 Prohibited activities; reports; penalties;
140 limitations.—
141 (3) Whoever violates any provision of this subsection
142 commits a misdemeanor of the first degree, punishable as
143 provided in s. 775.082 or s. 775.083.
144 (c) Except for an attorney who is retained by or for an
145 injured worker and who receives a fee or other consideration
146 from or on behalf of such worker, it is unlawful for any
147 attorney or other person, in his or her individual capacity or
148 in his or her capacity as a public or private employee, or for
149 any firm, corporation, partnership, or association to receive
150 any fee or other consideration or any gratuity from a person on
151 account of services rendered for a person in connection with any
152 proceedings arising under this chapter, unless such fee,
153 consideration, or gratuity is approved by a judge of
154 compensation claims or by the Deputy Chief Judge of Compensation
155 Claims.
156 Section 3. Paragraph (f) of subsection (2), paragraphs (d)
157 and (i) of subsection (3), paragraph (a) of subsection (4),
158 paragraphs (a) and (c) of subsection (5), and paragraphs (c) and
159 (d) of subsection (9) of section 440.13, Florida Statutes, are
160 amended, to read:
161 440.13 Medical services and supplies; penalty for
162 violations; limitations.—
163 (2) MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.—
164 (f) Upon the written request of the employee, the carrier
165 shall give the employee the opportunity for one change of
166 physician during the course of treatment for any one accident.
167 Upon the granting of a change of physician, the originally
168 authorized physician in the same specialty as the changed
169 physician shall become deauthorized upon written notification by
170 the employer or carrier. The carrier shall authorize an
171 alternative physician who shall not be professionally affiliated
172 with the previous physician within 5 business days after receipt
173 of the request. If the carrier fails to provide a change of
174 physician as requested by the employee, the employee may select
175 the physician and such physician shall be considered authorized
176 if the treatment being provided is compensable and medically
177 necessary.
178
179 Failure of the carrier to timely comply with this subsection
180 shall be a violation of this chapter and the carrier shall be
181 subject to penalties as provided for in s. 440.525.
182 (3) PROVIDER ELIGIBILITY; AUTHORIZATION.—
183 (d) A carrier must respond, by telephone or in writing,
184 must authorize or deny to a request for authorization from an
185 authorized health care provider by the close of the third
186 business day after receipt of the request. A carrier authorizes
187 the request if it who fails to respond to a written request for
188 authorization for referral for medical treatment by the close of
189 the third business day after receipt of the request consents to
190 the medical necessity for such treatment. All such requests must
191 be made to the carrier. Notice to the carrier does not include
192 notice to the employer.
193 (i) Notwithstanding paragraph (d), a claim for specialist
194 consultations, surgical operations, physiotherapeutic or
195 occupational therapy procedures, X-ray examinations, or special
196 diagnostic laboratory tests that cost more than $1,000 and other
197 specialty services that the department identifies by rule is not
198 valid and reimbursable unless the services have been expressly
199 authorized by the carrier, unless the carrier has failed to
200 respond within 10 business days to a written request for
201 authorization, or unless emergency care is required. The insurer
202 shall authorize such consultation or procedure unless the health
203 care provider or facility is not authorized, unless such
204 treatment is not in accordance with practice parameters and
205 protocols of treatment established in this chapter, or unless a
206 judge of compensation claims has determined that the
207 consultation or procedure is not medically necessary, not in
208 accordance with the practice parameters and protocols of
209 treatment established in this chapter, or otherwise not
210 compensable under this chapter. Authorization of a treatment
211 plan does not constitute express authorization for purposes of
212 this section, except to the extent the carrier provides
213 otherwise in its authorization procedures. This paragraph does
214 not limit the carrier’s obligation to identify and disallow
215 overutilization or billing errors.
216 (4) NOTICE OF TREATMENT TO CARRIER; FILING WITH
217 DEPARTMENT.—
218 (a) Any health care provider providing necessary remedial
219 treatment, care, or attendance to any injured worker shall
220 submit treatment reports to the carrier in a format prescribed
221 by the department. A claim for medical or surgical treatment is
222 not valid or enforceable against such employer or employee,
223 unless, by the close of the third business day following the
224 first treatment, the physician providing the treatment furnishes
225 to the employer or carrier a preliminary notice of the injury
226 and treatment in a format prescribed by the department and,
227 within 15 business days thereafter, furnishes to the employer or
228 carrier a complete report, and subsequent thereto furnishes
229 progress reports, if requested by the employer or insurance
230 carrier, at intervals of not less than 15 business days 3 weeks
231 apart or at less frequent intervals if requested in a format
232 prescribed by the department.
233 (5) INDEPENDENT MEDICAL EXAMINATIONS.—
234 (a) In any dispute concerning overutilization, medical
235 benefits, compensability, or disability under this chapter, the
236 carrier or the employee may select an independent medical
237 examiner. If the parties agree, the examiner may be a health
238 care provider treating or providing other care to the employee.
239 An independent medical examiner may not render an opinion
240 outside his or her area of expertise, as demonstrated by
241 licensure and applicable practice parameters. The employer and
242 employee shall be entitled to only one independent medical
243 examination per accident and not one independent medical
244 examination per medical specialty. The party requesting and
245 selecting the independent medical examination shall be
246 responsible for all expenses associated with said examination,
247 including, but not limited to, medically necessary diagnostic
248 testing performed and physician or medical care provider fees
249 for the evaluation. The party selecting the independent medical
250 examination shall identify the choice of the independent medical
251 examiner to all other parties within 15 business days after the
252 date the independent medical examination is to take place.
253 Failure to timely provide such notification shall preclude the
254 requesting party from submitting the findings of such
255 independent medical examiner in a proceeding before a judge of
256 compensation claims. The independent medical examiner may not
257 provide followup care if such recommendation for care is found
258 to be medically necessary. If the employee prevails in a medical
259 dispute as determined in an order by a judge of compensation
260 claims or if benefits are paid or treatment provided after the
261 employee has obtained an independent medical examination based
262 upon the examiner’s findings, the costs of such examination
263 shall be paid by the employer or carrier.
264 (c) The carrier may, at its election, contact the claimant
265 directly to schedule a reasonable time for an independent
266 medical examination. The carrier must confirm the scheduling
267 agreement in writing with the claimant and the claimant’s
268 counsel, if any, at least 7 business days before the date upon
269 which the independent medical examination is scheduled to occur.
270 An attorney representing a claimant is not authorized to
271 schedule the self-insured employer’s or carrier’s independent
272 medical evaluations under this subsection. Neither the self
273 insured employer nor the carrier shall be responsible for
274 scheduling any independent medical examination other than an
275 employer or carrier independent medical examination.
276 (9) EXPERT MEDICAL ADVISORS.—
277 (c) If there is disagreement in the opinions of the health
278 care providers, if two health care providers disagree on medical
279 evidence supporting the employee’s complaints or the need for
280 additional medical treatment, or if two health care providers
281 disagree that the employee is able to return to work, the
282 department may, and the judge of compensation claims shall, upon
283 his or her own motion or within 15 business days after receipt
284 of a written request by either the injured employee, the
285 employer, or the carrier, order the injured employee to be
286 evaluated by an expert medical advisor. The injured employee and
287 the employer or carrier may agree on the health care provider to
288 serve as an expert medical advisor. If the parties do not agree,
289 the judge of compensation claims shall select an expert medical
290 advisor from the department’s list of certified expert medical
291 advisors. If a certified medical advisor within the relevant
292 medical specialty is unavailable, the judge of compensation
293 claims shall appoint any otherwise qualified health care
294 provider to serve as an expert medical advisor without obtaining
295 the department’s certification. The opinion of the expert
296 medical advisor is presumed to be correct unless there is clear
297 and convincing evidence to the contrary as determined by the
298 judge of compensation claims. The expert medical advisor
299 appointed to conduct the evaluation shall have free and complete
300 access to the medical records of the employee. An employee who
301 fails to report to and cooperate with such evaluation forfeits
302 entitlement to compensation during the period of failure to
303 report or cooperate.
304 (d) The expert medical advisor must complete his or her
305 evaluation and issue his or her report to the department or to
306 the judge of compensation claims within 15 business days after
307 receipt of all medical records. The expert medical advisor must
308 furnish a copy of the report to the carrier and to the employee.
309 Section 4. Paragraph (a) of subsection (2) and paragraph
310 (e) of subsection (4) of section 440.15, Florida Statutes, are
311 amended to read:
312 440.15 Compensation for disability.—Compensation for
313 disability shall be paid to the employee, subject to the limits
314 provided in s. 440.12(2), as follows:
315 (2) TEMPORARY TOTAL DISABILITY.—
316 (a) Subject to subsection (7), in case of disability total
317 in character but temporary in quality, 66 2/3 or 66.67 percent
318 of the average weekly wages shall be paid to the employee during
319 the continuance thereof, not to exceed 260 104 weeks except as
320 provided in this subsection, s. 440.12(1), and s. 440.14(3).
321 Once the employee reaches the maximum number of weeks allowed,
322 or the employee reaches the date of maximum medical improvement,
323 whichever occurs earlier, temporary disability benefits shall
324 cease and the injured worker’s permanent impairment shall be
325 determined.
326 (4) TEMPORARY PARTIAL DISABILITY.—
327 (e) Such benefits shall be paid during the continuance of
328 such disability, not to exceed a period of 260 104 weeks, as
329 provided by this subsection and subsection (2). Once the injured
330 employee reaches the maximum number of weeks, temporary
331 disability benefits cease and the injured worker’s permanent
332 impairment must be determined. If the employee is terminated
333 from postinjury employment based on the employee’s misconduct,
334 temporary partial disability benefits are not payable as
335 provided for in this section. The department shall by rule
336 specify forms and procedures governing the method and time for
337 payment of temporary disability benefits for dates of accidents
338 before January 1, 1994, and for dates of accidents on or after
339 January 1, 1994.
340 Section 5. Subsection (2) of section 440.151, Florida
341 Statutes, is amended to read:
342 440.151 Occupational diseases.—
343 (2) Whenever used in this section the term “occupational
344 disease” shall be construed to mean only a disease which is due
345 to causes and conditions which are characteristic of and
346 peculiar to a particular trade, occupation, process, or
347 employment, and to exclude all ordinary diseases of life to
348 which the general public is exposed, unless the incidence of the
349 disease is substantially higher in the particular trade,
350 occupation, process, or employment than for the general public.
351 “Occupational disease” means only a disease for which there are
352 epidemiological studies showing that exposure to the specific
353 substance involved, at the levels to which the employee was
354 exposed, may cause the precise disease sustained by the
355 employee. Notwithstanding any provision of this chapter, for
356 firefighters, as defined in s. 112.81, multiple myeloma and non
357 Hodgkin’s lymphoma are deemed to be occupational diseases that
358 arise out of work performed in the course and scope of
359 employment.
360 Section 6. Subsections (2) and (5) of section 440.192,
361 Florida Statutes, are amended to read:
362 440.192 Procedure for resolving benefit disputes.—
363 (2) Upon receipt, the Office of the Judges of Compensation
364 Claims shall review each petition and shall dismiss each
365 petition or any portion of such a petition that does not on its
366 face meet the requirements of this section and the definition of
367 specificity under s. 440.02, and specifically identify or
368 itemize the following:
369 (a) The name, address, and telephone number, and social
370 security number of the employee.
371 (b) The name, address, and telephone number of the
372 employer.
373 (c) A detailed description of the injury and cause of the
374 injury, including the Florida county or, if outside of Florida,
375 the state location of the occurrence and the date or dates of
376 the accident.
377 (d) A detailed description of the employee’s job, work
378 responsibilities, and work the employee was performing when the
379 injury occurred.
380 (e) The specific time period for which compensation and the
381 specific classification of compensation were not timely
382 provided.
383 (f) The specific date of maximum medical improvement,
384 character of disability, and specific statement of all benefits
385 or compensation that the employee is seeking. A claim for
386 permanent benefits must include the specific date of maximum
387 medical improvement and the specific date that such permanent
388 benefits are claimed to begin.
389 (g) All specific travel costs to which the employee
390 believes she or he is entitled, including dates of travel and
391 purpose of travel, means of transportation, and mileage and
392 including the date the request for mileage was filed with the
393 carrier and a copy of the request filed with the carrier.
394 (h) A specific listing of all medical charges alleged
395 unpaid, including the name and address of the medical provider,
396 the amounts due, and the specific dates of treatment.
397 (i) The type or nature of treatment care or attendance
398 sought and the justification for such treatment. If the employee
399 is under the care of a physician for an injury identified under
400 paragraph (c), a copy of the physician’s request, authorization,
401 or recommendation for treatment, care, or attendance must
402 accompany the petition.
403 (j) The specific amount of compensation claimed to be
404 accurate and the methodology claimed to accurately calculate the
405 average weekly wage, if the average weekly wage calculated by
406 the employer or carrier is disputed. If the petition does not
407 include a claim under this paragraph, the average weekly wage
408 and corresponding compensation calculated by the employer or
409 carrier are presumed to be accurate.
410 (k)(j) A specific explanation of any other disputed issue
411 that a judge of compensation claims will be called to rule upon.
412
413 The dismissal of any petition or portion of such a petition
414 under this subsection section is without prejudice and does not
415 require a hearing.
416 (5)(a) All motions to dismiss must state with particularity
417 the basis for the motion. The judge of compensation claims shall
418 enter an order upon such motions without hearing, unless good
419 cause for hearing is shown. Dismissal of any petition or portion
420 of a petition under this subsection is without prejudice.
421 (b) Upon motion that a petition or portion of a petition be
422 dismissed for lack of specificity, the judge of compensation
423 claims shall enter an order on the motion, unless stipulated in
424 writing by the parties, within 10 days after the motion is filed
425 or, if good cause for hearing is shown, within 20 days after
426 hearing on the motion. When any petition or portion of a
427 petition is dismissed for lack of specificity under this
428 subsection, the claimant must be allowed 20 days after the date
429 of the order of dismissal in which to file an amended petition.
430 Any grounds for dismissal for lack of specificity under this
431 section which are not asserted within 30 days after receipt of
432 the petition for benefits are thereby waived.
433 Section 7. Section 440.34, Florida Statutes, is amended to
434 read:
435 440.34 Attorney Attorney’s fees; costs.—
436 (1)(a) A fee, gratuity, or other consideration may not be
437 paid by a carrier or employer for a claimant in connection with
438 any proceedings arising under this chapter, unless approved by
439 the judge of compensation claims or court having jurisdiction
440 over such proceedings. Any attorney fees attorney’s fee approved
441 by a judge of compensation claims for benefits secured on behalf
442 of a claimant must equal to 20 percent of the first $5,000 of
443 the amount of the benefits secured, 15 percent of the next
444 $5,000 of the amount of the benefits secured, 10 percent of the
445 remaining amount of the benefits secured to be provided during
446 the first 10 years after the date the claim is filed, and 5
447 percent of the benefits secured after 10 years.
448 (b) However, the judge of compensation claims shall
449 consider the following factors in each case and may increase or
450 decrease the attorney fees, based on a maximum hourly rate of
451 $250 per hour, if in his or her judgment he or she expressly
452 finds that the circumstances of the particular case warrant such
453 action:
454 1. The time and labor required, the novelty and difficulty
455 of the questions involved, and the skill requisite to perform
456 the legal service properly.
457 2. The fee customarily charged in the locality for similar
458 legal services.
459 3. The amount involved in the controversy and the benefits
460 resulting to the claimant.
461 4. The time limitation imposed by the claimant or the
462 circumstances.
463 5. The experience, reputation, and ability of the attorney
464 or attorneys performing services.
465 6. The contingency or certainty of a fee.
466 (c) The judge of compensation claims shall not approve a
467 compensation order, a joint stipulation for lump-sum settlement,
468 a stipulation or agreement between a claimant and his or her
469 attorney, or any other agreement related to benefits under this
470 chapter which provides for attorney fees paid by a carrier or
471 employer an attorney’s fee in excess of the amount permitted by
472 this section. The judge of compensation claims is not required
473 to approve any retainer agreement between the claimant and his
474 or her attorney. The retainer agreement as to fees and costs may
475 not be for compensation in excess of the amount allowed under
476 this subsection or subsection (7).
477 (2) In awarding a claimant’s attorney fees paid by a
478 carrier or employer attorney’s fee, the judge of compensation
479 claims shall consider only those benefits secured by the
480 attorney. An attorney is not entitled to attorney attorney’s
481 fees for representation in any issue that was ripe, due, and
482 owing and that reasonably could have been addressed, but was not
483 addressed, during the pendency of other issues for the same
484 injury. The amount, statutory basis, and type of benefits
485 obtained through legal representation shall be listed on all
486 attorney attorney’s fees awarded by the judge of compensation
487 claims. For purposes of this section, the term “benefits
488 secured” does not include future medical benefits to be provided
489 on any date more than 5 years after the date the claim is filed.
490 In the event an offer to settle an issue pending before a judge
491 of compensation claims, including attorney attorney’s fees as
492 provided for in this section, is communicated in writing to the
493 claimant or the claimant’s attorney at least 30 days prior to
494 the trial date on such issue, for purposes of calculating the
495 amount of attorney attorney’s fees to be taxed against the
496 employer or carrier, the term “benefits secured” shall be deemed
497 to include only that amount awarded to the claimant above the
498 amount specified in the offer to settle. If multiple issues are
499 pending before the judge of compensation claims, said offer of
500 settlement shall address each issue pending and shall state
501 explicitly whether or not the offer on each issue is severable.
502 The written offer shall also unequivocally state whether or not
503 it includes medical witness fees and expenses and all other
504 costs associated with the claim.
505 (3) If any party should prevail in any proceedings before a
506 judge of compensation claims or court, there shall be taxed
507 against the nonprevailing party the reasonable costs of such
508 proceedings, not to include attorney attorney’s fees. A claimant
509 is responsible for the payment of her or his own attorney
510 attorney’s fees, except that a claimant is entitled to recover
511 attorney fees an attorney’s fee in an amount equal to the amount
512 provided for in subsection (1) or subsection (7) from a carrier
513 or employer:
514 (a) Against whom she or he successfully asserts a petition
515 for medical benefits only, if the claimant has not filed or is
516 not entitled to file at such time a claim for disability,
517 permanent impairment, wage-loss, or death benefits, arising out
518 of the same accident;
519 (b) In any case in which the employer or carrier files a
520 response to petition denying benefits with the Office of the
521 Judges of Compensation Claims and the injured person has
522 employed an attorney in the successful prosecution of the
523 petition;
524 (c) In a proceeding in which a carrier or employer denies
525 that an accident occurred for which compensation benefits are
526 payable, and the claimant prevails on the issue of
527 compensability; or
528 (d) In cases where the claimant successfully prevails in
529 proceedings filed under s. 440.24 or s. 440.28.
530
531 Regardless of the date benefits were initially requested,
532 attorney attorney’s fees shall not attach under this subsection
533 until 30 days after the date the carrier or employer, if self
534 insured, receives the petition.
535 (4) In such cases in which the claimant is responsible for
536 the payment of her or his own attorney attorney’s fees, such
537 fees are a lien upon compensation payable to the claimant,
538 notwithstanding s. 440.22.
539 (5) If any proceedings are had for review of any claim,
540 award, or compensation order before any court, the court may
541 award the injured employee or dependent attorney fees an
542 attorney’s fee to be paid by the employer or carrier, in its
543 discretion, which shall be paid as the court may direct.
544 (6) A judge of compensation claims may not enter an order
545 approving the contents of a retainer agreement that permits
546 placing any portion of the employee’s compensation into an
547 escrow account until benefits have been secured.
548 (7) This section may not be interpreted to limit or
549 otherwise infringe on a claimant’s right to retain an attorney
550 and pay the attorney reasonable attorney fees for legal services
551 related to a claim under the Workers’ Compensation Law If an
552 attorney’s fee is owed under paragraph (3)(a), the judge of
553 compensation claims may approve an alternative attorney’s fee
554 not to exceed $1,500 only once per accident, based on a maximum
555 hourly rate of $150 per hour, if the judge of compensation
556 claims expressly finds that the attorney’s fee amount provided
557 for in subsection (1), based on benefits secured, fails to
558 fairly compensate the attorney for disputed medical-only claims
559 as provided in paragraph (3)(a) and the circumstances of the
560 particular case warrant such action.
561 Section 8. Effective July 1, 2018, subsection (10) of
562 section 624.482, Florida Statutes, is amended to read:
563 624.482 Making and use of rates.—
564 (10) Any self-insurance fund that writes workers’
565 compensation insurance and employer’s liability insurance is
566 subject to, and shall make all rate filings for workers’
567 compensation insurance and employer’s liability insurance in
568 accordance with, ss. 627.091, 627.101, 627.111, 627.141,
569 627.151, 627.171, and 627.191, and 627.211.
570 Section 9. Effective July 1, 2018, subsections (3), (4),
571 and (6) of section 627.041, Florida Statutes, are amended to
572 read:
573 627.041 Definitions.—As used in this part:
574 (3) “Rating organization” means every person, other than an
575 authorized insurer, whether located within or outside this
576 state, who has as his or her object or purpose the making of
577 prospective loss costs, rates, rating plans, or rating systems.
578 Two or more authorized insurers that act in concert for the
579 purpose of making prospective loss costs, rates, rating plans,
580 or rating systems, and that do not operate within the specific
581 authorizations contained in ss. 627.311, 627.314(2), (4), and
582 627.351, shall be deemed to be a rating organization. No single
583 insurer shall be deemed to be a rating organization.
584 (4) “Advisory organization” means every group, association,
585 or other organization of insurers, whether located within or
586 outside this state, which prepares policy forms or makes
587 underwriting rules incident to but not including the making of
588 prospective loss costs, rates, rating plans, or rating systems
589 or which collects and furnishes to authorized insurers or rating
590 organizations loss or expense statistics or other statistical
591 information and data and acts in an advisory, as distinguished
592 from a ratemaking, capacity.
593 (6) “Subscriber” means an insurer which is furnished at its
594 request:
595 (a) With prospective loss costs, rates, and rating manuals
596 by a rating organization of which it is not a member; or
597 (b) With advisory services by an advisory organization of
598 which it is not a member.
599 Section 10. Effective July 1, 2018, subsection (1) of
600 section 627.0612, Florida Statutes, is amended to read:
601 627.0612 Administrative proceedings in rating
602 determinations.—
603 (1) In any proceeding to determine whether prospective loss
604 costs, rates, rating plans, or other matters governed by this
605 part comply with the law, the appellate court shall set aside a
606 final order of the office if the office has violated s.
607 120.57(1)(k) by substituting its findings of fact for findings
608 of an administrative law judge which were supported by competent
609 substantial evidence.
610 Section 11. Effective July 1, 2018, subsection (1) of
611 section 627.062, Florida Statutes, is amended to read:
612 627.062 Rate standards.—
613 (1) The rates and loss costs for all classes of insurance
614 to which the provisions of this part are applicable may not be
615 excessive, inadequate, or unfairly discriminatory.
616 Section 12. Effective July 1, 2018, subsection (1) of
617 section 627.0645, Florida Statutes, is amended to read:
618 627.0645 Annual filings.—
619 (1) Each rating organization filing rates for, and each
620 insurer writing, any line of property or casualty insurance to
621 which this part applies, except:
622 (a) Workers’ compensation and employer’s liability
623 insurance;
624 (a)(b) Insurance as defined in ss. 624.604 and 624.605,
625 limited to coverage of commercial risks other than commercial
626 residential multiperil; or
627 (b)(c) Travel insurance, if issued as a master group policy
628 with a situs in another state where each certificateholder pays
629 less than $30 in premium for each covered trip and where the
630 insurer has written less than $1 million in annual written
631 premiums in the travel insurance product in this state during
632 the most recent calendar year,
633
634 shall make an annual base rate filing for each such line with
635 the office no later than 12 months after its previous base rate
636 filing, demonstrating that its rates are not inadequate.
637 Section 13. Effective July 1, 2018, subsections (1) and (5)
638 of section 627.072, Florida Statutes, are amended to read:
639 627.072 Making and use of rates.—
640 (1) As to workers’ compensation and employer’s liability
641 insurance, the following factors shall be used in the
642 determination and fixing of loss costs or rates, as applicable:
643 (a) The past loss experience and prospective loss
644 experience within and outside this state;
645 (b) The conflagration and catastrophe hazards;
646 (c) A reasonable margin for underwriting profit and
647 contingencies;
648 (d) Dividends, savings, or unabsorbed premium deposits
649 allowed or returned by insurers to their policyholders, members,
650 or subscribers;
651 (e) Investment income on unearned premium reserves and loss
652 reserves;
653 (f) Past expenses and prospective expenses, both those
654 countrywide and those specifically applicable to this state; and
655 (g) All other relevant factors, including judgment factors,
656 within and outside this state.
657 (5)(a) In the case of workers’ compensation and employer’s
658 liability insurance, the office shall consider utilizing the
659 following methodology in rate determinations: Premiums,
660 expenses, and expected claim costs would be discounted to a
661 common point of time, such as the initial point of a policy
662 year, in the determination of rates; the cash-flow pattern of
663 premiums, expenses, and claim costs would be determined
664 initially by using data from 8 to 10 of the largest insurers
665 writing workers’ compensation insurance in the state; such
666 insurers may be selected for their statistical ability to report
667 the data on an accident-year basis and in accordance with
668 subparagraphs (b)1., 2., and 3., for at least 2 1/2 years; such
669 a cash-flow pattern would be modified when necessary in
670 accordance with the data and whenever a radical change in the
671 payout pattern is expected in the policy year under
672 consideration.
673 (b) If the methodology set forth in paragraph (a) is
674 utilized, to facilitate the determination of such a cash-flow
675 pattern methodology:
676 1. Each insurer shall include in its statistical reporting
677 to the rating bureau and the office the accident year by
678 calendar quarter data for paid-claim costs;
679 2. Each insurer shall submit financial reports to the
680 rating bureau and the office which shall include total incurred
681 claim amounts and paid-claim amounts by policy year and by
682 injury types as of December 31 of each calendar year; and
683 3. Each insurer shall submit to the rating bureau and the
684 office paid-premium data on an individual risk basis in which
685 risks are to be subdivided by premium size as follows:
686
687 Number of Risks in
688 Premium Range Standard Premium Size
689
690 ...(to be filled in by carrier)... $300—999
691 ...(to be filled in by carrier)... 1,000—4,999
692 ...(to be filled in by carrier)... 5,000—49,999
693 ...(to be filled in by carrier)... 50,000—99,999
694 ...(to be filled in by carrier)... 100,000 or more
695 Total:
696 Section 14. Effective July 1, 2018, section 627.091,
697 Florida Statutes, is amended to read:
698 627.091 Rate filings; workers’ compensation and employer’s
699 liability insurances.—
700 (1) As used in this section, the term:
701 (a) “Expenses” means the portion of a rate which is
702 attributable to acquisition, field supervision, collection
703 expenses, taxes, reinsurance, assessments, and general expenses.
704 (b) “Loss cost modifier” means an adjustment to, or a
705 deviation from, the approved prospective loss costs filed by a
706 licensed rating organization.
707 (c) “Loss cost multiplier” means the profit and expense
708 factor, expressed as a single nonintegral number to be applied
709 to the prospective loss costs, which is associated with writing
710 workers’ compensation and employer’s liability insurance and
711 which is approved by the office in making rates for each
712 classification of risks used by that insurer.
713 (d) “Prospective loss costs” means the portion of a rate
714 which reflects historical industry average aggregate losses and
715 loss adjustment expenses projected through development to their
716 ultimate value and through trending to a future point in time.
717 The term does not include provisions for profit or expenses
718 other than loss adjustment expense.
719 (2)(1) As to workers’ compensation and employer’s liability
720 insurances, every insurer shall file with the office every
721 manual of classifications, rules, and rates, every rating plan,
722 and every modification of any of the foregoing which it proposes
723 to use. Each insurer or insurer group shall independently and
724 individually file with the office the final rates it proposes to
725 use. An insurer may satisfy this filing requirement by adopting
726 the most recent loss costs filed by a licensed rating
727 organization and approved by the office, and by otherwise
728 complying with this part. Each insurer shall file data in
729 accordance with the uniform statistical plan approved by the
730 office. Every filing under this subsection:
731 (a) Must state the proposed effective date and must be made
732 at least 90 days before such proposed effective date;
733 (b) Must indicate the character and extent of the coverage
734 contemplated;
735 (c) May use the most recent approved prospective loss costs
736 filed by a licensed rating organization in combination with the
737 insurer’s own approved loss cost multiplier and loss cost
738 modifier;
739 (d) Must include all deductibles required in chapter 440,
740 and may include additional deductible provisions in its manual
741 of classifications, rules, and rates. All deductibles must be in
742 a form and manner that is consistent with the underlying purpose
743 of chapter 440;
744 (e) May use variable or fixed expense loads or a
745 combination thereof, and may vary the expense, profit, or
746 contingency provisions by class or group of classes, if the
747 insurer files supporting data justifying such variations;
748 (f) May include a schedule of proposed premium discounts,
749 credits, and surcharges. The office may not approve discounts,
750 credits, and surcharges unless they are based on objective
751 criteria that bear a reasonable relationship to the expected
752 loss, expense, or profit experience of an individual
753 policyholder or a class of policyholders; and
754 (g) May file a minimum premium or expense constant Every
755 insurer is authorized to include deductible provisions in its
756 manual of classifications, rules, and rates. Such deductibles
757 shall in all cases be in a form and manner which is consistent
758 with the underlying purpose of chapter 440.
759 (3)(2) Every such filing shall state the proposed effective
760 date thereof, and shall indicate the character and extent of the
761 coverage contemplated. When a filing is not accompanied by the
762 information upon which the insurer or rating organization
763 supports the filing and the office does not have sufficient
764 information to determine whether the filing meets the applicable
765 requirements of this part, the office, it shall within 15 days
766 after the date of filing, shall require the insurer or rating
767 organization to furnish the information upon which it supports
768 the filing. The information furnished in support of a filing may
769 include:
770 (a) The experience or judgment of the insurer or rating
771 organization making the filing;
772 (b) The Its interpretation of any statistical data which
773 the insurer or rating organization making the filing it relies
774 upon;
775 (c) The experience of other insurers or rating
776 organizations; or
777 (d) Any other factors which the insurer or rating
778 organization making the filing deems relevant.
779 (4)(3) A filing and any supporting information are shall be
780 open to public inspection as provided in s. 119.07(1).
781 (5)(4) An insurer may become satisfy its obligation to make
782 such filings by becoming a member of, or a subscriber to, a
783 licensed rating organization that which makes loss costs such
784 filings and by authorizing the office to accept such filings in
785 its behalf; but nothing contained in this chapter shall be
786 construed as requiring any insurer to become a member or a
787 subscriber to any rating organization.
788 (6) A licensed rating organization may develop and file for
789 approval with the office reference filings containing
790 prospective loss costs and the underlying loss data, and other
791 supporting statistical and actuarial information. A rating
792 organization may not develop or file final rates or multipliers
793 for expenses, profit, or contingencies. After a loss cost
794 reference filing is filed with the office and is approved, the
795 rating organization must provide its member subscribers with a
796 copy of the approved reference filing.
797 (7) A rating organization may file supplementary rating
798 information and rules, including, but not limited to,
799 policywriting rules, rating plan classification codes and
800 descriptions, experience modification plans, statistical plans
801 and forms, and rules that include factors or relativities, such
802 as increased limits factors, classification relativities, or
803 similar factors, but that exclude minimum premiums. An insurer
804 may use supplementary rating information if such information is
805 approved by the office.
806 (8)(5) Pursuant to the provisions of s. 624.3161, the
807 office may examine the underlying statistical data used in such
808 filings.
809 (9)(6) Whenever the committee of a recognized rating
810 organization with authority to file prospective loss costs for
811 use by insurers in determining responsibility for workers’
812 compensation and employer’s liability insurance rates in this
813 state meets to discuss the necessity for, or a request for,
814 Florida rate increases or decreases in prospective loss costs in
815 this state, the determination of prospective loss costs in this
816 state Florida rates, the prospective loss costs rates to be
817 requested in this state, and any other matters pertaining
818 specifically and directly to prospective loss costs in this
819 state such Florida rates, such meetings shall be held in this
820 state and are shall be subject to s. 286.011. The committee of
821 such a rating organization shall provide at least 3 weeks’ prior
822 notice of such meetings to the office and shall provide at least
823 14 days’ prior notice of such meetings to the public by
824 publication in the Florida Administrative Register.
825 (10) An insurer group with multiple insurers writing
826 workers’ compensation and employer’s liability insurance shall
827 file underwriting rules not contained in rating manuals.
828 Section 15. Effective July 1, 2018, section 627.093,
829 Florida Statutes, is amended to read:
830 627.093 Application of s. 286.011 to workers’ compensation
831 and employer’s liability insurances.—Section 286.011 shall be
832 applicable to every prospective loss cost and rate filing,
833 approval or disapproval of filing, rating deviation from filing,
834 or appeal from any of these regarding workers’ compensation and
835 employer’s liability insurances.
836 Section 16. Effective July 1, 2018, subsection (1) of
837 section 627.101, Florida Statutes, is amended to read:
838 627.101 When filing becomes effective; workers’
839 compensation and employer’s liability insurances.—
840 (1) The office shall review all required filings as to
841 workers’ compensation and employer’s liability insurances as
842 soon as reasonably possible after they have been made in order
843 to determine whether they meet the applicable requirements of
844 this part. If the office determines that part of a required rate
845 filing does not meet the applicable requirements of this part,
846 it may reject so much of the filing as does not meet these
847 requirements, and approve the remainder of the filing.
848 Section 17. Effective July 1, 2018, section 627.211,
849 Florida Statutes, is amended to read:
850 627.211 Annual report by the office on the workers’
851 compensation insurance market Deviations; workers’ compensation
852 and employer’s liability insurances.—
853 (1) Every member or subscriber to a rating organization
854 shall, as to workers’ compensation or employer’s liability
855 insurance, adhere to the filings made on its behalf by such
856 organization; except that any such insurer may make written
857 application to the office for permission to file a uniform
858 percentage decrease or increase to be applied to the premiums
859 produced by the rating system so filed for a kind of insurance,
860 for a class of insurance which is found by the office to be a
861 proper rating unit for the application of such uniform
862 percentage decrease or increase, or for a subdivision of
863 workers’ compensation or employer’s liability insurance:
864 (a) Comprised of a group of manual classifications which is
865 treated as a separate unit for ratemaking purposes; or
866 (b) For which separate expense provisions are included in
867 the filings of the rating organization.
868
869 Such application shall specify the basis for the modification
870 and shall be accompanied by the data upon which the applicant
871 relies. A copy of the application and data shall be sent
872 simultaneously to the rating organization.
873 (2) Every member or subscriber to a rating organization
874 may, as to workers’ compensation and employer’s liability
875 insurance, file a plan or plans to use deviations that vary
876 according to factors present in each insured’s individual risk.
877 The insurer that files for the deviations provided in this
878 subsection shall file the qualifications for the plans,
879 schedules of rating factors, and the maximum deviation factors
880 which shall be subject to the approval of the office pursuant to
881 s. 627.091. The actual deviation which shall be used for each
882 insured that qualifies under this subsection may not exceed the
883 maximum filed deviation under that plan and shall be based on
884 the merits of each insured’s individual risk as determined by
885 using schedules of rating factors which shall be applied
886 uniformly. Insurers shall maintain statistical data in
887 accordance with the schedule of rating factors. Such data shall
888 be available to support the continued use of such varying
889 deviations.
890 (3) In considering an application for the deviation, the
891 office shall give consideration to the applicable principles for
892 ratemaking as set forth in ss. 627.062 and 627.072 and the
893 financial condition of the insurer. In evaluating the financial
894 condition of the insurer, the office may consider: (1) the
895 insurer’s audited financial statements and whether the
896 statements provide unqualified opinions or contain significant
897 qualifications or “subject to” provisions; (2) any independent
898 or other actuarial certification of loss reserves; (3) whether
899 workers’ compensation and employer’s liability reserves are
900 above the midpoint or best estimate of the actuary’s reserve
901 range estimate; (4) the adequacy of the proposed rate; (5)
902 historical experience demonstrating the profitability of the
903 insurer; (6) the existence of excess or other reinsurance that
904 contains a sufficiently low attachment point and maximums that
905 provide adequate protection to the insurer; and (7) other
906 factors considered relevant to the financial condition of the
907 insurer by the office. The office shall approve the deviation if
908 it finds it to be justified, it would not endanger the financial
909 condition of the insurer, and it would not constitute predatory
910 pricing. The office shall disapprove the deviation if it finds
911 that the resulting premiums would be excessive, inadequate, or
912 unfairly discriminatory, would endanger the financial condition
913 of the insurer, or would result in predatory pricing. The
914 insurer may not use a deviation unless the deviation is
915 specifically approved by the office. An insurer may apply the
916 premiums approved pursuant to s. 627.091 or its uniform
917 deviation approved pursuant to this section to a particular
918 insured according to underwriting guidelines filed with and
919 approved by the office, such approval to be based on ss. 627.062
920 and 627.072.
921 (4) Each deviation permitted to be filed shall be effective
922 for a period of 1 year unless terminated, extended, or modified
923 with the approval of the office. If at any time after a
924 deviation has been approved the office finds that the deviation
925 no longer meets the requirements of this code, it shall notify
926 the insurer in what respects it finds that the deviation fails
927 to meet such requirements and specify when, within a reasonable
928 period thereafter, the deviation shall be deemed no longer
929 effective. The notice shall not affect any insurance contract or
930 policy made or issued prior to the expiration of the period set
931 forth in the notice.
932 (5) For purposes of this section, the office, when
933 considering the experience of any insurer, shall consider the
934 experience of any predecessor insurer when the business and the
935 liabilities of the predecessor insurer were assumed by the
936 insurer pursuant to an order of the office which approves the
937 assumption of the business and the liabilities.
938 (6) The office shall submit an annual report to the
939 President of the Senate and the Speaker of the House of
940 Representatives by January 15 of each year which evaluates
941 insurance company solvency and competition in the workers’
942 compensation insurance market in this state. The report must
943 contain an analysis of the availability and affordability of
944 workers’ compensation coverage and whether the current market
945 structure, conduct, and performance are conducive to
946 competition, based upon economic analysis and tests. The purpose
947 of this report is to aid the Legislature in determining whether
948 changes to the workers’ compensation rating laws are warranted.
949 The report must also document that the office has complied with
950 the provisions of s. 627.096 which require the office to
951 investigate and study all workers’ compensation insurers in the
952 state and to study the data, statistics, schedules, or other
953 information as it finds necessary to assist in its review of
954 workers’ compensation rate filings.
955 Section 18. Effective July 1, 2018, section 627.2151,
956 Florida Statutes, is created to read:
957 627.2151 Workers’ compensation excessive defense and cost
958 containment expenses.—
959 (1) As used in this section, the term “defense and cost
960 containment expenses” or “DCCE” includes the following Florida
961 expenses of an insurer group or insurer writing workers’
962 compensation insurance:
963 (a) Insurance company attorney fees;
964 (b) Expert witnesses;
965 (c) Medical examinations and autopsies;
966 (d) Medical fee review panels;
967 (e) Bill auditing;
968 (f) Treatment utilization reviews; and
969 (g) Preferred provider network expenses.
970 (2) Each insurer group or insurer writing workers’
971 compensation insurance shall file with the office a schedule of
972 Florida defense and cost containment expenses and total Florida
973 incurred losses for each of the 3 years before the most recent
974 accident year. The DCCE and incurred losses must be valued as of
975 December 31 of the first year following the latest accident year
976 to be reported, developed to an ultimate basis, and at two 12
977 month intervals thereafter, each developed to an ultimate basis,
978 so that a total of three evaluations will be provided for each
979 accident year. The first year reported shall be accident year
980 2018, so that the reporting of 3 accident years under this
981 evaluation will not take place until accident years 2019 and
982 2020 have become available.
983 (3) Excessive DCCE occurs when an insurer includes in its
984 rates Florida defense and cost containment expenses for workers’
985 compensation which exceed 15 percent of Florida workers’
986 compensation incurred losses by the insurer or insurer group for
987 the 3 most recent calendar years for which data is to be filed
988 under this section.
989 (4) If the insurer or insurer group realizes excessive
990 DCCE, the office must order a return of the excess amounts after
991 affording the insurer or insurer group an opportunity for a
992 hearing and otherwise complying with the requirements of chapter
993 120. Excessive DCCE amounts must be returned in all instances
994 unless the insurer or insurer group affirmatively demonstrates
995 to the office that the refund of the excessive DCCE amounts will
996 render a member of the insurer group financially impaired or
997 will render it insolvent under provisions of the Florida
998 Insurance Code.
999 (5) Any excess DCCE amount must be returned to
1000 policyholders in the form of a cash refund or credit toward the
1001 future purchase of insurance. The refund or credit must be made
1002 on a pro rata basis in relation to the final compilation year
1003 earned premiums to the policyholders of record of the insurer or
1004 insurer group on December 31 of the final compilation year. Cash
1005 refunds and data in required reports to the office may be
1006 rounded to the nearest dollar and must be consistently applied.
1007 (6)(a) Refunds must be completed in one of the following
1008 ways:
1009 1. A cash refund must be completed within 60 days after
1010 entry of a final order indicating that excessive DCCE has been
1011 realized.
1012 2. A credit to renewal policies must be applied to policy
1013 renewal premium notices that are forwarded to insureds more than
1014 60 calendar days after entry of a final order indicating that
1015 excessive DCCE has been realized. If the insured thereafter
1016 cancels a policy or otherwise allows the policy to terminate,
1017 the insurer or insurer group must make a cash refund not later
1018 than 60 days after coverage termination.
1019 (b) Upon completion of the renewal credits or refunds, the
1020 insurer or insurer group shall immediately certify having made
1021 the refunds to the office.
1022 (7) Any refund or renewal credit made pursuant to this
1023 section is treated as a policyholder dividend applicable to the
1024 year immediately succeeding the compilation period giving rise
1025 to the refund or credit, for purposes of reporting under this
1026 section for subsequent years.
1027 Section 19. Effective July 1, 2018, section 627.291,
1028 Florida Statutes, is amended to read:
1029 627.291 Information to be furnished insureds; appeal by
1030 insureds; workers’ compensation and employer’s liability
1031 insurances.—
1032 (1) As to workers’ compensation and employer’s liability
1033 insurances, every rating organization filing prospective loss
1034 costs and every insurer which makes its own rates shall, within
1035 a reasonable time after receiving written request therefor and
1036 upon payment of such reasonable charge as it may make, furnish
1037 to any insured affected by a rate made by it, or to the
1038 authorized representative of such insured, all pertinent
1039 information as to such rate.
1040 (2) As to workers’ compensation and employer’s liability
1041 insurances, every rating organization filing prospective loss
1042 costs and every insurer which makes its own rates shall provide
1043 within this state reasonable means whereby any person aggrieved
1044 by the application of its rating system may be heard, in person
1045 or by his or her authorized representative, on his or her
1046 written request to review the manner in which such rating system
1047 has been applied in connection with the insurance afforded him
1048 or her. If the rating organization filing prospective loss costs
1049 or the insurer making its own rates fails to grant or rejects
1050 such request within 30 days after it is made, the applicant may
1051 proceed in the same manner as if his or her application had been
1052 rejected. Any party affected by the action of such rating
1053 organization filing prospective loss costs or insurer making its
1054 own rates on such request may, within 30 days after written
1055 notice of such action, appeal to the office, which may affirm or
1056 reverse such action.
1057 Section 20. Effective July 1, 2018, section 627.318,
1058 Florida Statutes, is amended to read:
1059 627.318 Records.—Every insurer, rating organization filing
1060 prospective loss costs, and advisory organization and every
1061 group, association, or other organization of insurers which
1062 engages in joint underwriting or joint reinsurance shall
1063 maintain reasonable records, of the type and kind reasonably
1064 adapted to its method of operation, of its experience or the
1065 experience of its members and of the data, statistics, or
1066 information collected or used by it in connection with the
1067 prospective loss costs, rates, rating plans, rating systems,
1068 underwriting rules, policy or bond forms, surveys, or
1069 inspections made or used by it, so that such records will be
1070 available at all reasonable times to enable the office to
1071 determine whether such organization, insurer, group, or
1072 association, and, in the case of an insurer or rating
1073 organization, every prospective loss cost, rate, rating plan,
1074 and rating system made or used by it, complies with the
1075 provisions of this part applicable to it. The maintenance of
1076 such records in the office of a licensed rating organization of
1077 which an insurer is a member or subscriber will be sufficient
1078 compliance with this section for any such insurer maintaining
1079 membership or subscribership in such organization, to the extent
1080 that the insurer uses the prospective loss costs, rates, rating
1081 plans, rating systems, or underwriting rules of such
1082 organization. Such records shall be maintained in an office
1083 within this state or shall be made available for examination or
1084 inspection within this state by the department at any time upon
1085 reasonable notice.
1086 Section 21. Effective July 1, 2018, section 627.361,
1087 Florida Statutes, is amended to read:
1088 627.361 False or misleading information.—No person shall
1089 willfully withhold information from or knowingly give false or
1090 misleading information to the office, any statistical agency
1091 designated by the office, any rating organization, or any
1092 insurer, which will affect the prospective loss costs, rates, or
1093 premiums chargeable under this part.
1094 Section 22. Effective July 1, 2018, subsections (1) and (2)
1095 of section 627.371, Florida Statutes, are amended to read:
1096 627.371 Hearings.—
1097 (1) Any person aggrieved by any rate charged, rating plan,
1098 rating system, or underwriting rule followed or adopted by an
1099 insurer, and any person aggrieved by any rating plan, rating
1100 system, or underwriting rule followed or adopted by a rating
1101 organization, may herself or himself or by her or his authorized
1102 representative make written request of the insurer or rating
1103 organization to review the manner in which the prospective loss
1104 cost, rate, plan, system, or rule has been applied with respect
1105 to insurance afforded her or him. If the request is not granted
1106 within 30 days after it is made, the requester may treat it as
1107 rejected. Any person aggrieved by the refusal of an insurer or
1108 rating organization to grant the review requested, or by the
1109 failure or refusal to grant all or part of the relief requested,
1110 may file a written complaint with the office, specifying the
1111 grounds relied upon. If the office has already disposed of the
1112 issue as raised by a similar complaint or believes that probable
1113 cause for the complaint does not exist or that the complaint is
1114 not made in good faith, it shall so notify the complainant.
1115 Otherwise, and if it also finds that the complaint charges a
1116 violation of this chapter and that the complainant would be
1117 aggrieved if the violation is proven, it shall proceed as
1118 provided in subsection (2).
1119 (2) If after examination of an insurer, rating
1120 organization, advisory organization, or group, association, or
1121 other organization of insurers which engages in joint
1122 underwriting or joint reinsurance, upon the basis of other
1123 information, or upon sufficient complaint as provided in
1124 subsection (1), the office has good cause to believe that such
1125 insurer, organization, group, or association, or any prospective
1126 loss cost, rate, rating plan, or rating system made or used by
1127 any such insurer or rating organization, does not comply with
1128 the requirements and standards of this part applicable to it, it
1129 shall, unless it has good cause to believe such noncompliance is
1130 willful, give notice in writing to such insurer, organization,
1131 group, or association stating therein in what manner and to what
1132 extent noncompliance is alleged to exist and specifying therein
1133 a reasonable time, not less than 10 days thereafter, in which
1134 the noncompliance may be corrected, including any premium
1135 adjustment.
1136 Section 23. Effective July 1, 2017, the sums of $723,118 in
1137 recurring funds and $100,000 in nonrecurring funds from the
1138 Insurance Regulatory Trust Fund are appropriated to the Office
1139 of Insurance Regulation, and eight full-time equivalent
1140 positions with associated salary rate of 460,000 are authorized,
1141 for the purpose of implementing this act.
1142 Section 24. Effective July 1, 2017, the sum of $24,720 in
1143 nonrecurring funds from the Operating Trust Fund is appropriated
1144 to the Office of Judges of Compensation Claims within the
1145 Division of Administrative Hearings for the purposes of
1146 implementing this act.
1147 Section 25. Except as otherwise expressly provided in this
1148 act, this act shall take effect July 1, 2017.
