MINNEAPOLIS--(BUSINESS WIRE)--Wolters Kluwer Financial Services today released the results of its review of the market conduct actions taken against U.S. property and casualty, life and health insurers in 2014. While compliance challenges exist across insurers’ functional areas, these three claims compliance violations continue to dominate the findings in the annual analysis: 1) Timely claim handling; 2) Incomplete documentation; and 3) Failure to provide required compliant disclosures.
“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 timeframes. The targeted end result is providing proper payment in accordance with policy provisions and state law.”
2014 Top 10 Market Conduct Actions for Property & Casualty Insurers
|1.||Failure to acknowledge, pay, investigate or deny claims within specified timeframes|
|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|
2014 Top 10 Market Conduct Actions for Life & Health Insurers
|1.||Failure to acknowledge, pay, investigate, or deny claims within specified timeframes|
|2.||Improper/incomplete documentation of underwriting and claim files|
|3.||Failure to pay claims properly in accordance with policy provisions and requirements|
|4.||Failure to adhere to producer appointment, termination, records and/or licensing requirements|
|5.||Failure to provide required claims and underwriting disclosures|
|6.||Failure to adhere to required claims grievance and appeal processes, including timeframes and disclosures|
|7.||Providing unverifiable and/or inaccurate responses in the Market Conduct Annual Statement|
|8.||Use of unfiled/unapproved or noncompliant policy forms|
|9.||Failure to adhere to advertising requirements including content and records retention|
|10.||Noncompliant claim denial notices|
The lists of top 10 market conduct actions taken against U.S. insurers is developed annually by Wolters Kluwer Financial Services using public data published during 2014. This is the 11th year the company’s Insurance division has compiled and ranked the compliance challenges facing U.S. insurers.
Information on Wolters Kluwer Financial Services’ Insurance products and services is available here.
About Wolters Kluwer Financial Services
Wolters Kluwer Financial Services provides customers worldwide with risk management, compliance, finance and audit solutions that help them successfully navigate regulatory complexity, optimize risk and financial performance, and manage data to support critical decisions. With more than 30 offices in 20 countries, our prominent brands include: AppOne®, AuthenticWeb™, Bankers Systems®, Capital Changes, CASH Suite™, GainsKeeper®, NILS®, OneSumX®, TeamMate®, Uniform Forms™, VMP® Mortgage Solutions and Wiz®. Wolters Kluwer Financial Services is part of Wolters Kluwer, which had 2014 annual revenues of €3.7 billion ($4.9 billion), employs 19,000 employees worldwide, and maintains operations in over 170 countries across Europe, North America, Asia Pacific, and Latin America. Wolters Kluwer is headquartered in Alphen aan den Rijn, the Netherlands. Its shares are quoted on Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices.