The Issue Whether Petitioner is entitled to additional compensation under the Agreement with Respondent?
Findings Of Fact On August 1, 1986, Respondent issued ,Invitation to Bid Number 87-2, which was titled, "Invitation to Bid for Providing Financial Services Related to the Payment of State Employees' Group Health Self Insurance Claims: (Invitation to Bid). Under the terms of the Invitation to Bid, the winning bidder would agree to provide banking services for two interest bearing accounts. One account (Prescription Drug Account), was to be used to transfer funds from the Respondent to Paid Prescriptions, Inc., the administrator of the prescription drug component of the State Employee's Group Health Self Insurance Plan (Plan). The other account (Health Claims Account) was to be used to pay drafts issued by Blue Cross and Blue Shield of Florida, Inc., to participants and providers for payment of all health claims, except prescription drugs. Blue Cross and Blue Shield of Florida, Inc., was the administrator of the Plan, except for Prescription drugs. For both accounts, the Invitation to Bid required that all fees and charges of the winning bidder must be offset by "the required minimum daily balance." The required minimum daily balance was an amount of money which Respondent would have to maintain deposited in the account with Petitioner. Interest earned by the winning bidder on the required minimum daily balance amount would compensate the winning bidder for providing the services required by Respondent. In addition, funds deposited in the accounts in excess of the required minimum daily balance would earn interest credited to the account each month. Responses to the Invitation to Bid were to be evaluated based on the amount of required minimum daily balances and the amount of interest Respondent would earn on funds on deposit in excess of the required minimum daily balance. Appendix 1 to the Invitation to Bid, was titled "Prescription Drug Account Activity" and contained the following information: Estimated number of deposits per month 2 Estimated number of wire transfers per month 2 Average amount per transfer from February 1986 through May 1986 $480,000 Appendix 2 to the Invitation to Bid was Titled "Heath Claims Account Activity" and contained the following information: The following data was collected from the Period May 1, 1985 through April 30, 1986. Average number of drafts paid per month $40,568 Average daily amount of drafts paid $395,398 Average number of deposits per month 8 Average number of stop Payments per month 19 In preparing its response to the Invitation to Bid, Petitioner based its calculations on the number of transactions set forth in the Appendix. Petitioner determined that, to cover its costs plus a 20 percent profit margin, it would need to receive 13.7 cents per draft handled on the Health Claims Account. By using the 13.7 cents per draft, the average number of drafts per month listed in Appendix 2, and by assuming that it could earn 6.3 percent interest on the required minimum daily balance, Petitioner determined that it needed to ask for a required minimum daily balance of $1,059,000, if the funds were to be maintained in a Demand Deposit Account. Before petitioner submitted its response, Mr. Dale Thompson, an employee of Petitioner's, contacted Mr. Andrew Lewis, Respondent's contact for the invitation to bid, to ask a few questions, and make sure Petitioner understood what it was doing. During this conversation, Mr. Thompson asked Mr. Lewis if he had any reason to expect that the average number of drafts listed in Appendix 2 would increase. Mr. Lewis responded that the number reflected what it had been over the last period and that he had no expectation that it would increase. Petitioner submitted a response which asked for a required minimum daily balance of $0.00 for the Prescription Drug Account, contingent upon having the Health Claims Account of $961,216, if funds were to be maintained in a zero interest Certificate of Deposit, $1,059,522, if funds were to be maintained in a Demand Deposit Account. Also, the amounts on deposit in excess of the required minimum daily balance would earn interest based on the current month's auction average of the ninety-day U. S. Treasury Bill Discount Rate, but not less than 4 Percent. Based on Respondent's analysis of the bids submitted by five firms, Petitioner was selected as having submitted the best bid. Thereupon, Petitioner and Respondent entered into and Agreement whereby Petitioner agreed to provide the services set forth in the Invitation to Bid and pay the interest set forth in Finding of Fact 13, supra, in exchange for Respondent's maintaining a required minimum daily balance of $1,059,522 in a Demand Deposit account with Petitioner. Nowhere in the Agreement is there mention of the average number of drafts listed on Appendix 2. Page 6 of the Agreement contains the following language: SECTION VI - ADDITIONAL DOCUMENTS Invitation to Bid Number 87-2, mailed August 1, 1986 and Capital City's Response to Invitation to Bid Number 87-2 are incorporated herein by reference, except where there is a conflict between this Agreement and the Invitation to Bid shall take precedence over Capital City's Response to the Invitation to Bid. Petitioner began performing services under the Agreement on November 8, 1986, and continued to do so until December 31, 1987, when the agreement expired. Immediately after beginning to perform services, the number of drafts being processed in the Health Claims Account exceeded the number Petitioner had anticipated. This continued for the entire period of the Agreement, during which Petitioner processed the following number of drafts: Nov. 8 - Nov. 30, 1986 38,291 December 55,313 January, 1987 59,887 February 73,309 March 74,468 April 68,654 May 67,911 June 81,065 July 86,838 August 74,337 September 82,846 October 85,624 November 74,474 December 76,374 Monthly Average 72,217 On April 21, 1987, Petitioner, requested that Respondent pay additional compensation to Petitioner based on 13.7 cents per draft for the number of drafts which were being processed in excess of the number reflected on Appendix 2 of the Invitation to Bid. By letter dated May 25, 1987, Respondent denied Petitioner's request, stating that the "unpredictable fluctuations in the volume of drafts was a business risk agreement." Petitioner's Exhibit 4.. After further oral communications between the parties, Petitioner requested an administrative hearing regarding its request for additional compensation. The number of drafts paid from Respondent's, account during May, 1985 through April 1986, which formed the basis for the average number of drafts listed on Appendix 2 were: May 1985 32,783 June 28,045 July 32,697 August 32,822 September 34,923 October 41,430 November 41,491 December 39,136 January 1986 53,103 February 51,390 March 50,775 April 48,176 Total $486,811 Additionally, the number of drafts paid in May, June and July, 1986 were 44,020; 45,123; and 53,095; respectively. At the time Mr. Lewis was working on the Invitation to Bid and had the conversation with Mr. Thompson described in Finding of Fact 12, supra, he was not aware that the number of drafts paid per month had been increasing over the prior three months. In preparing the Invitation to Bid, Mr. Lewis had asked someone in his office to give him an average for the past 12 months and the number he received is the number reflected in Appendix 2.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED, that Respondent issue a final order denying Petitioner's request for additional compensation. Done and ENTERED this 17th day of May, 1988, in Tallahassee, Florida. JOSE A. DIEZ-ARGUELLES Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32399-1550 Filed with the Clerk of the Division of Administrative Hearings this 17th day of May, 1988. APPENDIX The parties submitted proposed findings of fact which are addressed below. Paragraph numbers in the Recommended Order are referred to as "RO ." Petitioner's Proposed Findings of Fact Proposed Finding Ruling and Paragraph Number in of Fact Number Recommended Order Accepted. RO1, 2. Accepted, generally. RO3, 4 Accepted, generally. RO5 Accepted. RO9 Irrelevant Accepted. RO12 Accepted. RO11, 13 First sentence, accepted. RO14, 15. Second sentence, generally accepted, except to the extent it indicates that the number of items was limited by the Agreement. RO16, 17 and last paragraph of Conclusions of Law. Generally supported by the evidence, but irrelevant. The fact that Respondent had this information in its records does not mean that it had a duty to inform bidders when, at the time, it did not know its significance. Accepted. RO19 Accepted, except for parenthetical on incorporation by reference. RO19 Supported by competent evidence but not necessary for the decision reached 13-15. Rejected as argument Respondent's Proposed Finding's of Fact Proposed Finding Ruling and Paragraph Number in of Fact Number Recommended Order 1-3. Irrelevant 4,5. Accepted RO3, 4, 5, 13, 15 6. Accepted 7. Accepted generally. RO12 8. Accepted generally. RO12 9. Accepted 10. Accepted. RO5 11-13. Accepted. RO20 14. Supported by the evidence, but unnecessary to the decision. COPIES FURNISHED: James D. Beasley, Esquire Ausley, McMullen, McGehee, Carothers & Proctor 227 South Calhoun Street Post Office Box 391 Tallahassee, Florida 32302 Augustus D. Aikens, Jr., Esquire General Counsel Department of Administration 435 Carlton Building Tallahassee, Florida 32399-1550 Adis Vila, Secretary Department of Administration 435 Carlton Building Tallahassee, Florida 32399-1550
The Issue The issue in this case is the amount of the Petitioners' personal injury settlement required to be paid to the Agency for Health Care Administration (AHCA) to satisfy its Medicaid lien under section 409.910, Florida Statutes (2013).
Findings Of Fact The Petitioners are the grandparents and legal guardians of Taya Rose Savasuk-Maldonado, who is 11 years old. On October 2, 2010, Taya and six family members were involved in a horrific car crash. The driver of another car (the tortfeasor) failed to stop at an intersection and slammed into the family van, which rolled over, ejecting three passengers, including Taya and her great-grandparents. The great- grandparents died on the pavement next to Taya, and Taya suffered severe injuries, including a skull fracture, pancreatitis, bleeding in her abdomen, and severe road rash that required multiple skin graft surgeries and dressing changes so painful that anesthesia was required. Taya has significant, permanent scarring, which has left her self-conscious and unwilling to wear any clothing that exposes her scars, including bathing suits and some shorts. Taya's emotional injuries include nightmares and grief over the loss of both great-grandparents. Other family members also suffered injuries. Taya required emergency and subsequent medical care that has totaled $257,567 to date. It is not clear from the evidence how much, if any, of that total was reduced when providers accepted Medicaid. Future medical expenses are anticipated, but there was no evidence as to the amount of future medical expenses. The tortfeasor had a $100,000/$300,000 Hartford insurance liability policy on the car he was driving at the time of the accident. Hartford agreed to pay the policy limits. The injured family members agreed that $200,000 of the policy limits should be paid to Taya. On October 14, 2013, Hartford and the Petitioners agreed that the Petitioners would release Hartford, the tortfeasor and his wife (the other owner of the car) in return for payment of $200,000 to be held in trust by the Petitioners' attorneys for distribution as follows: $60,000 to be paid to the Prudential Assigned Settlement Services Corporation to fund future payments to Taya beginning in year 2020; up to $84,095 to lienholders in amounts to be determined; and the balance to the Petitioners' attorneys. The parties to that agreement, which did not include AHCA, agreed that $51,513 of the $200,000 should be allocated to payment of Taya's medical bills, with the rest allocated to claims other than medical expenses. There was no evidence that anything has been paid to AHCA towards its Medicaid lien, or that anything has been paid into an interest-bearing trust account for the benefit of AHCA pending the determination of the amount of its Medicaid lien, which at the time was claimed to be $55,944. The owner of the family van involved in the accident had a $10,000/$20,000 GEICO underinsured motorist policy, which also paid the policy limits. Although the evidence was not clear, the Petitioners appear to concede that all $20,000 was recovered by them for Taya's benefit. There was no evidence as to when the family's claim against the GEICO policy settled, or as to any agreement how the $20,000 should be allocated between medical expenses and other kinds of damages. There was no evidence that any of the $20,000 was paid to AHCA towards its Medicaid lien, or into an interest-bearing trust account for the benefit of AHCA pending the determination of the amount of its Medicaid lien. In addition to the insurance policy settlements, the owners of the other car paid the family approximately $250,000 from their own assets, which the family members agreed to apportion among themselves in a manner that was not disclosed by the evidence. There was no evidence as to when those funds were paid to the family, or when any of those funds was paid to Taya's benefit, if any. The evidence was not clear whether any of those funds was paid towards Taya's medical expenses that were not paid by Medicaid. The evidence suggested that some of the $250,000 was paid towards Taya's medical expenses to date, but it is possible that some of those expenses were reduced when providers accepted Medicaid. There was no evidence that any of those funds was paid to AHCA towards its Medicaid lien claim, or into an interest-bearing trust account for the benefit of AHCA, pending a determination of the amount of its Medicaid lien. A personal injury lawyer, who also was Taya's guardian ad litem, testified that the value Taya's claims against the owners of the other car was approximately $1.4 to $1.8 million. He did not testify as to the amount future medical expenses would contribute to the total value he estimated. AHCA has paid $55,710.98 in Medicaid benefits to treat Taya for her accident injuries. (The Petitioners stipulated to this amount.) Lee Memorial Hospital provided medical services for Taya and claims that it is owed $38,317.05, for which it appears to claim a statutory lien. The evidence was that Lee Memorial refused to accept Medicaid in payment for those services. If Medicaid were accepted, the amount of AHCA's lien would be more than $55,710.98, but probably not $38,317.05 more.
The Issue The issue for determination is whether Respondent committed the offenses set forth in the Administrative Complaint and, if so, what action should be taken.
Findings Of Fact At all times material hereto, Mr. Hannifin was licensed by the Department as a resident Life Agent, Life and Health Agent, General Lines (Property and Casualty Insurance) Agent, and Health Agent. Mr. Hannifin's license identification number is A110269. At all times material hereto, Mr. Hannifin was licensed by the State of Florida as an insurance agent. At all times material hereto, Mr. Hannifin was the president of Hannifin & Associates, Inc. He was the only insurance agent in Hannifin & Associates. An investigator with the Department investigated several complaints against Mr. Hannifin. The investigator tape recorded Mr. Hannifin's statement on September 3, 2003, after informing Mr. Hannifin of his Miranda rights and having Mr. Hannifin execute a Miranda warning card. During the statement, the investigator presented several documents to Mr. Hannifin and asked him several questions regarding the documents. The investigator testified at hearing and the tape recording was received into evidence. As to the identification of those documents, the undersigned finds the investigator's testimony credible. Mr. Hannifin made admissions during the taped statement2 (Statement). The undersigned finds the Statement credible. The undersigned took official recognition of a criminal matter involving Mr. Hannifin, regarding the issues in the Administrative Complaint, in the Circuit Court of Palm Beach County, Fifteenth Judicial Circuit: State of Florida v. Mark Dwain Hannifin, Case No. 03-0112566CFA02. In the Information filed in the court case on October 28, 2003, Mr. Hannifin was charged with two counts of misappropriation of insurance funds (Counts 1 and 2) and four counts of uttering a forgery (Counts 3-6). Pertinent to this matter, Count 2 of the Information involved Madd Dogs Installation, Inc. (Madd Dogs Install'n); Count 3 involved Double A Industries (Double A); Count 4 involved Rockwell Development Company (Rockwell Development); and Count 6 involved Royal Professional Builders, Inc. (Royal Professional Builders). Subsequently, Mr. Hannifin entered into a Pretrial Intervention Program, Deferred Prosecution Agreement on all counts, filed in the court case on April 12, 2005, in which, among other things, prosecution was deferred for a period of 12 months provided Mr. Hannifin abided by certain agreed conditions. COUNT I On or about September 20, 2001, Timothy McClure and Brett Carnahan of Madd Dogs Install'n met with Mr. Hannifin at his office.3 They sought to obtain workers' compensation insurance and commercial general liability insurance for Madd Dogs Install'n. Messrs. McClure and Carnahan agreed to obtain the workers' compensation insurance and commercial general liability insurance for Madd Dogs Install'n from Mr. Hannifin. The workers' compensation insurance was to be provided by Florida United Businesses Associations, Inc. (FUBA), and the commercial general liability insurance was to be provided by Burlington Insurance Company (BIC). On that same day, Messrs. McClure and Carnahan completed the applications for the insurance. Mr. Hannifin received from Messrs. McClure and Carnahan a partial premium payment for the workers' compensation insurance in the amount of $1,205.70 in cash; a premium payment for the commercial general liability insurance in the amount of $453.00 in cash; and an application fee for membership in FUBA in the amount of $50.00 in cash. Mr. Hannifin deposited the monies received into the business account of Hannifin & Associates. Hannifin & Associates sent Madd Dogs Install'n four invoices for monthly premiums relating to the workers' compensation insurance. Between November 2001 and February 2002, Madd Dogs Install'n, by and through Mr. McClure by check, made four monthly payments on the premiums due for the workers' compensation insurance. The payments were deposited into the business account of Hannifin & Associates. Mr. Hannifin failed to remit any of the payments from Madd Dogs Install'n to BIC, to FUBA or to any other insurance company. Mr. Hannifin never obtained the workers' compensation insurance and the commercial general liability insurance for Madd Dogs Install'n. Mr. Hannifin admitted in his Statement that, due to cash flow problems, he diverted the monies paid by Madd Dogs Install'n to his own use. Mr. Hannifin admitted in his Statement that he did not return the money to Mr. McClure.4 Among the conditions provided in the Deferred Prosecution Agreement was that Mr. Hannifin would pay Mr. McClure $8,763.60. COUNT II Mr. Hannifin issued to Madd Dogs Install'n a Certificate of Liability Insurance (Certificate). The date on the Certificate was November 28, 2001. The Certificate provided, among other things, that the insured was Madd Dogs Install'n; that the insurers were BIC for commercial general liability coverage and FUBA for workers' compensation coverage; that the policy number for the commercial general liability was B20394871; that the policy number for the workers' compensation coverage was F4673920; that the coverage period for the policy was September 20, 2001 through September 20, 2002; that the certificate holder was Rockwell Development; and that the "Certificate is issued as a matter of information only and confers no rights upon the certificate holder. . . ." Mr. Hannifin signed the Certificate, as the authorized representative. Madd Dogs Install'n provided a copy of the Certificate to Rockwell Development. Before permitting subcontractors to perform work on its projects, Rockwell Development requires the subcontractors to provided proof of insurance. Madd Dogs Install'n was a subcontractor of Rockwell Development. An inference is drawn and a finding is made that, without the Certificate, Rockwell Development would not allow Madd Dogs Install'n to perform any work at its (Rockwell Development) projects. Mr. Hannifin knew that Rockwell Development would receive a copy of the Certificate.5 Count II contains an allegation that Mr. Hannifin furnished a copy of the Certificate to Rockwell Development. The evidence failed to demonstrate that Mr. Hannifin or anyone in his office, which would satisfy showing that he furnished the Certificate, furnished the copy to Rockwell Development. However, failure to prove this allegation is inconsequential in that the evidence demonstrates that Mr. Hannifin knew that a copy of the Certificate would be furnished to Rockwell Development whether he, or someone in his office, or Madd Dogs Install'n furnished the copy. Madd Dogs Install'n was not insured with either BIC or FUBA. Mr. Hannifin knew that Madd Dogs Install'n did not become, and was not, insured by either BIC or FUBA. He did nothing to cure the non-insurance coverage. Further, as a result, Mr. Hannifin knew that the policy numbers for coverage were nonexistent and, therefore, false. The Certificate was a false material statement. COUNT III Mr. Hannifin issued to Madd Dogs Install'n a Certificate. The date on the Certificate was March 21, 2002. The Certificate provided, among other things, that the insured was Madd Dogs Install'n; that the insurers were BIC for commercial general liability coverage and FUBA for workers' compensation coverage; that the policy number for the commercial general liability was B958477322; that the policy number for the workers' compensation coverage was F4673920; that the coverage period for the policy was September 20, 2001 through September 20, 2002; that the certificate holder was Double A; and that the "Certificate is issued as a matter of information only and confers no rights upon the certificate holder. . . ." Mr. Hannifin signed the Certificate, as the authorized representative. Before permitting subcontractors to perform work on its projects, Double A requires the subcontractors to provided proof of insurance. Madd Dogs Install'n was a subcontractor of Double A. Based on the evidence presented, an inference is drawn and a finding is made that Mr. Hannifin provided a copy of the Certificate to Double A.6 An inference is drawn and a finding is made that, without the Certificate, Double A would not allow Madd Dogs Install'n to perform any work at its (Double A) projects. Mr. Hannifin knew that Double A would receive a copy of the Certificate. Madd Dogs Install'n was not insured with either BIC or FUBA. Mr. Hannifin knew that Madd Dogs Install'n did not become, and was not, insured by either BIC or FUBA. He did nothing to cure the non-insurance coverage. Further, as a result, Mr. Hannifin knew that the policy numbers for coverage were nonexistent. The Certificate was a false material statement. COUNT IV Mr. Hannifin issued to R. K. Drywall7 a Certificate. The date on the Certificate was August 26, 2002. The Certificate provided, among other things, that the insured was R. K. Drywall; that the insurer was Florida Citrus Association (FCA), which is also FUBA, for workers' compensation coverage; that the policy number for the workers' compensation coverage was FLWC96850049; that the coverage period for the policy was August 17, 2002 through August 17, 2003; that the certificate holder was Royal Professional Builders; and that the "Certificate is issued as a matter of information only and confers no rights upon the certificate holder. " Mr. Hannifin signed the Certificate, as the authorized representative. Mr. Hannifin did not forward any money to FCA for the workers' compensation coverage. R. K. Drywall was not insured by FCA. Mr. Hannifin knew that R. K. Drywall did not become, and was not, insured by FCA. He did nothing to cure the non- insurance coverage. Further, as a result, Mr. Hannifin knew that the policy number for coverage was nonexistent. The Certificate was a false material statement. An inference is drawn and a finding is made that, without the Certificate, Royal Professional Builders would not allow R. K. Drywall to perform any work at its (Royal Professional Builders) projects. Mr. Hannifin admitted in his Statement that he furnished Royal Professional Builders a copy of the Certificate. Mr. Hannifin also admitted in his Statement that he returned to R. K. Drywall all the monies paid to him. Count IV contains an allegation that Mr. Hannifin signed and furnished the Certificate to Royal Professional Builders on August 26, 2001, instead of August 26, 2002. In the proposed findings of fact of the Department's post-hearing submission, the Department again refers to the date as August 26, 2001, in spite of the evidence to the contrary; and, as supported by the evidence, refers to the year of another Certificate, showing R. K. Drywall as the insured and Badger Homes, Inc., as the certificate holder, as 2002. At no time did the Department make a request to declare the year of 2001 as a scrivener's error and to amend the Administrative Complaint accordingly. Taking into consideration that the burden of proof is upon the Department by clear and convincing evidence and taking into consideration the evidence presented at hearing and the Department's post-hearing submission, the undersigned considers the year of 2001 in the Administrative Complaint to be critical and not a harmless error. Therefore, the undersigned finds that the Department failed to show that the Certificate's date was August 26, 2001, as alleged in the Administrative Complaint.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department of Financial Services enter a final order: Finding that Mark D. Hannifin committed the following violations: Count I--violated Sections 626.611(7), (9) and (10) and 626.621(2) (by failing to comply with Section 626.561(1)), Florida Statutes (2001); and Counts II and III-- violated Sections 626.611(7) and (9), and 626.621(6) (by engaging in or committing the methods or acts or practices defined in Section 626.9541(1)(e)1.b. ,c., and e.), Florida Statutes (2001); and Revoking the licenses and appointments of Mark D. Hannifin. S DONE AND ENTERED this 5th day of December, 2005, in Tallahassee, Leon County, Florida. ___________________________________ ERROL H. POWELL Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 5th day of December, 2005.
The Issue Whether the Amended Notice and Order to Show Cause issued in DOAH Case Number 11-1150, with which this unadopted rule challenge is now consolidated, contains an agency statement that comes within the definition of a rule but has not been adopted through rulemaking procedures, in violation of section 120.54(1)(a), Florida Statutes, and if so, whether costs and attorney’s fees should be awarded.
Findings Of Fact The Financial Services Commission has responsibility over rules implementing provisions of the Florida Insurance Code conferring duties upon the Commission or its subunits. The Office of Insurance Regulation (the Office) is a subunit of the Financial Services Commission responsible for enforcing the provisions of the Florida Insurance Code with respect to licensees of the Office. Guarantee Trust Life Insurance Company (GTL) is a foreign insurer, domiciled in Illinois, which holds a certificate of authority to transact business as a life and health insurer in Florida. GTL offers insurance products nationwide, except for New York, including Medicare long-term care, supplemental, cancer, college student, accident, and sickness policies. GTL is subject to the jurisdiction of the Office under the Florida Insurance Code, including fines and disciplinary actions. It is substantially affected by the Office’s action and is entitled to a hearing to determine if the Administrative Complaint filed against it constitutes an unadopted rule. On or about May 5, 2010, GTL sent a Termination Letter to at least 216 Florida residents (Members) covered under an out-of-state group major medical policy (Policy), as well as to about 70 Florida residents who held individual policies offered by GTL.1/ The Termination Letter advised that major medical coverage would not be renewed and that GTL would no longer be offering major medical type coverage. On January 12, 2011, the Office served GTL with a Notice and Order to Show Cause alleging that GTL had violated the Florida Insurance Code by continuing to non-renew policies and failing to offer converted policies. A conversion policy is a form of replacement insurance coverage for which certificate holders in a group policy may be eligible when their coverage under a group policy is terminated. On January 28, 2011, GTL filed a Petition for Administrative Hearing with the Office. It amended that Petition on February 1, 2011, still maintaining that it was not required to offer conversion policies. On September 2, 2011, an Order was issued granting the Office’s Unopposed Motion to Amend Notice and Order to Show Cause. Counts I and II of the earlier complaint were amended. The earlier complaint had charged in these counts that “Guarantee Trust violated the Florida Insurance Code by failing to offer converted policies as required by Section 627.6675, Florida Statutes.” Amended counts I and II alleged that “Guarantee Trust violated the Florida Insurance Code by issuing the Termination Letter without offering converted policies required by the Florida Insurance Code and Section 627.6675, Florida Statutes.” On November 15, 2011, GTL filed a Petition to Challenge Unadopted Rule. The Petition was served on the Office more than 30 days before it was filed with the Division of Administrative Hearings, as stipulated at hearing. The Financial Services Commission has not adopted the statement that it was a violation of provisions of the Florida Insurance Code for GTL to “issue a termination letter without offering converted policies as required by Section 627.6675,” or any similar statement, by rulemaking procedures.
