69J-8: Alternative Procedure for Resolution of Disputed Sinkhole Insurance Claims
PURPOSE AND EFFECT: These rules implement Section 627.7074, F.S., by establishing standards for the alternate procedure for resolution of sinkhole claims. The rules specify a process for qualification and selection of neutral evaluators and the procedure for conducting evaluations. Some parts of the rules have intentionally been left blank for development through the workshop process.
SUBJECT AREA TO BE ADDRESSED: Disputed Sinkhole Insurance Claims.
SPECIFIC AUTHORITY: 627.7074(8) FS.
LAW IMPLEMENTED: 627.7074 FS.
IF REQUESTED IN WRITING AND NOT DEEMED UNNECESSARY BY THE AGENCY HEAD, A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
TIME AND DATE: Monday, November 20, 2006, 9:30 a.m.
PLACE: 139 Larson Building, 200 East Gaines Street, Tallahassee, Florida.
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 5 days before the workshop/meeting by contacting: Greg Thomas, (850)413-3130. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Greg Thomas, Chief of Education, Advocacy & Research, Division of Consumer Services, Department of Financial Services, 200 East Gaines Street, Tallahassee, FL 32399-0320, (850)413-3130.
THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:
ALTERNATIVE PROCEDURE FOR RESOLUTION OF DISPUTED SINKHOLE INSURANCE CLAIMS
69J-8.001 Purpose.
The alternative procedure for resolution of disputed sinkhole insurance claims authorized by Section 627.7074, F.S., shall be governed by these rules of procedure.
Specific Authority 627.7074(8) FS. Law Implemented 627.7074 FS. HistoryNew________.
69J-8.002 Definitions.
When used in this chapter, and Section 627.7074, F.S., the following terms are defined as follows:
(1) Affiliated: Having an ownership or employment relationship.
(2) Applicant: A person who submits and application to become a neutral evaluator.
(3) Department: Florida Department of Financial Services.
(4) Family Member: A spouse, child, parent, grandparent, grandchild, aunt, uncle, or first cousin of a party.
(5) Financial Interest: Ownership interest in or liabilities to or from a person that amounts to 5% or more of the applicants net worth or from which the evaluator received 5% or more of his income during the past 24 months exclusive of fees guaranteed through this program.
(6) Party: The insurer or policyholder participating in the program.
(7) Person: A natural person or business entity.
(8) Program: The alternative procedure for resolution of disputed sinkhole insurance claims authorized by Section 627.7074, F.S.
Specific Authority 627.7074(8) FS. Law Implemented 627.7074 FS. HistoryNew________.
69J-8.004 Qualification and Certification of Neutral Evaluators.
(1) Persons seeking certification as a neutral evaluator shall apply to the department using_______, Form _______(Effective._______) which is hereby incorporated by reference. The form shall be obtained from ______. The form shall be submitted to_________.
(2) Application for certification shall be granted if the applicant:
(a) Is a professional engineer as defined in Section 471.005, F.S., or a professional geologist as defined in Section 492.102(6), F.S.;
(b) Has completed a course of study in alternative dispute resolution approved under Rule 69J-8.003, F.A.C., above; and
(c) Is determined to be fair and impartial based on the criteria in subsection (3) below:
(3) An applicant shall be found to be fair and impartial unless:
(a) The applicant or a business entity affiliated with the applicant obtained more than ___% of its gross income or revenue in the prior calendar year from contracts with property insurers or persons acting on behalf of property insurers, exclusive of fees generated through the program;
(b) The applicant or a business entity affiliated with the applicant obtained more than ___% of its gross income or revenue in the prior calendar year from contracts with property insurance claimants or persons acting on behalf of property insurance policyholders;
(c) The applicant is currently an employee of a property insurer, or property insurance adjuster, or adjusting firm;
(d) The applicant, has through writings, public statements, or otherwise, expressed a bias for or against property insurance insurers or property insurance policyholders; or
(e) The applicant refuses to agree to be removed from a case in which a party is a family member, personal friend, or person in which the applicant has a financial interest.
(4) The department shall decertify any evaluator who ceases to meet the criteria in subsection (3) above.
Specific Authority 627.7074(8) FS. Law Implemented 627.7074 FS. HistoryNew________.
69J-8.005 Maintenance of a List of Neutral Evaluators.
(1) The department shall maintain a complete list of certified neutral evaluators who wish to serve in the program.
(2) The list shall be a public record and shall be provided to parties as required by Section 627.7074(7), F.S.
(3) The list shall contain the following information:
(a) Name
(b) Address
(c) Phone Number
(d) Fee Schedule
Specific Authority 627.7074(8) FS. Law Implemented 627.7074 FS. HistoryNew________.
69J-8.006 Notice of Program.
Insurers shall provide the notice of the right to participate in the program, required by Section 627.7074(3), F.S., in writing and such notice shall be accompanied by <title of pamphlet> <form number> <adoption date> which is herby incorporated by reference.
Specific Authority 627.7074(8) FS. Law Implemented 627.7074 FS. HistoryNew________.
69J-8.007 Request for Evaluation.
A person wishing to request neutral evaluation pursuant to Section 627.7074(4), F.S., shall make a request to the department by writing to the Department of Financial Services, Mediation Section, Bureau Education, Advocacy, and Research, Tallahassee FL 32399-4212, or by calling the department at 1(800)342-2762, or by faxing a request to the department at 1(850)488-6372.
Specific Authority 627.7074(8) FS. Law Implemented 627.7074 FS. HistoryNew________.
69J-8.008 Selection of Neutral Evaluator.
(1) The insurer shall contact the policyholder and the parties shall attempt to reach an agreement on selection of a neutral evaluator.
(2) If after 10 days the parties have failed to agree upon the neutral evaluator, the parties shall so inform the department by calling the department at 1(850)488-6372.
(3) When informed that the selection of a neutral evaluator could not be agreed upon by the parties, the department shall select a neutral evaluator by rotating sequentially through the list of willing neutral evaluators.
(4) The department will inform the parties of the selection.
(5) Either party may reject the selection by calling the department at 1(850)488-6372 within 5 days of notice being sent.
(6) Each party may reject up to 3 selections for a proceeding.
Specific Authority 627.7074(8) FS. Law Implemented 627.7074 FS. HistoryNew________.
69J-8.009 Evaluation Process.
(1) The neutral evaluator shall, within 5 days of referral, contact the parties to schedule the evaluation proceeding pursuant to Section 627.7074(7), F.S.
(2) The evaluation proceeding shall take the form of an informal conference, and shall not be subject to rules of procedure, or evidence applicable in a court or administrative proceeding.
(3) The evaluator shall give each party the opportunity to submit evidence, testimony, or other information which is reasonably expected to assist the neutral evaluator in determining the existence, nature, and scope of a sinkhole loss, and the nature, extent, and cost of repair and remediation.
(4) The neutral evaluator shall make inquiry of the parties and conduct such independent investigation as the neutral evaluator finds reasonably necessary to determine the existence, nature, and scope of a sinkhole loss, and the nature, extent, and cost of repair and remediation.
(5) The neutral evaluator shall inform the parties in writing as to the neutral evaluators opinion as to the existence of a sinkhole loss and the scope and value of necessary repair and remediation if any.
(6) The parties may settle the claim at any time.
(7) The neutral evaluator shall conclude the proceeding upon settlement of the claim or at any point that the neutral evaluator reasonably determines that settlement is not likely to be facilitated by the continuation of the proceeding.
(8) If the proceeding is concluded without reaching a settlement, the neutral evaluator shall prepare and file the report required under Section 627.7074(12), F.S., on the form adopted in Rule 69J-8.011, F.A.C., below.
(9) If the proceeding results in a settlement, the neutral evaluator shall inform the department that a settlement was reached.
Specific Authority 627.7074(8) FS. Law Implemented 627.7074 FS. HistoryNew________.
69J-8.010 Appointment of Department Employee for Consultation Policyholder Not Represented by an Attorney.
Pursuant to Section 627.7074(9), F.S., the department shall appoint an employee to consult with a policyholder participating in the program, but not represented by an attorney. The department employee shall not be an advocate on behalf of the policyholder and shall not render legal advice. The role of the department employee will be to provide the policyholder with information about the procedures of the program, and assist the policyholder in understanding technical information relating to the policyholders claim.
Specific Authority 627.7074(8) FS. Law Implemented 627.7074 FS. HistoryNew________.
69J-8.011 Neutral Evaluators Report.
The neutral evaluators report on matters that are not resolved by the parties, as required by Section 627.7074 (12), F.S., shall be on Form __________ (Effective__________), which is hereby incorporated by reference. The form shall be obtained from ____________. The form shall be submitted to __________________.
Specific Authority 627.7074(8) FS. Law Implemented 627.7074 FS. HistoryNew________.
