Top 10 Market Conduct Actions Against P/C Insurers

November 16, 2015

Slow claim handling, the use of unapproved rates and a failure to provide required compliant disclosures top the list of market conduct actions taken against U.S. property/casualty insurers in 2014, according to Wolters Kluwer Financial Services.

Wolters Kluwer Financial Services uses public data published in its annual lists of market conduct actions against insurers.

“Claims management has consistently been one of the top three compliance challenges for insurers over the last several years, and once again was the top compliance challenge in 2014 across all lines of business,” said Kathy Donovan, senior compliance counsel at Wolters Kluwer Financial Services. “Insurance claims professionals have to manage a variety of internal and external factors when processing claims, including claimant communications and mandatory disclosures, all within established time frames. The targeted result is providing proper payment in accordance with policy provisions and state law.”

The top 10 market conduct actions for P/C insurers using 2014 data were:

  1. Failure to acknowledge, pay, investigate or deny claims within specified time frames.
  2. Using unapproved/unfiled rates and rules or misapplying rating factors.
  3. Failure to provide required compliant disclosures in claims processing.
  4. Failure to cancel or non-renew policies in accordance with requirements.
  5. Failure to process total loss claims properly.
  6. Failure to adhere to producer appointment, termination, records and/or licensing requirements.
  7. Improper/incomplete documentation of underwriting files.
  8. Improper/incomplete documentation of claim files.
  9. Failure to provide required compliant disclosures in underwriting processes.
  10. Failure to process and pay claims in accordance with policies.

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