Findings Of Fact Joseph Henton Pelt is qualified as an Ordinary Combination Life, including disability insurance (2-10) and a Disability Insurance Agent (2-40). From 1978 until March 15, 1980 he was licensed by the Florida Insurance Department. In 1979 an Administrative Complaint (Exhibit 2) was filed against Pelt charging numerous violations of Chapter 626, Florida Statutes. A Consent Agreement (Exhibit 3) was entered into between Pelt and the department and, pursuant to that Consent Agreement, the Commissioner of Insurance by Order entered 15 March 1980 (Exhibit 4) suspended Pelt's license for a period of one year from the date of that Order. Paragraph five of Exhibit 4 provided that Respondent shall not, during the period of suspension, engage, directly or indirectly, in any insurance activities in the State of Florida which require a license issued by the department. On June 27, 1980 Respondent called upon Mr. and Mrs. Bronson, who had responded to an advertisement purporting to make insurance policies more beneficial. After discussing the policies Respondent completed the application forms (Exhibits 7 and 8) which Bronson signed, and collected the premium on these policies (Exhibit 9) in the amount of $224.80. On June 24, 1980 Respondent called on Mr. and Mrs. Bryant to discuss insurance. Woodrow Bryant signed an application for insurance and Avie Bryant signed two such applications (Exhibit 11), all filled out by Respondent. They gave Respondent a check for the premiums in the amount of $332.80. These applications were accepted July 9, 1980. On July 1, 1980 Respondent sold a medical insurance policy to John Morris (Exhibit 12) . The application form was completed by Respondent and signed by Morris. The premium payment in the amount of $120.36 was paid by Pinkie Stephens (Morris' wife) to Respondent. The receipt for this $120.36 was signed by William Giles as were all of the other applications. Some checks were endorsed "William Giles Insurance Agency." On August 15, 1980 Respondent met with Ono B. Coons to discuss insurance matters. She was interested in a policy providing for custodial care which Respondent told her could be provided. Respondent prepared applications for three policies subsequently issued by Union Fidelity Life Insurance Company and Ms. Coons gave him a check payable to Union Fidelity Life Insurance Co. in the amount of $679.75. Upon arrival the policies did not cover custodial care. This check was endorsed "Union Fidelity Life Ins. Co." followed by "William Giles" and "Joe H. Pelt" and deposited in Columbia County Bank, Lake City, Florida. Respondent was also charged with having signed William Giles' name on Ms. Coons' applications but no evidence was presented that the signature on those documents was that of Giles. It is noted that Giles' name is signed to all applications admitted into evidence, but only on the applications for Ms. Coons was Respondent charged with placing Giles' signature on the applications without Giles' knowledge or consent.
The Issue The issue in this case is whether the license of James Joseph Sines (Respondent) should be disciplined by the Department of Insurance and Treasurer (Petitioner) based upon actions he is alleged to have taken during July 1987, involving an insured, Eunice Chappell, which would constitute an unlawful misappropriation and conversion of her funds, as more particularly set forth in the Administrative Complaint issued herein on, or about June 22, 1989.
Findings Of Fact At all times material hereto, Respondent has been licensed, and eligible for licensure, in the State of Florida as a life and health debit agent, life and health agent, general lines agent limited to industrial fire insurance, and health insurance agent. From August 1, 1986, through August 28, 1987, Respondent was employed by Union National Life Insurance Company as a life and health debit agent. All funds received by Respondent under his licenses representing premiums, returned premiums, and other funds belonging to insured persons or insurers were trust funds received in a fiduciary capacity. It was Respondent's usual practice to cash checks for his debit policyholders when he visited them to collect their premiums, as many of his policyholders did not have checking or savings accounts, and thus, had some difficulty cashing checks. He did this as a service to policyholders, and as a way of making sure that insurance premiums were paid up to date, since when he cashed a check for a policyholder, he would deduct the amount of any outstanding overdue premiums, and return the balance of the check proceeds to the policyholder. The value of checks which Respondent cashed for policyholders ranged from $1 to $900, with the average check being around $300. Eunice Chappell was a policyholder with Union National Life Insurance Company at all times material hereto. Respondent visited her in her home on a regular basis, usually weekly, to collect the premiums on her debit policies, and to assist with the filing of any claims on her policies. In fact, he assisted her with the filing of a claim under policies with Union National for income replacement and convalescent benefits for a period of hospitalization from June 24, 1987, to July 3, 1987. On or about July 30, 1987, Respondent received Check Number 352955, dated July 28, 1987, issued by Union National Life Insurance Company and made payable to Eunice Chappell, in the amount of $729, representing benefits due her under policies with Union National for her period of hospital confinement in late June and early July 1987. Shortly after receiving this check, Respondent visited Chappell at her home. Since she was a number of weeks behind on her premiums, she asked him to cash this check for her, and to pay her overdue premiums out of the proceeds. However, Respondent did not have sufficient cash on hand. Therefore, he had her endorse the check, and took it to his bank to cash after he also endorsed the check and placed his account number under his endorsement. Due to her frail physical condition, Respondent had to help Chappell sign her name to the back of this check by placing his hand over hers and guiding it as she made her signature. The only person present during this visit in Chappell's home, other than Respondent and Chappell, was Michael Pierazek, a co-worker and fellow agent for Union National. When Respondent presented this check at his bank, it could not be cashed since he did not have sufficient funds in his account to cover it. Therefore, he returned to Chappell's house, accompanied by Pierazek, and told her he was unable to cash the check for her. However, she insisted that Respondent assist her in any way possible in cashing the check because of her severely limited physical abilities. He told her that the only thing he knew to do would be to return to the bank and deposit the check in his personal account, wait for the funds to clear in a few days, and then return with the proceeds. Chappell agreed to this procedure. It is strictly against the policy of Union National for agents to deposit into their own personal account any policyholder's check received in the course of their business. Respondent was aware of this policy, but sought no exemption from this policy. He did deposit Chappell's check in his account on or about August 3, 1987. On August 14, 1987, Eunice Chappell's daughter, Ethel Small, called the district manager for Union National, Donald R. Sanders, to inquire about the status of her mother's insurance claim check. She indicated to Sanders that her mother had never received the check for $729, dated July 28, 1987. From the evidence received, as well as the demeanor of the witnesses who testified, it is found that Small was simply unaware of her mother's arrangement with Respondent, and the fact that Check Number 352955 had been presented to Chappell by Respondent and subsequently deposited into his personal account with the knowledge and agreement of Chappell. Small was not present during this transaction. An affidavit executed by Chappell on August 21, 1987, states that she received no proceeds from Check Number 352955, which is correct. It does not state that she never was presented with said check. A second check was issued by Union National to Eunice Chappell dated August 19, 1987, which was delivered to her by Sanders and the Respondent on August 21, 1987. This second check was numbered 355819. Ethel Small endorsed this second check on behalf of her mother, under a purported power of attorney. However, the document which she claims gave her Eunice Chappell's power of attorney was signed by a notary public on August 6, 1987, at the place provided on the document for the signature of the person giving the power of attorney, and recites that Ethel Small, rather than Eunice Chappell, was known to, and appeared before said notary public acknowledging "the within power of attorney to be her (Ethel Small's) act and deed." Nowhere on this purported power of attorney does Eunice Chappell's signature or mark appear, nor is there any evidence that she even appeared before the notary public who signed this document. Between August 3, 1987, when he deposited Chappell's first check into his personal account, until August 14, 1987, when Ethel Small contacted the district manager of Union National, Respondent was waiting for this check to clear, and therefore, did not give Chappell any proceeds from this check. While it is not clear from the evidence presented exactly when this first check did clear, and funds became available in Respondent's personal account, it was established that Respondent did not give Chappell any proceeds from this first check. He had been instructed by his district manager, Sanders, not to contact Chappell in any way after August 14, except in his presence. Respondent complied with this directive, and awaited the issuance of a second check to accompany Sanders to Chappell's house to deliver this check. Respondent was terminated by Union National as a result of this transaction, and an amount equal to the proceeds from the first check was deducted by Union National from his personal savings account with the company, the balance of which he received at termination, in order to reimburse Union National for the issuance of the second check. There is no evidence that Respondent used the proceeds of the first Chappell check for his own benefit, or that Union National expended funds beyond what they were obligated to pay to Chappell on her claim as a result of Respondent's actions in this transaction. He did violate company policy by depositing Chappell's first check in his personal account, but this was done with her full knowledge and consent, and was, in fact, done at her request. At the time of hearing, Eunice Chappell was deceased, and therefore, the findings set forth herein concerning her arrangement with the Respondent are based upon the demeanor and credibility of witnesses who testified and who were present on July 30, 1987, when Respondent and Chappell met, as well as the demeanor of the one witness who disputes Respondent's account of this transaction, Ethel Small. It is specifically found that Small's testimony lacks credibility because it was conflicting and implausible, and because she had a personal motive to have a second check issued. She testified she was always present with her mother in the home and never left her side during the times in question, but then offered conflicting, vague and uncertain testimony about when she moved into her mother's house, times she had to leave her mother to go to the store, do laundry and cash checks, and about leaving her mother with her sister. She admitted that on two occasions each week she would take a taxi cab to the store and back, and this would take an hour or so, plus the time necessary to wait for the cab. Her testimony that she never left her mother's house when her husband periodically came to visit her from Deland is not credible. Small had a motive for wanting a second check to be issued by Union National after she found out that her mother had a private arrangement with Respondent concerning the first check. Under the purported power of attorney which she had executed only a few days after her mother gave the first check to Respondent, she endorsed and cashed the second check for $729. Ethel Small filed a complaint with the Petitioner concerning this matter in May or June 1988. No evidence was presented in support of the Respondent's affirmative defense of laches, and it was not shown that Petitioner's actions between receipt of this complaint and the filing of the Administrative Complaint in this matter was dilatory or prejudicial to Respondent.
Recommendation Based upon the foregoing, it is recommended that Petitioner enter a Final Order dismissing all charges against Respondent contained in the Administrative Complaint filed in this matter. DONE AND ENTERED this 18th of December, 1989 in Tallahassee, Florida. DONALD D. CONN Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 Filed with the Clerk of the Division of Administrative Hearings this 18th day of December, 1989. APPENDIX (DOAH CASE NO. 89-3999) Rulings on the Petitioner's Proposed Findings of Fact: Adopted in Finding 1. Adopted in Finding 2. Adopted in Finding 5. Rejected in Finding 14. Adopted in Findings 5, 6. Rejected as irrelevant and immaterial. Adopted in Finding 9. 8-9. Adopted and Rejected in part in Findings 9, 10. Rejected in Findings 6-10. Rejected in Findings 6, 14. Adopted in part in Finding 11, but otherwise rejected in Finding 14 and as not based on competent substantial evidence. Adopted and Rejected in part in Finding 10. Adopted in Finding 12. Adopted in Finding 15. Rulings on the Respondents Proposed Findings of Fact: Adopted in Findings 6 - 10, 14. Rejected in Finding 15. COPIES FURNISHED: John C. Jordan, Esquire 412 Larson Building Tallahassee, FL 32399-0300 Terry M. Brocklehurst, Esquire Countryside Place, Suite 110 2605 Enterprise Road East Clearwater, FL 34619 Don Dowdell, Esquire General Counsel Department of Insurance The Capitol, Plaza Level Tallahassee, FL 32399-0300 Hon. Tom Gallagher State Treasurer and Insurance Commissioner The Capitol, Plaza Level Tallahassee, FL 32399-0300
The Issue The issues in the case are whether the Respondent erred in 2006 when a life insurance program applicable to retired state employees was amended to provide for two levels of benefits with separate premiums, and, if so, whether the beneficiary of a retired, now deceased, state employee should receive a different life insurance benefit than was paid.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department of Management Service, Division of Group State Insurance, enter a final order determining that the life insurance benefit for James W. Black is $2,500.00. DONE AND ENTERED this 13th day of March, 2009, in Tallahassee, Leon County, Florida. S WILLIAM F. QUATTLEBAUM 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 13th day of March, 2009. COPIES FURNISHED: Sonja P. Mathews, Esquire Department of Management Services Office of the General Counsel 4050 Esplanade Way, Suite 260 Tallahassee, Florida 32399 Gregory D. Swartwood, Esquire The Nation Law Firm 570 Crown Oak Centre Drive Longwood, Florida 32750 John Brenneis, General Counsel Department of Management Services 4050 Esplanade Way Tallahassee, Florida 32399-0950
The Issue Whether Respondent, Forgue General Contracting, Inc., violated the provisions of chapter 440, Florida Statutes, by failing to secure the payment of workers’ compensation coverage; and, if so, what penalty is appropriate.
Findings Of Fact The Department is the state agency charged with enforcing workers’ compensation coverage requirements in Florida, including the requirement that employers secure the payment of workers’ compensation coverage for their employees. See § 440.107(3), Fla. Stat. Respondent operates a construction company in Florida, and Respondent has been in business since 2004. On October 31, 2018, Margaret Cavazos, a compliance investigator with the Department, conducted a random workers’ compensation check at a worksite located at 1172 East State Road 434 in Winter Springs, Florida. The worksite is a two-story commercial building with five individual storefronts. Investigator Cavazos arrived at the worksite at 8:30 a.m. There, she observed four individuals who she believed were preparing the exterior of the building for painting. One person was covering a window with tape and brown construction paper. Two more individuals were standing in the bucket of a boom lift approximately 15 feet above the ground next to the building. They appeared to be placing blue tape over a sign of one of the businesses in the building. A fourth person was positioned by a truck supervising the activity. Investigator Cavazos further noticed that several of the business names had already been covered with construction paper and tape. Investigator Cavazos approached the person standing by the truck and introduced herself. He identified himself as Jose Luis Chachel. Mr. Chachel informed Investigator Cavazos that he and the other three individuals at the worksite were working for a company called RC Painting Services, Inc. (“RC Painting”). Mr. Chachel further stated that they were preparing the building to be painted. The other three individuals at the worksite identified themselves to Investigator Cavazos as Juan Carlos Vasquez Garcia, Artemia Vasquez, and Jenny Araque. Investigator Cavazos watched the four individuals work at the jobsite for about an hour, then they departed. Investigator Cavazos, however, did not obtain any information from Mr. Chachel or the other individuals concerning how long they had worked for RC Painting, when they had arrived at the jobsite, their rate of pay, or whether RC Painting had actually paid them for their work. At the final hearing, Investigator Cavazos testified that her duties for the Department include inspecting businesses and worksites to determine whether a business has obtained the required workers’ compensation insurance coverage. Investigator Cavazos explained that a business that performs construction- related work must have workers’ compensation coverage. Therefore, Investigator Cavazos believed that, prior to beginning the painting activities, RC Painting should have secured sufficient workers’ compensation coverage for all four individuals identified at the worksite. After learning the name of the business that arranged for the presence of the four individuals at the jobsite, Investigator Cavazos consulted the Department’s Coverage and Compliance Automated System (“CCAS”) database for information on RC Painting. CCAS is a Department database that tracks workers’ compensation insurance coverage. CCAS contains coverage data from insurance carriers, as well as any workers’ compensation exemptions on file with the Department. Insurance providers are required to report coverage and cancellation information, which the Department uses to update CCAS. CCAS had no record that RC Painting carried any workers’ compensation coverage for the four individuals Investigator Cavazos observed at the worksite. While reviewing CCAS, Inspector Cavazos also noted that the Department did not have on file any request from RC Painting for an “exemption” from workers’ compensation coverage. An exemption is a method by which a business’s corporate officer may exempt him or herself from the requirements of chapter 440. See § 440.05, Fla. Stat. CCAS also revealed to Investigator Cavazos that on the date of her inspection, RC Painting had an active employee leasing agreement with SouthEast Personnel Leasing (“SouthEast Leasing”), an employee staffing company. At the final hearing, Inspector Cavazos explained that a business is not required to obtain workers’ compensation insurance for its employees if coverage is properly provided by or through an employee leasing company’s workers’ compensation policy. However, in order for an employee leasing company to become responsible for the workers’ compensation coverage of a particular employee, the business seeking coverage for that employee must ensure that the employee submits an application to the leasing company. Thereafter, if (and only if) the leasing company accepts the application, the leasing company becomes accountable for the workers’ compensation insurance coverage for that employee. Investigator Cavazos contacted SouthEast Leasing. SouthEast Leasing provided Investigator Cavazos an active roster of employees it leased to RC Painting. However, neither Mr. Chachel, Juan Carlos Vasquez Garcia, Artemia Vasquez, nor Jenny Araque were listed on this roster. Therefore, Investigator Cavazos concluded that none of the four individuals she identified at the worksite were covered by workers’ compensation insurance under RC Painting’s leasing arrangement with SouthEast Leasing on October 31, 2018. After determining that neither CCAS nor SouthEast Leasing recorded any workers’ compensation coverage for the persons at the worksite, Investigator Cavazos contacted RC Painting’s owner, Roberto Chavez. (Mr. Chachel provided Investigator Cavazos with his phone number during her inspection.) Investigator Cavazos testified that, during their phone call, Mr. Chavez confirmed that the four individuals worked for him. Mr. Chavez further informed Investigator Cavazos that RC Painting had been hired by Respondent to paint the building. At that point, Investigator Cavazos called Respondent to inquire about workers’ compensation coverage for Jose Luis Chachel, Juan Carlos Vasquez Garcia, Artemia Vasquez, and Jenny Araque. Investigator Cavazos spoke with one of Respondent’s employees, Anthony Gonzalez. Mr. Gonzalez confirmed that Respondent engaged RC Painting to paint the building. Continuing to search for active workers’ compensation coverage, Investigator Cavazos discovered that Respondent also had an employee leasing agreement with SouthEast Leasing. Investigator Cavazos reviewed SouthEast Leasing’s roster which recorded only two covered employees for Respondent, Anthony Gonzalez and Edward Forgue (Respondent’s president). As with RC Painting’s leasing agreement, Respondent’s leasing agreement with SouthEast Leasing did not cover Jose Luis Chachel, Juan Carlos Vasquez Garcia, Artemia Vasquez, or Jenny Araque on October 31, 2018. As detailed below, under section 440.10(1), a contractor is liable for, and is required to secure, workers’ compensation coverage for all employees of a subcontractor to whom the contractor sublets work. (Section 440.10(1)(c) also directs the contractor to require a subcontractor to provide evidence of workers’ compensation insurance.) Therefore, as a contractor hiring a subcontractor for construction work, Respondent was required to exercise due diligence to ensure that all RC Painting’s employees who were painting the building were covered by workers’ compensation insurance. On October 31, 2018, based on her findings, Investigator Cavazos issued a Stop-Work Order to RC painting. Later that day, Mr. Chavez ventured to the Department’s local office to determine how his business could be released from the Stop-Work Order. There, he met with district supervisor, Salma Qureshi. Ms. Qureshi informed Mr. Chavez that, in order for his company to return to work, he needed to pay a $1,000 fine and complete an Affirmation. She explained to Mr. Chavez that on the Affirmation, he was to describe how RC Painting intended to come into full compliance with workers’ compensation coverage requirements. Mr. Chavez had, in fact, brought with him a cashier’s check for $1,000. (The amount was included on the Stop-Work Order.) Mr. Chavez then completed an Affirmation before Ms. Qureshi. On the Affirmation, Mr. Chavez wrote the names of the four individuals Investigator Cavazos identified at the jobsite. Next to each name, Mr. Chavez wrote “$20.” Below the names, he wrote “I am terminating.” Mr. Chavez then signed and dated the Affirmation. At the final hearing, Ms. Qureshi expressed that Mr. Chavez told her that he was going to pay each of the four individuals $20 for the day’s work they performed on October 31, 2018, and then he was terminating them. In addition to issuing the Stop-Work Order to RC Painting, on October 31, 2018, Investigator Cavazos issued a Stop-Work Order for Specific Worksite Only to Respondent, which was served on November 2, 2018. Investigator Cavazos also served Respondent with a Request for Production of Business Records for Penalty Assessment Calculation. Through this document, the Department requested several categories of business records from Respondent for the period of November 1, 2016, through October 31, 2018. The requested documents pertained to: employer identification, payroll documents, account documents, disbursements, workers’ compensation coverage, professional employer organization records, temporary labor service, exemptions, subcontractor records, and subcontractors’ workers’ compensation coverage. Based on Investigator Cavazos’s investigation, the Department determined that Respondent failed to secure adequate workers’ compensation coverage for its employees. Therefore, the Department proceeded to calculate a penalty based on Respondent’s lack of compliance with chapter 440. The Penalty Calculation: Nathaniel Hatten, the penalty auditor who determined the penalty the Department seeks to impose on Respondent, testified regarding his computation. Mr. Hatten explained that the penalty essentially consists of the “avoided” premium amount, or the actual premium the employer would have paid in workers’ compensation insurance for the uncovered employees, multiplied by two. To calculate the appropriate penalty for Respondent’s failure to secure workers’ compensation coverage, the Department first ascertained Respondent’s period of non-compliance. To determine this time frame, the Department referred to Florida Administrative Code Rule 69L-6.028(2), which directs that: The employer’s time period or periods of non-compliance means the time period(s) within the two years preceding the date the stop-work order was issued to the employer within which the employer failed to secure the payment of compensation pursuant to chapter 440, F.S., and must be either the same time period as set forth in the business records request for the calculation of penalty or an alternative time period or period(s) as determined by the Department, whichever is less. The employer may provide the Department with records from other sources, including, but not limited to, the Department of State, Division of Corporations, the Department of Business and Professional Regulation, licensing offices, and building permitting offices to show an alternative time period or period(s) of non- compliance. Based on these instructions, the Department deduced that Respondent’s period of non-compliance ran from November 1, 2016, through October 31, 2018, which was the two-year period preceding the date of the Stop-Work Order. (This two-year period was also the time for which the Department requested business records from Respondent.) After determining Respondent’s period of non- compliance, the Department then calculated the monetary penalty it should impose upon Respondent. In accordance with section 440.107(7)(d)1., the Department must assess against an employer: a penalty equal to 2 times the amount the employer would have paid in premium when applying approved manual rates to the employer’s payroll during periods for which it failed to secure the payment of workers’ compensation required by this chapter within the preceding 2-year period or $1,000, whichever is greater. Therefore, the Department reviewed the business records Respondent provided to ascertain the amount of Respondent’s payroll during the two-year period of non-compliance. In response to the Department’s request for documents, Respondent produced its client leasing agreement with SouthEast Leasing. This leasing agreement, however, only covered Mr. Forgue and Mr. Gonzalez. Further, the leasing agreement was only in effect from February 7, 2018, through October 30, 2018, for Mr. Forgue and February 21, 2018, through October 30, 2018 for Mr. Gonzalez. No evidence establishes that Respondent made any other payments for workers’ compensation insurance coverage outside of the SouthEast Leasing agreement. Consequently, the evidence in the record establishes that Respondent had no workers’ compensation coverage for any of its employees, officers, or subcontractor employees from November 1, 2016, through February 6, 2018. And, only Mr. Forgue and Mr. Gonzalez were covered from February 2018 through October 30, 2018. Further, Respondent did not provide any payroll information to the Department per its request for business records. Consequently, the documentation was not comprehensive enough for the Department to determine all the wages Respondent paid to its employees, or the work they performed for the period of November 1, 2016, through October 31, 2018. Therefore, the Department determined that Respondent did not provide business records sufficient for it to calculate Respondent’s complete payroll or the actual employee wages it paid over the two-year period of non-compliance. Accordingly, the Department exercised its option to “impute” Respondent’s weekly payroll from November 1, 2016, through October 31, 2018. To calculate Respondent’s imputed weekly payroll, section 440.107(7)(e) directs that the gross payroll for an employer who provides insufficient business records is imputed at the statewide average weekly wage, multiplied by 1.5, for each employee who worked during the period requested for the penalty calculation. Therefore, the Department obtained the statewide average weekly wage effective at the time of the Stop- Work Order ($917.00)2/ for each identified employee, corporate officer, and subcontractor, then multiplied that number by 1.5. See § 440.107(7)(e), Fla. Stat.; and Fla. Admin. Code R. 69L- 6.028(3)(a). The Department imputed the payroll for all four individuals Investigator Cavazos observed at the worksite on October 31, 2018 (Jose Luis Chachel, Juan Carlos Vasquez Garcia, Artemia Vasquez, and Jenny Araque), for all periods of non- compliance (November 1, 2016 through October 31, 2018). No evidence established that these individuals were covered under a workers’ compensation policy either through Respondent, RC Painting, or SouthEast Leasing. The Department also included Mr. Forgue for a period of non-compliance from January 22, 2018, through February 8, 2018. The Department imputed his payroll during this period of time explaining that Respondent did not have an active workers’ compensation exemption on file for Mr. Forgue. Neither was he covered by SouthEast Leasing’s policy during this brief timeframe. Therefore, Respondent was required to carry workers’ compensation for Mr. Forgue from January 22, 2018, through February 8, 2018. See Fla. Admin. Code R. 69L-6.028(3)(b). To calculate a penalty based on the imputed payroll, the Department assigned Respondent’s employees the highest rated workers’ compensation classification code. The classification code is based on either the business records submitted or the investigator’s observation of the employees’ activities. In this case, the business records Respondent provided to the Department were not sufficient to categorize the exact type of work that the identified workers performed for Respondent over the two-year period of non-compliance. However, during her investigation of the jobsite on October 31, 2018, Investigator Cavazos observed the four employees engaging in activities associated with “painting.” According to the Scopes Manual issued by the National Council on Compensation Insurance, Inc. (“NCCI”), class code 5475 is applied to “painting contractors engaged in painting.”3/ Consequently, the Department used class code 5474 for all Respondent’s employees and corporate officer for the penalty period. See Fla. Admin. Code R. 69L-6.028(3)(b) and 69L- 6.021(2)(jj)(painting is classified as “construction activity”). Therefore, to calculate the premium amount for the workers’ compensation insurance Respondent should have paid for its “employees” (Jose Luis Chachel, Juan Carlos Vasquez Garcia, Artemia Vasquez, and Jenny Araque) and officer (Mr. Forgue), the Department applied the manual rates corresponding to class code 5474. Thereafter, based on: 1) the total periods of non- compliance, 2) Respondent’s calculated payroll for the periods of non-compliance, and 3) the estimated premium for workers’ compensation insurance, the Department issued the Amended Order of Penalty Assessment (“Penalty Assessment”) on November 30, 2018, which was served on Respondent on February 28, 2019. The Penalty Assessment seeks to impose a penalty of $129,089.60 against Respondent. At the final hearing, Respondent argued that the individuals Investigator Cavazos identified at the worksite on October 31, 2018, were never hired by Respondent’s subcontractor, RC Painting. Therefore, they are not “employees” under chapter 440, and Respondent is not an “employer” for purposes of securing workers’ compensation coverage. Consequently, Respondent argues that the penalty the Department seeks to assess against Respondent is not warranted. Mr. Chavez testified at the final hearing for Respondent describing his employment relationship with Jose Luis Chachel, Juan Carlos Vasquez Garcia, Artemia Vasquez, and Jenny Araque. Initially, Mr. Chavez confirmed that Respondent hired RC Painting to paint the exterior of the shopping plaza. Regarding the four individuals Investigator Cavazos identified at the jobsite, however, Mr. Chavez denied that they were “employees” of RC Painting on October 31, 2018. Mr. Chavez explained that he used SouthEast Leasing to “hire” his employees. Mr. Chavez asserted that before he puts someone to work, he requires them to complete an employment application with SouthEast Leasing. Only after SouthEast Leasing approved the employee would he allow the individual to work on a job. In this matter, Mr. Chavez denied that he had ever worked with Mr. Chachel before, or ever met the other three individuals that Mr. Chachel brought with him to the jobsite. Mr. Chavez maintained that he called Mr. Chachel on the evening of October 30, 2018, about the prospective painting job. He then asked Mr. Chachel to bring two other workers and meet him at the jobsite the following morning. Mr. Chavez testified that he instructed Mr. Chachel that he would need to send information to SouthEast Leasing before anyone actually started working on the project. Mr. Chavez further contended that he did not have any discussion with Mr. Chachel about wages or the rate of pay for the job. He declared that he never commits to paying any prospective employee before ascertaining what type of skills they possess. Mr. Chavez explained that, “anyone can tell you, ‘I’ve been painting all of my life,’ and they show up and don’t know how to paint, or they don’t know how to do anything.” In response to Inspector Cavazos’s testimony, Mr. Chavez exclaimed that he never told her that the four individuals were his “employees.” He merely relayed that they were “with” him. Mr. Chavez also insisted that he never authorized Mr. Chachel or his crew to start preparing the building for painting prior to meeting with him. Mr. Chavez further relayed that Respondent provided the boom lift for the job. But, he never instructed Mr. Chachel to begin using it. Mr. Chavez arrived at the shopping plaza around 9:30 a.m. However, by that time Investigator Cavazos had issued the Stop- Work Order, and only Mr. Chachel remained at the scene. Regarding the Affirmation he completed at the Department’s district office, Mr. Chavez testified that, other than Mr. Chachel, he did not know the names of individuals who Investigator Cavazos identified at the jobsite. He asserted that he wrote their names on the Affirmation only after Ms. Qureshi spelled them out for him on a sticky note. Mr. Chavez further professed that he only penned “$20” by each name because Ms. Qureshi told him that the Department would not release him from the Stop-Work Order until he added the wages he paid to each individual. Mr. Chavez claimed that Ms. Qureshi specifically instructed him to insert a number by each employee. Mr. Chavez declared that he felt like he had no choice but to include “$20” on the Affirmation if he wanted to return to work. In actuality, however, Mr. Chavez insisted that he did not pay Jose Luis Chachel, Juan Carlos Vasquez Garcia, Artemia Vasquez, or Jenny Araque anything for their activities on October 31, 2018. Ms. Qureshi testified for the Department on rebuttal. She credibly voiced that she did not write out the names of the four “employees” for Mr. Chavez to list on his Affirmation. Neither did she suggest a wage amount for their work, or force Mr. Chavez to write that he “terminated” them. On the contrary, Ms. Qureshi attested, clearly and without hesitation, that Mr. Chavez independently completed his sworn Affirmation, and he did not ask for her assistance with the specific information he wrote down. Ms. Qureshi persuasively stated that Mr. Chavez knew the names of Jose Luis Chachel, Juan Carlos Vasquez Garcia, Artemia Vasquez, and Jenny Araque when he composed the Affirmation. Further, Mr. Chavez expressly told her that he was going to pay the four individuals $20 for the day, and that he was terminating them. The competent substantial evidence in the record establishes that Jose Luis Chachel, Juan Carlos Vasquez Garcia, Artemia Vasquez, and Jenny Araque were “employees” of RC Painting under section 440.02(15) on October 31, 2018. Based on this finding, the Department demonstrated, by clear and convincing evidence, that Respondent failed to secure workers’ compensation insurance coverage or a workers’ compensation exemption for four employees for the period of November 1, 2016, through October 31, 2018, as well as its corporate officer from January 22, 2018, through February 8, 2018. Accordingly, the Department met its burden of proving that Respondent violated chapter 440 and should be penalized.
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 determining that Respondent, Forgue General Contracting, Inc., violated the requirement in chapter 440 to secure workers’ compensation coverage, and imposing a total penalty of $129,089.60. DONE AND ENTERED this 18th day of October, 2019, in Tallahassee, Leon County, Florida. S J. BRUCE CULPEPPER 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 18th day of October, 2019.
Findings Of Fact At all times material to this case, and at the time of the hearing, Gary Lee Baker ("Respondent") was licensed in Florida as a life and variable annuity agent, health and variable annuity agent, life agent, life and health agent, general lines agent, and health agent. The Respondent was a stockholder and officer in the "Murdock Insurance Agency, Inc.". Pete and Debi Valencia are the owners of the "Growing Concern," a floral shop. In 1991, the Growing Concern had obtained workers compensation (WC) coverage through Allstate Insurance. According to the Allstate policy, the coverage was effective from July 18, 1991 to July 18, 1992. The premium for the policy was $1,235.00. As of November, 1991, Mr. Valencia believed that Allstate Insurance was going to terminate his WC insurance coverage. The belief apparently was based on local gossip. There is no evidence that, absent payment of premium, Allstate intended to cancel the Valencia's WC insurance coverage prior to the expiration date set forth in the policy. Mr. Valencia contacted the Respondent, who was a business acquaintance of Mrs. Valencia, to discuss WC coverage. At the time of the initial meeting, Mr. Valencia offered to place all his insurance business with the Respondent if the Respondent could obtain satisfactory WC insurance rates for the Valencia's business. Mr. Valencia provided a copy of the then-current Allstate policy to the Respondent. Based on information provided by Mr. Valencia, the Respondent completed portions of a WC insurance application on behalf of Growing Concern on November 21, 1991. The application was to be submitted to the National Council of Compensation Insurance (NCCI) Atlantic Division upon receipt of additional information from Mr. Valencia and upon the lapse of the Allstate coverage. Among the information required by the NCCI was a copy of a Growing Concern quarterly tax filing (Form 941) from Mr. Valencia. The form is used by NCCI to verify the Growing Concern payroll, the basis of calculation of the WC premium. Pursuant to this meeting, Mrs. Valencia provided a check dated November 21, 1991, numbered 3737, for $360.00 as an initial payment on the WC premium. The Respondent deposited the check into his trust account and awaited receipt of the additional documentation. By January, 1992, the Respondent had not received the additional information. He contacted Mr. Valencia to obtain the copy of Form 941 and to obtain an additional premium payment of $121.00. On several occasions during January and February, 1992, the Respondent and his assistant attempted to contact Mr. Valencia to obtain the premium payment and information. Neither the information nor the payment was forthcoming. On March 8, 1992, Mrs. Valencia submitted a check numbered 3948 for $121.00 as payment of the additional premium. However, the Valencia's still failed to submit a signed copy of the Growing Concern's most recent Form 941. Although the Respondent assumed that the application would be rejected for the failure to include all the required information, the Respondent submitted the application on March 31, 1992 (without the required Form 941) to NCCI. A check on the account of Murdock Insurance Agency dated March 31, 1992, numbered 144, for $962.00 accompanied the application as payment of the premium due at that time. Although he had yet to collect such an amount from the Valencias, he believed their relationship was such that he could "front" the premium payment on their behalf. By letter dated April 24, 1992, NCCI informed the Respondent that the application would not be processed without the form which would permit verification of the payroll. On May 20, 1992, Mr. Valencia provided a signed copy of the Form 941 to the Respondent. By letter dated May 26, 1992, NCCI informed the Respondent that an additional premium payment of $423.00 was required. The total premium for the Growing Concern WC policy was $1,385.00 The Respondent contacted Mr. Valencia and requested the additional premium payment. Mr. Valencia directed the Respondent to void the transaction and to return the premium paid by the Growing Concern. The premium was returned by NCCI to the Respondent. Immediately upon receipt of the premium, the Respondent refunded $481.00, the amount paid by the Growing Concern, to Mr. Valencia on June 4, 1992. At all times, Mr. Valencia's premium funds were maintained in the Respondent's trust account until such time as they were submitted to NCCI. At no time did Mr. Valencia inform the Respondent that the Growing Concern's Allstate WC coverage had lapsed.
Recommendation Based on the foregoing, it is hereby RECOMMENDED that the Department of Insurance enter a Final Order dismissing the administrative complaint filed against Gary Lee Baker. DONE and RECOMMENDED this 4th day of January, 1994, in Tallahassee, Florida. WILLIAM F. QUATTLEBAUM Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, FL 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 4th day of January, 1994. APPENDIX TO RECOMMENDED ORDER, CASE NO. 93-4569 The following constitute rulings on proposed findings of facts submitted by the parties. Petitioner The Petitioner's proposed findings of fact are accepted as modified and incorporated in the Recommended Order, except as follows: Rejected, contrary to the greater weight of the evidence which establishes that the delay in submission of the application was based on the insured's failure to provide the requested information. The premium was refunded to the insured on June 4, 1992, (not January 4, 1992) immediately upon the receipt by the Respondent. Rejected, immaterial. The Allstate policy lapsed through no act by the Respondent, who was never informed of such lapse. Respondent The Respondent's proposed findings of fact are accepted as modified and incorporated in the Recommended Order except as follows: 9. Rejected, hearsay uncorroborated by other competent evidence. COPIES FURNISHED: Tom Gallagher State Treasurer and Insurance Commissioner The Capitol, Plaza Level Tallahassee, Florida 32399-0300 Bill O'Neil, General Counsel Office of State Treasurer The Capitol, PL-11 Tallahassee, Florida 32399-0300 Joseph D. Mandt, Esquire Division of Legal Services 612 Larson Building Tallahassee, Florida 32399-0333 Carl Joseph Coleman, Esquire Smith, Geraghty & Coleman Post Office Drawer 8 Fort Myers, Florida 33901
Findings Of Fact The Respondent Dorman Kennedy Hicks is licensed as an ordinary life, including disability agent in the State of Florida. On April 7, 1982, the Respondent visited Herbert G. and Oma Riley at their home in Pompano Beach, Florida, to sell them insurance. The Respondent sold Mr. and Mrs. Riley medicare supplement policy number 13-986-6209 issued by Union Fidelity Life Insurance Company. The Respondent was given by Mrs. Riley, a $358.30 check dated April 7, 1982 for a six-month premium for the medicare policy with Union Fidelity. Mr. and Mrs. Riley repeatedly told the Respondent that their medical histories were poor and he assured them that they could nevertheless obtain medical coverage through Union Fidelity. Despite Mr. and Mrs. Riley's request, the Respondent failed to include their poor medical histories with the application he forwarded to Union Fidelity. When Mr. and Mrs. Riley received a copy of their policy, their medical histories were not included. They then called the Respondent in order for him to submit the information to the insurance company. The Respondent assured the Rileys that he would forward the information to Union Fidelity; however, he never notified the company as he had told the Rileys. After Mr. and Mrs. Riley notified Union Fidelity directly about their medical histories, the company cancelled their coverage. The Respondent accepted payment from Mr. and Mrs. Riley knowing that he could not obtain medical coverage for them if their medical histories were disclosed to the company. The application which the Respondent solicited from Mr. and Mrs. Riley for coverage with Union Fidelity was dated April 27, 1982. The Respondent had been terminated by Union Fidelity for cause on April 8, 1982. On the date of the application which was solicited from Mr. and Mrs. Riley, the Respondent was not authorized to represent Union Fidelity. The application which the Respondent solicited from Mr. and Mrs. Riley for coverage with Union Fidelity dated April 27, 1982, was signed by Lester Fulford, a soliciting agent. Lester Fulford was not present at the time that the Respondent solicited the insurance application from Mr. and Mrs. Riley.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department of Insurance enter a Final Order revoking the insurance licenses of the Respondent Dorman Kennedy Hicks. DONE and ENTERED this 9th day of November, 1983, in Tallahassee, Florida. SHARYN L. SMITH, Hearing Officer Division of Administrative Hearings 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 9th day of November, 1983 COPIES FURNISHED: Dorman Kennedy Hicks 1041 N.W. 45th Street Pompano Beach, Florida 33064 Susan E. Koch, Esquire Department of Insurance 413-B Larson Building Tallahassee, Florida 32301 Donald Dowdell, Esquire General Counsel The Capitol, Plaza Level Department of Insurance Tallahassee, Florida 32301 Honorable William Gunter Insurance Commissioner and Treasurer The Capitol, Plaza Level Tallahassee, Florida 32301
The Issue The issues for determination in this proceeding are whether Respondent committed the acts alleged in the Amended Notice And Order To Show Cause and, if so, what, if any, penalty should be imposed.
Findings Of Fact Parties Petitioner is the state agency responsible for regulating insurance and insurance related activities in Florida. Petitioner is the agency responsible for regulating any licensed or unlicensed person or entity engaged in unfair insurance trade practices within the meaning of Section 626.951, Florida Statutes. 1/ Respondent, Leroy Preston, is licensed to sell life and health insurance in Florida. The other Respondents are not licensed to transact insurance in Florida and are not otherwise licensed by Petitioner pursuant to Chapters 624 through 632, 634, 635, 637, 638, 641, 648, and 651 (the "Florida Insurance Code"). Respondent, American Family Benefits Group, Incorporated ("AFBG, Inc.") is a Florida corporation wholly owned by the four individual Respondents. Respondent, Roy L. Beach, is an officer and director of AFBG, Inc., and is an attorney licensed to practice law in Florida. Respondents, Preston, Kenneth King, and Robert King, are officers and directors of AFBG, Inc. The individual Respondents comprise American Family Benefits Group ("AFBG") and the board of directors for AFBG, Inc. (the "Board"). Background Respondents designed a marketing program for the sale of memberships in AFBG, Inc. Promotional materials describing the benefits of membership were reviewed and approved by each member of the Board and mailed to thousands of prospective customers in 50 states. Memberships were offered to individuals at a price of $99 per membership. The benefits of membership included: life insurance up to $350,000 at no cost to members; a certificate of deposit of $5,000; a major bank credit card, regardless of credit history, secured by the certificate of deposit; non- qualifying mortgage loans; non-qualifying automobile leases; discounted long distance service; and discounted catalog prices. Respondents received approximately 140,000 applications for membership. Approximately 600 applications included payment of the $99 membership fee. Petitioner issued a Notice And Order To Show Cause on February 10, 1994. The marketing program for the sale of memberships in AFBG, Inc. was terminated by Respondents. Respondents returned the membership fee paid by approximately 300 applicants. On May 6, 1994, Petitioner issued an Amended Notice And Order To Show Cause ("Amended Notice"). The Amended Notice charges that Respondents violated Sections 626.9521, 626.9541(1)(a), (b), (h), (l), and (n). The Amended Notice charges that Respondents violated Section 626.9541(1)(a) by making misrepresentations for the purpose of effecting an assignment or pledge of insurance policies to secure a loan. Respondents allegedly violated Section 626.9541(1)(b) by representing that insurance policies obtained on the life of members would be used to secure a loan that would fund membership benefits. Respondents allegedly violated Section 626.9541(1)(h) by offering the payment of money to induce customers to enter into an insurance contract. The Amended Notice charges that Respondents violated Section 626.9541(1)(l) by inducing customers to pledge, assign, borrow on insurance policies, convert insurance policies, or to take out an insurance policy with another insurer ("twisting"). Finally, the Amended Notice charges that Respondents violated Section 626.9541(1)(n) by offering free insurance as an inducement for the purchase or sale or services directly or indirectly connected with real or personal property. Pledge Or Assignment To Effect A Loan: Section 626.9541(1)(a) Respondents knowingly issued and circulated a statement or sales presentation (the "promotional materials") that was a misrepresentation. The misrepresentation was made for the purposes of: effecting a pledge or assignment of an insurance policy; and effecting a loan against an insurance policy. Payment of the $99 membership fee did not entitle a new member to any of the benefits of membership. A new member was not required to elect any membership benefit, including the insurance benefits. Such a member could simply pay Respondents $99 and choose to receive none of the benefits of membership. A new member who wished to elect any of the benefits of membership was in substantially the same position as a new member who chose to receive no benefits. A new member who desired any one of the benefits of membership was first required to elect the insurance benefits. Insurance benefits entitled a new member to five universal life insurance policies on the life of the new member. Each policy was to be issued for $70,000. 2/ No life insurance policies were available unless a new member applied for and obtained all five policies and assigned four of the five policies to a bank. The bank must then make a loan in an amount and terms that were sufficient to fund all of the benefits of membership. 3/ A loan in the gross amount of $84,000 was needed to fund the benefits of membership. The net loan proceeds were to be used to purchase an annuity, a certificate of deposit to secure the credit card for the new member, pay Respondents a profit of $5,000, pay commissions and referral fees to independent parties up to $3,000, pay administrative costs, and fund the other benefits of membership. 4/ Respondents' pro forma projections of economic feasibility for the membership program showed an annual interest rate of six per cent, an amortization period of 20 years, and level periodic payments of principal and interest. Respondents' pro formal projections were based, in relevant part, on three assumptions. First, the insurance policies would be used as part of the collateral securing the loan needed to fund the benefits of membership. Second, Respondents were to be personally liable for each loan. Third, an annuity would secure the loan, pay the debt service on the loan, and pay the premiums for the insurance policies assigned to the lender. The insurance policies that new members were required to assign to the lender to secure the purported loan had no loan value. Respondents represented to prospective members that the life insurance policies were universal life policies. However, the policies were "skeleton" universal life policies that had de minimis cash value and no loan value. The loan to value ratio of any loan secured by the insurance policies would necessarily exceed 100 percent. Respondents' personal liability for loans to new members lacked economic substance. Capital contributions to AFBG, Inc. and Respondents' individual assets were inadequate to secure individual loans of $84,000 to 140,000 members. The annuity needed to pay the debt service on the loan and the insurance premiums on the policies securing the loan was not economically feasible. 5/ The membership fee of $99 was inadequate to pay the first year insurance premium on one $70,000 policy, much less the other four policies required to fund any of the benefits of membership. The economic reality of the membership program required a new member to pay Respondents $99 and to apply for and obtain five insurance policies from independent insurance agents. There was little or no probability of receiving any of the benefits of membership because the loan needed to fund those benefits had little or no economic reality. Thus, the membership program required a new member to pay $99 to Respondents for no benefits of membership. If $99 had been paid by all 140,000 applicants, Respondents would have received $13,860,000 in return for illusory promises of membership benefits. Insurance Policies To Secure Loan: Section 626.9541(1)(b) Respondents knowingly published, circulated, disseminated, and placed before the public an untrue statement concerning the business of insurance. Respondents represented that the universal life insurance policies obtained by individual members would be used as collateral to secure the loan needed to fund their insurance benefits. Respondents knew that the insurance policies were skeleton policies with little or no cash value and no loan value. The untrue statements issued by Respondents concerned the business of insurance. Respondents used economic incentives to induce prospective members to obtain life insurance policies. Without life insurance policies, new members were not entitled to any of the other benefits of membership including, a certificate of deposit, a credit card, non-qualifying mortgages, and non- qualifying car leases. The purchase and assignment of life insurance policies was an integral part of the business conducted by Respondents. The economic incentives used by Respondents were designed to effectuate a contract of insurance. Respondents effectuated approximately five contracts of insurance. The subsequent assignment of insurance policies to a lender also constituted the business of insurance. Those assignments constituted the transaction of matters subsequent to the insurance contract and arising out of the insurance contract. Unlawful Rebates: Section 626.9541(1)(h) 27. Respondents knowingly offered an indirect rebate of an insurance premium to prospective members as an inducement to enter into an insurance contract. Respondents' offer to pay the insurance premiums on members' insurance policies was a valuable consideration intended to induce new members to enter into insurance contracts. Twisting: Section 626.9541(1)(l) 28. Respondents knowingly made misleading representations with respect to insurance policies for the purpose of inducing or tending to induce new members to pledge, assign, borrow on, or convert an insurance policy or to take out a policy of insurance in another insurer. Respondents representations were misleading. 29. Respondents' representations led prospective members to believe that a pledge, assignment, or conversion of their insurance policies could be used to secure a loan needed to fund other membership benefits. The representation that a loan could be obtained by new members upon assignment of their insurance policies had no economic reality. Free Insurance: Section 626.9541(1)(n) Respondents offered to provide free insurance as an inducement for new members to purchase real or personal property. The benefits of membership included non-qualifying mortgages in real property, non-qualifying car leases, and non-qualifying bank credit cards. None of those benefits were available to new members unless they obtained life insurance policies and assigned those policies to a lender. The insurance policies were free to new members. There was no cost to new members. The insurance premiums were to be paid out of the annuity to be purchased from the net loan proceeds.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that Petitioner enter a Final Order finding Respondents guilty of all of the charges in the Amended Notice and ordering Respondents to permanently cease and desist the marketing of memberships in AFBG, Inc. It is further recommended that a fine of $4,000 should be imposed on each of the Respondents, not to exceed the aggregate amount of $20,000, and that the license of Respondent, Leroy Preston, should be suspended for 30 days. RECOMMENDED this 28th day of March, 1995, in Tallahassee, Florida. DANIEL MANRY 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 28th day of March, 1995.
Findings Of Fact Arnold J. Smith is currently qualified and licensed as an Ordinary Combination Life and Variable Annuity, including Health Insurance Agent in the State of Florida. Smith received these licenses based upon applications filed in early September, 1986, to mid-December, 1986. He currently works as a life insurance agent for Prudential Insurance Company of America, working out of that company's Jacksonville office. Prior to being licensed in Florida, Smith engaged in the insurance business in Tucson, Arizona. He primarily operated through or under the names Arnie Smith and Associates, Ltd., or MBS Insurance Company, or MBS Insurance Services, Inc. The earliest Arizona insurance agency in which Smith had an ownership interest was Smith, Kelly, and Houston, Inc., in which Smith was one of three principals. In 1982, Smith formed Arnie Smith and Associates, Ltd. On April 16, 1984, the Articles of Incorporation of Arnie Smith and Associates, Ltd. was changed by renaming the corporation as MBS Insurance Company. Subsequently, the name of Smith, Kelly and Houston, Inc., was changed in 1984 to Arnie Smith and Associates, Ltd. Ostensibly, this Arnie Smith and Associates, Ltd., is different then the Arnie Smith and Associates, Ltd., which was incorporated in 1982. Smith also did business as Arnie Smith Insurance and MBS Insurance Services, Inc. MBS Insurance Services, Inc., was never incorporated to do business in the state of Arizona. Smith continued to do business under the name Arnie Smith and Associates, Ltd., and MBS Insurance Services, Inc., through August, 1986. MBS Insurance Company's Certificate of Authority to transact business as a corporation was revoked by the State of Arizona on June 10, 1985. Arnold J. Smith was the President/Chief Executive Officer, Chairman of the Board of Directors and principal stockholder of Arnie Smith and Associates, Ltd., and MBS Insurance Company. During 1984, 1985, and 1986, Smith's agency encountered mounting financial problems. Major debts to various insurance companies and to banks were mounting. In April, 1985, Smith's auto insurance business was transferred to another agency, the Thim Agency, located in Tucson. On July 1, 1985, Smith sold the remainder of his property and casualty portion of the insurance business to another Tucson agency, the Lamb Agency. Smith retained only the life insurance business. However, he was unable to significantly reverse the financial problems. In June, 1986, Smith accepted that his agency would not be able to satisfy the mounting debts. He transferred his remaining files to another insurance agency in Tucson owned by a former employee of Smith's, Dennis Liljegren. In July, 1986, Smith left Tucson and moved to Florida. On August 12, 1986, Smith and his wife filed a Voluntary Petition for Bankruptcy under Chapter 7 of the United States Bankruptcy Code in Tucson, Arizona. In 1982, Smith executed an Agency Agreement with Auto Owners Insurance Company on behalf of Arnie Smith and Associates, Ltd. The Agreement provided that Arnie Smith and Associates, Ltd., held funds belonging to Auto Owners as Trustees. Pursuant to this Agency Agreement, Arnie Smith and Associates, Ltd., engaged in the sale of auto insurance from November, 1982, until Auto Owners terminated the Agency Agreement for nonpayment of indebtedness on March 27, 1985. Over this period of time, Arnie Smith and Associates, Ltd., became indebted to Auto Owners for more than $125,000.00 for premiums paid by insureds but never forwarded to Auto Owners. Following the termination of the Agency Agreement, in April, 1985, Auto Owners transferred the Smith Agency Auto Owners business to the Thim Agency. The Agency Sale Agreement transferring the business to the Thim Agency called for the reduction of the debt to Auto Owners by the Thim Agency from commissions on the Smith Agency's business over the next two years. The Agency Agreement between Auto Owners and Arnie Smith and Associate, Ltd., states that the "Agent shall remain liable for the balance of any indebtedness" under circumstances such as these. By the terms of that contract, the Agent is named as Arnie Smith and Associates, Ltd. Smith signed that contract as president of Arnie Smith and Associates, Ltd. While the Thim Agency did reduce the Smith Agency's debt, in 1987, two years after the transfer of the Auto Owners business to the Thim Agency, Arnie Smith and Associates, Ltd., remained indebted to Auto Owners in the amount of approximately $124,189.78 plus accrued interest. Smith bankruptcy's petition listed Auto Owners Insurance Company as an unsecured creditor without priority, having contingent and disputed claims. No evidence was presented to show that Auto Owners ever made any claim against Arnie Smith and Associates, Ltd., or against Smith personally after the termination of the Agency Agreement and transfer by Auto Owners of the Smith Agency's Auto Owners Insurance business to the Thim Agency. Apparently no claim was filed by Auto Owners in conjunction with the bankruptcy proceedings. In March, 1982, Smith signed a contract with Western Life Insurance Company on behalf of Smith, Kelly, and Houston, Inc. Smith also signed a personal guarantee of that contract. By signing that guarantee, Smith agreed to joint and several liability for any and all debts or other monetary obligations to the company. Subsequently, in September, 1982, Smith assigned the contract with Western Life to Arnie Smith and Associates, Ltd. This Arnie Smith and Associates, Ltd., was the corporation which changed its name to MBS Insurance Company in March, 1984. Thereafter, Smith continued to do business with Western Life under both the name Arnie Smith and Associates, Ltd., and MBS Insurance Company. In November, 1985, Smith executed a contract with Western Life Insurance on behalf of MBS Insurance Services, Inc., the corporation which was never authorized to do business in Arizona. Throughout the period of Smith's involvement with Western Life, he sold that company's products called LP-85 and LP-95 policies. He sold approximately 200 of these type policies while he was working in Arizona. The LP-85 and LP-95 policies are a high premium product which builds a large cash value in the first two years. The manner in which it was marketed by Western Life allowed the insured to borrow through a "minimum deposit loan agreement" to pay the premiums from the cash value. Generally, the payment of ten months premium provided sufficient cash to fund the policy premium payments through this minimum deposit loan arrangement for at least four or five years. The agent was able to receive advance annualized commissions upon the sale of these products, when the agency sent the initial premium to Western Life. In cases where ten months in premium were paid and a minimum deposit loan agreement was used to pay the balance of the first year premium and the full second year premium, the Smith Agency actually could receive, and did receive, a second year advanced annualized commission. In January, 1986, Smith sold and Western Life issued one of these life insurance policies to Dr. Bert Strug. In May, 1986, Smith stated in a letter that the annual premium on Strug's policy was $880,000. Later, in a letter dated August 1, 1986, Smith told Strug that the annual premium was $880.00. In fact, the annual premium was really $19,200.00. Shortly after initially writing the policy, the Smith Agency received an annualized commission of $17,500.00. However, Smith did not deliver Strug's policy to Dr. Strug until August 1, 1986. Smith used the annualized commission which he received to pay the premiums on Strug's policy for the first ten months. This permitted Smith to collect the annualized commission and the low premium payment from the insured and to then use this money to pay the first ten months of premium before the minimum deposit loan arrangement took over payment of the premiums. Thereafter, Smith would be able to collect the annualized commission even though no premiums were being paid. On February 17, 1986, Smith sold and Western Life issued one of these life insurance policies to Gerry S. Hendrickson. Hendrickson never paid a premium on this policy and Smith never delivered the policy to Hendrickson. However, Smith was paid an annualized commission by Western Life of $7,300.00. It is required that policies be delivered within thirty days. Smith sold and Western Life issued one of these life insurance policies to Dr. Frank P. Hall on April 11, 1986. Dr. Hall never paid a premium on this policy and the policy was never delivered by Smith to Dr. Hall. Smith was paid an annualized commission by Western Life of $12,000.00. In May, 1986, Smith sold and Western Life issued one of these life insurance policies to Dr. Vernon W. David. This policy was never delivered to Dr. Davis by Smith. Smith did receive an annualized commission from Western Life in the amount of $12,000.00. A policy was issued to Richard Flynn on February 21, 1986, pursuant to a sale of one of these insurance policies by Smith. Smith's invoice states that the annual premium was $485.00. The actual annual premium on this policy was $9,280.00. Smith was paid an annualized commission by Western Life in the amount of $8,000.00. In each of these instances, Smith intended to and did pay the premiums on the policies from the annualized commission which he received. Each of these policies was paid through an automated bank draft arrangement. While the usual and customary arrangement for paying an insurance policy through a bank draft arrangement presupposes usage of an account of the insured, in the present case, the bank drafts were being paid from an account controlled by Smith. For a period of time, the automated bank drafts were being paid through an account called "PPF" of the Arnie Smith and Associates, Ltd., agency. Until the PPF account was created, for a period of time, the bank drafts were being paid from an account in the name of MBS Insurance Services, Inc. The name was changed from MBS to the premium financing account, PPF, at the instruction of Western Life official in February, 1986. At that time, Western Life was concerned with the company sending advanced commissions by check made out to the same entity as the entity that was sending premium payments to Western Life. Western Life was concerned that this arrangement gave the appearance that the agency was paying the premiums. In fact, the agency was paying the premiums. Subsequently, in June, 1986, Western Life contacted Smith and advised that all bank drafts currently authorized through the PPF account would have to be changed to draft payments from bank accounts of the individual insureds. Coincidentally, it was at this same time that Smith reached the conclusion that he was not going to be able to solve the financial problems of his business and he began preparations for turning the business over to Liljegren. As of July 31, 1986, the combined balance due Western Life Insurance Company from Arnie Smith and Associates, Ltd., and from MBS Insurance Services, Inc., was approximately $16,000.00. Following Smith's departure for Florida, Western Life, through its representative, Dean Glenn, began to examine the various policies and payment practices connected with the Smith agencies. Eventually, Western Life reached the decision that it would not honor the policies sold by Smith under the above- described payment arrangements. Instead, Western Life rescinded approximately 25 policies and charged back the unearned commissions against the Smith Agency accounts. It does appear that in the course of the charging back process, Western Life did not give credit to the Smith Agency for the policy premiums which it paid from advanced annualized commission. However, the records of Western Life Insurance Company show that Arnie Smith and Associates, Ltd., is indebted to Western Life in the amount of $134,150.98, and that MBS Insurance Services, Inc., is indebted to Western Life in the amount of $57,847.12. Smith listed Western Life as an unsecured creditor with a contingent and disputed claim in the amount of $100,000.00 in the bankruptcy petition. In his various applications for different licenses filed with the Department, Smith answered "no" to question 11. Question 11 states: "Does any insurer or general agent claim you are indebted under any agency contract or otherwise?" As previously found, Smith listed Western Life Insurance Company, Auto Owners Insurance Company, and other insurers as unsecured creditors with disputed and contingent claims under Schedule A-3 of the bankruptcy petition. According to Smith, none of these insurance companies have any claim against him personally. He bases this position on advice of counsel. On all the applications filed with the Department by Smith, he answered "no" to question 12. Question 12 states "Have you ever had any agency contract cancelled?" It is undisputed that by letter dated March 27, 1985, Auto Owners Insurance Company terminated the Agency Agreement with the Smith Agency for nonpayment of indebtedness. Smith was the owner and principal of the agency. Smith takes the position that the word "you" in that question refers only to him personally and not to his corporate agency. It is found, however, that such a construction is unreasonable and that the word "you," in question 12 can only be reasonably interpreted to apply to Smith and any of his corporate or business entities which are solely owned and controlled by him.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department of Insurance and Treasury enter a Final Order and therein revoke the licenses previously issued to Arnold J. Smith and therein deny Smith's pending application for licensure. DONE AND ORDERED this 24th day of November, 1987, in Tallahassee, Leon County, Florida. DIANE K. KIESLING Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this this 24th day of November, 1987. APPENDIX TO RECOMMENDED ORDER CASE NOS. 87-1652 and 87-2975 The following constitutes my specific rulings pursuant to Section 120.59(2), Florida Statutes, on the proposed findings of fact submitted by the parties in this case. Specific Rulings on Proposed Findings of Fact Submitted by Arnold J. Smith 1. Each of the following proposed findings of fact are adopted in substance as modified in the Recommended Order. The number in parentheses is the Finding of Fact which so adopts the proposed finding of fact: 1(2 & 3); 2(1); 4(22); 5(24); 7(5,8,21); 11(2); 12(2); 13(6,8); 15(6); 17(4); 20(4); 21(8); 26(21); 30(10); 31(10); 32(10,11); 39(4); and 44(12). 2. Proposed findings of fact 3, 8, 9, 14, 16, 18, 19, 22-25, 27-29, 37, 38, 41, 42, 45-48, 65, 68-86 are subordinate to the facts actually found in this Recommended Order. 3. Proposed findings of fact 6, 10, 33-36, 40, 43, 49-64, 66 and 67 are rejected as irrelevant or unnecessary. Specific Rulings on Proposed Findings of Fact Submitted by Department of Insurance & Treasurer 1. Each of the following proposed findings of fact are adopted in substance as modified in the Recommended Order. The number in parentheses is the Finding of Fact which so adopts the proposed finding of fact: 1(1); 2(22); 3-5(9); 6-8(2); 9(9); 10(2); 11(20); 12(20); 13(19); 14(21); 15(3); 16-19(6); 20(8); 21(8); 23(12); 24(12): 25-27(13); 28- 30(14); 31(15); 32(15); 33(13); 34-36(12); 37(16); 38(16); 39(6); 40(12); 41(16); 42(13) 43(14); 44(15); 45- 48(18); and 49(24) 2. Proposed finding of fact 22 is rejected as unnecessary. COPIES FURNISHED: Robert V. Elias William W. Tharpe Department of Insurance and Treasurer Office of Legal Services 413-B Larson Building Tallahassee, Florida 32399-0300 Tom R. Moore, P.A. Robert C. Apgar, P.A. 119 E. Park Avenue Tallahassee, Florida 32301 Honorable William Gunter State Treasurer and Insurance Commissioner The Capitol, Plaza Level Tallahassee, Florida 32399-0300
