Wolters Kluwer Analysis Names Timely Claims Processing as Top Compliance Challenge for Insurers
Firm’s annual review of Top 10 market conduct issues provides vital checklist for insurers
Now in its 14th year, the review serves as a compliance checklist for insurers, providing them a good sense of the business areas that were not only examined by regulators, but also proved to be most challenging for the industry in terms of compliance.
“Effectively and sustainably embedding regulatory requirements into claims, underwriting and distribution processes continues to pose challenges for insurers,” said
Following is a summary of the top issues identified regarding examiners’ criticisms of insurance departments across the
2017 Top 10 Market Conduct Actions for Property and Casualty Insurers
1. Failure to acknowledge, pay, investigate or deny claims within specified timeframes
2. Failure to cancel, non-renew, renew policies in accordance with requirements
3. Failure to issue correct payments and/or compliant denial notices
4. Failure to provide required compliant disclosures in claims processing
5. Using unapproved/unfiled rates and rules, or misapplying rating factors
6. Failure to process total loss claims properly
7. Failure to adhere to producer appointment, termination, records and/or licensing requirements
8. Improper/incomplete documentation of underwriting files
9. Failure to provide required compliant disclosures in underwriting processes
10. Improper/incomplete documentation of claim files
2017 Top 10 Market Conduct Actions for Life and Health Insurers
1. Failure to acknowledge, pay, investigate, or deny claims within specified time frames
2. Failure to adhere to required claims grievance and appeal processes, including timeframes and disclosures
3. Noncompliant claim denial notices
4. Failure to provide required and compliant claims, underwriting, and policyholder disclosures
5. Failure to pay claims properly in accordance with policy provisions and requirements
6. Failure to use licensed and/or appointed producers, provide proper notification of producer appointments or terminations, and maintain appropriate documentation
7. Use of unfiled/unapproved or noncompliant forms
8. Failure to adhere to replacement requirements
9. Failure to issue compliant Explanation Of Benefits notices
10. Failure to respond to regulatory requests for information
The above lists of top market conduct actions taken against
To access Wolters Kluwer’s 2018 webinar focused on property and casualty market conduct actions, listen here; for the webinar on life and health market conduct actions, listen here. Learn more about Wolters Kluwer’s insurance compliance expertise and solutions.
About Wolters Kluwer Governance, Risk & Compliance
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Source: Wolters Kluwer
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