Top 10 Market Conduct Complaints by Regulators Against P/C Insurers

October 9, 2013

Failure to handle claims within specified time frames and using unapproved forms and rates are the top two criticisms of property/casualty insurers by market conduct regulators, according to a new report.

Waltham, Mass.-based Wolters Kluwer Financial Services reported its annual top 10 lists of criticisms found on U.S. insurance market conduct exams.

The data from the company’s ninth annual report show that claims-handling, licensing and underwriting issues continue to dominate regulators’ complaints against insurers.

“The regulatory landscape is getting more complex as industry requirements, laws and regulations change constantly under the direction of government and industry oversight, making it extremely challenging to embed regulatory requirements into claims, underwriting and distribution processes,” said Kathy Donovan, senior compliance counsel, Insurance, at Wolters Kluwer Financial Services. “Strong regulatory change management processes and frequent self-audits are extremely effective in helping stay on top of these changes.”

In addition to those criticisms on the “top 10″ lists, insurers were also frequently criticized for the manner in which they maintained complaint handling, their failure to provide requested data to market conduct examiners, as well as the failure to conduct business in their “own name.”

To develop its list, the company said its regulatory experts reviewed last year’s state market conduct exams to identify areas with the most criticisms.  The company provides compliance and risk management services for banking, insurance and other financial firms. The firm says its report can serve as a checklist to help insurers minimize compliance risk exposure.

According to Wolters Kluwer Financial Services, the top 10 most common market conduct compliance criticisms for property and casualty insurance are:

  1. Failure to acknowledge, to pay, or deny claims within specified time frames
  2. Using unapproved/unfiled forms and rates
  3. Failure to provide required compliant disclosures in claims processing
  4. Improper documentation of underwriting files
  5. Failure to maintain claims documentation
  6. Failure to process/pay total loss claims properly
  7. Failure to provide required compliant disclosures in underwriting processing
  8. Failure to adhere to producer appointment, termination and/or licensing requirements and adjuster licensing requirements
  9. Failure to issue compliant adverse action underwriting notices
  10. Failure to apply rates, rules and guidelines correctly

 Source: Wolters Kluwer Financial Services

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