CA Finanical Information Privacy Act
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
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
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
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.
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
Notice by Mail
CA Code of Regulations (CCR)
National Association of Insurance Commissioners (NAIC)
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
False Financial Statement