conn -2A GAD THE TREASURER OF THE STATE OF FLORIDA‘ JUL -2 P DEPARTMENT OF INSURANCE - TOM GALLAGHER ane ' th Taurer and Docketed by: eer IN THE MATTER OF: CASE NO.: 41329-02-AG PATRICIA ANN MURPHY ADMINISTRATIVE COMPLAINT We TO: PATRICIA ANN MURPHY 7856 Autumn Wood Drive Orlando, Florida 32825-3344 You, PATRICIA ANN MURPHY, f/k/a PATRICIA ANN MURPHY-GRAVARINSKI and a/k/a PATTY MURPHY (hereinafter referred to as “PATRICIA ANN MURPHY”) 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 and as a result of which it is alleged: GENERAL ALLEGATIONS 1. Pursuant to Chapter 626, Florida Statutes, you, PATRICIA ANN MURPHY, are currently licensed in this state as health (2-40) agent. Your license identification number is A187546. 2. Pursuant to Chapter 626, Florida Statutes, the Florida Department of Insurance (hereinafter referred to as the “Department” has jurisdiction over your license and appointments. 3. Pursuant to Section 626.062, Florida Statutes, no person, unless licensed in this State as a health insurance agent, shall solicit insurance or procure applications or engage or hold himself or herself out as engaging in the business of analyzing or abstracting insurance policies or of counseling or advising or giving opinions to persons relative to insurance contracts. 4. At all times relevant to the dates and occurrences referred to herein you, PATRICIA ANN MURPHY, were the regional manager for United Benefit Life Insurance Company and worked out of your home located at 7856 Autumn Wood Drive, Orlando Florida. 5. At all time relevant to the dates and occurrence alleged herein you, PATRICIA ANN MURPHY, employed Mark Horne, of 7731 University Garden Drive, Winter Park, Florida to solicit and procure health insurance applications and contracts and to collect premium payments. 6. At all time relevant to the dates and occurrences alleged herein, Mr. Horne was not licensed in this state to sell health insurance. 7. At all time relevant to the dates and occurrence alleged herein, you, PATRICIA ANN MURPHY, employed Frank Gavarinski to solicit and procure health insurance applications and contracts and to collect premium payments. 8. At all time relevant to the dates and occurrences alleged herein, Mr. Gavarinski was not licensed in this state to sel] health insurance. COUNT I 9. The above general allegations 1 through 8 are hereby realleged and fully incorporated herein by reference. 10. In July 1999, you, PATRICIA ANN MURPHY, or someone under your direct supervision and control made an appointment for Mark Horne to meet Eva Fajardo, whose business is located at 934 North Magnolia, Suite 234, Orlando, Florida, for the purpose of soliciting the sale of health insurance. 11. On or about July 15, 1999, Mr. Horne met Ms. Fajardo at her office and solicited and procured from her an application for health insurance. Ms. Fajardo gave Mr. Horne two checks totaling $196 for the initial premium payment and other associated costs. Mr. Horne delivered the application and checks to you, PATRICIA ANN MURPHY. 12. You, PATRICIA ANN MURPHY signed the application as the producing agent and forwarded it to the insurer and in doing so made a material misstatement to the insurer. 13. You, PATRICIA ANN MURPHY, knew or should have known that Mr. Horne was not licensed to sell health insurance in this State and thus could not solicit or procure health insurance applications and contracts or collect premium payments or otherwise engage in activities that could only be performed by a licensed agent. 14. You, PATRICIA ANN MURPHY, aided and abetted Mark Horne in the transaction of insurance without a license. IT IS THEREFORE CHARGED that you, PATRICIA ANN MURPHY, have violated or are accountable under one or more of the following provisions of the Florida Insurance Code which constitute grounds for the suspension or revocation of your licenses as an insurance agent in this state: (a) A license or appointment issued under this part is valid only as to the person named and is not transferable to another person. No licensee or appointee shall allow any other person to transact insurance by utilizing the license or appointment issued to such licensee or appointee. [Section 626.441, Florida Statutes] (b) __ 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 Statute] (c) Demonstrated lack of fitness or trustworthiness to engage in the business of insurance. [Section 626.611(7), Florida Statutes] (d) Demonstrated lack of reasonably adequate knowledge and technical competence to engage in the transactions authorized by the license or appointment. [Section 626.611(8), Florida Statutes} (e) Unlawfully rebating, attempting to unlawfully rebate, or unlawfully dividing or offering to divide his or her commission with another. [Section 626.611(11), Florida Statutes] (f) 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) In the conduct of business under the license or appointment, engaging in unfair methods of competition or in unfair or deceptive acts or practices, as prohibited under part IX of this chapter, or having otherwise shown himself or herself to be a source of injury or loss to the public. [Section 626.621(6), Florida Statutes} (h) Knowingly aiding, assisting, procuring, advising, or abetting any person in the violation of or to violate a provision of the insurance code or any order or rule of the department. [Section 626.621(12), Florida Statutes] @ 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] COUNT I 15. The above general allegations 1 through 8 are hereby realleged and fully incorporated herein by reference. 16. In September 1999, you PATRICIA ANN MURPHY, or someone under your direct supervision and control, made an appointment for Mark Horne to meet with Freddy Alequin who resides at 2728 Millican Drive, Orlando, Florida, for the purpose of soliciting the sale of health insurance. 17. On or about August 14, 1999, Mr. Horne met with Mr. Alequin and his wife Laura Alequin and solicited and procured from them an application for Health Insurance. The application was delivered to you, PATRICIA ANN MURPHY. 18. You, PATRICIA ANN MURPHY signed the application as the agent and forwarded it to the insurer and in doing so made a material misstatement to the insurer. 19, You, PATRICIA ANN MURPHY, knew or should have known that Mr. Horne was not licensed to sell health insurance in this State and thus could not solicit or procure health insurance applications and contracts or collect premium payments or otherwise engage in activities that could only be performed by a licensed agent. 20. You, PATRICIA ANN MURPHY, aided and abetted Mark Horne in the transaction of insurance without a license. IT IS THEREFORE CHARGED that you, PATRICIA ANN MURPHY, have violated or are accountable under one or more of the following provisions of the Florida Insurance Code which constitute grounds for the suspension or revocation of your licenses as an insurance agent in this state: (a) Sections 626.441, 626.611(5), 626.611(7), 626.611(8), 626.611(11), 626.621(2), 626.621(6), 626.621(12), and 626.954 1(1)(k) 1, Florida Statutes which are more fully set forth in Count I above and fully incorporated herein by reference. COUNT Ill 21. The above general allegations 1 through 8 are hereby realleged and fully incorporated herein by reference. 22. On or about June 17, 1999, Frank Gavarinski met with Danielle Ponsolle, who resides at 1022 Empress Lane, Orlando, Florida, and solicited and procured from her an application for health insurance. Ms. Ponsolle gave Mr. Gavarinski a check in the amount of $171 for the initial premium payment and other associated costs. The application and check were delivered to you, PATRICIA ANN MURPHY. 23. You, PATRICIA ANN MURPHY signed the application as the agent and forwarded it to the insurer and in doing so made a material misstatement to the insurer. 24. You, PATRICIA ANN MURPHY, knew or should have known that Mr. Gavarinski was not licensed to sell health insurance in this State and thus could not solicit or procure health insurance applications and contracts or collect premium payments or otherwise engage in activities that could only be performed by a licensed agent. 25. You, PATRICIA ANN MURPHY, aided and abetted Frank Gavarinski in the transaction of insurance without a license. IT IS THEREFORE CHARGED that you, PATRICIA ANN MURPHY, have violated or are accountable under one or more of the following provisions of the Florida Insurance Code which constitute grounds for the suspension or revocation of your licenses as an insurance agent in this state: (a) Sections 626.441, 626.611(5), 626.611(7), 626.611(8), 626.611(11), 626.621(2), 626.621(6), 626.621(12), and 626.9541(1)(k) 1, Florida Statutes which are more fully set forth in Count I above and fully incorporated herein by reference. COUNT IV 26. The above general allegations 1 through 8 are hereby realleged and fully incorporated herein by reference. 27. On or about June 23, 1999, Frank Gavarinski met with Milton Ponsolle, who resides at 1022 Empress Lane, Orlando, Florida, and solicited and procured from him an application for health insurance. Mr. Ponsolle gave Mr. Gavarinski a check in the amount of $238 for the initial premium payment and other associated costs. The application and check were delivered to you, PATRICIA ANN MURPHY. 28. You, PATRICIA ANN MURPHY signed the application as the agent and forwarded it to the insurer and in doing so made a material misstatement to the insurer. 29. You, PATRICIA ANN MURPHY, knew or should have known that Mr. Gavarinski was not licensed to sell health insurance in this State and thus could not solicit or procure health insurance applications and contracts or collect premium payments or otherwise engage in activities that could only be performed by a licensed agent. 30. You, PATRICIA ANN MURPHY, aided and abetted Frank Gavarinski in the transaction of insurance without a license. IT IS THEREFORE CHARGED that you, PATRICIA ANN MURPHY, have violated or are accountable under one or more of the following provisions of the Florida Insurance Code which constitute grounds for the suspension or revocation of your licenses as an insurance agent in this state: (a) Sections 626.441, 626.611(5), 626.611(7), 626.611(8), 626.61 1(11), 626.621(2), 626.621(6), 626.621(12), and 626.9541(1)(k) 1, Florida Statutes which are more fully set forth in Count J above and fully incorporated herein by reference. COUNT V 31. The above general allegations 1 through 8 are hereby realleged and fully incorporated herein by reference. 32. On or about August 24, 1999, Frank Gavarinski met with Jerald Coomes, who resides at 1920, Duskin Avenue, Orlando, Florida 32839, and solicited and procured from him an application for health insurance. The application was delivered to you, PATRICIA ANN MURPHY. 33. You, PATRICIA ANN MURPHY signed the application as the agent and forwarded it to the insurer and in doing so made a material misstatement to the insurer. 34. You, PATRICIA ANN MURPHY, knew or should have known that Mr. Gavarinski was not licensed to sell health insurance in this State and thus could not solicit or procure health insurance applications and contracts or collect premium payments or otherwise engage in activities that could only be performed by a licensed agent. 35, You, PATRICIA ANN MURPHY, aided and abetted Frank Gavarinski in the transaction of insurance without a license. IT IS THEREFORE CHARGED that you, PATRICIA ANN MURPHY, have violated or are accountable under one or more of the following provisions of the Florida Insurance Code which constitute grounds for the suspension or revocation of your licenses as an insurance agent in this state: (a) Sections 626.441, 626.611(5), 626.611(7), 626.611(8), 626.611(11), 626.621(2), 626.621(6), 626.621(12), and 626.9541(1)(k) 1, Florida Statutes which are more fully set forth in Count I above and fully incorporated herein by reference. COUNT VI 36. The above general allegations 1 through 8 are hereby realleged and fully incorporated herein by reference. 37. In February 2000, you, PATRICIA ANN MURPHY, met with Tereza Dasilivia, who resides at 1613 Peregine Falcons, Building 11, #206, Orlando, Florida, for the purpose of selling health insurance coverage to her. 38. You, PATRICIA ANN MURPHY, told Ms. Dasilivia that the policy would cover her and family worldwide, including in Brazil. You also told her that the deductible was $1000 and the insurer paid 80% of covered expenses. Based on these representations made by you Ms. Dasilivia purchased the policy. 39. | When Ms. Dasilivia received the policy she discovered that it did not provide worldwide coverage, the deductible was $1500 and the insurer only paid 50% of covered expenses. 40. You, PATRICIA ANN MURPHY, knew or should have known the actual policy terms and should have clearly explained these terms to the consumer. IT IS THEREFORE CHARGED that you, PATRICIA ANN MURPHY, have violated or are accountable under one or more of the following provisions of the Florida Insurance Code which constitute grounds for the suspension or revocation of your licenses as an insurance agent in this state: (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] (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 626.611(8), Florida Statutes] (d) Fraudulent or dishonest practices in the conduct of business under the license or appointment. [Section 626.611(9), Florida Statutes] (e) In the conduct of business under the license or appointment, engaging in unfair methods of competition or in unfair or deceptive acts or practices, as prohibited under part IX of this chapter, or having otherwise shown himself or herself to be a source of injury or loss to the public or detrimental to the public interest. [Section 626.621(6), Florida Statutes] (f) Misrepresentations and false advertising of insurance policies. Knowingly making, issuing, circulating, or causing to be made, issued, or circulated, any estimate, illustration, circular, statement, sales presentation, omission, or comparison, which misrepresents the benefits, advantages, conditions, or terms of any insurance policy. [Section 626.9541(1)(a) 1, Florida Statutes] (g) | Misrepresentation in insurance applications — 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] COUNT VII 41. The above general allegations 1 through 8 are hereby realleged and fully incorporated herein by reference. . 42. In November, 1999, you, PATRICIA ANN MURPHY, met with Ken Luzadder, who resides at 1811 Lorena Lane, Orlando, Florida, for the purpose of selling health insurance coverage to him. At the time you met with Mr. Luzadder he had health insurance coverage with Aetna. 43. You, PATRICIA ANN MURPHY, presented a United Benefit Life Insurance Company (UBL) policy and told Mr. Luzadder that coverage would be the same as the Aetna policy, but the premium would be less expensive. You specifically told Mr. Luzadder that the total policy deductible was $2000, emergency room visits required only a $20 co-payment and that mammograms and pap smears were 100% covered. Based on the representations made by you, Ms. Luzadder purchased the UBL policy and cancelled the Aetna policy. 44. After purchasing the policy Mr. Luzadder discovered that the deductible was $2000 per person, and emergency room visits, mammograms and pap smears were not covered. 45. You, PATRICIA ANN MURPHY, knew or should have known the actual policy terms and should have clearly explained these terms to the consumer. IT IS THEREFORE CHARGED that you, PATRICIA ANN MURPHY, have violated or are accountable under one or more of the following provisions of the Florida Insurance Code which constitute grounds for the suspension or revocation of your licenses as an insurance agent in this state: (a) Sections 626.611(5) 626.611(7) 626.611(8), 626.611(9), 626.621(6), 626.9541(1)(a) 1, and 626.9541(1)(k) 1, Florida Statutes which are more fully set forth in Count VI above and fully incorporated herein by reference. COUNT VIII 46. The above general allegations 1 through 8 are hereby realleged and fully incorporated herein by reference. 47. On or about April 12, 2000, you, PATRICIA ANN MURPHY, met with Rick Hageter and his wife Sandra, who reside at 2826 Gleason Avenue, Orlando Florida, for the purpose of selling health insurance coverage to them. 48. You, PATRICIA ANN MURPHY, presented a Provident health insurance policy to the Hageters and told them that the policy provided critical injury coverage. Based on your representations the Hagters purchased the policy. 49. After purchasing the policy, Mr. Hageter discovered that the policy did not provide critical injury coverage. 50. | You, PATRICIA ANN MURPHY, knew or should have known the actual policy terms and should have clearly explained these terms to the consumer. IT IS THEREFORE CHARGED that you, PATRICIA ANN MURPHY, have violated or are accountable under one or more of the following provisions of the Florida Insurance Code which constitute grounds for the suspension or revocation of your licenses as an insurance agent in this state: (a) Sections 626.611(5) 626.611(7) 626.611(8), 626.611(9), 626.621(6), 626.9541(1)(a) 1, and 626.9541(1)(k) 1, Florida Statutes which are more fully set forth in Count VI] above and fully incorporated herein by reference. COUNT IX 51. The above general allegations 1 through 9 are hereby realleged and fully incorporated herein by reference. 52. On or about October 1, 1999, you, PATRICIA ANN MURPHY, met with Shirley Hintz of Coca, Florida and her Daughter-in-law Kimberly Hintz of Merritt Island, Florida for the purpose of selling health insurance coverage to them. At the time of the meeting, Shirley and Kimberly Hintz had health insurance coverage with UBL. 53. You, PATRICIA ANN MURPHY, presented a Provident health insurance policy to them. You led the Hintzes to believe the policy deductible did not apply to routine office visits, that OB-GYN visits were considered to be routine office visits, and as such were covered except for the co-payment, and mammograms and pap smears were 100% covered. Based on the representation that you made, Shirley Hintz purchased polices for her and for her daughter-in- law and son, Kimberly and Chad Hintz. | 54. After purchasing the policy, Shirley Hintz discovered that the deductible did apply to routine office visits, OB-GYN visits were not cover until after six months and mammograms and pap smears were only 80% covered. 55. You, PATRICIA ANN MURPHY, knew or should have known the actual policy terms and should have clearly explained these terms to the consumer. IT IS THEREFORE CHARGED that you, PATRICIA ANN MURPHY, have violated or are accountable under one or more of the following provisions of the Florida Insurance Code which constitute grounds for the suspension or revocation of your licenses as an insurance agent in this state: (a) Sections 626.611(5) 626.611(7) 626.611(8), 626.611(9), 626.621(6), 626.9541(1)(a) 1, and 626.9541(1)(k) 1, Florida Statutes which are more fully set forth in Count VI above and fully incorporated herein by reference. WHEREFORE, you, PATRICIA ANN MURPHY, 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. You are further notified that any order entered in this case revoking or suspending any license or eligibility for licensure held by you shall also apply to all other licenses and eligibility held by you under the Florida Insurance Code. NOTICE OF RIGHTS You have the right to request a proceeding to contest this action by the Department pursuant to sections 120.569 and 120.57, Florida Statutes, and Rule 28-107, Florida Administrative Code. The proceeding request must be in writing, signed by you, and must be filed with the Department within twenty-one (21) days of your receipt of this notice. Completion of the attached Election of Proceeding form and/or a petition for administrative hearing will suffice as a written request. The request must be filed with the General Counsel as acting Agency Clerk, at the Florida Department of Insurance, 612 Larson Building, 200 East Gaines Street, Tallahassee, Florida 32399-0333. The Department must receive your written response no later than 5:00 p.m. on the twenty-first day after your receipt of this notice. Mailing the response on the twenty-first day will not preserve your right to a hearing. YOUR FAILURE TO RESPOND IN WRITING WITHIN TWENTY-ONE (21) DAYS OF YOUR RECEIPT OF THIS NOTICE 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. If you request a proceeding, you must provide information that complies with the requirements of Rule 28-107.004, Florida Administrative Code. As noted above, completion of the attached Election of Proceeding form conforms to these requirements. Specifically, your response must contain: (a) | The name and address of the party making the request, for purpose of service; (b) A statement that the party is requesting a hearing involving disputed issues of material fact, or a hearing not involving disputed issues of material fact; and (c) A reference to the notice, order to show cause, administrative complaint, or other communication that the party has received from the agency. If a hearing of any type is requested, you have the right to be represented by counsel or other qualified representative at your expense, to present evidence and argument, to call and cross-examine witnesses, and to compel the attendance of witnesses and the production of documents by subpoena. If a proceeding is requested and there is no dispute of material fact, the provisions of section 120.57(2), Florida Statutes, apply. In this regard, you may submit oral or written evidence in opposition to the action taken by the Department or a written statement challenging the grounds upon which the Department 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. However, if you dispute material facts, which are the basis for the Department’s action, you must request an adversarial proceeding pursuant to sections 120.569 and 120.57(1), Florida Statutes. 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, Florida. Failure to follow the procedure outlined with regard to your response to this notice may result in the request being denied. All prior oral communication or correspondence in this matter shall be considered freeform agency action, and no such oral communication or correspondence shall operate as a valid request for an administrative proceeding. Any request for an 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. Mediation of this matter pursuant to section 120.573, Florida Statutes, is not available. No Department attorney will discuss this matter with you until the response has been received by the Department of Insurance. DATED and SIGNED this 244 day of Marg , 2002. ELON N\ KENNEY Sooghiry Deputy Insurance Commissioner *%) via aca CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT and ELECTION OF RIGHTS has been furnished to PATRICIA ANN MURPHY, 7856 Autumn Wood Drive, Orlando, Florida 32825-3344, by Certified Mail this 4 bay of hed Igrida Department of Insurance Division of Legal Services 612 Larson Building Tallahassee, Florida 32399-033 (850) 413-4188 Fla, Bar No. 318530

Docket for Case No: 02-002657PL