‘ 1 tw NAY 22 2001 Treasurer and {nsurence Covpipggioner Docketed by: THE TREASURER OF THE STATE OF FLORIDA DEPARTMENT OF INSURANCE TOM GALLAGHER IN THE MATTER OF DEBORAH FRENCH HEWELL CASE NO.: 42184-01-AG / ADMINISTRATIVE COMPLAINT TO: DEBORAH FRENCH HEWELL DEBORAH FRENCH HEWELL : HBH INSURANCE GROUP 5921 JENKINS AVENUE 224 FORREST AVENUE. . COCOA, FLORIDA 32927 COCOA, FLORIDA 32922 You, DEBORAH FRENCH HEWELL, 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 as an insurance agent in this State, as a result of which it is alleged: ; GENERAL ALLEGATIONS 1. You, DEBORAH FRENCH HEWELL are currently licensed and eligible for licensure in thig state asa life, variable annuity and health agent (0215), a life and health agent (0218), a health agent (0240), and a general lines agent (220). — 2. Atall times material to the dates and occurrences herein, you, DEBORAH FRENCH HEWELL were eligible for licensure as an insurance agent in this State. 3. Atall times material to the dates and occurrences herein, “N.A.P.T.” was the acronym EXHIBIT A ERE Pa Oa rRNA ” wale mee or pseudonym for a multitude of entities that engaged in the business of insurance, or operated as one or more Multipte Employer Welfare Arrangenients (hereafter, "“MEWASs") in Florida, including: National Association of Physical Therapists National Association of Professionals & Technicians National Association of Professional Technical National Association of Professional Trackers National Association of Professional Traders National Association of Chiropractic Professionals National Association of Dental Professionals (Dental Division] National Tourism & Hospitality Association [Division] National Veterinarian Association National Real Estate Association [Division] Physician’s Choice Limited a/k/a Physician’s Choice, Ltd. 4. Section 624.02, Florida Statules defines “Insurance” as: “Insurance” is a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable beviefit upon determinable contingencies. 5. Section 624.03, Florida Statutes defines “Insurer” as: “Insurer” includes every parson engaged as indemnitor, surety, or contractor in the business of entering into contracts of. insurance or annuity. 6. Section 624.09, Florida Statutes defines “Authorized”, “Unauthorized insurer” as: (1) An “authorized” insurer is one duly authorized by a subsisting certificate of authority issued by the department to transact insurance in this state. (2) An “uneuthoriaed” insurer is one not so authorized 7. Section 624.10, Florida Statutes defines “Transacting insurance” as: ‘7. vansact” with t feet comte ts: ak respect to insurance includes any of the following, in addition to olher applicable provisions of the code; (2) solicitation or inducernsnt. (2) Preliminary negotiations. (3) Effectuation ofa contract of insurance. (4) Transaction of matiers subsequent 10 the effectuation of a contract of insurance and arising oul of il. 8. Section 624.437(1), Florida Statutes defines “Multiple Employer Welfare Arrangement” (hereafter, “MEWA”) as: [a]n employee welfare benefil plan or dny other arrangement which is established or maintained for the purpose of offering or providing health insurance benefils or any other benefits, described in s. 624.33, other than life insurance benefits, t0 the employees of two or more employers, or to their beneficiaries. 9. Allinsurers and MEWAs are required by Florida Insurance Code to possess a Certificate of Authority from the Department in order to conduct business in this State. 10, Atno time material to the dates and occurrences herein, did N.A.P.T. or any of the entities for which it was the acronym or pseudonym, possess a Certificate of Authority from the Department to engage in the business of insurance, or to operate as a MEWA, in Plorida. . Ll, Neither NAPT, nor any of the entities for which it was the acronym or pseudonym, was subject to any exception to the licensure requirement of the Florida Insurance Code.in order to lawfully engage in the business of insurance or to operate as a MEWA, in Florida. COUNT] 12, All statements, claims, and allegations of Paragraphs | through 11, inclusive, are incorporated herein by reference. 13, In or about late 1999, you, DEBORAH FRENCH HEWELL, contacted Sterling Casino Lines of Cape Canaveral, Florida, for the purpose of inducing it and its employees, including Gerald Brown, to enter into {a health benefits contract(s) with N.A.P.T. | 14. In or about late, 1999, you, DEBORAH FRENCH HEWELL, solicited and induced | Sterling Casino Lines and its employees, including Gerald Brown to enter into [a] health benefits contract(s) with N.A.P.T. 15. As part of your solicitation of Sterling Casino Lines and its employees, you represented to it and to its employees, including Gerald Brown, that N.A.P.T, was a self-insured “association” and therefore exempt from the regulation and oversight of the Department by virtue of the federal Employee Retirement Income Security Act (hereafter, “BRISA”). 16. Atthe time that you made the representation set forth in the foregoing paragraph, you knew or should have known that it was false, as you knew or should have known that N.A.P.T. operated as an insurer or asa MEWA, and therefore, required a Certificate of Authority from the Department in order to transact business in Florida. 17. Inor about late, 1999, Sterling Casino Lines and its participating employees, including Gerald Brown, did, based upon your solicitation, enter into [a] health benefits contract(s) with N.A.P.T. 18, At the time of your solicitation, inducement, representations concerning, and sale of the N.AP.T. contract and at all times thereafter, N.A.P.T. was not authorized to transact insurance or MEWA business in Florida, and was not subject to any exception to the licensure requirement, of all of which you knew or should have known. COUNTD V9, All statements, claims, and allegations of Paragmphs | through 11, inclusive, are incorporated herein by reference. 20. In or about late, 2000, you, DEBORAH FRENCH HEWELL, contacted Advanced Dental Care of Orlando, Florida, to induce it and its employees, including, Soraya Leyton to enter into [a] health’ benefits contract(s) with NAP.T. 21. In or about late, 2000, you, DEBORAH FRENCH HEWELL, solicited and induced Advanced Dental Care of Orlando, Florida and its employees, including, Soraya Leyton, to enter into [a] health benefits contract(s) with N.A.P.T. a mE eR i ER * 22. As part of your solicitation of Advanced Dental Caze and its employees, including, Soraya Leyton, you represented to it that NLAP.T,. was 2 self-insured “association” and therefore exempt from the regulation and oversight of the Department by virtue of the federal Employee Retirement Income Seourity Act (hereafter, “ERISA”). 23. Atthe time that you made the representation set forth in the foregoing paragraph, you knew or should have known that it was false, as you knew or should have known that N.AP-T. operated as an insurer or as a MEWA, and therefore, required 2 Certificate of Authority from the Department in order to transact business in Florida. 94, In or about early, 2000 employees of Advanced Dental Care, including Soraya Leyton did, based upon your solicitation, enter into [a] health benefits contract(s) with N.A.P.T. 25, Atthe time of your solicitation, inducement, representations concerning, and sale of the NLA.P.T, contract, and atall times thereafter,N.A.P "T, was not authorized to transact insurance OF MEWA business in Florida, and was not subject to any exception to the licensure requirement, al of which you knew or should have known. ) COUNTID. 26. All statements, claims, and allegations of Paragraphs | through 11, inclusive, are inoorporated herein by reference. 27. In or about November, 2000, you, DEBORAH FREN CH HEWELL, intentionally and for . your own financial gain, solicited one, Teri Maglio, 2 licensed insurance agent in Broward County, Florida to herself promote, solicit, and/or sell N.A-P T. bealth benefit contracts to the general public. 28. Atthe time of such solicitation, you knew or should have known that N.A.P.T, was not authorized to transact insurance oT MEWA business in Florida. . BASED UPON ALL OF THE FOREGOING, IT IS THEREFORE CHARGED that you, eS AT a ft ~ - . . ~ DEBORAH FRENCH HEWELL, have violated or are accountable under the following provisions of the Florida Insurance Code and Rules of the State Treasurer and Insurance Commissioner, which violations constitute grounds for the revocation or suspension of your insurance licenses ans eligibility for licensure: A). No person shall transact insurance in this state, or relative to a subject of insurance resident, located, or to be performed in this state, without complying with the applicable provisions of this code. [Section 624.11, Florida Statuses}. B). No person shall act as an insurer, and no insurer ot its agents, attomeys, subsonbers, ot representatives shall directly or indireotly transact insurance in this state except as authorized by a subsisting certificate of authority issued to the insurer by the Department, except as to such transactions as are expressly otherwise provided for in this code {Section 624.401(1), Florida Statutes}; C). No person shall, from offices or by personnel or facilities located in this state, or in any other state or country, directly or indirectly act as agent for, or otherwise aid on behalf of another, any insurer not then authorized to transact insurance in this state int” (a). The solicitation, negotiation, procurement, or effectuation of insurance or annuity contracts, or renewals thereof, (b). The dissemination of information as to coverage or rates, (c). The forwarding of applications: (d). The delivery of policies or contracts; (e). The inspection of risks, . (f). The fixing of rates; (g). The investigation or adjustment of claims or losses, or (h). The collection or forwarding of premiums, or in any other manner represent or assist such an insurer in the transaction of insurance with respect to subjects of insurance resident, located, or to be performed in this state. [Section 626.901(1), Florida Statutes); D). Ifan unauthorized insurer fails to pay in full or in part any claire or loss within the provisions of any insurance contract which 1s entered into in violation of this section, any person who knew or reasonably should have known that such contract was entered inte in violation of this section and who solicited, negotiated, took application for, or effectuated such insurance contract is liable to the insured for the full amount of the claim or loss not paid. [Section 626.901(2), Florida Statutes} ). In addition to any other penalties provided in the insurance code any insurance agent Kioensed in this state who in this state represents oF aids an unauthorized insurer in violation of s. 626.901 commits a misdemeanor of the second degree, punishable as provided in s. 778.082 or 5. 775.083, and each such violator shall be Siable, personally, jointly, and severally with any other person or persons Yable therefor, for payment of taxes payable on account of such insurance under s. 626.938. [Section 626,902, Florida Statutes). F). No person shall engage in this state in any trade practice which is defined in this part as, or determined pursuant to 5.626.951 or 8.626.956! to be, an unfair method or competition or an unfair or deceptive act of practice involving the business of insurance. {Section 626.9521(1), Florida | Statutes), G). Any person who violates any provision of this part shall be subject to a fine in an amount not greater than $2,500 for each non-willful violation and not preater than $20,000 for each willful violation. Fines under this subsection may not exceed an aggregate amount of $10,000 for all non~ willful violations arising out of the same action or an aggregate amount of $100,000 for all willful Violations arising out of the same action. The fines authorized by this subsection may be imposed in addition to any other applicable penalty. [Section 626.9521(2), Florida Statutes}. H). Knowingly making, issuing, circulating, or causing to be made, issued, or cireulated, any estimate, illustration, circular, statement, sales presentation, omission, or comparison which: 1, misrepresents the benefits, advantages, conditions, or terms of any insurance policy; uo 2. is amisrepresentation for the purpose of inducing, jor tending to induce, the lapse, forfeiture, exchange, conversion, or surrender of any insurance policy: 3, uses any advertisement that would mislead or atherwise cause a reasonable person to believe mistakenly that the state or the Federal Government is responsible for the insurance sales activities of any person or stands behind any person’s credit or that the person, state, or the Federal Government guarantees any retums on insurance products or is a source of payment of any insurance obligation of or sold by any person. (Section 626.9541(1){a), Florida Statutes); 1). Knowingly making, publishing, disseminating, circulating, or placing before the public, of causing, directly or indirectly, to be made, published, disseminated, circulated, or placed before the public, 1. in a newspaper, magazine, or other publication, 2. in the form of a notice, circular, pamphlet, letter, or poster, 3. over any radio or television station, or 4. in any other way an advertisement, announcement, or statement containing any assertion, representation, or statement with respect to the business of insurance, which is untrue, deceptive, or misleading [Section 626.9541 (1)(c), Florida Statutes), J), Knowingly: a. Filing with any supervisory or other public official, ~ b, Making, publishing, disserninating, circulating, c. Delivering to any person, d. Placing before the public, ; e. Causing, directly or indirectly, to be made, published, disseminated, circulated, i delivered to any person, or placed before the public. ) any false material statement (Section 626.954 1(1)(e)1., Florida Statutes), 8 2 a 9 Te X). Knowingly making any false entry ofa materia} fact in any book, report, or statement of any person, or knowingly omitting to make a true entry of any materja) fact pertaining to the business of such person in any book, report, or statement of Such person, [Section 626.9541(1)( e)2.,Florida Statutes), L). Committing or performing with such frequency as to indicate a general business practice any of the following: a. Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue; b. Failing to acknowledge and act promptly upon communications with respect to claims; c. Denying claims without conducting reasonable investi gations based upon available information; d. Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide 2 written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed; . e. Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim ar for the offer of a compromise settlement, f. Failing to promptly notify the insured of any additional information necessary for the processing of a claim, or ' Failing to clearly explain the nature of the requested'information and the reasons why such information is necessary. [Section 626.954 L(1)(D3., Florida Statuses]. WHEREFORE, you, DEBORAH FRENCH HEWELL, are hereby notified that the Treasurer and Insurance Commissioner intends to enter an Order: I, Revoking or suspending your licenses as an insurance agent in this state pursuant to Sections 626.61] and 626.621, Florida Statules. I. Imposing an administrative penalty for the willful violation of Section 626.901{1), Florida Statutes, , MH. Holding you personally responsible for the payment ofall unpaid claims of those Florida residents to whom you or the agents working under you, sold contracts or policies issued by N.A.P.T., in accordance with Section 626.90}(2), Florida Statutes, IV. Holding you personally responsible for the payment ofitaxes on account of the coverage afforded under the N.A.P.T. contracts or policies pursuant to Section 626.938, Florida Statutes, in accordance with Section 626.902(2), Florida Statutes, . v. Imposing an administrative penalty for the willful violation of Section 626.9541(1)(a), Florida Statures; : VL Imposing an administrative penalty for the willful violation of Section 626.9541(1)(), Florida Statutes; VI. Imposing an administrative penalty for the willful violation of Section 626.9541(1)(e)1., Florida Statutes; . VIL. Imposing an administrative penalty for the willful violation of Section 626.9541(1)(€)2., Florida Statutes; IX. Imposing an administrative penalty for the willful violation of Section 626.9541(1)(0)2.,. Florida Statutes. 10 NOTICE OF RIGRTS , Pursuant to Sections 120.569 and 120.57. Florida Statutes and Rule Chapter 28-106, Florida Administrative Code (F.A.C.), you have a right to request a proceeding to contest this action by 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 Counse! 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 Larsoa 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 32399-0333. The Petition or Blection 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, AN ORDER OF REVOCATION WILL BE ENTERED AGAINST YOU AND MONETARY ADMINISTRATIVE PENALTIES WILL BE ASSESSED. ‘ 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 or 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 Chapter 28-106, F.A.C. and contain: i a) _ A statement identifying with particularity the allegations of the Department which you dispute and the nature of the dispute; b) An explanation of what relief you are seeking and believe you are entitled to; ¢) 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. If you request a hearing, you have the right to be represented by counsel, or other qualified representative, to take testirnony, to call and 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 shal! 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, You are hereby further notified that you have a right to requést an advisory opinion or information letter as to your status and as to the effect of certain acts and transactions under the Retirement Income Security Act (ERISA) pursuant to ERISA Proc. 76-1, from the Pension and Welfare Benefits Administration of the United States Department of Labor, 200 Constitution Avenue NW, Washington, D.C. 20210 DATED and SIGNED this Z2NO day of May, 2001. ia Kenney Shipley Deputy Insurance Commissioner “12 CERTIFICATE OF SERVICE | HEREBY CERTIFY that a true and correct copy of the foregoing Administrative Complaint has b been sent by Certified Mail this aN day of May, 200] to: DEBORAH FRENCH HEWELL DEBORAH FRENCH HEWELL BH INSURANCE GROUP §921 JENKINS AVENUE 224 FORREST.A VENUE COCOA, FLORIDA 32927 COCOA, FLORIDA 32922 hoe LUKE S. BROWN Senior Executive Attorney Unauthorized Entities Supervisor Florida Department of Insurance 200 East Gaines Street, 6” Floor Tallahassee, Florida 32399-0333 Telephone: 850/ 413-4040 Fax: 850/ 488-2632 |

Docket for Case No: 04-003258PL