FILED DEC 24 2001 THE TREASURER OF THE STATE OF FLORIDA DEPARTMENT OF INSURANCE TOM GALLAGHER IN THE MATTER OF: JAMES EDWARD TURNER ADMINISTRATIVE COMPLAINT TO: JAMES EDWARD TURNER 3473 Diamond Terrace Mulberry, FL. 33860-8614 You, JAMES EDWARD TURNER, license I.D. #4316197, are hereby notified that the Insurance Commissioner of the State of Florida has caused to be made an investigation of your activities while licensed as an insurance agent in this state, as a result of which it is alleged: GENERAL ALLEGATIONS 1. Pursuant to Chapter 626, Florida Statutes, you, JAMES EDWARD TURNER, are currently licensed in this state as a health agent (2-40). 2. At all times pertinent to the dates and occurrences referred to herein, you, JAMES EDWARD TURNER, were licensed in this state as a health agent (2-40). 3. Pursuant to Chapter 626, Florida Statutes, the Florida Department of Insurance (hereinafter referred to as “Department”) has jurisdiction over your insurance license and appointments. Enel > 0A- 5°73 PL OCR ORI RE RE Cenme Crome ere wey a ie RPE 4. At all times pertinent to the dates and occurrences referred to herein, you, JAMES | EDWARD TURNER, were appointed to represent Mega Life & Health Insurance Company (hereinafter referred to as “Mega Life”). COUNT I 5. The above general allegations are hereby realleged and fully incorporated herein by reference. 6. On or about August 18, 2000, you, JAMES EDWARD TURNER, went to the Spurgeon Baptist Bible College and met with the employees to present Mega Life’s health insurance plan. 7. At that time, you, JAMES EDWARD TURNER, met with Mary and Ron Copeland (hereinafter referred to as “The Copelands”). 8. During the aforementioned visit, the Copelands told you, JAMES EDWARD TURNER, that Ron Copeland would have cancer surgery on or about September 8, 2000. The Copelands asked you whether Mega Life would cover the surgery. 9. You, JAMES EDWARD TURNER, told the Copelands that Mega Life would cover Ron Copeland’s impending cancer surgery because the Copelands had never been without insurance coverage at any time. 10. At that time, you, JAMES EDWARD TURNER, did not explain the pre-existing condition clause of Mega Life’s insurance policy to the Copelands. 11. Based upon your statements, the Copelands switched from Florida First Insurance Company to Mega Life. 12. On September 8, 2000, Ron Copeland had surgery and his doctor filed a claim with Mega Life on or about September 22, 2000. ore Se ee [ore ee aad Se grr 13. On or about March 3, 2001, the Copelands received a letter from Mega Life stating that their claim would be denied based on the preexisting condition clause in the insurance policy. Subsequently, Mary Copeland called Mega Life and inquired as to why ihe claim had not been paid. Paige Clark, a Claims Representative for Mega Life, referred Ms. Copeland back to you, JAMES EDWARD TURNER, for further explanation. 14. | When Ms. Copeland called you about the claim, you, JAMES EDWARD TURNER, told her that there was a mistake and that you were sure the surgery was covered because there had been no lapse in insurance coverage. Also, you stated that you would check into the claim with Mega Life and return her call as soon as possible. You never returned her phone call. 15. Two weeks later, Ms. Copeland called you about the claim. You, JAMES EDWARD TURNER, stated that you thought Ron Copeland had already had the surgery, at the initial sales presentation, and that the claim was only for follow-up care. 16. You, JAMES EDWARD TURNER, knew or should have known that follow-up care was not discussed at the initial meeting with the Copelands. IT IS THEREFORE CHARGED that you, JAMES EDWARD TURNER, have violated or are accountable under the following provisions of the Florida Insurance Code and Rules of the State Treasurer and Insurance Commissioner which constitute grounds for the suspension or revocation of your insurance licenses and eligibility for licensure: (a) Willful misrepresentation of any insurance policy or annuity contract or willful deception with regard to any such policy or contract, done either in person or by any form of dissemination of information or advertising. [Section 626.611(5), Florida Statutes]; uw Ge kak a de emer ore (b) Demonstrated lack of fitness or trustworthiness to engage in the business of insurance. [Section 626.611(7), Florida Statutes]; (c) Demonstrated lack of reasonably adequate knowledge and technical competence to engage in the transactions authorized by the license or appointment. [Section 626.61 1(8), Florida Statutes]; | (d) Fraudulent or dishonest practices in the conduct of business under the license or permit. [Section 626.611(9), Florida Statutes]; (e) Willful failure to comply with, or willful violation of, any proper order or rule of the department or willful violation of any provision of this code. [Section 626.61 1(13), Florida Statutes]; (63) Violation of any provision of this code or of any other law applicable to the business of insurance in the course of dealing under the license or appointment. [Section . 626.621(2), Florida Statutes]; (g) Violation of any lawful order or rule of the department. [Section 626.621(3), Florida Statutes]; (h) In the conduct of business under the license or appointment, engaging in unfair methods of competition or in unfair or deceptive acts or practices or having otherwise shown himself or herself to be a source of injury or loss to the public. [Section 626.621(6), Florida . Statutes]; (i) Knowingly making, issuing, circulating, or causing to be made, issued, or circulated, any estimate, illustration, circular, statement, sales presentation, omission, or comparison which: yemperep mg ee omer ae Te ree 1. Misrepresents the benefits, advantages, conditions, or terms of any insurance policy. 6. Is amisrepresentation for the purpose of inducing, or tending to induce, the lapse, forfeiture, exchange, conversion, or surrender of any insurance policy. [Section 626.9541(1)(a)1,6, Florida Statutes]; Gg) Knowingly making a false or fraudulent written or oral statement or representation on, or relative to, an application or negotiation for an insurance policy for the purpose of obtaining a fee, commission, money, or other benefit from any insurer, agent broker, or individual. [Section 626.9541(1)(k)1, Florida Statutes]: (k) Knowingly making any misleading representations or incomplete or fraudulent comparisons or fraudulent material omissions of or with respect to any insurance policies or insurers for the purpose of inducing, or tending to induce, any person to lapse, forfeit, surrender, terminate, retain, pledge, assign, borrow on, or convert any insurance policy or to take out a policy of insurance in another insurer. [Section 626.9541(1)(1)., Florida Statutes]; WHEREFORE, you, JAMES EDWARD TURNER, are hereby notified that the Treasurer and Insurance Commissioner intends to enter an Order suspending or revoking your licenses and appointments as an insurance agent or to impose such penalties as may be provided under the provisions of Sections 626.611, 626.621, 626.681, 626.691; and 626.9521, Florida Statutes, and under the other referenced sections of the Florida Statutes as set out in this Administrative Complaint. NOTICE OF RIGHTS Pursuant to Sections 120.569 and 120.57, Florida Statutes and Rule 28-106, Florida Administrative Code (F.A.C.), you have a right to request a proceeding to contest this action by ore enpyerneen = CREE Tr mere per or» ror oF orp e the Department. You may elect a proceeding by completing the attached Election of Rights form or filing a Petition. Your Petition or Election of a proceeding must be in writing and must be filed with the General Counsel acting as the Agency Clerk, Department of Insurance. If served by U.S. Mail the Petition or Election should be addressed to the Florida Department of Insurance at 612 Larson Building, Tallahassee, Florida 32399-0333. If Express Mail or hand delivery is utilized, the Petition or Election should be delivered to 612 Larson Building, 200 East Gaines Street, Tallahassee, Florida 32399-0300. The Petition or Election must be received by, and filed in the Department within twenty-one (21) days of the date of your receipt of this notice. YOUR FAILURE TO RESPOND TO THIS ADMINISTRATIVE COMPLAINT WITHIN TWENTY-ONE (21) DAYS WILL CONSTITUTE A WAIVER OF YOUR RIGHT TO REQUEST A PROCEEDING ON THE MATTERS ALLEGED HEREIN AND AN ORDER OF REVOCATION WILL BE ENTERED AGAINST YOU. Ifa proceeding is requested and there is no dispute of fact the provisions of Section 120.57(2), Florida Statutes would apply. In this regard you may submit oral or written evidence in opposition to the action taken by this agency or a written statement challenging the grounds upon which the agency has relied. While a hearing is normally not required in the absence of a dispute of fact, if you feel that a hearing is necessary one will be conducted in Tallahassee, Florida or by telephonic conference call upon your request. If you dispute material facts which are the basis for this agency's action you may request a formal adversarial proceeding pursuant to Sections 120.569 and 120.57(1), Florida Statutes. If you request this type of proceeding, the request must comply with all of the requirements of Rule 28-106, F.A.C. and contain SR ey tore cr a) A statement identifying with particularity the allegations of the Department which you dispute and the nature of the dispute; i" b) An explanation of what relief you are seeking and believe you are entitled to; c) Any other information which you contend is material. These proceedings are held before a State administrative law judge of the Division of Administrative Hearings. Unless the majority of witnesses are located elsewhere the Department will request that the hearing be conducted in Tallahassee. Ifa hearing is requested, you have the right to be represented by counsel, or other qualified representative, to take testimony, to call and to cross-examine witnesses, and to have subpoena and subpoena duces tecum issued on your behalf. You are hereby notified that mediation under Section 120.573, Florida Statutes, is not available. Failure to follow the procedure outlined with regard to your response to this notice may result in the request being denied. All prior correspondence in this matter shall be considered freeform agency action, and no such correspondence shall operate as a valid request for an administrative proceeding. Any request for administrative proceeding received prior to the date of this notice shall be deemed abandoned unless timely renewed in compliance with the guidelines as set out above. th ; DATED and SIGNED this24H day of December, 2001. KENNEY SHIPLEY / Deputy Insurance Commissioner EE Ree emery Song cp roa ger Ter ere ream eee rer ore gr wer CERTIFICATE OF SERVICE IHEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT and ELECTION OF RIGHTS has been furnished to: JAMES EDWARD ; TURNER, 3473 Diamond Terrace, Mulberry, Florida 33860-8614; by Certified Mail this 2Y day of { Jecem ber , 2001. Division of Legal Sérvices 612 Larson Building 200 East Gaines St. Tallahassee, Florida 32399-0333 (850) 413-4210 ower TOOT RRS Re ome

Docket for Case No: 02-000578PL