Wolters Kluwer Financial Services Identifies Top 10 Criticisms on Insurance Market Conduct Exams

WALTHAM, Mass.--(BUSINESS WIRE)--To help insurance companies avoid noncompliance violations, Wolters Kluwer Financial Services has released its annual list of the top 10 reasons insurers are found to be out of compliance during market conduct examinations.

“If regulators were to conduct an audit today, these are the key areas that would be looked at. So insurers need to ask, ‘How would our organization fare?’”

Wolters Kluwer Financial Services’ Insurance Compliance Solutions group reviewed and analyzed the content in last year’s market conduct exams from across the United States, and assigned the criticisms to various categories. The categories with the most criticisms comprise the top 10 lists for property and casualty insurance, and life and health insurance.

“This research helps serve as a checklist for insurers so they can assess noncompliance risks,” said Kathy Donovan, manager of Government Relations for Insurance Compliance Solutions at Wolters Kluwer Financial Services. “If regulators were to conduct an audit today, these are the key areas that would be looked at. So insurers need to ask, ‘How would our organization fare?’”

Wolters Kluwer Financial Services’ industry research shows that the top 10 most common market conduct compliance criticisms for property and casualty insurance are:

1. Failure to acknowledge, pay or deny claims within specified time frames

2. Failure to properly terminate a policy, including inadequate days’ notice and omitted required language

3. Improper documentation of claim files

4. Using unapproved or unfiled rates and/or rating errors

5. Failure to provide required disclosures (such as selection/rejection or coverage notices in the underwriting process or notices such as statute of limitations, reasons for denials, and bill of rights in the claims process)

6. Failure to provide notification of producer appointments or terminations

7. Improper documentation of underwriting and policy files

8. Failure to communicate a delay in the settlement of claims in writing

9. Using unapproved or unfiled forms

10. Failure to produce requested records for an examination

The top 10 most common criticisms for life and health insurance are:

1. Failure to acknowledge, to pay or deny claims within specified time frames

2. Using unapproved, unfiled and/or noncompliant forms that do not provide mandated benefits

3. Failure to provide required disclosures, such as Explanation of Benefits statements, coverage issues, or guaranty fund notices

4. Failure to adhere to advertising requirements

5. Failure to adhere to replacement requirements

6. Failure to provide notification of producer appointments or terminations

7. Using unapproved, unfiled rates and/or rating errors

8. Failure to adhere to grievance and appeals and utilization review requirements

9. Improper documentation of claim files

10. Failure to properly terminate a policy

“It’s a challenging, ongoing task for insurers to monitor the regulatory environment and make sure they are continually in compliance with requirements governing the industry,” said David Evans, vice president and general manager of Insurance Compliance Solutions at Wolters Kluwer Financial Services. “This research is yet another tool we can offer insurers to help them identify potential problem areas and prevent the negative impact of noncompliance on their organization and their customers.”

About Wolters Kluwer Financial Services

Wolters Kluwer Financial Services provides best-in-class compliance, content, and technology solutions and services that help financial organizations manage risk and improve efficiency and effectiveness across their enterprise. The organization’s prominent brands include Bankers Systems, VMP® Mortgage Solutions, PCi, GulfPak, Desert Document Services®, AppOne®, GainsKeeper®, CCH® Capital Changes, NILS, AuthenticWeb™, Uniform Forms™ and CCH® Wall Street.

Wolters Kluwer Financial Services’ solutions include integrated and stand-alone compliance and workflow tools, documentation, analytics, authoritative information and professional services. Customers include banks, credit unions, mortgage lenders, and securities and insurance organizations of all sizes throughout the United States. For more information on Wolters Kluwer Financial Services, visit www.WoltersKluwerFS.com.

Wolters Kluwer is a leading global information services and publishing company. The company provides products and services globally for professionals in the health, tax, accounting, corporate, financial services, legal and regulatory sectors. Wolters Kluwer has annual revenues (2007) of €3.4 billion ($4.8 billion), maintains operations in over 33 countries across Europe, North America and Asia Pacific and employs approximately 19,500 people worldwide. Wolters Kluwer is headquartered in Amsterdam, the Netherlands. Visit www.WoltersKluwer.com for information about our market positions, customers, brands and organization.