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Top Property


... Enacted May 17, 2011 Limits public adjuster compensation for reopened or supplemental claims to 20 percent of the claim; ... – PowerPoint PPT presentation

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Title: Top Property

Top Property Casualty Regulatory Changes and
Emerging Issues
Credit Scoring
NCOIL Credit Scoring Model 2009 Revision
  • Protect people affected by the current financial
  • Extraordinary life circumstances (ELC) serious
    illness or injury death of a spouse, child or
    parent divorce identity theft temporary loss
    of employment or military deployment
  • Insurers required to provide an exemption from
    "rates, rating classifications, company or tier
    placement, or underwriting rules or guidelines
    to those who have filed written request

Credit Scoring - ELC
  • Iowa Kansas -New Hampshire
  • Written request from a consumer
  • Insurer shall provide reasonable exceptions to
    the insurer's rates, rating classifications,
    company or tier placement, or underwriting rules
    or guidelines for a consumer who has experienced
    and whose credit information has been directly
    influenced by extraordinary life circumstances
  • 2010

Credit Scoring - 2010
  • Connecticut
  • Adverse action cannot be based solely on
    information contained in an insured's or
  • credit history
  • credit rating, or
  • lack of credit history
  • Effective January 1, 2011

Credit Scoring - ELC
  • Connecticut
  • Insurers must disclose to each applicant that the
    credit history maybe used in the underwriting or
    rating of applicants policy, and
  • That the applicant has the right to request, in
    writing, that the insurer consider an
    extraordinary life circumstance which occurred
    within 3 years before the date of the application
  • Insurer must provide at policy issuance a written
    disclosure that includes
  • Insurer name, address, telephone number and
    toll-free telephone number
  • Details about how credit information is used to
    underwrite or rate
  • Summary of consumer protections regarding the use
    of credit
  • Effective July 1, 2011

Credit Scoring - 2010
  • New Hampshire
  • Insurers prohibited from cancelling, nonrenewing,
    or declining automobile or homeowners policies
    solely on the basis of credit information
    obtained from a credit rating, a credit history,
    or a credit scoring model, without consideration
    of any other applicable and permitted
    underwriting factors
  • Effective January 1, 2011

Credit Scoring 2011 Activity
  • Rhode Island Regulation 116 establishes
    guidelines regarding the use of insurance scores
    in underwriting and rating of homeowners and/or
    private passenger automobile insurance when a
    consumer experiences an extraordinary life event.
  • Colorado HB 1127 Disclosure to include the
    particular components of credit information that
    factored into the decision to take the adverse
    action and the weight accorded each component.
  • Iowa SF 219 Proposed prohibition on the use of
    credit information to underwrite or rate risks
    for private passenger automobile.

Credit Scoring 2011 Activity
  • Maine
  • HP 294 Provide consumer with notice of the
    credit score and identify the impact of that
    score on rates and coverage as part of the policy
    issued to the consumer.
  • HP 320 Prohibits a user of a consumer report
    from assigning a consumer a low credit score
    solely on the basis of a consumer's having no
    credit history if the consumer can demonstrate
    the ability to meet that consumer's financial
    obligations without borrowing on credit.
  • Massachusetts
  • HB 309 Proposes allowing an insurer to utilize
    credit information, including insurance scores,
    in its rating plan or tier placement plan.

Credit Scoring 2011
  • Maryland
  • HB 1083 Prohibits a private passenger motor
    vehicle insurer from rating a risk based, in
    whole or in part, on the credit history of an
    applicant or insured in any manner.
  • HB 929 Prohibits adverse action against consumer
    based solely on the number of requests made to a
    consumer reporting agency to furnish a consumer
    report on the consumer.

Credit Scoring 2011
  • Michigan SB 300 Proposes to regulate use of
    credit information and credit scoring
  • Mississippi SB 2674 Would prohibit use of credit
    information in determining rating or eligibility
    for coverage.
  • Missouri HB 920 Prohibit an insurer from using a
    credit report or insurance credit score as a
    factor in underwriting or to take an adverse
    action based on a credit report or insurance
  • Montana SB 137 Extraordinary life circumstances
    in personal lines underwriting and the use of
    credit information in automobile insurance rating
    and coverage eligibility. SB 29 added military
    service overseas as an ELC HB 125 added credit
    report terminology

Credit Scoring 2011
  • Nevada
  • AB 74 Provide reasonable exceptions to the
    insurer's rates, rating classifications, company
    or tier placement, or underwriting rules or
    guidelines for an applicant or policyholder who
    has experienced and whose credit information has
    been directly influenced by any of the specified
    ELCs require that request be made not more than
    60 days after the date of the application for
    insurance or the policy renewal.
  • AB 162 Prohibit the use of credit information or
    the absence of credit information, a consumer
    credit report, as a basis to deny, cancel or fail
    to renew a policy, determine the rate of a new or
    existing policy, or make any change in the terms
    or amount of coverage of a new or existing

Credit Scoring 2011
  • New Hampshire HB 359 proposes to amend RSA 4174
    by making it a discriminatory and unfair
    insurance trade practice to charge higher
    premiums based on credit rating.
  • New Jersey SB 176 Prohibits the use of insurance
    scoring by property-casualty insurers in
    rate-making for personal lines insurance
  • New York SB 694 Proposes to require that an
    insurer writing commercial lines insurance, which
    uses credit information in underwriting or
    rating, must disclose such fact to the consumer
    and name the source of the credit information
    that will be used.  

Credit Scoring 2011
  • New York
  • AB 4677 Proposes to require commercial lines
    insurers to provide notice to consumers when
    credit information is used in the rating or
    underwriting of such insurance
  • AB 3660 Prohibit automobile insurers from using
    an applicant's or insured's credit history in the
    underwriting, rating or premiums for a policy of
    automobile insurance
  • AB 5273 Calls for promulgation of rules
    limiting the use of credit scores to determine
    automobile insurance premiums.

Credit Scoring 2011
  • Ohio
  • SB 34/HB 70 propose to amend section 3901.21 to
    prohibit an insurer's use of a credit score,
    credit history, or credit report in fixing a
    premium rate for, or the terms and conditions of,
    an insurance policy, or in determining whether to
    issue, continue, or renew an insurance policy

Credit Scoring 2011
  • Pennsylvania
  • SB 126 Prohibit an insurer from denying,
    canceling or refusing to renew personal insurance
    due in whole or in part to an insured's credit
  • HB 1230 proposes to provide for use of the
    credit history of insured
  • HB 1285 proposes to regulate the use of credit
    information for personal lines insurance
  • South Carolina HB 3101 and SB 85
  • Prohibitions on the use of credit reports in
    rating and underwriting.

Credit Scoring 2011
  • Rhode Island
  • HB 5077 proposes to amend 31-47-18 to prohibit
    the consideration of an applicant's credit
    history in determining automobile insurance rates
  • SB 89 proposes to amend 27-9-56 to provide that
    insurers shall not use credit ratings to
    underwrite or rate risks
  • SB 317 proposes to amend Section 31-47-18 to
    prevent the consideration of an applicant's
    credit history in determining automobile
    insurance rates  

Credit Scoring 2011
  • Texas
  • HB 194 Prohibit an insurer from rating a risk
    based wholly or partly on the credit information,
    credit report, or credit score.
  • HB 739 Prohibit an insurer from refusing to
    underwrite, cancel, or refuse to renew, or rate a
    risk, based in whole or in part on a credit
  • Washington
  • HB 1318 Prohibit an insurer from denying,
    cancelling or non-renewing personal insurance
    based in whole or in party on credit history,
    insurance score, education or income.

Credit Scoring 2011
  • West Virginia
  • HB 2049 Prohibit the use of a person's credit
    history in insurance transactions.
  • HB 2319 Prohibit the use of credit scores in
    casualty rate filings.
  • HB 2467 Prohibit the use of credit scoring as a
    rating factor in homeowners or automobile
    liability policies and prohibit declinations of
    automobile insurance if based, in any part, on
    the number of inquiries reflected in a credit
    report, credit score report or CLUE report or
    upon any information contained in any of these
    reports, if the accuracy is disputed by the

Credit Scoring MCE Criticism
  • During the investigation of a consumer complaint,
    the Company revealed to OIC that it was using the
    number of credit inquiries on a consumer's credit
    report in setting premiums.  (48.19.035)
  • WA 3/10

Consumer Protection Disclosures
  • Clarification
  • Informed coverage decisions
  • Personal lines concentration
  • Workers compensation claims

Claims Release Disclosure
  • New Hampshire
  • I certify that I have read the above warning and
    fully understand it.
  • Effective January 1, 2010

Policy Limits Disclosure
  • New Hampshire
  • Disclosure to the claimant, or his or her
    counsel, the policy limits of the policy or
    policies of all liability insurance applicable to
    the defendant as to such claim.
  • Effective January 1, 2010

Medical Records Disclosure
  • New Hampshire
  • Request for medical records must contain this
    notice in
  • bold print
  • font size at least 2 points larger than that used
    in the request
  • "This request is strictly limited to medical
    information relevant to the occupational injury
    or illness that underlies the patient's workers'
    compensation claim, including any past history of
    complaints of, or treatment of, a condition
    similar to that presented in the claim."
  • Effective July 1, 2010

Replacement Cost Estimates - 2011
  • California
  • Replacement cost estimate for insured/applicant
    must meet the following requirements
  • Include expenses that would reasonably be
    incurred to rebuild the insured structure in its
    entirety, including at least the following (1)
    cost of labor, building materials and
    supplies (2) overhead and profit (3) cost of
    demolition and debris removal (4) cost of
    permits and architects plans and (5)
    consideration of components and features of the
    insured structure, including at least those
    criteria listed in the regulation.

Property Insurance Disclosures - 2011
  • California AB 2022
  • Revised the mandatory language of the California
    Residential Property Insurance Disclosure
  • Simplified and rearranged the descriptions of
    types of coverage
  • Includes additional information concerning
    insurance limits
  • Effective July 1, 2011

Property Insurance Disclosures - 2011
  • "California Residential Property Insurance Bill
    of Rights (Ins s 10103.5 ) includes
  • The insurance company's customer service
    telephone number for underwriting, rating, and
    claims inquiries
  • A written explanation for any cancellation or
    nonrenewal of policy
  • An explanation of how policy limits were
  • An itemized written scope of loss report prepared
    by the insurer or its adjuster within a
    reasonable time period
  • In the event of a claim, a copy of the Unfair
    Practices Act and, if requested, a copy of the
    Fair Claims Settlement Practices Regulations
  • In the event of a claim, notification of a
    consumer's rights with respect to the appraisal
    process for resolving claims disputes
  • An offer of coverage and premium quote for
    earthquake coverage, if eligible
  • A consumer is also entitled to select a licensed
    contractor or vendor to repair, replace, or
    rebuild damaged property covered by the insurance
  • Effective July 1, 2011

Homeowners Disclosure - 2011
  • Maryland SB 136 (Pending)
  • Homeowner's insurers to provide to an applicant
    or insured, at the time of application or
    renewal, a written notice that states whether the
    insurer's standard homeowner's insurance policy
    provides coverage for loss that
  • is caused by or results from a discharge of water
    from a plumbing system or plumbing source,
    including a discharge from a water main break,
    whether the plumbing system or plumbing source is
    located on or off the insured premises and
  • is not caused by the negligence of the insured.

Property Insurance Disclosure - 2011
  • Connecticut HB 6233 (Pending)
  • Policies providing coverage for repair or
    remediation following a covered loss must bear on
    the declaration page, in not less than 12-point
    boldface type in capital letters, the following

Property Insurance Disclosure - 2011
  • Connecticut HB 5110
  • Requires notice to an insured that he or she may
    choose the person who will perform the repair or
    remediation for a loss covered under a personal
    or commercial risk policy. (Pending)

Consumer Protection Total Losses
Total Losses
  • Oregon
  • Provide any valuation or appraisal reports relied
    upon by the insurer to determine value of total
  • DOI developed disclosure form that includes
    information about the total loss, vehicle
    valuation, and the duties of the insurer, how and
    when the insured may contact the Division
  • Effective January 1, 2010

Total Losses
  • Louisiana
  • Policy provides for the adjustment and settlement
    of vehicle total losses for ACV or replacement
    with like kind and quality
  • The insurance company chooses a cash settlement
    based on the actual cost to purchase a comparable
    motor vehicle
  • Costs must be derived by using either a fair
    market value survey conducted using qualified
    dealers in the local market area, or, if there
    are no dealers in the local market area, the
    nearest reasonable market can be used
  • Effective August 15, 2010

Total Losses
  • Oklahoma
  • Insurer may elect the cash settlement actual cost
  • May be determined by the cost of a vehicle in the
    local market area if the vehicle is currently or
    recently available in the prior 90 days
  • Cash settlement and owner retention in total loss
    under specified conditions
  • Effective November 1, 2010

Total Losses
  • Connecticut
  • Retail value of a total loss vehicle may be
    determined from any publicly available automobile
    industry source approved by the DOI
  • Insurers must provide written notice including
    the insurance company's calculation of the
    vehicle's total loss, a valuation report and a
    notice to dispute the claims settlement
  • Effective January 1, 2011

Nevada 2011 Total Loss
  • SB 142
  • The owner of a motor vehicle who makes a claim
    under a policy of insurance for damages to the
    motor vehicle shall be deemed to have given his
    or her consent for the motor vehicle to be towed
    and placed in storage at the direction and
    expense of the insurer upon being given notice
    that the insurer has declared the vehicle a total
  • Insurer not required to obtain any other form of
    release from the owner of the motor vehicle to
    have the motor vehicle towed and placed in storage

Total Loss MCE Criticisms
  • Examiners identified 21 first/third party total
    loss settlements, in which the Company failed to
    pay appropriate tax, license registration and/or
    air quality fees. ( 20-461, 20-462, A.A.C.
    R20-6-801) AZ 11/10
  • Company did not always include sales tax and fees
    in the actual cash value calculations on owner
    retained salvage claimsCompanies violated WAC
    284-30-3908 by deducting sales tax and fees in
    the actual cash value calculations in 1,788 owner
    retained salvage claims WA 3/11

Insurer Protection Fraud
Fraud Initiatives - 2010
  • Rhode Island
  • All claim forms and applications for insurance
    must contain the following statement or a
    substantially similar statement
  • Any person who knowingly presents a false or
    fraudulent claim for payment of a loss or benefit
    or knowingly presents false information in an
    application for insurance is guilty of a crime
    and may be subject to fines and confinement in
  • Effective January 1, 2010

Fraud Initiatives - 2010
  • Arizona Makes it a crime for an auto glass
    repair shop to bill an insurer for
    misrepresentations on a repair of an automobile
  • California DOI meetings with insurers to discuss
    insurance fraud immunity for meeting discussions
    of specific suspected, anticipated, or completed
    acts of insurance fraud
  • Florida Property insurance reform bill sets
    stricter regulations on public adjusters

Fraud Initiatives - 2010
  • Louisiana (effective 1/1/11)
  • Anti-fraud plan
  • Must be filed with the commissioner
  • Must outline specific procedures, actions, and
  • Must include how the authorized insurer will
  • Detect, investigate, and prevent all forms of
    insurance fraud ,
  • Educate appropriate employees on fraud detection
    and the insurer's or health maintenance
    organization's anti-fraud plan.
  • Provide for fraud investigations
  • Report a suspected fraudulent insurance act to
    the DOI and others
  • Pursue restitution for financial loss caused by
    insurance fraud

Fraud Initiatives - 2010
  • Minnesota Roofers providing goods and services
    to be paid by an insured from the proceeds of a
    property or casualty insurance policy, cannot
    advertise or promise to pay or rebate all or part
    of any applicable insurance deductible.
  • New York Annual report filed with legislature to
    include incidences of misrepresentation of where
    vehicle is garaged

Fraud Initiatives - 2010
  • Rhode Island
  • All insurance companies must have anti-fraud
    initiatives in place for detection, reporting,
    preventing fraud
  • May include
  • Fraud investigators, who may be insurer employees
    or independent contractors or
  • An antifraud plan
  • Effective January 1, 2011

Fraud Initiatives 2011 Pending
  • Minnesota SF 389
  • Amends the anti-runner statute and sets standards
    for providers who offer inducements for services.
  • New Jersey AB 3486
  • Policy may be voided to an insured who commits
    fraud or a policy the extension of coverage under
    such policy would not be denied to an innocent
    spouse, or the estate of an innocent spouse, even
    though the insured has committed fraud or is
    found to be in violation of the policys

Fraud Initiatives 2011 Pending
  • Michigan SB 211
  • Each insurer in this state shall develop, and
    file with the commissioner, a plan to detect and
    prevent insurance fraud
  • Nebraska LB 478
  • Sets fines for acting as a runner or hiring a
    runner solicit clients or patients.

Certificates of Insurance
Certificates of Insurance - 2010
  • Arkansas, Connecticut, Iowa, Kansas, Missouri,
    Montana, Nebraska, North Dakota, Texas and Utah
    issued bulletins in 2010
  • Essentially serving as reminders about not
    issuing or using a Certificate of Insurance form
    that contains language that conflicts with or
    purports to alter any policy coverage, exclusion,
    provision or condition

Certificates of Insurance 2010 Example
  • Texas Evidence of Commercial Property Insurance
  • Forms are sometimes issued as a matter of
    information only or similar language without the
    contemporaneous issuance of a binding document or
    policy of insurance 
  • Insurers or agents should not use any form or
    make attestations that do not accurately reflect
    what actually exists for the benefit of the
    policyholder or beneficiary, whether the form or
    attestation references a binder, policy, or
    action to be taken by the insurer with regard to
    issuing a binder or policy
  • Insurers or agents should not issue or sign forms
    that create rights and obligations outside the
    insurance contract

Certificates of Insurance - 2011
  • Arizonas Bulletin 2011-01 outlines the
    requirements that certificates must clearly and
    accurately state the insurance coverage provided
    and may not obscure or misrepresent the coverage
    or terms of a policy
  • Georgias Directive 11-EX-2 reminder that every
    certificate of insurance, except automobile
    liability insurance cards, is to include the
    following statement, or a substantially similar
    one, printed conspicuously and in no smaller than
    10 point font, boldfaced type This document is
    issued as a matter of information only and
    confers no rights upon the document holder. This
    document does not amend, extend, or alter the
    coverage, terms, exclusions, conditions, or other
    provisions afforded by the policies referenced

Certificates of Insurance 2011 -
  • Kentucky Advisory Opinion 2011-02 Certificates
    of Insurance Restatement of Advisory Opinion
  • New Jersey Bulletin 11-04

Certificates of Insurance 2011 -
  • Oregon HB 3005
  • Sets standards for certificates of insurance
    authorizes Department of Consumer and Business
    Services to make rules regulating certificates of
    insurance and makes misuse of certificates an
    Insurance Code violation.
  • Utah HB 79
  • "Property and Casualty Certificate of Insurance
    Act" - applicable July 1, 2012

Certificates of Insurance 2011
  • Georgia HB 66 (Enacted)
  • Certificate of insurance to contain the following
    or similar statement
  • This certificate of insurance is issued as a
    matter of information only and confers no rights
    upon the certificate holder. This certificate
    does not amend, extend, or alter the coverage,
    terms, exclusions, and conditions afforded by the
    policies referenced herein.
  • ACORD or ISO forms are deemed approved and not
    required to be filed
  • No person may knowingly prepare or issue a
    certificate of insurance that contains any false
    or misleading information or that purports to
    affirmatively or negatively alter, amend, or
    extend the coverage provided by the policy of
    insurance to which the certificate makes reference

Certificates of Insurance 2011
  • North Dakota SB 2062
  • A person may not alter or modify a certificate of
    insurance form approved by the commissioner
  • CNR Notice requirements The only circumstance
    under which a certificate holder is entitled to
    the legal right to notice of cancellation,
    nonrenewal, or any material change or any similar
    notice concerning a policy of insurance is if the
    certificate holder has such notice rights under
    the terms of the policy or under any endorsement
    to the policy.

States are looking at
  • Issued certificates of insurance containing
    fictitious and or unauthorized application/policy
    numbers representing coverage when there was no
    coverage in effect without Company's
    authorization, knowledge or consent to the
    following clients.
  • AZ 9/10

Consumer Protection
Consumer Protection 2011- Pending
  • Connecticuts SB 168 would prohibit property and
    casualty insurers from assessing late fees on
    policyholders who make late premium payments.
  • New Jerseys AB 3509 and SB 2432 both seek a
    requirement for insurers to allow payment of
    homeowners' insurance premiums in monthly

South Carolina - Pending
  • HB 3344 would
  • Enact the Unfair Discrimination Against Subjects
    of Abuse in Insurance Act
  • Provide that it is unfair discrimination for an
    insurer to deny, refuse to issue or renew,
    cancel, restrict or exclude coverage, deny a
    claim or limit payments, or add a premium
    differential to a policy or certificate of
    coverage on the basis that an applicant or
    insured has been or is perceived to have been
    abused or may be a subject of abuse and
  • Provide penalties, including fines up to 200,000

Florida Claims Enacted May 17, 2011
  • Limits public adjuster compensation for reopened
    or supplemental claims to 20 percent of the
    claim requires additional disclosure statements
  • Requires insurers to provide two replacement cost
    coverage options for payment of personal property
    insurance claims 1st option pays the full
    replacement cost 2nd option pays the depreciated
    value and retains remainder of coverage until the
    policyholder provides receipts
  • Requires a policyholder to file
    windstorm/hurricane claims within 3 years
  • Specifically defines structural damage to
    narrow the definition of a sinkhole loss
    policyholder required to pay 50 percent of
    sinkhole testing costs up to 2,500 if the
    policyholder requests testing after an insurer
    denies the sinkhole claim sinkhole claims must
    be filed within 2 years of the covered loss
  • Reinstates file-and-use for rates until May 1,

Virginia - Enacted Claims
  • SB 1416
  • When a vehicle has been damaged by water to such
    an extent that the insurance company insuring it
    has paid a claim of 3,500 or more because of
    this water damage, the insurance company shall
    report the payment to the Department

North Dakota - Enacted Claims
  • SB 2237
  • Insurers prohibited from making or permitting any
    unfair discrimination, including consideration of
    an individual's history or status as a subject of
    domestic abuse

Nonadmitted and Reinsurance Reform Act
States and the NRRA
  • Connecticut HB 6363 - Pending
  • Proposes enactment of the NCSLs SURPLUS LINES
  • New Hampshire HB 424 Pending
  • This bill enables premium taxes for non-admitted
    insurance, including surplus line insurance, to
    be collected and disbursed
  • Also allows a foreign insurance company to be
    designated as a surplus line insurer under
    certain circumstances

States and the NRRA
  • Montana SB 331 - Enacted
  • Per the Nonadmitted and Reinsurance Reform Act of
  • the transaction of surplus lines insurance is
    subject to the statutory and regulatory
    requirements of the home state of the insured,
    regardless of whether a multistate risk is
  • For purposes of this state if, at the time of the
    surplus lines insurance transaction, the home
  • is Montana, the surplus lines insurance
    transaction is subject to the applicable
    statutory and regulatory requirements in Montana
  • is not Montana, the Montana statutory and
    regulatory requirements regarding the surplus
    lines insurance transaction are preempted by the
    statutory and regulatory requirements of the home

Federal - MSP
  • November 9, 2010
  • Revised the implementation timeline for TPOC
    settlements, judgments, awards, or other payments
  • Extended current dollar thresholds for liability
    insurance and workers' compensation
  • Changed the required submission of initial claim
    reports from the 1st calendar quarter of 2011 to
    the first calendar quarter of 2012 for all
    liability insurance TPOC amounts with no ORM
  • Liability insurance ORM reporting is not delayed

Federal - MSP
  • HR 1063 Strengthening Medicare and Repaying
    Taxpayers Act SMART Act
  • Discretionary assessment of civil money penalties
    based on the knowing, willful, and repeated
    nature of the violation
  • Fines for an insurer failing to report
    settlements and ORM with Medicare beneficiaries
    becomes up to 1,000 for each day of
  • Accounts for good faith efforts to comply

Federal - MSP
  • HR 1063 Strengthening Medicare and Repaying
    Taxpayers Act SMART Act
  • Provides for expedited determination of
    reimbursement amount to improve program
  • CMS to develop an alternate way of identifying
    whether someone is a Medicare beneficiary through
    the query system in place of the use of the
    claimants full Social Security number or
    Medicare number

  • Questions?