FILED AUG 20 2002 THE TREASURER OF THE STATE OF FLORIDA uv DEPARTMENT OF INSURANCE Docketed by: TOM GALLAGHER t IN THE MATTER OF: Ad-Y 77 GPL CASE NO.: 61909-02-AG CARROLL HARVEY BENNETT ; re ADMINISTRATIVE COMPLAINT - TO: CARROLL HARVEY BENNETT . 11832 Newcastle Avenue ue Baton Rouge, LA 70816-8997 CARROLL HARVEY BENNETT 5836 Landmor Drive Greenwell Springs, LA 70739-4435 You, CARROLL HARVEY BENNETT, are hereby notified that, pursuant to Chapter 626, Florida Statutes, 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, CARROLL HARVEY BENNETT, are currently licensed as a Non-Resident Life Agent (8-16), and a Non-Resident Life & Health Agent (8-18) in this state, license ID#A299189. 2. At all times pertinent to the dates and occurrences referred to herein, you, CARROLL HARVEY BENNETT, were licensed in the state of Florida as a Non-Resident Life Agent (8-16), and a Non-Resident Life & Health Agent (8-18). 3. Pursuant to Chapter 626, Florida Statutes, the Florida Department of Insurance has jurisdiction over your insurance licenses and appointments. COUNT I 4. The above general allegations are realleged and incorporated fully herein by reference. 5. On or about October 7th, 1998, you, CARROLL HARVEY BENNETT, submitted an application for life insurance coverage in behalf of Earl H. Heffelfinger as the insured to Guarantee Reserve Life Insurance Company. Eligibility for such insurance coverage required the applicant to reveal whether he had been treated for certain medical conditions. If the applicant met these requirements he could obtain a policy without a medical exam, a blood test, a urine test, or financial information, and agents who submitted such application were given full commission upon issuance. 6. In order to meet such requirements, you, CARROLL HARVEY BENNETT, knowingly prepared and submitted false and fraudulent documentation on his life insurance application to reflect that Mr. Heffelfinger had no history of being treated for the conditions Chronic Obstructive Lung Disease (COPD), Emphysema, and Congestive Heart Failure, and that he was not on oxygen at that time. However, Mr. Heffelfinger had been treated for Chronic Obstructive Lung Disease, Emphysema, and Congestive Heart Failure, and was in fact on oxygen at the time you visited his home. 7. Based on your willful misrepresentation of Mr. Heffelfinger’s medical history N and his condition at the time he signed his application for life insurance, he was issued Policy Number #4917866 through Guarantee Reserve Life Insurance Company. 8. You, CARROLL HARVEY BENNET, knowingly made false or fraudulent written or oral misrepresentations relative to an application for a life insurance policy for the purpose of obtaining a fee, commission, money, or other benefit. IT IS THEREFORE CHARGED, that you, CARROLL HARVEY BENNETT, have violated and are accountable under the following provisions of the Florida Insurance Code and Rules of the Department of Insurance which constitute grounds for the suspension or revocation of your licenses and eligibility as an insurance agent: (a) 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]; (b) Demonstrated lack of fitness or trustworthiness to engage in the business of insurance. [Section 626.611(7), Florida Statutes]; (c) Fraudulent or dishonest practices in the conduct of business under the license or appointment. [Section 626.611(9), Florida Statutes]; (d) 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]. (e) 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}; wa COUNT II 9. The above general allegations are hereby realleged and fully incorporated herein by reference. 10. You, on or about October 7th, 1998, met with Earl H. Heffelfinger and his daughter Melinda Heffelfinger in their home. The purpose of your visit was to sell Mr. Heffelfinger a life insurance policy through Guarantee Reserve Life Insurance Company, for which he was the insured. 11. Mr. Heffelfinger believed that he was signing an application for modified whole life insurance, a guaranteed policy which did not require medical underwriting. In fact, Mr. Heffelfinger’s application was submitted to Guarantee Reserve Life Insurance as an application for a traditional whole life policy, not a modified whole life policy. This was not the policy Mr. Heffelfinger desired, nor was it the policy for which he believed he was applying. IT IS THEREFORE CHARGED, that you, CARROLL HARVEY BENNETT, have violated and are accountable under the following provisions of the Florida Insurance Code and Rules of the Department of Insurance which constitute grounds for the suspension or revocation of your licenses and eligibility as an insurance agent: (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 626.61 1(5), Florida Statutes}; (b) ) Demonstrated lack of fitness or trustworthiness to engage in the business of insurance. [Section 626.611(7), Florida Statutes]; (c) ) Fraudulent or dishonest practices in the conduct of business under the license or appointment. [Section 626.611(9), Florida Statutes]; COUNTII 12. The above general allegations are hereby realleged and fully incorporated herein by reference. 13. In or about 1998, you, CARROLL HARVEY BENNETT, moved your place of residence, principal business street address, or mailing address, and failed to notify the Department within 30 days of this change. IT IS THEREFORE CHARGED, that you, CARROLL HARVEY BENNETT, have violated and are accountable under the following provisions of the Florida Insurance Code and Rules of the Department of Insurance which constitute grounds for the suspension or revocation of your licenses and eligibility as an insurance agent: (a) Every licensee shall notify the department in writing within 30 days after a change of name, residence address, principal business street address, or mailing address. Any licensed agent who has moved his or her residence from this state shall have his or her license and all appointments immediately terminated by the Department. [Section 626.551, Florida Statutes]; WHEREFORE, you, CARROLL HARVEY BENNETT, are hereby notified that the Treasurer and Insurance Commissioner intends to enter an Order suspending or revoking your licenses and eligibility for licensure as an insurance agent or to impose such lesser penalties as may be provided under the provisions of Chapter 626, 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. Your written response must be received by the Department 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. Ifa 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 20k day of Aust , 2002. KENNEY SHIPLEY Deputy Insurance Commissioner CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT and ELECTION OF RIGHTS has been furnished to: CARROLL HARVEY BENNETT, COLONIAL LIFE AND ACCIDENT, 11832 Newcastle Avenue, Baton Rouge, Baton Rouge 70816-8997; CARROLL ney BAN 5836 Landmor Drive, Greenwell Springs, LA 70739-4435 by Certified Mail this day of. AUgUst. , 2002. Florida Bar Number 03124] Division of Legal Services 612 Larson Building 200 East Gaines Street Tallahassee, Florida 32399-033 Phone: (850) 413-4110 Fax (850) 487-4907 ‘ STATE OF FLORIDA DEPARTMENT OF INSURANCE DIVISION OF LEGAL SERVICES IN THE MATTER OF: ‘ CASE NO.: 61909-02-AG CARROLL HARVEY BENNETT / ELECTION OF PROCEEDING Ihave received and have read the Notice of the ADMINISTRATIVE COMPLAINT filed against me, including the Notice of Rights contained therein, and I understand my options. I am requesting disposition of this matter as indicated below. (Choose one) 1] I do not dispute any of the Department’s factual allegations and I do not desire a hearing. I understand that by waiving my right to a hearing, the Department may enter a final order that adopts the Administrative Complaint and imposes the sanctions sought, including revoking my licenses and appointments as may be appropriate. 2. I do not dispute any of the Department's factual allegations and I hereby elect a proceeding to be conducted in accordance with section 120.57(2), Florida Statutes. In this regard, I desire to (Choose one): C] Submit a written statement and documentary evidence in lieu of a hearing; or [] Personally attend a hearing conducted by a department hearing officer in Tallahassee; or {] Attend that same hearing by way of a telephone conference call. 3. [ ] I do dispute one or more of the Department's factual allegations. I hereby request a hearing pursuant to section 120.57(1), Florida Statutes, to be held before the Division of Administrative Hearings. TO PRESERVE YOUR RIGHT TO A HEARING, YOU MUST FILE YOUR RESPONSE WITH THE DEPARTMENT OF INSURANCE WITHIN TWENTY-ONE (21) DAYS OF YOUR RECEIPT OF THE ADMINISTRATIVE COMPLAINT. THE RESPONSE MUST BE RECEIVED BY THE DEPARTMENT NO LATER THAN 5:00 P.M. ON THE TWENTY-FIRST DAY AFTER YOUR RECEIPT OF THE ADMINISTRATIVE COMPLAINT. The address for filing is: General Counsel as acting agency clerk, Florida Department of Insurance, 612 Larson Building, 200 East Gaines Street, Tallahassee, Florida 32399-0333. Signature Print Name Date: Address: Phone No.:

Docket for Case No: 02-004779PL