Florida Senate - 2025 SB 1428 By Senator DiCeglie 18-01081A-25 20251428__ 1 A bill to be entitled 2 An act relating to consumer protection in insurance 3 matters; amending s. 626.854, F.S.; requiring public 4 adjusters, public adjuster apprentices, and public 5 adjusting firms to provide a specified response within 6 a specified timeframe after receiving a request for 7 claim status from a claimant, an insured, or a 8 designated representative; requiring such adjusters, 9 apprentices, and firms to retain a copy of such 10 response; creating s. 627.4815, F.S.; defining terms; 11 requiring that universal life insurance policies 12 include a provision requiring a certain annual report; 13 specifying requirements for the annual report; 14 providing applicability; amending s. 627.6515, F.S.; 15 revising applicability relating to group health 16 insurance policies; creating s. 627.7293, F.S.; 17 requiring certain automobile insurers, under certain 18 circumstances, to provide a specified statement in a 19 certain manner; requiring the automobile insurer to 20 obtain express consent before submitting specified 21 claims; providing applicability; creating s. 627.7431, 22 F.S.; defining terms; requiring insurers to pay or 23 deny certain claims within a specified timeframe; 24 providing an exception; requiring insurers to provide 25 certain explanations to policyholders under certain 26 circumstances; specifying that certain payments bear 27 specified interest; specifying when the interest 28 begins to accrue; providing construction; requiring 29 the insured to select the manner of receiving 30 prejudgment interest under certain circumstances; 31 specifying that the failure to comply with certain 32 provisions does not form the basis of a private cause 33 of action; providing applicability; specifying that 34 certain requirements are tolled under certain 35 circumstances; providing an effective date. 36 37 Be It Enacted by the Legislature of the State of Florida: 38 39 Section 1.Subsection (24) is added to section 626.854, 40 Florida Statutes, to read: 41 626.854Public adjuster defined; prohibitions.The 42 Legislature finds that it is necessary for the protection of the 43 public to regulate public insurance adjusters and to prevent the 44 unauthorized practice of law. 45 (24)A public adjuster, public adjuster apprentice, or 46 public adjusting firm must provide a specific response to a 47 written or electronic request for claim status from a claimant, 48 an insured, or the persons designated representative within 14 49 days after receiving the request. The public adjuster, public 50 adjuster apprentice, or public adjusting firm must retain a copy 51 of its response for its records. 52 Section 2.Section 627.4815, Florida Statutes, is created 53 to read: 54 627.4815Universal life policies. 55 (1)As used in this section, the term: 56 (a)Cash surrender value means the net cash surrender 57 value plus any amounts outstanding as policy loans. 58 (b)Fixed premium universal life insurance policy means a 59 universal life insurance policy other than a flexible premium 60 universal life insurance policy. 61 (c)Flexible premium universal life insurance policy 62 means a universal life insurance policy that permits the 63 policyowner to vary, independently of each other, the amount or 64 timing of one or more premium payments or the amount of 65 insurance. 66 (d)Net cash surrender value means the maximum amount 67 payable to the policyowner upon surrender. 68 (e)Policy value means the value of any individual life 69 insurance policy, rider, group master policy, or individual 70 certificate. The term includes separately identified interest 71 credits, except those related to dividend accumulations, premium 72 deposit funds, or other supplementary accounts, and mortality 73 and expense charges. 74 (f)Universal life insurance policy means any individual 75 life insurance policy, rider, group master policy, or individual 76 certificate that includes separately identified interest credits 77 and mortality and expense charges. A universal life insurance 78 policy may also include other types of credits and charges. The 79 term does not apply to policies, riders, group master policies, 80 or individual certificates in connection with dividend 81 accumulations, premium deposit funds, or other supplementary 82 accounts. 83 (2)A universal life insurance policy issued in this state 84 must include a provision requiring the policyowner to receive, 85 at no cost, an annual report on the policys status. The report 86 must be sent within 3 months after the end of the reporting 87 period. The report must include all of the following: 88 (a)The beginning and end of the current reporting period. 89 (b)The policy value at the end of the previous reporting 90 period and at the end of the current reporting period. 91 (c)The total amounts that have been credited or debited to 92 the policy value during the current reporting period, identified 93 by type. 94 (d)The current death benefit at the end of the current 95 reporting period on each life covered by the policy. 96 (e)The net cash surrender value of the policy as of the 97 end of the current reporting period. 98 (f)The amount of outstanding loans, if any, as of the end 99 of the current reporting period. 100 (g)For fixed premium policies, if, assuming guaranteed 101 interest, mortality and expense loads, and continued scheduled 102 premium payment, the policys net cash surrender value is such 103 that it would not maintain insurance in force until the end of 104 the next reporting period, a notice to that effect. 105 (h)For flexible premium policies, if, assuming guaranteed 106 interest and mortality and expense loads, the policys net cash 107 surrender value will not maintain insurance in force until the 108 end of the next reporting period unless further premium payments 109 are made, a notice to that effect. 110 (i)For fixed premium or flexible premium policies, if, 111 assuming guaranteed interest and mortality and expense loads, 112 the policys net cash surrender value will not maintain 113 insurance in force until maturity of the contract, the projected 114 date on which policy values will be insufficient to continue 115 coverage in force. 116 (3)This section applies to all universal life insurance 117 policies except variable contracts as defined in s. 627.8015. 118 Section 3.Subsection (2) of section 627.6515, Florida 119 Statutes, is amended to read: 120 627.6515Out-of-state groups. 121 (2)Except as otherwise provided in this part, this part 122 does not apply to a group health insurance policy issued or 123 delivered outside this state under which a resident of this 124 state is provided coverage if: 125 (a)The policy is issued to an employee group the 126 composition of which is substantially as described in s. 127 627.653; a labor union group or association group the 128 composition of which is substantially as described in s. 129 627.654; an additional group the composition of which is 130 substantially as described in s. 627.656; a group insured under 131 a blanket health policy when the composition of the group is 132 substantially in compliance with s. 627.659; a group insured 133 under a franchise health policy when the composition of the 134 group is substantially in compliance with s. 627.663; an 135 association group to cover persons associated in any other 136 common group, which common group is formed primarily for 137 purposes other than providing insurance; a group that is 138 established primarily for the purpose of providing group 139 insurance, provided the benefits are reasonable in relation to 140 the premiums charged thereunder and the issuance of the group 141 policy has resulted, or will result, in economies of 142 administration; or a group of insurance agents of an insurer, 143 which insurer is the policyholder; 144 (b)Certificates evidencing coverage under the policy are 145 issued to residents of this state and contain in contrasting 146 color and not less than 10-point type the following statement: 147 The benefits of the policy providing your coverage are governed 148 primarily by the law of a state other than Florida; and 149 (c)The policy provides the benefits specified in ss. 150 627.419, 627.6562, 627.6574, 627.6575, 627.6579, 627.6612, 151 627.66121, 627.66122, 627.6613, 627.667, 627.6675, 627.6691, and 152 627.66911, and complies with the requirements of s. 627.66996. 153 (d)Applications for certificates of coverage offered to 154 residents of this state must contain, in contrasting color and 155 not less than 12-point type, the following statement on the same 156 page as the applicants signature: 157 158This policy is primarily governed by the laws of 159 ...(insert state where the master policy is filed).... 160 As a result, all of the rating laws applicable to 161 policies filed in this state do not apply to this 162 coverage, which may result in increases in your 163 premium at renewal that would not be permissible under 164 a Florida-approved policy. Any purchase of individual 165 health insurance should be considered carefully, as 166 future medical conditions may make it impossible to 167 qualify for another individual health policy. For 168 information concerning individual health coverage 169 under a Florida-approved policy, consult your agent or 170 the Florida Department of Financial Services.171 172 This paragraph applies only to group certificates providing 173 health insurance coverage which require individualized 174 underwriting to determine coverage eligibility for an individual 175 or premium rates to be charged to an individual except for the 176 following: 177 1.Policies issued to provide coverage to groups of persons 178 all of whom are in the same or functionally related licensed 179 professions, and providing coverage only to such licensed 180 professionals, their employees, or their dependents; 181 2.Policies providing coverage to small employers as 182 defined by s. 627.6699. Such policies shall be subject to, and 183 governed by, the provisions of s. 627.6699; 184 3.Policies issued to a bona fide association, as defined 185 by s. 627.6571(5), provided that there is a person or board 186 acting as a fiduciary for the benefit of the members, and such 187 association is not owned, controlled by, or otherwise associated 188 with the insurance company; or 189 4.Any accidental death, accidental death and 190 dismemberment, accident-only, vision-only, dental-only, hospital 191 indemnity-only, hospital accident-only, cancer, specified 192 disease, Medicare supplement, products that supplement Medicare, 193 long-term care, or disability income insurance, or similar 194 supplemental plans provided under a separate policy, 195 certificate, or contract of insurance, which cannot duplicate 196 coverage under an underlying health plan, coinsurance, or 197 deductibles or coverage issued as a supplement to workers 198 compensation or similar insurance, or automobile medical-payment 199 insurance. 200 Section 4.Section 627.7293, Florida Statutes, is created 201 to read: 202 627.7293Towing and labor coverage requirements. 203 (1)An automobile insurer that provides towing and labor 204 coverage as a filed claim shall provide the following language 205 or substantially similar language on any web or electronic 206 platform through which a towing or labor claim is made or 207 verbally stated to the claimant if the claim is being made over 208 the phone: 209 210 Your auto insurance policy provides coverage for 211 towing and labor. Use of this coverage requires a 212 filing of a claim. Such claim filing will remain in 213 your claims history for use of future underwriting of 214 any initial or renewal offer made by this insurer or 215 any other insurer. 216 217 (2)The automobile insurer shall obtain the claimants 218 express consent before submitting a claim filed under the towing 219 and labor coverage. 220 (3)This disclosure requirement provided under subsection 221 (1) does not apply if the towing and labor claim is filed as 222 part of a crash-related damage claim. 223 Section 5.Section 627.7431, Florida Statutes, is created 224 to read: 225 627.7431Payment of first-party claim. 226 (1)For purposes of this section, the term: 227 (a)Claim means any first-party claim under an insurance 228 policy providing coverage for a private passenger motor vehicle 229 as defined in s. 627.732. 230 (b)Factors beyond the control of the insurer means: 231 1.Any of the following events that is the basis for the 232 office issuing an order finding that such event renders all or 233 specified motor vehicle insurers reasonably unable to meet the 234 requirements of this section in specified locations and ordering 235 that such insurer or insurers may have additional time, not 236 exceeding 30 days, as specified by the office, to comply with 237 the requirements of this section: a state of emergency declared 238 by the Governor under s. 252.36, a breach of security that must 239 be reported under s. 501.171(3), or an information technology 240 issue. 241 2.Actions by the policyholder or the policyholders 242 representative which constitute fraud, lack of cooperation, or 243 intentional misrepresentation regarding the claim for which 244 benefits are owed, when such actions reasonably prevent the 245 insurer from complying with any requirement of this section. 246 3.Actions by any repair company which constitute fraud, 247 lack of cooperation, or intentional misrepresentation regarding 248 the claim for which benefits are owed, when such actions 249 reasonably prevent the insurer from complying with any 250 requirement of this section. 251 4.Inaccessibility to or delay in the arrival of parts 252 necessary for the repair of the vehicle. 253 (2)Within 60 days after an insurer receives notice of an 254 initial, reopened, or supplemental first-party physical damage 255 insurance claim from a policyholder, the insurer shall pay or 256 deny such claim or a portion of the claim unless the failure to 257 pay is caused by factors beyond the control of the insurer. The 258 insurer shall provide a reasonable explanation in writing to the 259 policyholder of the basis in the insurance policy, in relation 260 to the facts or applicable law, for the payment, denial, or 261 partial denial of a claim. If the insurers claim payment is 262 less than that specified in any insurers detailed estimate of 263 the amount of the loss, the insurer must provide a reasonable 264 explanation in writing of the difference to the policyholder. 265 Any payment of an initial or supplemental claim or portion of 266 such claim made 60 days after the insurer receives notice of the 267 claim, or made after the expiration of any additional timeframe 268 provided to pay or deny a claim or a portion of a claim made 269 pursuant to an order of the office finding factors beyond the 270 control of the insurer, whichever is later, bears interest at 271 the rate set forth in s. 55.03. Interest begins to accrue from 272 the date the insurer receives notice of the claim. This 273 subsection may not be waived, voided, or nullified by the terms 274 of the insurance policy. If there is a right to prejudgment 275 interest, the insured must select whether to receive prejudgment 276 interest or interest under this subsection. Interest is payable 277 when the claim or portion of the claim is paid. Failure to 278 comply with this subsection constitutes a violation of this 279 code. However, failure to comply with this subsection does not 280 form the sole basis for a private cause of action. 281 (3)This section applies to surplus lines insurers and 282 surplus lines insurance authorized under ss. 626.913-626.937 283 providing personal automobile coverage. 284 (4)This section does not apply to any of the following 285 claims: 286 (a)Any claims covered under an insurance policy providing 287 coverage for commercial motor vehicles as defined in s. 627.732. 288 (b)Any portion of a claim covered under an insurance 289 policy covering private passenger motor vehicles if the portion 290 of the claim is based on coverage for: 291 1.Personal injury protection; 292 2.Property damage liability; 293 3.Bodily injury; 294 4.Uninsured motorists or underinsured motorists; or 295 5.Medical payments. 296 (5)The requirements of this section are tolled: 297 (a)During the pendency of any mediation proceeding under 298 s. 627.745 or any alternative dispute resolution proceeding 299 provided for in the insurance contract. The tolling period ends 300 upon the end of the mediation or alternative dispute resolution 301 proceeding. 302 (b)Upon the failure of a policyholder or a representative 303 of the policyholder to provide material claims information 304 requested by the insurer within 10 days after the request was 305 received. The tolling period ends upon the insurers receipt of 306 the requested information. Tolling under this paragraph applies 307 only to requests sent by the insurer to the policyholder or to a 308 representative of the policyholder at least 15 days before the 309 insurer is required to pay or deny the claim or a portion of the 310 claim under subsection (2). 311 Section 6.This act shall take effect July 1, 2025.