G9: Market Regulation (Section I)

CA Finanical Information Privacy Act

STATE LEVEL

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Cal-GLBA

Cal-GLBA affected insurance producers business in several aspects

Insurer must accept or deny claim within 40 days of receiving proof of loss.

If more time is needed to process a claim, insurer must provide a written update every 30 days.

Claim must be paid within 30 days of acceptance.

Any violation of the Unfair Trade Practices is a misdemeanor and is subject to penalties:

Cease & Desist order

Violation of Cease and Desist Order

Statute of Limitations

Insurance Information & Privacy Protection ACt

Pretext Interview

Insurers are NOT allowed to use Pretext Interview.

Unless its for investigation

Adverse Underwriting Decisions, refers to any of the following actions taken by an insurer:

If claimant files a claim, the Agent has 15 days to respond regarding the claim.

Adverse Writing Decision CANNOT be based on:

Agent must IMMEDIATELY transmit a Notice of a claim.

Prior to 1999, Glass-Steagall Act of 1933 PROHIBITED banks from offering

Starting in 1999

Gramm-Leach-Bliley Act Components

The insurer has 15 days to acknowledge receipt & begin investigation

Gramm-Leach-Bliley ACt (GLBA) Privacy ACt

FEDERAL

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CA Life and Health Insurance Guarantee Association (CLHIGA)

CLHIGA benefits paid on PER LIFE BASIS (NOT PER POLICY)

CHLHIGA LIFE BENEFITS

CLHIGA Annuities Benefits

Covered by CLHIGA

NOT COVERED by CLHIGA

Insurers are NOT allowed to advertise membership in Guarantee Association

Fair Claims Settlement Practices

Claimant

1st Party Claimant

3rd party claimant

Notice of Legal Action

Proof of Claim

File and Record Documentation

Misrepresentation: it is unfair to misrepresent pertinent facts about policies or contract provisions.

Promptness

Fair Settlements

Forcing Litigation

Altering Applications

Advertising Material

Specific Coverage

Delay

Attorney

CA Insurance Code (CIC)

Insurance is primarily regulated at the state level. Insurance laws are established by State legislatures.

State Legislature introduces Bill, Legislature passes Bill, Bill approves Bill, Bill becomes Law

Policy Provision Interpretation

CA Insurance Commissioner
(DAVE JONES)

Shall

May

Notice by Mail

CA Code of Regulations (CCR)

National Association of Insurance Commissioners (NAIC)

NAIC Mission

Although highly influential, NAIC had NO authority or jurisdiction over the states.

Market Conduct Regulation refers to the laws that regulate insurers practices regarding...

Unfair Trade Practices

Misrepresentation

Deceptive

Boycotting

Coercion

Intimidation

False Financial Statement

Unfair Discrimination

Guarantee Association

Fair Discrimination

Unfair Discrimination