Missing claims deadlines, improper policy termination and failure to pay claims properly top the list of reasons why property-casualty insurers are out of compliance during market conduct exam, according to the 5th annual listing by Wolters Kluwer Financial Services, a Minneapolis provider of compliance, content, and technology solutions and services. The list separates property-casualty from life and health insurers.

Property-casualty insurance market conduct compliance criticisms

1. Failure to acknowledge, pay or deny claims within specified time frames

2. Failure to properly terminate a policy, including inadequate days' notice, improper reasons and omitted required language

3. Failure to pay claims properly (sales, tax, loss of use)

4. Improper documentation of claim files

5. Using unapproved or unfiled rates and/or rating errors

6. Failure to provide required and appropriate disclosures, such as selection/rejection or coverage notices in the underwriting process or notices such as statute of limitations, reasons for denials, and bill of rights in the claims process

7. Failure to use licensed producers and provide proper notification of producer appointments or terminations, including maintenance of producer register

8. Failure to communicate a delay in the settlement of claims in writing

9. Using unapproved or unfiled forms

10. Use of unlicensed claims adjusters or appraisers.

Life and health Insurance market conduct compliance criticisms

1. Failure to adhere to advertising requirements

2. Failure to adhere to replacement requirements

3. Failure to use licensed and appointed producers, and failure to provide proper notification of producer appointments or terminations, including maintenance of producer registers

4. Failure to adhere to grievance and appeals and utilization review requirements

5. Improper documentation of files

6. Failure to properly terminate a policy, including conversion requirements

7. Failure to properly acknowledge, pay, investigate or deny claims within specified time frames

8. Using unapproved, unfiled or noncompliant forms

9. Failure to provide required disclosures, such as explanation of benefits statements, coverage issues, fraud warnings, free-look periods, right of appeal or guaranty fund notices

10. Failure to pay claims properly.

Special Reports /

Industry IQ: Top 10 ways insurers are non-compliant

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