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Florida Regulatory Action a Reminder that TPAs Must Be Licensed Before Conducting Business

A recent regulatory action against a Delaware domiciled TPA ("Company") demonstrates the importance for companies to be properly licensed with state insurance regulators where they are conducting business.

In June 2017, the Florida Office of Insurance Regulation ("OIR") denied an application submitted by the Company's parent for licensure as a TPA based on the OIR's determination that all information required to process the application had not been provided. In June 2017, the denial was appealed with the Florida Division of Administrative Hearings to preserve all rights. On October 4, 2017, the OIR withdrew its prior denial of the TPA license application.

On February 14, 2018, the OIR entered into a Consent Order granting the Company a TPA license. However, in the Consent Order, the OIR determined the Company had previously administered business on behalf of authorized insurers with respect to Florida residents, in violation of Section 626.8805 Florida Statutes. The determination that the Company had been administering business in violation of Section 626.8805 Florida Statutes was based on the OIR's review of fourteen (14) administrative agreements under which the Company had been conducting business prior to submitting its TPA application to the OIR.

As a result of this finding, the Company was assessed a fine of $140,000, pursuant to Section 626.8805(l) Florida Statutes.

 

© Polsinelli PC, Polsinelli LLP in California

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About this Author

Steven L. Imber, Polsinelli PC, Insurance Regulatory Attorney, Enforcement Actions Lawyer,
Shareholder

Steve Imber chairs Polsinelli's Insurance Business and Regulatory group.  As a former General Counsel at a state insurance department, Steve Imber has the knowledge and experience to provide quality counsel to insurers, third party administrators, insurance agencies, medical discount plans and other insurance regulated entities. His practice includes representing and assisting clients on multi-state and national licensing projects, research projects, enforcement actions, market conduct examinations, audits and compliance programs and various other regulatory and...

913.234.7469
Shareholder

Justin Liby has a talent for organizing and managing large national and multi-state licensure and research projects. This knack provides him with a solid foundation for crafting and implementing sound, efficient strategies that achieve success for his clients. Justin concentrates his efforts on helping the insurance industry navigate the formidable federal and state regulatory maze to achieve the industry’s business needs. He stays current in the insurance industry's evolution, as well as the legislation and regulatory activity impacting the industry.

Justin is a former regulator for the Kansas Insurance Department and in-house counsel for a national third-party administrator.

913-234-7427
Counsel

Jennifer Osborn Nix works diligently for insurance companies, third-party administrators, and other regulated entities to further their goals and help them remain compliant within the 50-state regulatory scheme. She focuses on insurance regulatory and compliance issues, with a primary emphasis on life and health insurance matters.

Jennifer works with many regulated entities, including many in the health care sector, who rely on her for research, advice, strategic counsel, and licensing.

913.234.7472