RFI No. 2324-01 Attachment A.pdf

Attachment A

RFI No.: 2324-01 RFI CS Insurance Dispute Data Analytics

ATTACHMENT A

Civil Remedy Notice of Insurer Violation (CRN) Section 624.155, Florida Statutes Rule: 69J-123.003, F.A.C.

Online Form Filing System: https://apps.fldfs.com/CivilRemedy/

List of Fields included on Notice form Complainant Information (all fields required unless noted)

• Last/Business Name

• First Name (not required)

• Street Address

• City

• State

• Zip

• Email Address

• Complainant Type: (dropdown selection) o Insured o Third Party, or o Other

Insured (all fields required unless noted)

• Last/Business Name

• First Name (not required)

• Policy Number

• Claim Number

Attorney (if attorney is applicable, all fields required)

• Last Name

• First Name

• Middle Initial (not required) Street Address

• City

• State

• Zip

• Email Address

Violation (all fields required)

• Insurer Name: user selects insurance company name from dropdown list pulled from COREN.

• Name of individual responsible for violation (if any): (free text field, required, but user can enter

"not applicable" or similar if this field does not apply)

• Type of Insurance: (dropdown selection) o Accident & Health o Life & Annuity o Medicare Supplement o Auto o Residential Property & Casualty o Commercial Property & Casualty http://www.leg.state.fl.us/statutes/index.cfm?mode=View%20Statutes&SubMenu=1&App_mode=Display_Statute&URL=0600-0699/0624/Sections/0624.155.html https://www.flrules.org/gateway/readFile.asp?sid=0&tid=8064112&type=1&file=69J-123.002.doc https://apps.fldfs.com/CivilRemedy/ o Professional Liability o Miscellaneous o Other (if other selected, user must type brief description)

• Reason for Notice: (dropdown selection, multiple selections allowed) o Cancellation o Non-renewal o Claim Denial o Claim Delay o Unsatisfactory Settlement Offer o Unfair Trade Practice o Other (if other selected, user must type brief description(s))

• Statutory provision(s) which the insurer allegedly violated. (dropdown selection, multiple selections allowed) o Includes each paragraph from the statutes referenced in Section 624.155(1)(a) that could be considered a violation.

o Note: All statute references currently available for users to select available upon request.

• Specific policy language that is relevant to the violation. (free text field, max characters allowed)

• Facts and circumstances giving rise to the violation. (free text field, max characters allowed)

Property Insurance Intent to Initiate Litigation Notice (PIITIL) Section 627.70152, Florida Statutes Rule: 69J-123.003, F.A.C.

Online Form Filing System: https://piitil.myfloridacfo.gov/

List of Fields included on Notice form Claimant (all fields required)

• Name

• Email Address

• Street Address

• City

• State

• Zip Code

• Policy Number

• Claim Number

Attorney (if attorney is applicable, all fields required)

• First Name

• Last Name

• FL Bar Number

• Email Address

• Street Address

• City

• State

• Zip Code

• Firm Name

• Role on Claim: "Represent Insured" or "Form Filing Only" (dropdown selection)

Notice Details (all fields required, unless noted)

• Insurer Name: User selects insurance company name from dropdown list pulled from COREN.

• Alleged Acts or Omissions of the Insurer: Free text field, up to 1500 characters.

• Users select one of two options:

o This Notice is being provided following a denial of coverage.

o This Notice is being provided following alleged acts or omissions by the insurer other than the denial of coverage.

• If "denial of coverage" option selected:

o Estimate of Damages, if known: dollar amount entered by user o Or select checkbox: "Check here if the Estimate of Damages amount is unknown."

– If user selects this checkbox, dollar amount not required in Estimate of Damages field.

http://www.leg.state.fl.us/statutes/index.cfm?mode=View%20Statutes&SubMenu=1&App_mode=Display_Statute&URL=0600-0699/0627/Sections/0627.70152.html https://www.flrules.org/gateway/readFile.asp?sid=0&tid=26765615&type=1&file=69J-123.003.doc https://piitil.myfloridacfo.gov/

Note:

o Section 627.70152(3)(a)4, Florida Statutes, states:

The notice must state with specificity all of the following information: …

4. If the notice is provided following a denial of coverage, an estimate of damages, if known.

• If "alleged acts or omissions… other than denial" option selected:

o Presuit Settlement Demand: dollar amount entered by user o Damages: dollar amount entered by user o Attorney Fees: dollar amount entered by user o Costs: dollar amount entered by user o Disputed Amount: dollar amount entered by user o Or select checkbox: "Check here if the Disputed Amount is unknown."

– If user selects this checkbox, dollar amount not required in Disputed Amount field.

Note:

o Section 627.70152(3)(a)5, Florida Statutes, states:

The notice must state with specificity all of the following information: …

5. If the notice is provided following acts or omissions by the insurer other than denial of coverage, both of the following:

a. The presuit settlement demand, which must itemize the damages, attorney fees, and costs.

b. The disputed amount.

o Note: Section 627.70152(2)(b), Florida Statutes, defines disputed amount as:

"Disputed amount” means the difference between the claimant’s presuit settlement demand, not including attorney fees and costs listed in the demand, and the insurer’s presuit settlement offer, not including attorney fees and costs, if part of the offer.

Attachments (not required)

• Users can include PDF attachments, up to 50 MB total.