Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-142 - INSURER CONDUCT › Section 69O-142.002 - Insurer Complaint Ratios

Current through Reg. 50, No. 138; July 16, 2024
(1) This
				rule implements the publication requirements of Section
				624.313, F.S., which requires
				the Office to publish complaint ratios for the 10 largest insurers or insurer
				groups by line of insurance and each insurer or insurer group that has 1
				percent or more of a line of insurance in this state. This rule does not apply
				to private passenger automobile insurance coverages. This rule also identifies
				the procedures by which insurer complaint ratios, herein referred to as
				complaint indexes, are calculated. Insurer Complaint indexes can be used by the
				Office to identify insurers with questionable claims handling practices and
				allow the Office to take appropriate regulatory action to avoid an interruption
				in services to the insurance consumer. The insurance consumer will be able to
				compare insurers by line of insurance to assist in the purchase of
				insurance.
(2) Definitions. The
				following words and phrases, when used in this rule shall have the following
				meanings, except where the context clearly indicates a different meaning:
(a) "Bureau" means the Bureau of Consumer
				Assistance, a bureau within the Division of Insurance Consumer
				Services.
(b) "Complaint" for
				purposes of the complaint index, means any written communication, by an insured
				or named beneficiary, primarily expressing a grievance or dissatisfaction over
				which the Office has regulatory authority. Complaints which will not be used to
				calculate the complaint index include complaints against an incorrect entity;
				complaints against companies providing administrative services for self-funded
				benefit plans; complaints regarding properly filed or approved rates; suspected
				fraudulent claim complaints; and complaints which are duplicative, harassing or
				frivolous.
(c) "Complaint Index"
				means an index derived by dividing the complaint share by the market share for
				a specific insurer by line of insurance.
(d) "Complaint Share" means the percentage of
				complaints received by the Office relevant to an insurer for any given line of
				insurance when compared to the total complaints received by the Office for that
				line of insurance.
(e) "Office"
				means the Office of Insurance Regulation.
(f) "Direct Written Premium" means a
				consideration paid, or to be paid, to the insurer for the issuance and delivery
				of any binder or policy of insurance or annuity written directly to the
				consumer.
(g) "Division" means the
				Division of Insurance Consumer Services, a division within the Department of
				Financial Services.
(h) "Insurer"
				includes every individual, company, association, organization, partnership,
				syndicate, business trust, corporation or legal entity engaged as indemnitor,
				surety or contractor, holding a certificate of authority issued by the Office,
				which is authorized to enter into contracts of insurance or annuity.
(i) "Line of Insurance" means the
				subclassifications of kinds of insurance which are required to be annually
				reported on the standardized Annual Statement adopted by the Office.
(j) "Market Share" means the percentage of
				the direct written premiums when compared to the total direct written premiums
				in the State of Florida for a given line of insurance.