Navigating a California Claims or Rating and Underwriting Exam - - PowerPoint PPT Presentation
Navigating a California Claims or Rating and Underwriting Exam Association of Insurance Association of Insurance Compliance Professionals Compliance Professionals WELCOME! WELCOME! Who Are We? Who Are We? Field Field Rating &
Association of Insurance Association of Insurance Compliance Professionals Compliance Professionals
Field
Field
Statutory Examinations
Routine Examinations
Data
Data
Target Examinations
Reexaminations
Prop
Prop 103 assessment 103 assessment (All FRUB P&C Exams)
(All FRUB P&C Exams)
Direct Billed to Insurer
Direct Billed to Insurer (All FCB, and non
(All FCB, and non-
Prop 103)
Rate is $152 per hour
Rate is $152 per hour
Recalculated on an annual basis
Recalculated on an annual basis
Recalculated on an annual basis
Recalculated on an annual basis
Statutory Requirements
Market Analysis
Complaints
Complaints
Market Conduct Annual Statement (MCAS)
Market Conduct Annual Statement (MCAS)
Financial Info
Financial Info
Financial Info
Financial Info
Info From Other Units (Investigations, Financial, etc.)
Info From Other Units (Investigations, Financial, etc.)
Premium Writings
Lines of Business and Type of Exam
Lines of Business and Type of Exam
Marketplace Info
Notification of Exam
Notification of Exam
Examiner In Charge Contact
Examiner In Charge Contact
Opening Meeting
Opening Meeting File Review File Review
File Review
File Review
Exit Meeting
Exit Meeting
Non
Non-
Compliance Letter (FRUB)
Draft Report
Draft Report
Adopted Report
Adopted Report
Statutory Compliance
Statutory Compliance
Internal
Internal Compliance Compliance
Unfair Discrimination
Unfair Discrimination
Documentation
Documentation Notices to Policyholders Notices to Policyholders
Notices to Policyholders
Notices to Policyholders
Compliance w/ New Laws or Changes in Law
Compliance w/ New Laws or Changes in Law
Compliance with Filed Rates
Compliance with Filed Rates
Eligibility Guidelines
Eligibility Guidelines
Advertising and Marketing
Advertising and Marketing
Resolved
Resolved Without Further Without Further Action Action
Resolved With Ongoing Insurer Action
Resolved With Ongoing Insurer Action
Direct
Direct Enforcement Action Enforcement Action
Legal
Legal Division Action Division Action
CCR CCR § 2632.13 2632.13
51
51% of legal % of legal cause cause
Bodily
Bodily injury or injury or death death
PD
PD excess $1,000 excess $1,000
None of the statutory
None of the statutory exceptions apply exceptions apply
rd Party Designee
CIC CIC § § 396 396
Effective January 1, 2016 Effective January 1, 2016
Upon New Business
Notification
at least Every 2 Years
CCR CCR § § 2632.13(f)(2) 2632.13(f)(2)
Policyholder’s address
Policyholder’s address
Driver’s Name
Driver’s Name
Date of Incident
Date of Incident
At
At-
fault Indicator
Property Damage
Property Damage
Bodily Injury/Death
Bodily Injury/Death
Statutory Exceptions Were Considered
Statutory Exceptions Were Considered
Annual Mileage Annual Mileage – – CCR CCR § § 2632.5(c)(2) 2632.5(c)(2)
Estimated vs. Verified
Estimated vs. Verified
Insured’s Estimate
Insured’s Estimate New Business New Business
New Business
New Business
Renewal
Renewal
Third Party Reports
Third Party Reports
Substantial Increase in
Fraud or Material
Fraud or Material
Non
Substantial Relationship to Loss
Underwriting
Underwriting
Rating
DOCUMENT, DOCUMENT, DOCUMENT!!!
DOCUMENT, DOCUMENT, DOCUMENT!!!
DOCUMENT, DOCUMENT, DOCUMENT!!!
Subjective vs. Objective
Characteristics of a risk not otherwise
Adhere to filed rating plan
“a” rating
Rate Ranges
Document!
Additional Mail Time Based on Location
Additional Mail Time Based on Location
Code of Civil Procedures
Code of Civil Procedures § § 1013(a 1013(a) ) – – Add 5/10/20 Days Add 5/10/20 Days
Private Passenger Automobile
Private Passenger Automobile
CIC
CIC § § 662 662 – – Cancellations Cancellations
CIC
CIC § § 663 663 – – Notice of Renewal/Non Notice of Renewal/Non-
Renewal
Homeowners
Homeowners
CIC
CIC § § 677.4 677.4 – – Cancellations Cancellations
CIC
CIC § 678 678 – Notice of Renewal/Non Notice of Renewal/Non-Renewal Renewal
CIC
CIC § 678 678 – Notice of Renewal/Non Notice of Renewal/Non-Renewal Renewal
Commercial Insurance
Commercial Insurance
CIC
CIC § § 677.2(c) 677.2(c) – – Cancellations Cancellations
CIC
CIC § §678.1 678.1 – – Non Non-
renewal ( (Commercial/Excess Umbrella) Commercial/Excess Umbrella)
CIC
CIC § § 676.2(c)(1) 676.2(c)(1) – – Midterm premium change, Reduction in Coverage, Change in Midterm premium change, Reduction in Coverage, Change in conditions conditions
Workers’ Compensation
Workers’ Compensation
CIC
CIC § § 676.8 676.8 – – Cancellations Cancellations
CIC
CIC § § 11664(c) 11664(c) – – Non Non-
renewal
What are the required timeframes?
30 DAYS for Group DAYS for Group Life Seniors age 65 Life Seniors age 65 + [CIC + [CIC § § 786] 786]
10-
30 DAYS for Ind. Life/Annuities [CIC for Ind. Life/Annuities [CIC § § 10127.9] 10127.9]
30 DAYS for Ind. Life/Annuities age 60+ [CIC CIC § § 10127.9 10127.9] ]
30 DAYS for Replacements [CIC CIC § 10509.6] 10509.6]
30 DAYS for Replacements [CIC CIC § 10509.6] 10509.6]
rd Party Designee
CIC CIC § § 10113.72 10113.72
Upon New Business
Annual Notification
CIC
Opt
Opt-
in Consent Disclosure
Two Standards of Delivery
Two Standards of Delivery
Two Standards of Delivery
Two Standards of Delivery
Automobile
In total loss settlements, were all required taxes and fees
included and was any deduction for salvage value based on a guaranteed bid? [CCR § 2695.8(b)]
Does the company have procedures for identifying if there
was a child passenger restraint system damaged or in use in the accident? [CIC § 11580.010] in the accident? [CIC § 11580.010]
Property
Is the basis for depreciation documented in the file,
explained in writing to the claimant, and determined considering the age, condition, and useful life of the item?[CCR§ 2695.9(f)]
General
specifics in timeline, etc., for certain lines and products, the following points are valuable to keep in mind overall:
Does acknowledgment of claim occur promptly and are
claimant contacts and inquiries responded to promptly?
Are investigations thorough and diligent? Are procedures in
place to prevent duplicate requests, or requests not
Are investigations thorough and diligent? Are procedures in
place to prevent duplicate requests, or requests not pertinent to resolving the claim? (Special focus for health and disability income claims)
Are claims paid timely once liability is determined? Is appropriate interest included when claims payments do
not meet regulatory requirements for promptness? (Especially relevant to life and health claims)
CIC
CIC § § 10172.5(a) 10172.5(a)
Was
Was the payment made within 30 the payment made within 30 days days after date after date of death?
If no, was interest included
If no, was interest included in the in the death death proceeds proceeds? in the in the death death proceeds proceeds?
CIC
CIC § § 10172.5(c) 10172.5(c)
Disclosure of interest rate
Disclosure of interest rate
CCR
CCR § § 2695.4(a) 2695.4(a)
Were all available settlement
Were all available settlement
Paid within 30
Late Payment
Late Payment
Late Payment
INVESTIGATION
INVESTIGATION -
CCR § § 2695.7(d) 2695.7(d)
State Disability Income (SDI)
State Disability Income (SDI) – – Offsets Offsets