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OFFICE OF THE TREASURER, DEPARTMENT OF INSURANCE vs. HOWARD PAUL HAUSER, 89-001226 (1989)
Division of Administrative Hearings, Florida Number: 89-001226 Latest Update: Jul. 21, 1989

Findings Of Fact At all times pertinent to this proceeding Respondent, HOWARD P. HAUSER, was eligible for licensure and licensed in this state by the Florida Department of Insurance as a Life and Health Insurance Agent; General Lines Insurance Agent - Property, Casualty, Surety, and Miscellaneous Lines; and Legal Expense Insurance Agent. At all times pertinent hereto, Respondent was the registered agent and an officer or director of Hauser and Associates Insurance Agency, Incorporated of 7770 Davie Road Extension, Hollywood, Florida. Beginning on or about January 1, 1986, and continuing through August 31, 1987, Respondent represented to one of his clients that he had obtained insurance coverage for that client's three restaurants. This representation of coverage was false. Respondent received from the client insurance premium payments of $56,550.00, more or less, for the insurance of the client's three restaurants. These funds were obtained by Respondent under false pretenses. Respondent provided the mortgagee of one of the restaurants owned by his client with a document purporting to be a certificate of insurance on that restaurant from Scotsdale Insurance Company insuring the restaurant for the period December 11, 1985, to December 11, 1986. Respondent further provided the mortgagee with a declaration sheet stating that Protective Insurance Company would insure the restaurant from January 1, 1987, to January 1, 1990. Respondent falsified these declaration sheets. Respondent's client suffered no loss, other than the loss of his premium dollars, because of Respondent's misrepresentations as to coverage. Respondent was charged with one count of Grand Theft of the Second Degree, a second degree felony, based on the dealings with his client. Respondent entered a plea of nolo contendere to the charge of Grand Theft of the Second Degree. The Circuit Court, in and for Broward County, Florida, placed Respondent on probation for a period of three years and withheld adjudication of guilt. As a condition of the Order of Probation, the court required that Respondent make restitution to his client in the amount of $56,550.00 and further required that $15,000.00 be paid toward restitution on October 24, 1988, the date Respondent entered his plea of nolo contendere and the date the court entered the Order of Probation. Respondent made a restitution payment of $15,000.00 on October 24, 1988. Respondent has been licensed by Petitioner since April 1972. Although Petitioner has received other complaints about Respondent, no formal action has been previously taken against him. Respondent has been a good citizen, except for this misconduct, and a good family man. Respondent regrets his misconduct. Respondent timely requested a formal hearing after the Administrative Complaint was served upon him.

Recommendation Based on the foregoing findings of fact and conclusions of law it is RECOMMENDED that the Department of Insurance enter a final order which revokes all licenses issued by the Department of Insurance to Respondent, Howard Paul Hauser. DONE and ENTERED this 21st of July, 1989, in Tallahassee, Leon County, Florida. CLAUDE B. ARRINGTON Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 904/488-9675 Filed with the Clerk of the Division of Administrative Hearings this 21st day of July, 1989. APPENDIX The proposed findings addressed as follows: of fact submitted on behalf of Petitioner are 1. Addressed in paragraph 1. 2. Addressed in paragraph 2. 3. Addressed in paragraph 6. 4. Addressed in paragraph 3. 5. Addressed in paragraph 4. 6. Addressed in paragraphs 3-4. The proposed findings of fact submitted on behalf of Respondent are addressed as follows: Addressed in paragraph 9. Addressed in paragraph 6. Addressed in paragraph 6. Rejected as being unnecessary to the conclusions reached. Addressed in paragraph 7. Addressed in paragraph 5. Addressed in part in paragraph 7. Rejected in part as being speculative. Rejected as being a conclusion of law and not a finding of fact. COPIES FURNISHED: Robert G. Gough, Esquire, (at the hearing) and Charles Christopher Anderson, Esquire, (on the proposed recommended order) Office of Legal Services 412 Larson Building Tallahassee, Florida 32399-0300 Gary D. Weiner, Esquire, Glendale Federal Building Suite 209 901 Southeast 17th Street Fort Lauderdale, Florida 33316 Honorable Tom Gallagher State Treasurer and Insurance Commissioner The Capitol, Plaza Level Tallahassee, FL 32399-0300 Don Dowdell, General Counsel Department of Insurance and Treasurer The Capitol, Plaza Level Tallahassee, FL 32399-0300

Florida Laws (2) 120.57626.611
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DEPARTMENT OF FINANCIAL SERVICES vs ARTHUR WALTER BROWN, JR., 06-003304PL (2006)
Division of Administrative Hearings, Florida Filed:Gainesville, Florida Sep. 05, 2006 Number: 06-003304PL Latest Update: Dec. 25, 2024
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DEPARTMENT OF FINANCIAL SERVICES vs WILLIAM FRANKLIN OUTLAND, III, 03-002758PL (2003)
Division of Administrative Hearings, Florida Filed:Reddick, Florida Jul. 30, 2003 Number: 03-002758PL Latest Update: Jan. 27, 2004

The Issue Should Petitioner impose discipline against the licenses held by Respondent as a Life (2-16), Life and Health (2-18), General Lines, Property and Casualty Insurance (2-20), Health (2-40) and Legal Expense (2-56) agent pursuant to provisions within Chapter 626, Florida Statutes?

Recommendation Based on the facts found and the conclusions of law reached, it is RECOMMENDED: That a Final Order be entered finding Respondent in violation of Counts I through V pertaining to his obligations as a fiduciary set forth in Section 626.561(1), Florida Statutes, his violation of Section 626.611(7), (9) and (10), Florida Statutes, and his violation of Section 626.621(4), Florida Statutes, in effect when the violations transpired and that the various licenses held by Respondent be suspended for six months as suggested by counsel for Petitioner. DONE AND ENTERED this 2nd day of December, 2003, in Tallahassee, Leon County, Florida. S CHARLES C. ADAMS 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 2nd day of December, 2003. COPIES FURNISHED: James A. Bossart, Esquire Department of Financial Services 612 Larson Building 200 East Gaines Street Tallahassee, Florida 32399-0333 William Franklin Outland, III 10840 Northwest 100th Street Reddick, Florida 32686 Honorable Tom Gallagher Chief Financial Officer Department of Financial Services The Capitol, Plaza Level 11 Tallahassee, Florida 32399-0300 Mark Casteel, General Counsel Department of Financial Services The Capitol, Lower Level 11 Tallahassee, Florida 32399-0300

Florida Laws (5) 120.569120.57626.561626.611626.621
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NATIONAL COUNCIL ON COMPENSATION INSURANCE vs DEPARTMENT OF INSURANCE, 01-004828 (2001)
Division of Administrative Hearings, Florida Filed:Tallahassee, Florida Dec. 12, 2001 Number: 01-004828 Latest Update: Jun. 14, 2002

The Issue Whether the workers' compensation insurance rate filing made by Petitioner, as amended on September 21, 2001, should be approved.

Findings Of Fact The Parties NCCI is a rating organization within the meaning of Section 627.041(3), Florida Statutes. NCCI is licensed by the Department pursuant to Section 627.221, Florida Statutes, to make rates for workers' compensation insurance, and has been, for decades, the only rating organization licensed to perform this function in Florida. NCCI also acts as the statistical agent for the State. In that capacity, NCCI collects a variety of workers' compensation insurance data from its (approximately 300) member companies, each of which is authorized to provide workers' compensation insurance in Florida, and reports such data to the Department. The Department is an agency which generally administers Florida's insurance laws. With respect to workers' compensation insurance, the Department reviews rate filings in accordance with the provisions of Part I, Chapter 627, Florida Statutes, (2001), also known as the Rating Law (Rating Law). The Consumer Advocate is appointed by the Insurance Commissioner pursuant to Section 627.0613, Florida Statutes, to represent the general public of the state before the Department. Nature of the Proceedings and Burden of Proof This is a de novo proceeding to review NCCI's Revised Rate Filing. The burden is upon NCCI to show by a preponderance of the evidence that its Revised Rate Filing would result in rates that are not excessive, inadequate, or unfairly discriminatory within the meaning of Section 627.062(1), Florida Statutes (2001). Application of the Rating Law As the issues were refined over the course of the proceedings, there is no dispute as to whether the Revised Rate Filing, if approved, would result in inadequate or unfairly discriminatory rates. It would not. Rather, the dispute concerns whether the Revised Rate Filing would produce rates which are excessive. The Rating Law governs the process by which premiums for all businesses required to maintain workers' compensation insurance are proposed, and thereafter approved or disapproved by the state. This process is often referred to as ratemaking, and relies heavily upon individuals credentialed in actuarial science (actuaries). Unlike other types of mathematics, algebra or arithmetic, for example, actuarial science does not purport to be able to come up with one and only one correct answer. Rather, actuaries are statisticians who seek to estimate on a prospective basis insurance rates which fall within a "range of reasonableness." The range of reasonableness is legally defined to be somewhere between rates that are neither inadequate nor excessive. Put another way, the law recognizes the right of people who invest in the business of providing workers' compensation insurance to receive a fair rate of return on their investments, but the law does not permit a rate of return which is unreasonably high in relation to the risk involved. Actuaries do not contend that there can be only one correct rate at any given time. Instead, there may be a large area of overlap in the range of reasonableness recognized by different actuaries with respect to the same set of facts. There is substantial disagreement among actuaries and others as to the central issue in this case---what constitutes an unreasonably high rate of return---and how to draw the line between a reasonable and an unreasonable rate of return. In part, this is so because actuarial "science" is not science at all: while all practitioners of the science of chemistry agree about the formula by which water is produced, not all actuaries agree about the formula to be applied to various components of the ratemaking process. The ratemaking process is not like the multiplication tables---it cannot be learned by rote. Ratemaking requires the constant exercise of informed professional judgment. Actuaries' jobs involve making educated guesses about things which will happen in the future. To take the most basic element of guessing which is unique to workers' compensation ratemaking, actuaries must guess as to how much money will be received as premiums under policies to be written under any given rate filing, and how much money will be paid out in benefits under claims made on these policies. These and numerous other complex variables are considered in the ratemaking process and have significant impacts upon the range of reasonableness of insurance premiums. Good faith differences of opinion exist, and to a large degree, actuarial judgment is affected by whether, and to what extent, a particular actuary is employed by insurance companies, or by agencies or businesses with a broader or narrower focus. A difference of opinion on even one of the factors involved in ratemaking can yield a substantial difference in the premium of a single business from one year to the next. Across the spectrum of businesses which are required to purchase workers' compensation insurance, the difference can amount to millions of dollars. In its Revised Rate Filing, NCCI sought a premium level increase, made up of individual components which were expressed in the Revised Rate Filing as follows: Experience, Trend & Benefits 5.4% Experience 1.9% Trend 2.8% Benefits 0.7% Total 5.4% Production and General Expenses 0.8% Production 0.7% General 0.1% Total 0.8% Taxes and Assessments 0.1% Profit and Contingencies 1.6%1 The Rating Law specifies factors and standards to be considered by the Department in deciding whether a rate filing should be approved or disapproved. See Sections 627.062 (2)(b); 627.062(2)(e)(1); and 627.072, Florida Statutes. The factors and standards relevant to the Revised Rate Filing were appropriately taken into account by the Department in its review. In entering its Order on Rate Filing, the Department had the benefit of evidence in the form of presentations which analyzed relevant statutory criteria, and which were organized along the same lines for the public hearing and for the final hearing in this case. To the extent possible, the undersigned has organized this Recommended Order in a similar format. The most significant disputes between the parties regarding the factors relevant to the Revised Rate Filing are: Whether the experience and trend adjustment factors proposed by NCCI, which translate into an overall premium level increase of 1.9% and 2.8%, respectively, are reasonable and would not result in excessive rates. Whether an overall premium level increase of 0.8% for the production and general expenses component is reasonable and would not result in excessive rates. Whether an overall premium level increase of 1.6% for the profit and contingencies component is reasonable and would not result in excessive rates. Other issues were less seriously disputed, or not disputed at all. Both disputed and undisputed issues are, to the extent necessary, addressed separately below. NCCI's Revised Rate Filing requests an overall premium level increase of 8.0% for the industrial classifications and a 10% overall premium level increase for the federal classifications.2 The federal classifications constitute about 20 of the approximately 600 total classifications. This translates to roughly $20 million of the approximately $2.7 billion in total workers' compensation premium dollars in Florida, or less than 1% of the market. Although the parties did not explicitly say so, it is apparent that NCCI almost arbitrarily tacked on an additional 2% upon its proposed industrial class increase, which forms the main focus of the Revised Rate Filing, in order to come up with a proposed figure for the federal classifications. The Department did not object to this procedure from an actuarial science standpoint. Rather, it concedes that if the Department were to approve NCCI's industrial class increase as filed, it would be appropriate to approve the federal classifications increase at the proposed 10% level. Federal classifications will be treated separately in this Recommended Order. NCCI's Revised Rate Filing also seeks an increase in the so-called expense constant from $200 to $220. If granted, this translates into an overall premium level offset of 0.1%. In this setting, the expense constant is an amount which NCCI has determined should be collected to cover the expenses of issuing a workers' compensation insurance policy regardless of the type or amount of risk and associated premium collected from employers. The expense constant is essentially an accounting device which arbitrarily assumes that the overhead associated with getting every piece of new workers' compensation business is identical. Because the expense constant is not intended to result in a premium level increase, NCCI offsets the requested increase in the expense constant against the total premium level increase. After taking into account an offset of 0.1% for the proposed change in the expense constant, the overall net rate level increase requested in the Revised Rate Filing for the industrial classifications is 7.9%.3 NCCI's undisputed evidence supports an increase in expense constant from $200 to $250; however, NCCI seeks to raise the expense constant to a lesser amount, $220. The unrebutted evidence in this case supports, by a preponderance of the evidence, a finding that an increase in the expense constant as proposed by NCCI is reasonable and does not result in excessive rates. The manner in which NCCI proposed to spread a premium increase across the hundreds of industrial classifications is not disputed by the Department. Under NCCI's plan, 8% is an overall premium level increase, which means that rates for some types of businesses would go up even higher than 8% over current levels, and rates for other types of businesses would fall. The crux of the dispute is the reasonableness of certain key components which produce the 8% overall premium level increase. Each of these key components of the Revised Rate Filing is therefore separately considered. Experience, Trend and Benefits NCCI filed for an overall premium level increase of 5.4% for the experience, trend and benefits component of the Revised Rate Filing. This is by far the single largest component of the overall 8% increase sought by NCCI in the Revised Rate Filing. Before the Department and in these proceedings, NCCI sought to prove that a 5.4% increase over current rates was required, as of January 1, 2002, to produce enough premiums from policies issued on or after that date to cover the reasonably expected cost of claims arising under those policies. After careful consideration of the testimony of all of the expert actuaries and economists who testified on behalf of the parties, the documents relied upon by these experts, and numerous other documents in the record, including, but not limited to, deposition testimony and interrogatories, documents and exhibits introduced at the final hearing, the undersigned concludes that a preponderance of the evidence does not support a finding that the 5.4% increase sought by NCCI under the category of experience, trend, and benefits is reasonable and would not result in excessive rates. Part of NCCI's failure of proof relates to the method by which the so-called trend adjustment is computed. The ratemaking process seeks to address what is known as loss development, an essential component to forecasting trend.4 The process by which premiums and losses are properly adjusted, in actuarial terms, requires that they first be "brought on-level" with current rates and benefit levels; then the losses are developed to what actuaries call an "ultimate level." The manner in which this calculation was achieved was a disputed issue between the parties. The Department rejected NCCI's methodology in its Order on Rate Filing, principally because NCCI, for the first time in 20 years,5 elected to compute loss development factors by calculating the average change in the loss reports for the most recent three years for which data was available. Previously NCCI had used a two-year average in computing loss development factors in its annual rate filings. By using a three-year average for the nineteenth ultimate loss development factor (also referred to as the tail factor) in the Revised Rate Filing, NCCI achieves a tail factor which drives the rate increase substantially upward, an approach which the Department disapproved. Considering the entire record, including the credentials, professional history, demeanor of the witnesses while testifying on this and other factors of the parties' disputes over various aspects of the rate-making process, together with the exhibits and prior testimony related to this issue, the undersigned is of the view that NCCI has failed to sustain its burden to prove by a preponderance of the evidence that its methodology in calculating the tail factor, as applied to this Revised Rate Filing, has been adequately justified so as to prove by a preponderance of the evidence that it is reasonable and will not produce rates which are excessive. Trend Adjustment After adjusting the 1999 and 2000 calendar-accident year data to the current level of premiums and benefits, and then developing those losses to an ultimate level, the final adjustment which NCCI made to the loss experience data was to apply a trend analysis to account for expected changes in premiums and benefits from the experience period to the forecast period, which begins January 1, 2002. In so doing, NCCI argues for a trend factor of 1% in the experience, trend and benefits component of the Revised Rate Filing. The trend factor which has been approved by the Department for rates currently in effect is 0.5%, so the Revised Rate Filing seeks an additional 0.5% for the trend factor. At a trend factor of 1%, the Revised Rate Filing produces an overall premium level increase of 2.8%. The purpose of trending analysis is described in the Revised Rate Filing as follows: As noted above, the filing relies primarily on the experience from calendar- accident years 2000 and 1999. However, the proposed rates are intended for use with policies with effective dates starting on January 1, 2002. It is necessary to use trend factors that forecast how much the future of Florida workers' compensation experience will differ from the past. These trend factors measure anticipated changes in the amount of indemnity and medical benefits as compared to anticipated changes in the amount of workers' wages. For example, if benefit costs are expected to grow faster than wages, then a trend factor greater than zero should be applied. Conversely, if wages are expected to grow faster than benefit costs, then a trend factor less than zero is indicated. (Petitioner's Exhibit 1, p. 4). Upon consideration of the entire record as it relates to trend, which includes, but is not limited to, consideration of the expert testimony on same, including the credentials and demeanor of the experts who testified concerning these matters, (including their expectations with respect to inflationary pressures; changes in the frequency of claims; changes in the severity of claims; availability of indemnity awards; and types of medical services being provided and expected to be provided in the future) as well as the numerous exhibits relating to trend, and in particular Petitioner's evidence and arguments concerning "Florida Total Loss Ratio,"6 the undersigned is of the view that these elements of the record, singly or in combination, are insufficient to tilt the balance in favor of the 1% trend factor NCCI seeks. They do, however, establish by a preponderance of the evidence that the current trend factor of .5% is justified. While the Department presented some evidence that a flat trend, or even a slightly negative trend, could be actuarially supported, the Department's evidence was insufficient to overcome NCCI's proof that the current trend factor is reasonable given the currently verifiable measures of claim frequency and claim severity. Change in the Medical Fee Schedule (Benefits) The Revised Rate Filing seeks an overall premium level increase of 0.7% as the result of a change in the Medical Fee Schedule. In general, the Medical Fee Schedule provides limits upon the amounts at which physicians and medical providers may be reimbursed for specific procedures and services performed for workers' compensation insurance claimants. Following the original Rate Filing, a statutorily- created entity known as the Three Member Panel7 voted in favor of changes in the Medical Fee Schedule. NCCI was aware of the exact nature of the proposed changes, which had been under consideration for some period of time prior to the Revised Rate Filing. Similarly, the Three Member Panel was aware, at the time the changes were approved, that NCCI had reasonably concluded that the impact of adopting such changes upon workers' compensation insurance rates would be an overall increase of 0.7%. In its Order on Rate Filing, the Department disapproved NCCI's request for the 0.7% premium level increase for the change in the Medical Fee Schedule, citing a report by the Workers' Compensation Research Institute (WCRI) entitled Benchmarking Florida Workers' Compensation Medical Fee Schedules. The WCRI report estimated that the impact of the change in the fee schedule will be a decrease of 2% in the provider fees, a decrease which should yield a decrease in rates of 0.6%. However, by the time of the final hearing in this case, WCRI had retracted its report as follows: The Flash Report [initial WCRI report] concluded that the proposed new Florida fee schedule would have little impact on overall costs estimated to be a reduction of 2 percent. This finding remains that the new fee schedule would have little impact on overall costs, but the estimate is revised to be an increase of 2.9 percent. There was unrebutted evidence that the WCRI's revised estimate would in fact support an overall premium level increase of 0.8%, as opposed to the 0.7% increase requested by NCCI in the Revised Rate Filing. However, the WCRI report was not relied upon by NCCI in the Revised Rate Filing and it is not an appropriate subject for fact-finding in this forum. Instead, the undersigned finds that NCCI has demonstrated that its request for a 0.7% increase based solely upon the change in the Medical Fee Schedule is justified by a preponderance of the evidence and will not result in excessive rates. Production and General Expenses NCCI has requested an overall premium level increase of 0.8% for the production and general expenses component of the Revised Rate Filing, of which .7% is allocated to production and 0.1% to general expenses. The Department disapproved the method by which NCCI calculated these proposed increases for the production and general expense factors--averaging the countrywide expenses over the three most recent years for which fully analyzed data is available: 1997, 1998, and 1999. Taking into account the experience, background and demeanor of the expert witnesses who testified regarding this issue, the undersigned is unable to say that NCCI's case is more persuasive. Therefore, NCCI has failed to show, by a preponderance of the evidence, that its requested increase for production and general expenses is justified, and will not result in excessive rates. Taxes and Assessments NCCI has requested an overall premium level increase of 0.1% for the taxes and assessments component of the Revised Rate Filing. The Department does not dispute that this figure reflects an expected increase in the Workers' Compensation Guaranty Association assessment from 1.75% to 2.00% and a reduction in the General Administration assessment from 2.75% to 2.56% and the evidence establishes the validity of these figures. Therefore, NCCI has shown by a preponderance of the evidence that the 0.1% proposed overall premium level increase allocated to taxes and assessments is reasonable and does not result in a excessive rates. Profit and Contingencies NCCI has requested an overall premium level increase of 1.6% for the profit and contingencies component of the Revised Rate Filing. The requested 1.6% overall premium level increase results from the use of a profit factor of negative 3.0% in the Revised Rate Filing. The profit and contingencies factor underlying the currently approved rates is negative 4.1%, and has been for the past six years. The resolution of the dispute regarding this component of the Revised Rate Filing centers around one's view of how to best determine the cost of capital, also known as rate of return, for policies to be written during the term of the Revised Rate Filing. The undersigned has carefully considered the exhibits and testimony reflecting the views of NCCI's experts, Dr. Martin Wolf and Dr. David Appel, and the testimony of the Department's expert, Dr. Richard Cohn, all well-credentialed economists who devote a substantial portion of their practices to the study of cost of capital in the context of workers' compensation rate making. The arguments in favor of the parties' respective positions are fairly summarized at pages 34-52 of Petitioner's Proposed Recommended Order and at pages 27-55 of the Department's Proposed Recommended Order. The undersigned is of the view that NCCI has not carried its burden of proof by a preponderance of the evidence to show that its proposed profit factor is reasonable and does not result in excessive rates. In rejecting the methodology employed by NCCI's experts, the Department has chosen to credit methodology used by Cohn and recently adopted by insurance regulators in the state of Massachusetts. NCCI has not made a persuasive legal or factual case for its argument that Florida regulators, in so doing, are acting outside their statutory authority. Policyholder Dividends One factor in the determination of the profit component, policyholder dividends, requires separate mention. The Department has historically required NCCI to exclude policyholder dividends from its profit calculation, at least on paper in its annual rate filing. At the final hearing, the Department claimed to not know why NCCI makes such an exclusion, a claim which the undersigned rejects in light of the fact that Florida law specifically provides for the use of policyholder dividends in calculating the profit factor, and doing so would work to NCCI's advantage in terms of justifying this or any other premium level increase sought. Section 627.072(1)(d), Florida Statutes, provides, in pertinent part: As to workers' compensation and employer's liability insurance, the following factors shall be used in the determination and fixing of rates: * * * (d) Dividends, savings or unabsorbed premium deposits allowed or returned by insurers to their policyholders, members, or subscribers; . . . The statute is consistent with Actuarial Standard of Practice No. 30, "Treatment of Profit and Contingency Provisions and the Cost of Capital in Property/Casualty Insurance Ratemaking" ("ASOP 30") which is an authoritative source in the field of actuarial science, and which explicitly includes policyholder dividends as a valid consideration in determining the profit factor. The Department's contention at the Final Hearing, through its chief actuary, that he still did not understand why NCCI excluded policyholder dividends from its calculation of the profit factor included in the Revised Rate Filing, while disingenuous, does not affect the Findings of Fact as to profit, because NCCI did not prove, by a preponderance of evidence, that NCCI "had adequately reflect[ed] investment income on unearned premium and loss reserves."8 Without such proof by a preponderance of evidence, it is impossible to tell what, if any, impact the Department's requirement that dividends be excluded had on the profit number used in the Revised Rate Filing. Thus, NCCI has failed to carry its burden to show, by a preponderance of evidence, that its proposed profit factor is reasonable and would not result in excessive rates. Federal Classifications NCCI has requested an overall premium level increase of 10% for the federal classifications. Based upon a review of the Order on Rate Filing and the record as a whole, it is apparent that the Department has disapproved the requested overall premium level increase for the federal classifications based upon the same grounds that it disapproved the requested overall premium level increase of 8% for the industrial classifications. For the reasons set forth above, the evidence establishes that NCCI has failed to prove by a preponderance of the evidence that its proposed components for experience and trend, production and general expenses, and profit and contingencies as set forth in the Revised Rate Filing are actuarially reasonable and would not result in excessive rates for the federal classifications; thus, NCCI has similarly failed to establish by a preponderance of the evidence that its requested overall premium level increase of 10% should be approved. However, NCCI has established by a preponderance of the evidence the validity of its proposed increases in medical benefits and taxes and assessments.

Recommendation Based upon the foregoing findings of fact and conclusions of law, it is recommended that: The Department enter a final order disapproving the Revised Rate Filing of an overall premium level increase of 8% for the industrial classifications and 10% for the federal classifications. DONE AND ENTERED this 12th day of April, 2002, in Tallahassee, Leon County, Florida. FLORENCE SNYDER RIVAS 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 12th day of April, 2002.

Florida Laws (14) 120.569120.57627.031627.041627.0613627.062627.0625627.072627.091627.101627.111627.151627.215627.221
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DEPARTMENT OF FINANCIAL SERVICES vs DAVID BRIGHT, 05-001736PL (2005)
Division of Administrative Hearings, Florida Filed:Jacksonville, Florida May 13, 2005 Number: 05-001736PL Latest Update: Nov. 29, 2005

The Issue Should discipline be imposed by Petitioner against Respondent's licenses as a life agent (2-16), life and health agent (2-18), and health agent (2-40), held pursuant to Chapter 626, Florida Statutes (2004)?

Findings Of Fact Respondent in accordance with Chapter 626, Florida Statutes (2005), currently holds licenses as a life agent (2- 16), life and health agent (2-18), and a health agent (2-40). On June 24, 2003, in an Administrative Complaint brought by Petitioner against Respondent, also under Case No. 64776-03-AG, accusations were made concerning violations of Chapter 626, Florida Statutes (2003). On October 4, 2004, the parties resolved the earlier case through a settlement stipulation for Consent Order. On October 20, 2004, the Consent Order was entered. In pertinent part the Consent Order stated: The Settlement Stipulation for Consent Order dated October 11, 2004, is hereby approved and fully incorporated herein by reference; * * * (c) Respondent agrees that he has a continuing obligation for claims, which may not have arisen or otherwise be known to the parties at the time of the execution of the Settlement Stipulation for Consent Order and this Consent Order Respondent shall be responsible for satisfying claims that were covered under the Plans sold by Respondent, up to the amount covered by such Plan, less any applicable deductibles or co-payments. Respondent may attempt to negotiate with the providers for compromised amounts, but any such compromise must result in the release of the consumer from any responsibility for the amounts that would have been covered under the terms of such Plan, less any applicable deductibles or co-payments; * * * (f) Within ninety (90) days following the issuance of this Consent Order, the Respondent shall complete the Section 626.2815(3)(a), Florida Statutes, continuing education requirement relative to unauthorized entities; * * * Within thirty (30) days of the issuance of this Consent Order, Respondent agrees to pay to the Department, a fine, in the amount of ONE THOUSAND AND 00/100 ($1,000.00) DOLLARS. Within ninety (90) days following the issuance of this Consent Order, Respondent shall satisfy any unpaid claims for persons insured under the Local 16 Plans he sold, including claims which may not have arisen or otherwise be known to the parties at the time of the execution of the Settlement Stipulation for Consent Order and this Consent Order. Respondent shall only be responsible, however, for satisfying claims that were covered under the Plans sold by Respondent, up to the amount covered by such Plan, less any applicable deductibles or co- payments. Respondent may attempt to negotiate with the providers for compromised amounts, but any such compromise must result in the release of the consumer from any responsibility for the amounts that would have been covered under the terms of such Plan, less any applicable deductibles or co- payments; Within one hundred (100) days following issuance of this Consent Order, the Respondent shall provide proof to the Department that the full amount of claims or losses under all contracts or health plans solicited or sold by Respondent on behalf of Local 16 have been paid or satisfied. Failure of the Respondent to comply with this paragraph shall constitute a material breach of this Consent Order, unless otherwise advised in writing by the Department; Respondent in the future shall comply with all the terms and conditions of this Consent Order; and, shall strictly adhere to all provisions of the Florida Insurance Code, Rules of the Department, and all other laws of the State of Florida. The Respondent shall give the Department full and immediate access to all books and records relating to the Respondent's insurance business, upon request; If, in the future, the Department has good cause to believe that the Respondent has violated any of the terms and conditions of this Consent Order, the Department may initiate an action to suspend or revoke the Respondent's license(s) or appointments, or it may seek to enforce the Consent Order in Circuit Court, or take any other action permitted by law; Respondent paid the $1,000.00 administrative fine required by the Consent Order, but the payment was 20 days late. Respondent completed the continuing education on unauthorized entities. He completed the course on June 3, 2005, beyond the deadline called for in the Consent Order by a number of months. Respondent took the course at Florida Community College in Jacksonville, Florida, an institution that he was familiar with. He took the course to be completed on June 3, 2005, because it was the earliest course available at that school. Respondent was unfamiliar with other schools who may have offered the course at a time that would meet the due date set forth in the Consent Order. Consistent with the expectations in the Consent Order, Petitioner's employees have reviewed their files to determine whether Respondent has satisfied unpaid insurance claims in relation to the insurance plan for Local 16. Those employees involved in that review are Kerry Edgill, a legal assistant in the Legal Division in charge of complaint settlements and Pamela White who works with the Division of Consumer Services as a senior management analyst. Neither employee found any evidence that Respondent had satisfied the unpaid insurance claims as called for in the Consent Order. In correspondence from Respondent to Petitioner's counsel in this case, dated December 6, 2004, there is no indication that the unpaid insurance claims have been satisfied. Respondent in his testimony explained the extent to which he had attempted to determine who had outstanding unpaid insurance claims. Respondent went to the location where Local 16 union members were employed. His contact with union members had to be outside the building proper. He spoke to several members at that time. This contact took place on June 1, 2005. Respondent identified the persons contacted as James, Luther, Gregory, and Michael. Michael's last name may have been Williams, as Respondent recalls. Of the persons Respondent spoke with on June 1, 2005, none of them had an unpaid insurance claim which needed to be satisfied. Respondent provided correspondence to a person or persons whose name(s) was or were not disclosed in the testimony. The June 6, 2005, correspondence was addressed to the Amalgamated Transit Union, in reference to insurance claims for Local 16. Respondent's Exhibit Numbered 17 is a copy of that correspondence. In the body of the correspondence it stated: June 6, 2005 Amalgamated Transit Union Local 1197 P.O. Box 43285 Jacksonville, FL 32203 Re: Claims for Local 16 To union members and trustees, This letter is to follow up me meeting members at the station on June 1, 2005 to discuss any issues or concerns that you may be or have had relating to the unpaid claims with Local 16 National Health Fund. Although, I feel I am not responsible for the issue I would gladly help assist with resolving any problems or concerns that you may have. Should any members have any correspondents that need immediate attention please forward them to me at: David Bright, P.O. Box 441963, Jacksonville, FL 32222. Should you need to speak to me I can be reached at 904-207-0141. Thanks for your cooperation in this long due matter! In relation to what Respondent refers to as accounts for Local 16 which he was servicing, that refers to insurance coverage, it involved a couple of hundred insureds. Respondent in his testimony acknowledged that union members had insurance claims that were unpaid.

Recommendation Upon consideration of the facts found and the conclusions of law reached, it is RECOMMENDED: That a final order be entered finding Respondent in violation of Sections 626.611(7) and (13), and 626.621(2) and (3), Florida Statutes (2004), finding no violation of Section 626.611(9), Florida Statutes (2004), or 626.9521, Florida Statutes (2004), and suspending Respondent's respective licenses as a life agent (2-16), life and health agent (2-18), and health agent (2-40), for a period of six (6) months. DONE AND ENTERED this 7th day of October, 2005, in Tallahassee, Leon County, Florida. S CHARLES C. ADAMS 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 7th day of October, 2005.

Florida Laws (10) 120.569120.57626.2815626.611626.621626.681626.691626.951626.9521626.9561
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DEPARTMENT OF FINANCIAL SERVICES, DIVISION OF WORKERS' COMPENSATION vs GARY THE CARPENTER CONSTRUCTION, INC., 08-004630 (2008)
Division of Administrative Hearings, Florida Filed:Kingsley, Florida Sep. 19, 2008 Number: 08-004630 Latest Update: May 22, 2009

The Issue The issues in this case are whether Respondent, Gary the Carpenter Construction, Inc., failed to comply with the requirements of Sections 440.10, 440.107, and 440.38, Florida Statutes, and, if so, the appropriate amount of penalty which should be assessed against Respondent.

Findings Of Fact The Department of Financial Services (hereinafter referred to as the “Department”), is the state agency charged with the responsibility of enforcing the requirement of Section 440.107, Florida Statutes, that employers in Florida secure workers' compensation insurance coverage for their employees. § 440.107(3), Fla. Stat. Respondent, Gary the Carpenter Construction, Inc. (hereinafter referred to as “GTC”), is a Florida corporation, which at the times relevant employed subcontractors in the performance of its general contracting business located in Key West, Florida. GTC and its subcontractors, at the times relevant, were performing construction activities in the State of Florida. On March 25, 2008, GTC was renovating a structure at 1300 Virginia Street, Key West, Florida. An investigator of the Department’s Division of Workers’ Compensation (hereinafter referred to as the “Division”), conducted a compliance check at the construction site, determining that GTC was the general contractor and that it was using an out-of-state business entity, Pryjomski Construction (hereinafter referred to as “Pryjomski”), as a subcontractor. A Stop-Work Order was issued to Pryjomski. Pryjomski is a Michigan corporation. As a result of the Division investigator’s findings with regard to Pryjomski, on or about April 22, 2008, a Business Records Request was made by the Division to GTC. In response to the records request, GTC provided documentation of its workers’ compensation coverage. Those records were reviewed by Russell Gray, the Department’s “Penalty Calculator.” Based upon his review of GTC’s records, it was found that GTC’s employees were covered for workers’ compensation insurance through an employee leasing service. The records provided by GTC also indicated, however, that GTC utilized the services of numerous subcontractors. A review of Department records concerning the subcontractors revealed that four of the subcontractors utilized by GTC did not meet coverage requirements: Christian Construction, Perez Painting, Pryjomski, and Tiles Etcetera. The accuracy of the penalty assessment proposed by the Department attributable to Christian Construction and Perez Painting was stipulated to by the parties, and GTC did not contest that amount of the penalty assessment attributable to those two subcontractors. Pryjomski As to Pryjomski, it was discovered that it had two Certificates of Liability Insurance (hereinafter referred to as “Certificates”), both with issuance dates after March 25, 2008, the date the Division’s investigator conducted the compliance check at GTC’s construction site. A 2007-2008 workers’ compensation policy was issued two days after March 25, 2008, and a 2006-2007 workers’ compensation policy was issued September 29, 2009. Obviously, these policies were obtained by Pryjomski because it had no coverage for 2006-2007 and 2007- 2008, as of March 25, 2008. Even if the policies obtained by Pryjomski had been effective prior to March 25, 2008, the policies were written by an out-of-state insurance company not licensed to write policies in Florida, and the policies did not have a Florida Endorsement under “Item 3A” of the declaration page of the policies. Any policy issued to an out-of-state business like Pryjomski must have an endorsement indicating that the foreign entity is paying Florida rates for Florida classification codes. This endorsement is found under “Item 3A” of the declaration page of a policy. The Pryjomski policies did not have the appropriate endorsement. At the times relevant to this matter, Pryjomski was not listed by the Department as a business with appropriate workers' compensation coverage in Florida. GTC could not, therefore, have exercised due diligence in an effort to ensure that Pryjomski had the required insurance coverage when it utilized Pryjomski’s construction services. If due diligence had been exercised, GTC would have been aware of Pryjomski’s lack of appropriate coverage. Based upon documentation provided by GTC, the Division calculated the total amount of Pryjomski’s “payroll” for which GTC was responsible. Absent any receipts for materials for which the payments were made by GTC to Pryjomski, the Division treated 20 percent of the payments as non-payroll pursuant to Florida Administrative Code Rule 69L-6.035(1)(i). Payroll for 2007, less materials, was determined to be $22,106.00. For 2008, payroll, less materials, was determined to be $10,811.93. Utilizing the “finish carpentry” classification code (number 5437) and the approved manual rate therefore of the National Council on Compensation Insurance of 13.01, the penalty for 2007 was determined to be $4,313.99. The rate for 2008 was determined to be 10.47, and the penalty was determined to be $1,698.02. Tiles Etcetera Tiles Etcetera had previously been issued a Certificate of Exemption from coverage for Gregory Veliz, the president of Tiles Etcetera. That Certificate, however, expired on August 23, 2007. Any contract amounts paid to Tiles Etcetera by GTC while the Certificate was in effect are not subject to assessment and have not been included in the penalty assessment in this matter. Amounts paid by GTC to Tiles Etcetera while the Certificate of Exemption had expired are subject to penalty. Based upon documentation provided by GTC, the Division calculated the total amount of “payroll” paid to Tiles Etcetera for which GTC was responsible. Absent any receipts for materials for which the payments were made by GTC to Tiles Etcetera, the Division treated 20 percent of the payments as non-payroll pursuant to Florida Administrative Code Rule 69L- 6.035(1)(i). Payroll for the period from August 24, 2007, to October 19, 2007, less materials, was determined to be $22,269.17. Utilizing the tile installation classification code (number 5438) and the approved manual rate therefore of the National Council on Compensation Insurance of 8.34, the penalty for 2007 was determined to be $2,786.88.

Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department of Financial Services, Division of Workers' Compensation, enter a final order: Finding that Respondent, Gary the Carpenter Construction, Inc., failed to secure the payment of workers’ compensation for its employees, in violation of Section 440.107, Florida Statutes; and Assessing a penalty against Gary the Carpenter Construction, Inc., in the amount of $11,122.74. DONE AND ENTERED this 31st day of March, 2009, in Tallahassee, Leon County, Florida. LARRY J. SARTIN 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 31st day of March, 2009. COPIES FURNISHED: Kristian E. Dunn, Esquire Department of Financial Services Division of Workers' Compensation 200 East Gaines Street Tallahassee, Florida 32399-4229 Jerry D. Sanders, Esquire Vernis & Bowling of Key West, P.A. 604 Truman Avenue, Suite 3 Key West, Florida 33040 Honorable Alex Sink Chief Financial Officer Department of Financial Services The Capitol, Plaza Level 11 Tallahassee, Florida 32399-0300 Daniel Sumner, General Counsel Department of Financial Services The Capitol, Plaza Level 11 Tallahassee, Florida 32399-0300

Florida Laws (8) 120.569120.57440.02440.05440.10440.107440.38698.02 Florida Administrative Code (3) 69L-6.01569L-6.01969L-6.035
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DEPARTMENT OF FINANCIAL SERVICES, DIVISION OF WORKERS' COMPENSATION vs CIELO RESIDENTIAL DESIGN AND CONSTRUCTION, INC., 15-004525 (2015)
Division of Administrative Hearings, Florida Filed:Tallahassee, Florida Aug. 13, 2015 Number: 15-004525 Latest Update: Feb. 12, 2016

The Issue The issues are whether the Respondent, Cielo Residential Design and Construction, Inc. (Cielo), failed to secure workers’ compensation insurance as required by chapter 440, Florida Statutes (2014); and, if so, what penalty should be imposed.

Findings Of Fact The Department is the state agency charged with enforcing the requirement in chapter 440, that employers in Florida secure workers’ compensation coverage for their employees. While an exemption can be obtained for up to three corporate officers, any employer in the construction industry with at least one employee must have workers’ compensation coverage. § 440.02(15), Fla. Stat. At all times relevant to the instant case, Cielo was a Florida-based corporation with its principal office located at 10090 Deerwood Club Road, Jacksonville, Florida 32256. Jose Bird is a Department investigator who visits construction sites and verifies whether workers’ compensation coverage has been secured. On April 24, 2015, Mr. Bird visited a construction site at 1844 Packard Avenue in Jacksonville, Florida and observed John Hockenberry, Jesse Brown, Robert Singleton, and Coty Moore doing carpentry work there. After speaking with those four individuals and learning that they were employed by Cielo, Mr. Bird returned to his car and accessed the Department’s Coverage and Compliance Automated System (CCAS) to ascertain whether Cielo had obtained workers’ compensation coverage for the aforementioned individuals. CCAS indicated that Cielo had no coverage. After relaying this information to his supervisor, Mr. Bird received authorization to serve Mr. Hockenberry with a Stop-Work Order, and he did so on April 24, 2015. That Stop-Work Order required Cielo to “cease all business operations for all worksites in the State” based on the Department’s determination that Cielo had failed to obtain workers’ compensation coverage. In addition, the Department notified Cielo that it would be penalized an amount, “equal to 2 times the amount [Cielo] would have paid in premium when applying approved manual rates to the employer’s payroll during periods for which it [had] failed to secure the payment of compensation within the preceding 2-year period.” Along with the Stop-Work Order, Mr. Bird also served a “Request for Production of Business Records for Penalty Assessment Calculation” (the BRR). In order to ascertain Cielo’s payroll disbursements during the relevant time period and the resulting penalty for Cielo’s failure to obtain workers’ compensation coverage, the BRR requested Cielo to remit several different types of business records covering the period from July 15, 2013 through April 24, 2015 (i.e., the audit period). The business records sought by the Department included items such as time sheets, payroll summaries, check journals, certificates of exemption, and evidence that any Cielo subcontractors had obtained workers’ compensation coverage. Section 440.107(7)(e) provides that if an employer failed to provide business records sufficient to enable the Department to ascertain the employer’s actual payroll for the time period in question, then the Department would impute the employer’s payroll based on the statewide average weekly wage, multiplied by two. After Cielo responded to the BRR, the Department reviewed the provided records and served an Amended Order of Penalty Assessment on June 1, 2015, stating that the Department was seeking to impose a penalty of $162,106.06. Cielo then provided additional records which led to the Department issuing a 2nd Amended Order of Penalty Assessment, stating that the proposed penalty had been reduced to $91,023.60. Cielo continued to provide records that led to the preparation and issuance of a Fourth Amended Order of Penalty Assessment on the day prior to the final hearing in this matter. Through that Order, the Department notified Cielo that it was seeking to impose a penalty of $23,447.60. Lawrence Pickle, a penalty auditor for the Department, calculated the penalties set forth in the aforementioned Orders of Penalty Assessment. With regard to the Fourth Amended Order of Penalty Assessment, Mr. Pickle testified that he utilized a penalty calculation worksheet which the Department has incorporated by reference through Florida Administrative Code Rule 69L-6.027. Mr. Pickle was able to use the business records provided by Cielo to identify the people employed by Cielo during the audit period and listed those employees in the penalty calculation worksheet. Through review of the business records provided by Cielo, Mr. Pickle was also able to ascertain the nature of those employees’ work and assigned each employee a classification code from the Scopes® Manual, which has been adopted by the Department through rule 69L-6.021. Classification codes pertain to various occupations or types of work, and each one has an approved manual rate used by insurance companies to assist in the calculation of workers’ compensation insurance premiums. An approved manual rate corresponds to the risk associated with a particular occupation or type of work. For example, class code 8810 pertains to clerical work and has a lower manual rate than class code 5645 for carpentry. Using the approved manual rates and the wages paid during the audit period, Mr. Pickle determined the individual insurance premiums Cielo would have paid for the employees identified by Mr. Pickle if Cielo had procured workers’ compensation coverage during the audit period. Then, and as required by section 440.107(d)(1), Mr. Pickle multiplied each individual premium by two in order to calculate the penalty associated with each employee for whom records were available. With the exception of April 24, 2015, Mr. Pickle was able to use the records provided by Cielo to ascertain the payroll amounts. As for the penalty associated with April 24, 2015, Mr. Pickle followed the same process set forth above. However, and as required by section 440.107(7)(e), Mr. Pickle calculated the wages from April 24, 2015, by using the statewide average weekly wage for the time period in question and then multiplying that number by two. Kathleen Larriviere, the president and managing partner of Cielo, appeared on Cielo’s behalf at the final hearing. While testifying, Ms. Larriviere described the nature of Cielo’s business as renovations and additions to homes. In addition, she acknowledged that Cielo is in the construction industry. Ms. Larriviere asserted during the final hearing and in her Proposed Recommended Order that she had decided against procuring workers’ compensation coverage at Cielo’s inception based on the advice of her accountant and on her own interpretation of section 440.02(15)(d). Specifically, Ms. Larriviere concluded that Cielo’s employees were independent contractors and exempt from the workers’ compensation requirement because they satisfied many of the criteria enumerated under section 440.02(15)(d). However, and as discussed in the Conclusions of Law below, Ms. Larriviere clearly misread the statute. Even if Cielo’s employees are independent contractors within the meaning of section 440.02(15)(d), the statute clearly specifies that an independent contractor engaged in the construction industry is an “employee” for purposes of chapter 440. The Department has proven by clear and convincing evidence that Cielo was required to have workers’ compensation coverage during the time period in question and violated chapter 440 by failing to do so. As for the $23,447.60 penalty sought by the Department, Ms. Larriviere stated during the final hearing that if Cielo had been required to have workers’ compensation insurance during the time period in question, then Mr. Pickle’s calculations were accurate.

Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department of Financial Services, Division of Workers’ Compensation, enter a final order finding that Cielo Residential Design & Construction, Inc., failed to secure the payment of workers’ compensation insurance coverage at certain times between July 15, 2013 through April 24, 2015, in violation of section 440.107, and imposing a penalty of $23,447.60. DONE AND ENTERED this 24th day of November, 2015, in Tallahassee, Leon County, Florida. S G. W. CHISENHALL Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 24th day of November, 2015. COPIES FURNISHED: Trevor S. Suter, Esquire Department of Financial Services 200 East Gaines Street Tallahassee, Florida 32399-4229 (eServed) Kathleen A. Larriviere, President Cielo Residential Design & Construction, Inc. 10090 Deerwood Club Road Jacksonville, Florida 32256 (eServed) Julie Jones, CP, FRP, Agency Clerk Division of Legal Services Department of Financial Services 200 East Gaines Street Tallahassee, Florida 32399-0390 (eServed)

Florida Laws (7) 106.06120.569120.57120.68440.01440.02440.107
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GOVERNMENT EMPLOYEES CREDIT UNION OF FLORIDA vs. 1ST FLORIDA PUBLIC EMPLOYEES CREDIT UNION, ET AL., 82-002518 (1982)
Division of Administrative Hearings, Florida Number: 82-002518 Latest Update: Jun. 15, 1983

The Issue This presentation concerns the application by Government Employees Credit Union of Florida for the approval of a proposed by-law amendment by the Department of Banking and Finance which would allow an expansion of the field of membership of that credit union to include employees of the State of Florida, Department of Environmental Regulation. The hearing in this matter was occasioned by the protest to the expansion, filed by 1st Florida Public Employees Credit Union. (In the course of the facts reported, Government Employees Credit Union of Florida shall be referred to as "Applicant"; 1st Florida Public Employees Credit Union shall be referred to as "Protestant"; and the Office of the Comptroller, Department of Banking and Finance shall be referred to as "Department".)

Findings Of Fact On August 13, 1982, the Applicant filed its Application for Approval of a proposed By-Law Amendment with the Department. In accordance with Subsection 120.60(4), Florida Statutes, notice of the application was published in the Florida Administrative Weekly, dated August 27, 1982. By letter dated August 30, 1982, Protestant, in the person of its manager, Helen Ferrell, filed a protest to the application. On September 16, 1982, the Applicant filed a petition requesting a hearing to allow it to demonstrate that the proposed by- law amendment of the credit union was in the best interest of the membership, provided means for better service to the membership, was in accord with sound credit union practices, and did not expose the members' funds to unnecessary risks. The Department requested the Division of Administrative Hearings to conduct a final hearing, by correspondence dated September 8 and 23, 1982. A Hearing Officer was appointed to consider that request, and pursuant to Hearing Officer's Notice of Hearing of October 20, 1982, a final hearing date was established for January 24, 1983. Applicant is a Florida chartered credit union, which primarily serves employees of the State of Florida, Department of Health and Rehabilitative Services. By this request, Applicant seeks to amend its charter, Article II, Section 1, to expand the field of membership to include ". . .employees of the Department of Environmental Regulation. . ." The employees who would be added to the field of membership of the Applicant are employees of the State of Florida. Should the application request be honored, the limited field of membership of the Applicant would include those employees of the Department of Environmental Regulation and the other groups serviced as set forth in Applicant's Exhibit No. 1 admitted into evidence. The Department of Environmental Regulation has approximately 744 employment positions within that agency, of which 670 positions were filled effective December 31, 1982. That agency has a total of 353 employees in Tallahassee, Florida. Approximately 400 Department of Environmental Regulation employees are members of the Protestant credit union, with 300 of those members being housed in offices in Tallahassee, Florida. Employees of Department of Environmental Regulation are also included in the field of membership of two credit unions unrelated to this controversy, with 17 of their employees being members of those credit unions. The other two credit unions are Sunshine State Employees Credit Union and Hillsborough County Employees Credit Union. Only the 68 employees of the Department of Environmental Regulation, who relocated in Hillsborough County, Florida, are eligible for membership in Hillsborough County Employees Credit Union. Those employees of the Department of Environmental Regulation not located in Tallahassee are dispersed throughout the state. Department of Environmental Regulation employees represent approximately 50 percent of the use of the Protestant's Tallahassee branch office. This percentage is as a result of information obtained on January 19, 1983, two days prior to a payday for Department of Health and Rehabilitative Services and 12 days prior to Department of Environmental Regulation payday. Approximately 75 percent of Department of Environmental Regulation's employees in Tallahassee are members of the Protestant credit union, with 67 percent of those members maintaining share-draft accounts in Protestant's Tallahassee office. The results of a limited survey conducted in November, 1982, indicated that Department of Environmental Regulation members were responsible for the contribution of 25 percent or $440,000 of the total share deposits; 32 percent or $136,000 total sharedraft deposits; 21 percent or $120,000 of the total certificates of deposit; and 19 percent or $373,000 of the total loans in the Protestant's branch office in Tallahassee. Should the request for expansion of membership be granted, the field of membership could potentially increase to the extent of 740 Department of Environmental Regulation employees and their families. In the latter part of 1982, a survey was conducted of Department of Environmental Regulation employees in Tallahassee to ascertain the satisfaction of those employees with services by Protestant credit union. Of the 143 responses received, 121 were not in opposition to the quality of service being provided by Protestant credit union. The remainder had expressed some dissatisfaction with the services. Several Department of Environmental Regulation employees have expressed an interest in having the Applicant provide credit union services for Department of Environmental Regulation. This indication was made to an employee in the Tallahassee branch office operated by the Applicant. At present, the Applicant has approximately 15,000 members, with a potential membership of 35,000 employees and their families. Applicant has experienced growth in assets from approximately 2.6 million dollars in 1973 to an excess of 15 million dollars in 1983. Applicant's principal office location is Jacksonville, Florida. It maintains a branch location in Tallahassee, Florida. The office in Jacksonville is owned by the Applicant and contains 10,400 square feet of useable space. The Jacksonville office has an additional 2,300 square feet of unused space to meet future needs. Applicant's Tallahassee branch is leased and contains 1,800 square feet of useable space. Applicant has doubled the floor space in the Tallahassee office during the course of its lease to meet present needs and anticipated expansion. In 1982, the Applicant spent $110,000 for the purchase of real estate in Tallahassee for constructing a building in the future. That construction is not contingent upon the approval of the expansion of membership which is the subject of this proceeding. On December 23, 1982, the fee simple title to that parcel of property was received, constituted of a 1.42 acre site located at the corner of Blair Stone Road and Old St. Augustine Road. Should the building be constructed, it would contain 5,000 square feet, primarily directed to service of Leon County area credit union members. The Applicant employs 25 to 26 full time employees to serve credit union members, and four of those employees are located in the Tallahassee branch office. In addition to the full time employees of the Applicant, it utilizes 400 credit union representatives throughout the state and those representatives maintain a supply of credit union forms to assist out-of-town members in credit union transactions. Approximately 2,000 members of the Applicant's credit union utilize the Tallahassee facility. Those members utilizing the Tallahassee facility may also utilize the main office in Jacksonville, which is additionally available to the balance of the credit union membership. The Jacksonville office could be used by the potential Department of Environmental Regulation employees, and this useage would be facilitated by the existence of two suncom lines, three unlimited incoming watts lines, and a 24-hour recorded telephone service. Should the amendment be allowed, Applicant would not alter its membership requirements or lending policies. Applicant's Exhibit No. 3 contains a list and description of various services provided by the Applicant credit union. Some of those services are common to opportunities provided by Protestant. Some services are unique to the Applicant and Protestant credit unions. Protestant's Exhibit No. 8 is a list of services provided by that institution. A comparison of Applicant's No. 3 and Protestant's No. 8, in the context of testimony given by management officials within those credit unions, point out differences in services provided and requirements to be met before a member may avail himself or herself of particular services offered. In addition to the services described, Applicant expects to participate in February of 1984 in a statewide system of automatic teller machines. This system would allow the credit union members to conduct transactions with their credit union through 300 Publix Supermarkets stores. Protestant offers credit union services to the State of Florida, Department of Health and Rehabilitative Services; State of Florida, Department of Corrections; and State of Florida, Department of Environmental Regulation. Protestant has a membership of 11,821 members and approximately 17.7 million dollars in assets. Protestant has a potential membership of over 32,000 employees and their families. Protestant's membership is composed of approximately 5,400 members of the Department of Health and Rehabilitative Services; 5,200 members of the Department of Corrections, and the 400 employee members of Department of Environmental Regulation. Among its membership, 1,650 members are located in the Tallahassee area. The principal office of Protestant is located in Jacksonville, Florida. Petitioner also owns and maintains a 4,000 square feet branch office building in Tallahassee located on Blair Stone Road across from the Department of Environmental Regulation's Tallahassee office. Protestant expended $300,000 in establishing the Tallahassee branch office facility. At present, Protestant's Tallahassee facility is in the posture of an even financial position, that is to say, no significant gains or losses in the operation. By way of future services, Protestant anticipates the installation of an automatic teller machine in 1983, and the potential for access to other automatic teller machines beyond that point. Applicant and Protestant have within their limited fields of membership employees of the State of Florida, Department of Health and Rehabilitative Services. The effect of this overlap is to draw members from a common limited field of membership, and as a consequence, at times, enroll members to the exclusion of the competing credit union, who might otherwise have enrolled as a member in that competing credit union. Protestant also is in a position of overlapping limited fields of membership by other credit unions. Notwithstanding these overlaps, Applicant and Protestant maintain a sound financial position. As stated, neither Applicant nor Protestant have reached the maximum potential for membership in their respective credit unions. Additional membership gains lead to more efficient utilization of credit union employees. Conversely, losses of members acts to the detriment of the efficiency of credit union employees. Expansion of the membership also promotes diversification of services and a better return for investments made in the credit unions. If expansion was allowed to the field of membership, that action would not overly tax facilities of the Applicant or dilute or impair services offered. Nor would the expansion create risk or loss, insolvency or dissipation of assets or offer serious prejudice to the interest of the members of the Applicant's credit union. Protestant has expressed particular concern about the effect of approval of this amendment on its Tallahassee branch office operations. Success of that operation is a primary concern of the Protestant; however, the success of that facility is not vital to the existence of Protestant. Likewise, Applicant's request for expansion of membership, while desired, is not necessary to the continued existence of that entity.

Florida Laws (2) 120.55120.60
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EXECUTIVE RISK CONSULTANTS, INC. vs DEPARTMENT OF LABOR AND EMPLOYMENT SECURITY, 94-003224RP (1994)
Division of Administrative Hearings, Florida Filed:Tallahassee, Florida Jun. 10, 1994 Number: 94-003224RP Latest Update: Dec. 07, 1994

The Issue Whether the Department of Labor and Employment, Division of Safety's, proposed adoption of Rule Chapter 38I-17, Florida Administrative Code, notice of which was published on pages 3569 through 3576 of the May 20, 1994, edition of Florida Administrative Weekly, constitutes an invalid exercise of delegated legislative authority for the reasons asserted by Petitioners?

Findings Of Fact Based upon the evidence adduced at hearing, and the record as a whole, the following Findings of Fact are made: Petitioner Executive Risk Consultants, Inc. (hereinafter referred to as "ERC"), is a servicing carrier and third-party administrator for workers' compensation self-insurance funds. It has over six hundred employees in the State of Florida. For its services, which include marketing, enrollment, premium billing 2/ and collection, claims handling and investigation, and safety counseling, ERC is typically paid an agreed upon percentage 3/ of the total premiums it bills and collects for the self-insurance funds it services. The granting of premium credits therefore serves to decrease the amount of compensation ERC receives for its services. The Florida Homebuilders Self-Insurers Fund (hereinafter referred to as "FHSIF") and the Florida United Businesses Self-Insurers Fund (hereinafter referred to as "FUBSIF") are two of the workers' compensation self-insurance funds for whom ERC provides services. FHSIF and FUBSIF have approximately 12,300 and 10,000 participating employer members/policyholders. 4/ In 1993, FHSIF's and FUBSIF's premium volumes were approximately 200 million dollars and 39 million dollars, respectively. 5/ The granting of premium credits serves to lower premium volume. Fund members are subject to assessment if premium volume is lowered to such an extent that it is insufficient to pay claims and expenses. Florida United Businesses Association, Inc. (hereinafter referred to as "FUBA"), is a general business trade association comprised of various types of small to medium-sized Florida businesses. It has just over 10,000 members, the vast majority of whom are also members/policyholders of FUBSIF. 6/ FUBA's purpose, as stated in its articles of incorporation, is "to represent the interests of Florida businesses, to educate Florida businesses, and to perform all acts provided in the Florida Not-For-Profit Corporation Act." 7/ FUBA monitors all legislation, rules and regulations that affect the Florida business community and advises its members concerning these matters. Notice of the Department's intention to adopt proposed Rule Chapter 38I-17, Florida Administrative Code, was published in the May 20, 1994, edition of Florida Administrative Weekly. The notice described the "purpose and effect" of proposed Rule Chapter 38I-17, Florida Administrative Code, as follows: The Florida Legislature authorized the granting of "specific identifiable consideration" under a rating plan approved by the Department of Insurance, for each employer who implements a safety program approved by the Division of Safety. Ch. 93-415, 94, Laws of Fla. (amending 627.0915, Fla. Stat.) The Division of Safety intends that this rule chapter establish specifications for a safety program that will enable employers to qualify for premium credits authorized by law. The division anticipates that this rule chapter will enable employers to become eligible for reduced workers' compensation insurance premiums and to promote occupational safety and health with the implementation of a workplace safety program. The notice also provided the following "summary" of the proposed rule chapter: This rule chapter establishes the requirements for a workplace safety program that will enable an employer to qualify voluntarily for a workers' compensation insurance premium credit in an amount determined by the Department of Insurance. Under this rule chapter, a safety program must contain the following elements: management commitment and involvement, safety committee, safety and health training, first aid procedures, accident investi- gation, recordkeeping procedures, and safety rules, policies, and procedures. The division further delineates a typical safety program, designates help supply services companies as the employer for purposes of this rule chapter, identifies dispute resolution procedures, and prescribes an effective date. Proposed Rule Chapter 38I-17, Florida Administrative Code, is comprised of proposed Rules 38I-17.001 (Purpose and Scope), 38I-17.002 (Definitions), 38I-17.003 (Essential Requirements for a Safety Program), 38I- 17.004 (A Typical Written Safety Program), 38I-17.005 (Client Employer Training Requirements of Help Supply Services Company Employees), 38I-17.006 (Disputes Regarding Employer Eligibility) and Rule 38I-17.200 (Effective Date). Proposed Rule 38I-17.001, Florida Administrative Code, provides as follows: The purpose of this rule is to promote safety and health in the workplace, thereby decreasing the frequency and severity of work- related injuries. Any employer who implements a safety program that meets or exceeds the requirements specified in this rule chapter may be eligible for a premium credit under a rating plan approved by the Department of Insurance. Employers who implement the safety program described in this rule chapter shall contact their carrier or agent for the proper procedure to apply for a premium credit. This rule chapter applies to Florida public and private sector employers, except the federal government. Proposed Rule 38I-17.002, Florida Administrative Code, defines the terms "Calendar year," "Division," "employee representative," "hazard," "illness," "premium credit," "safe," "safety," "safety committee," "safety- related incident," "scheduled meeting," and "workplace." It further provides that "the definition for 'accident,' 'carrier,' 'employee,' and 'injury' contained in section 440.02, Florida Statutes, and the definition of 'occupational disease' contained in section 440.151(2), Florida Statutes," as well as "the definition of 'employer' contained in section 440.02(14), Florida Statutes," are "incorporate[d] by reference" in the proposed rule chapter. Proposed Rule 38I-17.003, Florida Administrative Code, describes in detail the required "elements" of a safety program. Among these required elements is the "safety committee" element described in subsection (2)(h) of the proposed rule, which reads as follows: The safety committee shall: Establish and communicate procedures by which the employer shall conduct internal safety inspections of the workplace. The procedures shall be used to evaluate the effectiveness of engineering, administrative, and personal protective control measures provided by the employer to protect employees from recognized hazards in the work and work environment; Establish and communicate procedures by which the employer shall investigate all workplace accidents, safety-related incidents, injuries, illnesses, occupational diseases, and fatalities; Evaluate the effectiveness of and recommend improvements to the employer's safety rules, policies, and procedures for accident and illness prevention programs in the workplace and, when approved by the employer, ensure that written updates and changes to the safety program are completed; Establish and communicate procedures by which the employer shall train committee members on the requirements of this rule chapter; Post the scheduled date, time, and location of committee meetings in a conspicuous place where employees normally gather; Provide minutes of committee meetings in a conspicuous place where employees normally gather and provide a copy thereof to individual employees upon written request; and Retain all original written communications between the employer and the committee, or true copies thereof, in the workplace. Copies of these written communications shall be made available to the division upon request. As stated in its introductory paragraph, Proposed Rule 38I-17.004, Florida Administrative Code, "prescribes a typical written safety program that conforms with [proposed] rule 38I-17.003[,] . . . show[ing] the level of detail required for compliance and . . . language suitable for use by an employer." The proposed rule states that "[a]n employer may enhance any subsection of the typical written safety program to reflect actual operations and work practices, provided that the enhancement comports with rule 38I-17.003." Proposed Rule 38I-17.005, Florida Administrative Code, provides as follows: A help supply services company shall comply with the responsibilities of employers under this rule chapter, except that the client of a help supply services company shall include the employees of the help supply services company in the client's safety and training program, as prescribed in rule 38I-17.003(3), unless the company and the client otherwise contract in writing. No such contract shall alter the rights and responsibilities of help supply service companies provided in section 440.11, Florida Statutes. Proposed Rule 38I-17.006, Florida Administrative Code, provides as follows: An employer should direct initially all inquiries concerning eligibility for a premium credit under section 627.0915, Florida Statutes, to its carrier or agent. If the employer cannot resolve a complaint or dispute concerning the employer's eligibility, the employer should contact the Department of Insurance by calling the consumer assistance line at 1-800-342-2762, or writing to: Consumer Services, 200 E. Gaines Street, Tallahassee, Florida 32399. The Department of Insurance should direct to the division questions that ultimately ask whether a workplace safety program conforms to this rule chapter. 8/ Proposed Rule 38I-17.200, Florida Administrative Code, provides as follows: This rule chapter shall take effect twenty days after the date the division files this rule chapter for adoption, provided that an employer has imple- mented or maintained a safety program between January 1, 1994 and the effective date of this rule chapter, which safety program complies with the requirements of this rule chapter, may be eligible for a premium credit under a rating plan approved for the period of program operation that precedes the effective date. Such a rating plan, filed by the National Council on Compensation Insurance, 9/ was approved by the Department of Insurance on July 1, 1994. The filing memorandum submitted by the National Council on Compensation Insurance provided as follows: ITEM 05-FL-94 -- FLORIDA SAFETY PREMIUM CREDIT (To be effective upon approval by the Florida Department of Insurance applicable pro rata subject to a policy anniversary rating date of January 1, 1994 or after). PURPOSE: The purpose is to comply with Section 94 of Florida's workers compensation reform legislation, Senate Bill 12C. Senate Bill 12C amended section 627.0915 of Florida Statutes to allow for a safety premium credit for employers who implement approved safety programs. BACKGROUND: Florida Senate Bill 12C, which was signed into law effective January 1, 1994, provides that the Florida Department of Insurance shall approve rating plans for workers compensation insurance for employers who implement a safety program approved by the Division of Safety pursuant to rules adopted by the Department of Labor and Employment Security. IMPACT: This filing makes a 2 percent safety premium credit available to those employers who certify adoption of an approved Workplace Safety Program developed by the Florida Department of Labor and Employment Security. IMPLEMENTATION: Attached is the Florida State Special Rule to implement the Employer Safety Premium Credit Program along with a proposed Application for Employer Safety Program Premium Credit. 10/ Upon approval of this filing, NCCI will notify all of its members and subscribers by Circular and publish the rules in the Basic Manual for Workers Compensation and Employers Liability. The "Florida State Special Rule to implement the Employer Safety Premium Credit" appended to the filing memorandum read as follows: The premium for a risk shall be reduced by 2 percent for an insured which has certified that it has established a Safety Program in accordance with Rule 38I-17, as established by the Division of Safety of the Florida Depart- ment of Labor and Employment Security. The premium credit shall be applied to the insured's policy pro rata as of the date of certification by the employer, but no earlier than the date a final rule is adopted by the Department of Labor and Employment Security, subject to an anniversary rate date of January 1, 1994, or after. Self-certification by the employer may be accomplished by completing Florida Form- Safety 09-1 and is subject to physical verification by the insurer and/or the Division of Safety. The premium credit shall be applied to a risk in a multiplicative manner, after increased limits factors and deductible credits, if applicable, but before application of experience modification, and before application or any other premium surcharges (including Joint Underwriting Association Surcharges), factors, the Florida Contracting Classification Premium Adjustment Program (FCCPAP) and expense accounts. Expected losses used in the calculation of the insured's experience modification factor will be decreased by the policy credit percentage. Standard earned premium figures reported to the National Council on Compensation Insurance, Inc. on the aggregate calls for experience (e.g., policy year, calendar/accident year, etc.) must be net of the effects of the credits (i.e., be after). The net standard premium will then be the basis of any adjustment (i.e., guaranteed cost or retro). The Employer Safety Premium credits must be reported under statistical code 9880 on unit statistical reports submitted to the National Council on Compensation Insurance, Inc. Certification is required for each year in which premium credit is permitted under this program and is based upon evidence contained in the file of the insurer at the time the credit is allowed. The insured's policy is subject to reimbursement of premium credit, and cancellation if it is determined that the insured misrepresented its compliance with Rule 38I-17 as promulgated by the Division of Safety.

Florida Laws (11) 120.52120.54120.565120.68440.02440.11440.151440.38624.461627.0915628.6011
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DEPARTMENT OF FINANCIAL SERVICES, DIVISION OF WORKERS' COMPENSATION vs MAD DOG MARKETING GROUP, INC., 13-003217 (2013)
Division of Administrative Hearings, Florida Filed:Tangerine, Florida Aug. 22, 2013 Number: 13-003217 Latest Update: Mar. 19, 2015

The Issue The issue is whether the Stop-Work Order and the Third Amended Order of Penalty Assessment entered by Petitioner on July 25, 2013, and August 13, 2013, respectively, should be upheld.

Findings Of Fact The Department is the state agency tasked with the responsibility of enforcing the requirement of section 440.107(3), Florida Statutes, that employers in Florida secure the payment of workers' compensation for their employees. Respondent, Mad Dog Marketing Group, Inc., is a corporation organized under chapter 607, Florida Statutes, and was registered with the Florida Department of State, Division of Corporations, throughout the period of July 26, 2010, to July 25, 2013. At all times relevant to this proceeding, Respondent was engaged in the operation of a hardware store business with three locations in Florida. On July 25, 2013, based upon an anonymous referral, Tracey Gilbert, the Department's compliance investigator, commenced a workers' compensation compliance investigation of Respondent by visiting the job site, an appliance parts store at 730 West Brandon Boulevard, Brandon, Florida, and interviewing Sharon Belcher. According to Ms. Gilbert, Ms. Belcher informed her that she had 11 employees at the time of the site visit and that she did not have workers' compensation coverage for them. Ms. Belcher showed Ms. Gilbert an application for workers' compensation insurance and said she had not taken action with it since the company wanted a $10,000 premium. She also showed Ms. Gilbert some OSHA and workplace posters, but not the typical "broken arm poster" that describes workers' compensation coverage for a place of business. Ms. Belcher then gave Ms. Gilbert a list of Respondent's 11 current employees. On her laptop computer, Ms. Gilbert consulted the Department's Coverage and Compliance Automated System (CCAS) database to determine whether Respondent had secured workers' compensation coverage or an exemption from the requirements for coverage for its employees. CCAS is the database Ms. Gilbert routinely consults during the course of her investigations. She determined from CCAS that Respondent neither had workers' compensation coverage for her employees nor had received an exemption from such coverage from the Department. Ms. Belcher's recollection of her meeting with Ms. Gilbert differs from Ms. Gilbert's. Ms. Belcher recalled that she had applied for insurance with ADP on July 11, 2013, received the "broken arm poster," and believed she was covered at the time Ms. Belcher conducted her investigation. She offered an exhibit showing photographs of posters (but not the "broken arm poster") on the office bulletin board. She also offered an exhibit she testified was the UPS label from the tube containing the "broken arm poster." No photograph of the "broken arm poster" was produced as an exhibit. Ms. Gilbert did not contact ADP to verify whether Respondent had coverage on the date of her site visit to the Brandon store. Ms. Gilbert issued a Stop-Work Order to Respondent and a concurrent Request for Production of Business Records for Penalty Assessment Calculation at 11:20 a.m. on July 25, 2013. Ms. Belcher first submitted an application for workers' compensation coverage on July 11, 2013, but coverage was not bound on that date. Ms. Belcher submitted the paperwork to bind her insurance coverage on the afternoon of July 25, 2013, according to Mark Cristillo, an employee of ADP Insurance. Mr. Cristillo testified that he had made several attempts during the month of July 2013 to obtain the signed documents from Ms. Belcher, including an attempt as late as July 23, 2013, at 11:45 a.m. Ms. Belcher told Mr. Cristillo at that time that she had not reviewed the quote package. At 11:20 a.m., the time Ms. Gilbert's issued the Stop-Work Order on July 25, 2013, Ms. Belcher had not bound her insurance coverage. When she submitted the payment with the signed documents to ADP later that afternoon, the coverage was bound effective 12:01 a.m. on July 25, 2013. The records produced by Ms. Belcher were given to Chad Mason, one of the Department's penalty auditors, to calculate the penalty. He reviewed the records and determined the amount of gross payroll paid to Respondent's employees during the three- year penalty period preceding the investigation during which Respondent was not in compliance with the workers' compensation coverage requirements. Using Respondent's bi-weekly payroll chart, Respondent's Florida Department of Revenue UCT-6 reports, and the classification codes for each employee, Mr. Mason calculated a Third Amended Order of Penalty Assessment of $42,251.43, based upon what Respondent would have paid in workers' compensation premiums had it been in compliance with Florida's Workers' Compensation Law. The order was issued on October 24, 2013. Mr. Mason determined that the appropriate codes for Respondent's employees were 8010 and 8810, which are hardware store employees and general clerical employees, respectively. These codes were derived from the Scopes Manual, which lists all of the various jobs that may be performed in the context of workers' compensation. The manual is produced by NCCI, the National Council on Compensation Insurance, Inc., the nation's most authoritative data collecting and disseminating organization for workers' compensation. The parties stipulated prior to hearing that all of the individuals listed on the penalty worksheet of the Amended Order of Penalty Assessment were "employees" in the state of Florida of Respondent during the periods of non-compliance listed on the penalty worksheets. However, Respondent claimed that some of the employees were out-of-state and not subject to Florida law. Ms. Belcher testified that, as of July 25, 2013, three of its employees, Fred Hasselman, Douglas Strickland, and Josh Hyers, were employees of the Tennessee store and not subject to a Florida penalty. Mr. Hyers was a Florida employee prior to July 1, according to Ms. Belcher. However, all three of the employees were listed on the Florida Department of Revenue's UCT-6 form for the time period of the non-compliance. The UCT-6 form lists those employees who are subject to Florida's Unemployment Compensation Law. Mr. Mason reasonably relied upon the UCT-6 filings for the relevant time period to calculate Respondent's gross payroll in Florida. No evidence was produced to show them listed as Tennessee employees on that state's comparable tax form or any official document from outside Florida. The logical assumption is that they are Florida employees under the law. Accepting all the employees disclosed by Respondent as Florida employees led Mr. Mason to make his calculations of the penalty assessment using the appropriate codes from the Scopes Manual for hardware store and general clerical workers, 8010 and 8810. All the named employees on the Third Amended Order of Penalty Assessment were paid by Respondent in the amounts indicated on the penalty worksheet that accompanies that assessment during the penalty period of July 26, 2010, through July 25, 2013. Even though small discrepancies came up at the hearing regarding the classifications of some of Respondent's employees, the parties had stipulated to the accuracy of the classifications of those employees so those numbers will be accepted for purposes of this decision. Based upon the testimony at the hearing and the pre-hearing stipulations of the parties, the penalty assessment in the amount of $42,251.43 is accurate. Mr. Mason correctly applied the methodology for determining the amount of coverage required, determining that the appropriate premium for the three- year period would have been $28,167.50. When multiplied by the factor used to calculate the penalty, 1.5 times the premium, the total amount due is $42,251.43. The Department has proven by clear and convincing evidence that at the time the Stop-Work Order was issued and served on Respondent on the morning of July 25, 2013, Respondent had not secured workers' compensation coverage for its employees as required by chapter 440. On two occasions, August 2 and August 21, 2013, Ms. Gilbert returned to Respondent's Brandon location after the Stop-Work Order had been issued. The first was to serve the Amended Order of Penalty Assessment and the second was to serve the Second Amended Order of Penalty Assessment. On both occasions, the business was open in violation of the Stop-Work Order. A business under a Stop-Work Order may elect to enter into a payment plan after a ten percent down payment to keep the business open while a challenge to DOAH is under way. Respondent had not entered into such a plan. Therefore, the Department seeks $1,000 penalty for each of the days Ms. Gilbert visited the Brandon store and saw it open for business. This total additional penalty of $2,000 could have been greater had the Department further investigated whether the business remained open on other days after the Stop-Work Order had been imposed.

Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department issue a final order upholding the Stop-Work Order and Third Amended Order of Penalty Assessment, and assess a penalty in the amount of $42,251.43. It is further RECOMMENDED that the Department fine Respondent an additional $1,000 per day for the two days Respondent did not comply with the Stop-Work Order, resulting in a total penalty of $44,251.43. DONE AND ENTERED this 20th day of December, 2013, in Tallahassee, Leon County, Florida. S ROBERT S. COHEN Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 20th day of December, 2013. COPIES FURNISHED: Trevor S. Suter, Esquire Department of Financial Services 200 East Gaines Street Tallahassee, Florida 32399 Kristian Eiler Dunn, Esquire Dickens and Dunn, P.L. 517 East College Avenue Tallahassee, Florida 32301 Julie Jones, CP, FRP, Agency Clerk Division of Legal Services Department of Financial Services 200 East Gaines Street Tallahassee, Florida 32399-0390

Florida Laws (9) 120.569120.57120.68440.02440.05440.10440.107440.3857.105 Florida Administrative Code (1) 28-106.2015
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