Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69J - Division of Consumer Services › Chapter 69J-166 - PROPERTY INSURANCE CLAIMS › Section 69J-166.002 - Mediation of Commercial Residential Property Insurance Claims

Current through Reg. 50, No. 138; July 16, 2024
(1) Purpose and Scope. This rule implements
				Section  627.7015, F.S. The program
				established under this rule is prompted by the critical need for effective,
				fair, and timely handling of commercial residential property claims. This
				program is available to all first-party claimants and insurers prior to
				commencing the appraisal process set forth in their policies or commencing
				litigation. The program is also available to litigants referred to the
				Department from Circuit or County court. For claims which have not previously
				been mediated under any Department mediation program, the mediation procedures
				described in this rule are available to all commercial residential property
				claims for property located in the State of Florida. This rule does not apply
				to commercial insurance, private passenger motor vehicle insurance, or to
				liability coverage contained in property insurance policies. This program does
				not apply to policies issued under the National Flood Insurance Program
				established under the National Flood Insurance Act of 1968. Personal lines
				residential insurance claims can be mediated pursuant to Rule
				 69J-166.031, F.A.C. Before
				resorting to these procedures, policyholders and insurers are encouraged to
				resolve claims as quickly and fairly as possible.
(2) Definitions. The following definitions
				shall apply for purposes of this rule:
(a)
				"Administrator" means the Department or its designee.
(b) "Mediator" means an individual selected
				by the Department pursuant to Chapter 69B-250, F.A.C.
(c) "Claim".
1. "Claim" refers to any dispute between the
				insurer and policyholder relating to a material issue of fact other than:
a. A dispute as to which the insurer has
				reported allegations of fraud, based on an investigation by the insurer's
				special investigative unit, to the Department's Investigative and Forensic
				Services, or
b. A dispute where,
				based upon agreed facts as to the cause of loss, there is no coverage under the
				policy.
2. Unless the
				parties agree to mediate a claim involving a lesser amount, a claim involves
				the policyholder requesting $500 or more to settle the dispute, or the
				difference between the positions of the parties is $500 or more, either of
				which is notwithstanding of any applicable deductible.
3. A policy must have been in effect at the
				time of the loss to qualify as a claim.
(d) "Complainant" refers to the party
				requesting mediation.
(e)
				"Department" means the Department of Financial Services.
(f) "Department office" means a designated
				office of the Division of Consumer Services, Department of Financial
				Services.
(g) "Party" or "Parties"
				means the policyholder and their insurer, including Citizens Property Insurance
				Corporation, when applicable.
(h)
				"Respondent" refers to the party not first requesting mediation.
(i) "Authorized representative" means that
				individual who has been authorized, by the appropriate governing body of a
				condominium association, cooperative association, or homeowners' association,
				to represent the association at mediation, make decisions on the association's
				behalf at mediation, and enter into a binding settlement agreement on behalf of
				the association.
(j) "Governing
				documents" are those documents creating the forms of property ownership
				governed by Chapters 718, 719 and 720, F.S., and those documents creating the
				entities governed by Chapters 718, 719 and 720, F.S.