A reader recently asked a fair question on LinkedIn that caught my attention:

“And why isn’t Florida doing the same? OIR is complicit in this behavior for condoning it.”

The comment concerned the Oklahoma Attorney General’s lawsuit against Allstate. The complaint alleges that Allstate implemented what the Attorney General calls a “Disaster Payment Minimization Scheme” designed to reduce payments on wind and hail claims through restrictive internal standards, centralized reviewers, outcome-oriented engineering reports, and the removal of meaningful authority from field adjusters. These are allegations and not established findings. The Oklahoma Attorney General is asking a court for an injunction, restitution, disgorgement, civil penalties, and structural relief under Oklahoma’s consumer-protection and racketeering laws. I discussed this action in Did Allstate’s Good Hands Hide a Disaster Payment Minimization Scheme.

The reader’s question deserves more than a quick social-media response because it exposes a fundamental difference between Oklahoma and Florida. It also raises an uncomfortable question: In Florida, who is actually responsible for investigating an insurer-wide claims-payment scheme?

Florida Is Not Oklahoma, and Hail Is Not Florida’s Greatest Threat

Fairness requires an important qualification. Hail claims are economically significant in Oklahoma. Hail is not the most consequential property-insurance peril facing Florida policyholders. Florida’s catastrophic insurance problems are driven primarily by hurricanes, tropical windstorms, storm surge, flooding, and the complicated water and structural damage that follows those events.

But the particular peril is not the larger point. A corporate claims program designed to reduce payments before the individual facts are fairly evaluated can be applied to hail, hurricane, fire, smoke, water, or virtually any other type of loss. The real concern is not whether Florida has Oklahoma’s hail problem. It is whether Florida insurers use centralized directives, undisclosed standards, financial targets, or claims-review systems that override policy language and the judgment of qualified field adjusters.

So, who owns it in Florida?

OIR Regulates Insurance Company Claims Systems

The Florida Office of Insurance Regulation is the agency with the clearest responsibility for investigating an insurance company’s systemic claims practices. Florida law expressly provides that OIR is responsible for activities concerning insurers, including “market conduct” and “claims.” OIR is part of the Financial Services Commission, but it is not subject to the control, supervision, or direction of the Department of Financial Services.

The OIR has the authority to examine the insurer itself, including its corporate claims manuals, operating procedures, management directives, data, training programs, vendor relationships, and internal standards. It can conduct market-conduct examinations to determine whether insurers are complying with Florida’s insurance laws.

Florida law specifically directs OIR to prioritize examinations when complaint information suggests disproportionate failures to timely communicate, timely pay claims, follow policy terms, use licensed adjusters, maintain adequate records, or follow the company’s own claims-handling manual.

OIR also has substantial enforcement authority. If a market-conduct examination establishes a pattern or practice of willful unfair claims-handling violations that harmed policyholders, OIR may require the insurer to file its claims-handling policies, guidelines, protocols, instructions, and directives for public inspection for 36 months.

So, when the allegation concerns a company-wide program to systematically deny or underpay claims, OIR should be the principal investigating agency.

DFS Receives the Complaints and Regulates the Adjusters

The Florida Department of Financial Services performs a different role. DFS’s Division of Consumer Services receives insurance complaints, assists policyholders, and reports apparent or potential violations to OIR or the appropriate DFS division.

DFS also investigates and disciplines individual adjusters, agents, and insurance agencies. Florida law authorizes DFS to suspend or revoke an adjuster’s license for misrepresenting policy coverage, attempting to settle a claim on less favorable terms than the policy provides, incompetence, dishonesty, or a lack of trustworthiness.

So, DFS receives consumer complaints and regulates the licensed people handling the claims. OIR regulates the insurer and the corporate system that those people are required to follow.

The problem is what happens in the space between the two.

A single complaint may look like an adjuster mistake. Ten similar complaints may reveal a training problem. Twenty-five complaints involving the same coverage position, estimating practice, vendor, engineering conclusion, or managerial review process may reveal a corporate program.

Someone must connect those dots. My impression is there is often a disconnect.

Florida’s Attorney General Has a Limited Lane

The Florida Attorney General is one of the four members of the Financial Services Commission, along with the Governor, Chief Financial Officer, and Commissioner of Agriculture. The commission participates in rulemaking and appoints or removes the Insurance Commissioner. But the Attorney General is not Florida’s ordinary day-to-day insurance claims regulator.

Florida also differs significantly from Oklahoma because the Florida Deceptive and Unfair Trade Practices Act generally does not apply to people or activities regulated under laws administered by OIR or to activities administered by DFS that the Department of Insurance formerly handled. That insurance exemption removes one of the most obvious consumer-protection tools an attorney general might otherwise use against an insurer.

It does not mean the Florida Attorney General can never become involved. Evidence of independent criminal activity should be referred to appropriate law-enforcement and prosecutorial authorities. Florida law expressly requires OIR to make such referrals when an investigation suggests that criminal law has been violated. Still, criminal activity has much higher proof requirements.

The bottom line: Florida’s Attorney General does not possess the same straightforward consumer-protection path used in the Oklahoma complaint.

Is OIR “Complicit”?

I would be cautious about using that word without proof that OIR knew of a particular practice, understood its systemic nature, and consciously allowed it to continue.

OIR has taken enforcement action. In 2025, it imposed more than $2 million in penalties against eight insurers following market-conduct examinations involving Hurricane Ian and Hurricane Idalia claims. The findings included untimely communications, improper adjuster appointments, failures to provide required disclosures, and failures to pay claims or interest within statutory deadlines.

These enforcement actions should be acknowledged, as I did in “Florida Regulators Fine Insurers Over $2 Million for Hurricane Claims Misconduct: Is It More Show Than Substance?” But it does not eliminate the larger structural concern.

Florida has divided consumer complaint intake, adjuster discipline, corporate market-conduct regulation, criminal referrals, and broader consumer advocacy among separate offices. Each office has authority over a piece of the problem. The danger is that no single official takes ownership of the entire investigation from the first complaint through the examination of the corporate program.

Fragmented authority can become fragmented accountability. DFS may say it sent the complaints to OIR. OIR may say the complaints concern individual claims or adjusters. The Attorney General may say the matter falls within OIR’s regulatory jurisdiction and outside FDUTPA. Meanwhile, the policyholders are left wandering through a regulatory Bermuda Triangle.

Florida Lacks a Single Point of Accountability

The answer is not that Florida has no agency capable of investigating systemic claims misconduct. OIR has that authority. DFS has the complaint information and authority over licensed adjusters. The Attorney General sits on the Financial Services Commission and may become relevant when evidence moves beyond regulatory violations into criminal conduct.

What Florida lacks is an obvious public official who owns the entire issue and can be held accountable for ensuring that complaints are aggregated, patterns are identified, insurer directives are examined, adjusters are interviewed, vendors are investigated, and findings are publicly reported.

The right question is not simply whether a policyholder should complain to DFS, OIR, or the Attorney General. The better question is:

Who is responsible for making certain that all three offices work together when the evidence suggests that the problem is not one adjuster or one claim, but an insurer-wide claims practice?

Until Florida answers that question clearly, insurers may benefit from the seams between the agencies charged with regulating them. I have raised this issue a number of times, including Florida’s Divided Insurance Regulation Is Under Fire — and for Good Reason.

Thought for the Day

“It is important that consumers have confidence that they are getting what they pay for.”
—Florida Insurance Commissioner Mike Yaworsky