69L-24.007. Pattern and Practice

(1) A pattern or practice constitutes a willful violation if the regulated entity that committed the pattern or practice:

(a) Did so intentionally and with knowledge of the act’s unlawfulness or with disregard to the unlawfulness of the act; or

(b) Failed to comply with an order of the Department and the insurer has exhausted all appellate rights.

(2) The penalties assessed under subsection (1) of this rule shall be $20,000 for a single willful violation and not exceed an aggregate of $100,000 for all pattern or practice violations arising out of the same action.

(3)(a) The Department shall issue a non-willful violation for a pattern or practice of unreasonable claims handling for any monitoring, examining, or investigating review activity listed in subsection 69L-24.004(2), F.A.C. For each such non-willful violation, a penalty of $2,500 shall be assessed against the insurer by the Department, with such fines not exceeding an aggregate of $10,000 for all pattern or practice violations arising out of the same action. Any penalty imposed under this paragraph for a non-willful violation shall not duplicate a penalty imposed under another provision of chapter 440, F.S. or Department Rules governing Florida Workers’ Compensation law.

(b) The Department will calculate a regulated entity’s performance in order to determine if a non-willful violation will be assessed for a pattern or practice of unreasonable claims handling. If the performance falls below 90% compliance during an audit, examination or investigation, except as otherwise stated in chapter 440, F.S. and Department Rules, the Department shall assess a penalty pursuant to subsection (3), herein.

Rulemaking Authority 440.13, 440.185(10), 440.20(6), 440.525(4), 440.591, 440.593(5) FS. Law Implemented 440.13(11), 440.185, 440.20(6), (8), 440.525, 440.593 FS. History–New 1-12-10.