Section 69O-142.002 - Insurer Complaint Ratios(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.(3) Computing the Complaint Index. (a) All direct written premiums for the reporting period will be compared to determine the market share of insurance business for each insurer by line of insurance.(b) Insurer complaint information for the reporting period will be obtained from the Division for all insurers. 1. Complaint information will be subdivided by line of insurance for each insurer.2. The complaint share will be determined for each insurer by line of insurance based on complaints received by the Office.(c) An insurer complaint index, for each insurer, will be calculated by dividing the complaint share by line of insurance by the market share of direct written premium for that line of insurance.1. A complaint index of 1.00 will indicate that the insurer has received a proportionate number of complaints as compared to the market share of direct written premium for a particular line of insurance.2. A complaint index of less than 1.00 will indicate that the insurer has a complaint share that is less than their market share of direct written premium for that particular line of insurance.3. A complaint index of more than 1.00 will indicate that the insurer has a complaint share that is more than their market share of direct written premium for that line of insurance.(4) Complaint Indexes. Complaint indexes by line of insurance will be published by the Office annually as required by Section 624.313, F.S., and may be published at such other times as the Office deems appropriate. The Office shall make available to insurers, upon written request, a copy of the index prior to publication. If the insurer disagrees with the index, the insurer shall provide the Office with written supporting documentation within 15 days of receipt of the index.Fla. Admin. Code Ann. R. 69O-142.002
Rulemaking Authority 624.308 FS. Law Implemented 624.307(1), 624.313, 624.4241 FS.
New 8-3-93, Formerly 4-142.002.New 8-3-93, Formerly 4-142.002.