Term
(Commissioner's general duties and powers)
What are the Commissioner's primary duties and power? |
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Definition
- see the insurance laws are properly executed and public interest is protected by these laws
- revoke licenses of insurers, adjusters, and producers
- regulate insurers for solvency, approve policy forms, and regulate most insurance premium rates
- revoke and suspend licenses
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Term
(Commissioner's general duties and powers)
What will the Commissioner do? |
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Definition
- license insurance producers
- approve and administer or contract for the overall administration of the preexam, program, preexam courses of study, insurance producer licensing exams, and continuing education programs
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Term
(Commissioner's general duties and powers)
What might the Commissioner do?
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Definition
- issue rule and regulations to implement insurance code, but may not change the code itself
- secure required documents and info necessary to verify the accuracy of info on an application
- participate w/ the NIC for submitting or obtaining info on insurance producers
- approve forms to be used by individuals and business entities for insurance producer license
- approve additional limited lines of authority
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Term
(Commissioner's general duties and powers)
What must an insurance producer do when representing an insurance consumer?
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Definition
- execute a written agreement with the insurance consumer prior to representing or acting on their behalf
- written agreement must: delineates the services to be provided, provide full and complete disclosure of the fee to be paid to the insurance producer by the insurance consumer
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Term
(Commissioner's general duties and powers)
What must an insurer to that appoints an insurance producer?
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Definition
| They must file with the Department a notice of appointment |
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Term
(Commissioner's general duties and powers)
When does an insurance producer remain appointed until?
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Definition
- the insurer terminates the appointment in writing to the insurance producer
- the insurance producer's license is suspended, revoked, or otherwise terminated
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Term
(Commissioner's general duties and powers)
What does an insurer do when they terminate an appointment?
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Definition
| They must notify the Department in writing in a form approved by the Department w/in 30 days following the date of the termination. |
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Term
(Commissioner's general duties and powers)
What must an insurer do w/in 15 days of making a notification of termination?
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Definition
- insurer must mail a copy of the notification to the licensee's last known home address by: certified mail, return receipt requested, postage prepaid, or overnight delivery using a nationally recognized carrier
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Term
(Commissioner's general duties and powers)
What must a licensee do w/in 30 days of receiving the notification of termination from the insurer?
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Definition
| A licensee may file written comments concerning the substance of the notification w/ the Department. They must simultaneously mail a copy of the comments to the insurer by certified ail, return receipt request, postage prepaid, or overnight delivery using a nationally recognized carrier. |
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Term
(Commissioner's general duties and powers)
What happens when an insurer or licensee fails to report as required under the provisions of termination or that is found to have falsely reported with malice?
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Definition
| They may, after notice and hearing, have its license or certification of authority suspended or revoked and may have civil penalties imposed against the insurer or licensee in an amount not to exceed $5,000 for each violation |
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Term
(Commissioner's general duties and powers)
How many years must an insurer maintain records of their agents after termination appointments?
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Definition
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Term
(Company Regulation)
What are the minimum levels of capital stock and surplus that insurers doing business in PA must maintain? (Life & annuities) (Accident & health) (Property) (Casualty) (Title) |
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Definition
Life & Annuities
$1,000,000 capital, $500,000 surplus (stock insurers)
$1,000,000 policyholders surplus (mutual insurers)
Accident & Health
$100,000 capital; $50,000 surplus
Property
$100,000 capital; $50,000 surplus
Casualty
$750,000 capital; $375,000 surplus
Title
$500,000 capital; $250,000 contributed surplus |
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Term
(Producer Regulation)
What is the fiduciary responsibility? |
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Definition
| A produce shall be responsible in a fiduciary capacity for all funds received or collected as an insurance producer and shall not mingle the funds with other producers own funds or w/ funds held by the insurance producer in any other capacity. |
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Term
(Producer regulation)
How does a company maintain books and records?
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Definition
| Every company must keep all books, records, papers, accounts, documents, and all computer or other recordings relating to its property assets, business and affairs for such time periods that the Department may require this info to verify the financial condition of a company or person. |
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Term
(Producer Regulation)
When does an insurance company issue commissions and fees? |
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Definition
- may pay a commission, brokerage fee, service fee, or other compensation to a licensee for selling, soliciting or negotiating a contract of insurance.
- A fee to an unlicensed person for referring someone who is interested in purchasing insurance if the referring person does not discuss specific terms of a contract of insurance.
- May charge fee in addition to a commission to a person for the sale, solicitation, or negotiation of a contract of insurance for commercial business.
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Term
(Producer Regulation)
What are the prohibited acts of an applicant or licensee?
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Definition
- provide incorrect, misleading, incomplete, r false information to Dept. in application
- violate insurance laws or regulations of this Commonwealth
- obtain or attempt a license through misrepresentation or fraud
- improperly withhold, misappropriate, or convert money or property received in course of doing business
- intentionally misrepresent the terms of an actual of proposed contract
- to have committed or to be found any unfair insurance practice or fraud
- using fraudulent, coercive or dishonest practices in the conduct of doing business in PA
- have an producer or financial services license that has been denied, suspended, or revoked
- forge another person's name on application or any other document.
- cheat on examination for an insurance producer license
- knowingly accepting insurance business form a person who is not licensed as an insurance producer
- fail to comply with an administrative or court order imposing a child support obligation
- fail to comply state income tax
- commit a felony or its equivalent
- commit a misdemeanor that involves misuse or theft of money or property
- commit fraud, forgery, or dishonest acts or an act involving a breach of fiduciary duty
- transfer insurance coverage to an insurer without the consent of the insured
- fail to notify the Dept. of a change of address within 30 days
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Term
(Unfair Insurance Practices)
What is rebating?
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Definition
no producer may offer, promise, allow, give, set off, or pay a rebate of, or part of, a premium payable on the contract of insurance or on the insurance producer's commission, earnings, profits, dividends or other benefit.
Violators commits a third degree misdemeanor in the third degree. |
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Term
(Unfair Insurance Practices)
What is Misrepresentation?
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Definition
| No company, officer or producer may make, issue, circulate, or use or cause or permit to be made any written or oral statement misrepresenting the terms of a policy or contract of insurance. |
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Term
(Unfair Insurance Practices)
What is Twisting?
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Definition
| No producer may make any misrepresentation or incomplete comparison of policies to any insured person for the purpose of inducing the policyholder to lapse, forfeit, or surrender his insurance and take out a policy in another company, association, or exchange insuring against similar risks. |
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Term
(Unfair Insurance Practices)
What is False Advertising?
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Definition
| Making, issuing, publishing, or circulating, an advertisement, announcement, or statement containing any representation or statement with respect to the business of insurance or with respect to any person in the conduct of his insurance business that is untrue, deceptive, or misleading |
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Term
(Unfair Insurance Practices)
What is Defamation?
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Definition
| making, issuing, publishing, or circulating, any oral or written statement that is false or maliciously critical of or derogatory to the financial condition of any person and that is meant to injure the person. |
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Term
(Unfair Insurance Practices)
What is Boycotting, Coercion, and Intimidation
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Definition
| Entering into any agreement to commit or by any concerted action committing any active boycott, coercion, or intimidation resulting in or tending to result in unreasonable restraint of or monopoly in the business of insurance is illegal |
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Term
(Unfair Insurance Practices)
What is the misappropriation of funds?
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Definition
| a producer who acts in negotiating a contract of insurance for an insurance company and who embezzles or fraudulently converts his own use, or who disposes of or fraudulently withholds any money or substitutes for money received by him as a producer, without consent of the company, is guilty of larceny. |
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Term
(Unfair Insurance Practices)
What is considered unfair discrimination?
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Definition
| making unfair discrimination between individuals of the same class who have the same life expectancy in the rates charged for any contract of insurance is prohibited. |
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Term
(Unfair Insurance Practices)
What is illegal inducement?
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Definition
| Offering anything not expressly stated in an insurance contract, including a rebate of premiums or special favors or dividends, as an inducement to buy insurance. |
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Term
(Privacy of consumer financial Information)
What are stipulations that a producer can disclose non-personal information to a nonaffiliated third party? |
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Definition
- the licensee has provided to the consumer an initial notice
- licensee has provided consumer with opt-out notice
- licensee has given consumer reasonable opportunity to opt out of the disclosure
- the consumer does not opt out
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Term
(Privacy of consumer financial Information)
What does opt out mean?
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Definition
| an instruction by the consumer to the licensee not to disclose nonpublic personal financial information about that consumer to a non-financial third party. |
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Term
(Privacy of consumer financial Information)
What must a licensee provide to customer in regards to privacy policies?
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Definition
A licensee must provide clear and conspicuous initial notice that accurately describes its privacy policies to an customer not later that when the licensee establishes a customer relationship and a consumer.
A licensee must provide a clear and conspicuous notice to customers that accurately privacy policies not less than annually during the continuation of the customer relationship. |
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Term
(Privacy of consumer financial Information)
What does the privacy notice include?
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Definition
- categories of non-public personal financial information that the licensee collects
- the categories of non-public personal financial information that the licensee discloses
- categories of affiliates and nonaffiliated third parties to whom the licensee discloses nonpublic financial information.
- categories about licensee's former customers
- an explanation of consumers right to opt out of the disclosure
- any disclosures that the licensee makes under the federal Fair Credit Reporting Act
- licensee's policies and practices with respect to protecting the confidentiality and security.
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Term
(Insurance fraud regulation)
When a person commits fraud, knowingly, what is that person doing? |
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Definition
- person filed with state or local government agency a document that contains false, incomplete, or misleading information concerning any fact to the agency's determination
- presents or causes to be presented to any insurer of self-insured any statement forming a claim that contains and false, incomplete, or misleading information concerning any fact material to the claim.
- assisting, soliciting, or conspiring with another to prepare any statement that is to be presented to any insurer/self-insurer in connection with a claim that contains any information that misleads the claim.
- engages in unlicensed or unauthorized activity knowingly and with intent to defraud insurer.
- knowingly benefits from the proceeds derived from a violation of fraud
- owner, administrator or employee of any health care facility and knowingly allows the use of that facility in furtherance of a scheme to violate fraud
- borrows or uses another persons financial responsibility to be used by another knowingly to commit a fraudulent claim to an insurer.
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Term
(Insurance fraud regulation)
What are penalties when court has founded by a court for insurance fraud?
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Definition
- not more than $5,000 for 1st violation
- not more than $10,000 for 2nd violation
- not more than $15,000 for each subsequent violation
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Term
(Insurance fraud regulation)
What is the purpose of the Insurance Fraud Prevention Act?
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Definition
| to coordinate and fund fraud prevention activities and to support enforcement of the insurance fraud laws. |
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