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DEPARTMENT OF INSURANCE AND TREASURER vs. MANUEL AMOR, 81-002585 (1981)
Division of Administrative Hearings, Florida Number: 81-002585 Latest Update: Oct. 30, 1990

Findings Of Fact The Respondent has been licensed by the Department of Insurance as an insurance agent since 1966. Prior to the initiation of this proceeding, he has not been the subject of any disciplinary action by the Department. The Respondent has had a successful career as an insurance agent, and has been an active member of his community. During 1977 the Respondent actively marketed membership in a program known as the National Business Conference Employee Benefit Association (NBCEBA). The program offered by NBCEBA constituted a health insurance plan, and as such was subject to regulation under the Florida Insurance Code. The NBCEBA program operated as if it were exempt from state regulation under the Federal Employee Retirement Income Security Act (ERISA), Chapter 18, United States Code, Sections 1001, et seq. Qualified plans under ERISA were not subject to regulation under state insurance codes. The plan offered by NBCEBA did not qualify as an ERISA plan. Such plans could only be offered by employee organizations. NBCEBA solicited members who were employed by diverse employers, and who participated in diverse occupations. Membership in NBCEBA thus lacked the commonality of employment status among members required of employee organizations under ERISA. Since the plan offered by NBCEBA did not qualify as an ERISA plan, it was subject to regulation by the State of Florida as a program of insurance. Indeed, the essence of the NBCEBA plan was to offer a program of insurance to its "members." NBCEBA has never held a certificate of authority to transact an insurance business in the State of Florida. The Department of Insurance became aware of the plan being offered by NBCEBA to Florida citizens. The Department came to the conclusion that the plan constituted Insurance program not subject to exemption from state regulation under ERISA. By letter dated September 26, 1977, the Department advised Florida agents who were selling memberships in the NBCEBA program of its opinion that the program did not qualify for exemption from state regulation under ERISA, and that NBCEBA was acting as an unauthorized insurer in Florida. The letter requested that the agents cease and desist from further solicitation of prospective members of the plan. This letter was sent to the Respondent. The Respondent received it in the ordinary course of the mail. Shortly after sending this letter, the Department requested an opinion from the United States Department of Labor as to whether the NBCEBA program was exempt from state regulation. During March, 1978, the Department received a response in which the United States Department of Labor advised that in its opinion, NBCEBA was not a qualified program under Chapter 18, United States Code, and that the NBCEBA plan was subject to regulation by the State of Florida. After receiving the letter from the Department advising him of its opinion that the NBCEBA plan was not a qualified insurance program, the Respondent discussed the letter with Mr. Robert Klein, the owner of Planned Marketing Systems. Planned Marketing Systems was the general agent for the NBCEBA program in Florida. Mr. Klein advised the Respondent that the plan would eventually be approved in Florida. The Respondent did not cease marketing the NBCEBA plan. On or about October 31, 1977, he completed an application and accepted a premium payment for membership in the plan on behalf of Mr. Rafael Sanchez. Sanchez had been a friend of the Respondent and had used the Respondent as his insurance agent. The premiums on Sanchez's health insurance policy had increased dramatically during 1977. Membership in the NBCEBA plan was considerably cheaper than premiums that Sanchez needed to pay for other health insurance programs. Sanchez did not appear as a witness at the hearing, and the evidence would not support a finding as to what, if any, representations were made by the Respondent to Sanchez respecting the failure of NBCEBA to qualify as an insurance plan under the laws of the State of Florida. The evidence would not support a finding as to whether Respondent advised Sanchez as to his correspondence from the Department relating to NBCEBA. During May, 1978, Sanchez made an application to NBCEBA for benefits. NBCEBA did not honor the claim, and has since filed for bankruptcy in the United States District Court for the District of Oregon. Sanchez has thus been left liable to pay medical expenses that should have been covered under the NBCEBA plan.

Florida Laws (6) 120.57626.611626.621626.681626.901626.9541
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DEPARTMENT OF FINANCIAL SERVICES vs MAGALY SOSA, 05-000088PL (2005)
Division of Administrative Hearings, Florida Filed:Miami, Florida Jan. 11, 2005 Number: 05-000088PL Latest Update: Jan. 11, 2025
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DEPARTMENT OF INSURANCE vs MARTHA AGUIRRE, 00-002409 (2000)
Division of Administrative Hearings, Florida Filed:Miami, Florida Jun. 08, 2000 Number: 00-002409 Latest Update: Jan. 11, 2025
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DEPARTMENT OF FINANCIAL SERVICES vs MATTHEW DAVID LANZA, 05-000961PL (2005)
Division of Administrative Hearings, Florida Filed:Tamarac, Florida Mar. 15, 2005 Number: 05-000961PL Latest Update: Jan. 11, 2025
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DEPARTMENT OF FINANCIAL SERVICES vs DAVID ALLEN SHERMAN, 05-000157PL (2005)
Division of Administrative Hearings, Florida Filed:West Palm Beach, Florida Jan. 19, 2005 Number: 05-000157PL Latest Update: Jan. 11, 2025
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DEPARTMENT OF INSURANCE vs WILLIAM FRANK STEVENS, 01-003458PL (2001)
Division of Administrative Hearings, Florida Filed:Port Charlotte, Florida Aug. 30, 2001 Number: 01-003458PL Latest Update: Jan. 11, 2025
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DEPARTMENT OF FINANCIAL SERVICES vs DAVID BARSKY, 03-000566PL (2003)
Division of Administrative Hearings, Florida Filed:Lake Worth, Florida Feb. 19, 2003 Number: 03-000566PL Latest Update: Jan. 11, 2025
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DEPARTMENT OF FINANCIAL SERVICES vs MANNY ANGELO VARAS, 03-004175PL (2003)
Division of Administrative Hearings, Florida Filed:Fort Myers, Florida Nov. 06, 2003 Number: 03-004175PL Latest Update: Jan. 11, 2025
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DEPARTMENT OF FINANCIAL SERVICES vs JAVID ANDRES VALENZUELA, 17-000034PL (2017)
Division of Administrative Hearings, Florida Filed:Miami, Florida Jan. 04, 2017 Number: 17-000034PL Latest Update: Jan. 11, 2025
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DEPARTMENT OF FINANCIAL SERVICES vs ARTHUR WALTER BROWN, JR., 07-005597PL (2007)
Division of Administrative Hearings, Florida Filed:Gainesville, Florida Dec. 10, 2007 Number: 07-005597PL Latest Update: Jan. 11, 2025
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