Chapter 8 Part II
Fungi .
- All non-chlorophyll-bearing plants of a lower order than mosses and liverworts, such as rusts, smuts, mildews, molds, yeasts, and bacteria not living in humans or other animals
Catastrophic Ground Cover Collapse
- Geological activity that results in all the following: ◾The abrupt collapse of the ground cover. ◾A depression in the ground cover clearly visible to the naked eye. ◾Structural damage to the covered building, including the foundation. ◾The insured structure being condemned and ordered to be vacated by the governmental agency authorized by law to issue such an order for that structure.
Unpaid Premium -
Upon the payment of a claim under this policy, any premium then due and unpaid or covered by any note or written order may be deducted therefrom.
For dwellings with limits between $100,000 and $250,000, what may the insurer offer in lieu of a $500 hurricane deductible?
◾The insurer guarantees it will not be nonrenewed for reasons of reducing hurricane loss for one renewal period. ◾Contains up to a 2% hurricane deductible
What statement must appear on the loss estimate when making a payment on a third party claim for partial damage to an auto?
"Failure to use the insurance proceeds in accordance with the security agreement, if any, could be a violation of s. 812.014 (Theft, Robbery, and Related Crimes), Florida Statutes. If you have any questions, contact your lending institution."
Upon the declaration of an Emergency by the Commissioner of Insurance Regulation, How much notice must be given for a cancelation, termination, or non renewal?
, an insurer may not cancel or nonrenew a personal/commercial residential property policy covering a dwelling/residential property in Florida damaged by hurricane or wind loss and subject to the declaration of emergency for a period of 90 days after the property has been repaired (this means it has restored to the extent that it is insurable).
What deductibles must be offered for limits of $250,000 or more?
2%, 5%, or 10% of the policy dwelling limits. Notification of the separate hurricane deductible must include the following: ◾"THIS POLICY CONTAINS A SEPARATE DEDUCTIBLE FOR HURRICANE LOSSES, WHICH MAY RESULT IN HIGH OUT-OF-POCKET EXPENSES TO YOU." ◾"THIS POLICY CONTAINS A CO-PAY PROVISION THAT MAY RESULT IN HIGH OUT-OF-POCKET EXPENSES TO YOU." ◾The actual dollar value of the hurricane deductible must appear on the declarations page of the policy at issuance and, for renewal, on the renewal declarations page of the policy or on the premium renewal notice. ◾For any personal lines residential property insurance policy containing an inflation guard rider, the policy at issuance and the renewal declarations page or premium renewal notice must include the: ◾Actual dollar value of the hurricane deductible. ◾Possibility that the hurricane deductible may be higher than indicated when loss occurs due to application of the inflation guard rider.
If a person and an insurer have agreed in writing to the settlement of a claim, how long does the insurer have to settle the claim?
20 days after the settlement is reached
Structural Damage
A covered building, regardless of the date of its construction, has experienced the following: ◾Interior floor displacement. ◾Foundation displacement or deflection. ◾Damage resulting in listing, leaning, or buckling of the exterior load-bearing walls. ◾Damage resulting in movement or instability of the ground.
What does not constitute catastrophic ground cover collapse?
Damage consisting merely of the settling or cracking of a foundation, structure, or building does not constitute a loss resulting from a catastrophic ground cover collapse.
Premium Financing by an Insurance Agent or Agency -
A general lines agent may make reasonable service charges for financing insurance premiums on policies produced by the agent or agency: ◾The service charge cannot exceed $3 per installment, or $36 per year. ◾Charge a rate of interest not to exceed 18% simple interest per year on the unpaid balance or average unpaid balance billed over the term and subject to endorsement changes.
Sinkhole
A landform created by subsidence of soil, sediment, or rock as underlying strata dissolved by groundwater; a sinkhole forms by collapse into subterranean voids created by dissolution of limestone or dolostone or by subsidence as these strata are dissolved.
Time of Payment of Claims -
After receiving written proof of loss, the insurer will pay monthly all benefits then due for (type of benefit). Benefits for any other loss covered by this policy will be paid as soon as the insurer receives proper written proof.
Examination Testimony
A person may ask to be excused from testifying or producing records involving an examination, hearing, or investigation conducted by the DFS or Office of Insurance Regulation, for fear that it might incriminate the person who will then be prosecuted. DFS or the Office will direct the person to testify or produce the evidence, but the person will not be prosecuted or subjected to any penalty or forfeiture.
Professional Engineer
A person who has a bachelor's degree or higher in engineering, and experience and expertise in the identification of sinkhole activity as well as other potential causes of structural damage
Professional Geologist
A person who has a bachelor's degree or higher in geology or related earth science and experience and expertise in the identification of sinkhole activity, as well as other potential geologic causes of structural damage.
Civil Immunity
A person, other than a person filing a required report or other required information, may provide the department, commission, or office with information about the financial condition of an insurer. Unless the person acted with knowledge that the information was false or with reckless disregard for the truth or falsity of the information, he or she is immune from civil liability arising out of the provision of the information.
What is a secure hurricane deductible?
A personal lines residential insurance policy providing hurricane coverage may, at the mutual option of the insured and insurer, include a secured hurricane deductible. ◾The first $500 of any claim, regardless of the peril causing the loss, is fully deductible. ◾With respect to hurricane losses only, the next $5,000 in losses is fully insured, subject to a copayment requirement of 10%. ◾With respect to hurricane losses only, the remainder of the claim is subject to the hurricane deductible chosen by the insured up to 10% of the policy dwelling limits. ◾The insurer agrees to renew the coverage on a guaranteed basis for a period of years after initial issuance of the secured deductible equal to at least 1 year for each 2 percentage points of deductible unless the policy is canceled for nonpayment of premium or the insured fails to maintain the certificate of security. ◾The Florida Hurricane Catastrophe Fund will negotiate agreements creating a financing consortium to serve as an additional source of lines of credit to secure deductibles. Any licensed insurance agent may act as the agent of such consortium.
What are the deductibles for Catastrophic Ground Collapse
A policy for residential property insurance may include a deductible amount applicable to sinkhole losses equal to 1%, 2%, 5%, or 10% of the policy dwelling limits, with appropriate premium discounts offered with each deductible amount.
Dual Interest
A property insurer must transmit claims payments directly to the primary policyholder, payable to the primary policyholder only. A dual endorsement from any mortgage holder or lienholder is not required for amounts payable under the policy for: ◾Personal property and contents ◾Additional living expenses ◾Other covered items not subject to a recorded security interest
What are the stipulations of using an premium finance company?
A service charge up to $12 out of every $100 per year plus a nonrefundable additional charge up to $20 assessed by the premium finance company will be separately stated, identified, and included on the installment bill. A premium finance company must file all forms, service charge and interest rate plans with the Office for approval. The premium finance agreement allows the company to cancel any insurance policy listed in the agreement after mailing a written notice of 10 days' if the insured fails to pay a defaulted installment.
Hurricane
A storm system that has been declared a hurricane by the National Hurricane Center of the National Weather Service.
Hurricane Watch
A warning given when it is likely that a hurricane will strike an area within 24 hours.
False Claims -
All claim forms must contain a warning that insurance claim fraud is subject to a 3rd degree felony.
What is the maximum amount of Controlled Business an agent is allowed to write?
An agent may have no more than 50% of his/her total business within a 12-month period be from controlled sources.
Rebating
An agent may not offer or extend anything of value to a client that is not already a part of the contract, as an incentive to purchase insurance. Example: Offering to pay the client's first 3 months of premiums if they buy the policy.
Exclusion of Contents
An insurer issuing a residential property insurance policy, except for a condominium unit owner's policy or a tenant's policy, must make available, at the option of the policyholder, an exclusion of coverage for the contents. The coverage may be excluded only if the policyholder personally writes and provides to the insurer the following statement in his or her own handwriting and signs his/her signature, which must also be signed by every other named insured on the policy, and dated: "I do not want the insurance on my (home/mobile home) to pay for the costs to repair or replace any contents that are damaged. I will pay those costs. My insurance will not."
Unfair Discrimination
An insurer may not discriminate against a policy holder by refusing to underwrite, refusing to issue or renew a policy, by denying a claim, by terminating a policy or by increasing rates because the insured's claims may result from abuse, assault, battery or sexual assault from a family or household member.
How much notice must an insurer give if canceling a policy for a reason other than non-renewal or non-payment
An insurer must give the named insured written notice of cancellation other than nonrenewal at least 45 days prior to the effective date of the cancellation
How much notice must an insurer provide if cancelling a policy for Nonpayment of Premium?
At least 10 days' written notice of cancellation must be given for nonpayment of premium.
Ethics
Avoid the commission of acts or the existence of circumstances that would constitute grounds for suspension, revocation, or refusal of licensees. The purpose of an insurance license issued to an agent is to authorize and enable the licensee to actively and in good faith engage in the insurance business as an agent with respect to the general public and to facilitate the public supervision of such activities in the public interest. Examples of Unfair Trade and Marketing Practices include: ◾Twisting ◾Rebating ◾Defamation ◾Misrepresentation
Hurricane Occurrence
Beginning - A hurricane watch or warning is issued for any part of Florida by the National Hurricane Center of the National Weather Service. ◾During - The hurricane continues for the time period during which hurricane conditions exist anywhere in Florida. ◾End - 72 hours following the termination of the last hurricane watch or warning issued for any part of Florida by the National Hurricane Center of the National Weather Service
Payment of Claims -
Benefits will be paid to the insured. Loss-of-life benefits are payable in accordance with the beneficiary designation in effect at the time of payment. If none is then in effect, the benefits will be paid to the insured's estate. Any other benefits unpaid at death may be paid, at the insurer's option, either to the insured's beneficiary or estate.
Unfair Rate Increases for Persons in Military Service -
Charging an increased premium for reinstating a motor vehicle insurance policy that was canceled by the insured solely because he/she was deployed outside the United States.
Can claims due to an act of God or water damage be a reason for cancellation or non renewal
Claims on property insurance policies that are the result of an act of God or the result of water damage may not be used as a cause for cancellation or nonrenewal, unless the insurer can demonstrate, by claims frequency or otherwise, that the insured has failed to take action reasonably necessary as requested by the insurer to prevent recurrence of damage to the insured property.
What perils in addition to the named perils are covered for HO 2,3,4, 5 and 6?
Collapse - As a result of an abrupt falling down or caving in of the structure or part of the structure caused by perils insured against, hidden decay, hidden insect or vermin damage, weight of contents, equipment, animals or people, weight of rain which collects on a roof, or use of defective material or methods in construction, remodeling, or renovation if the collapse occurs during the construction. ◾Ordinance or Law - Provides limited coverage for increased costs due to the enforcement of any ordinance or law that requires any construction be brought up to code. ◾Golf Cart - Bodily injury or property damage liability and physical damage coverage. ◾Animal Liability - Damage caused by owned dogs. ◾Identity Theft - Expenses incurred by the insured as a result of identity theft.
Hurricane Damage
Ensuing damage to the interior of a building, or to property inside a building, caused by rain, snow, sleet, hail, sand, or dust if the direct force of the windstorm first damages the building, causing an opening through which rain, snow, sleet, hail, sand, or dust enters and causes damage.
Who must provide Catastrophic Ground Collapse Coverage?
Every insurer authorized to transact property insurance in Florida must provide coverage for a catastrophic ground cover collapse. The insurer must make available, for an appropriate additional premium, coverage for sinkhole losses on any structure, including the contents of personal property.
What if a cancelation is scheduled during a Hurricane?
If any cancellation or nonrenewal of a policy is to take effect during the duration of a hurricane, the effective date of cancellation or nonrenewal is extended until the end of the duration of the hurricane.
Hurricane Warning
Issued 36 hours before the anticipated onset of tropical storm force winds of 74 mph or higher; warning can stay in effect when dangerously high water or a combination of dangerously high water and waves continue.
Defamation
It is deemed unethical for an agent to make any statement (oral or written) or promote any statement that is designed to be malicious or critical about any person or company in the insurance industry.
Twisting -
Knowingly making any misleading representations or incomplete or fraudulent comparisons or material omissions with respect to any insurance policy for the purpose of inducing a person to lapse a policy. A valid replacement based on accurate data and resulting in an improvement to the client is not twisting.
False Advertising
Knowingly making, publishing, disseminating, circulating, or placing before the public, or causing, directly or indirectly, to be made, published, disseminated, circulated, or placed before the public: ◾In a newspaper, magazine, or other publication. ◾In the form of a notice, circular, pamphlet, letter, or poster. ◾Over any radio or television station; or ◾In any other way, an advertisement, announcement, or statement containing any assertion, representation, or statement with respect to the business of insurance, which is untrue, deceptive, or misleading.
Hurricane Coverage
Loss or damage caused by the peril of windstorm during a hurricane. (Windstorm means wind, wind gusts, hail, rain, tornadoes, or cyclones caused by a hurricane resulting in direct physical loss or damage to property.)
Mold -
Microscopic filamentous fungi that causes disintegration of organic matter and produces spores; breeds contamination in any moist ground; can destroy buildings and personal property if not prevented.
Excess Charges -
Occur when agent collects money over and above what a policy requires
Mold Mitigation
Prevent or mitigate the spread of fungi, including, but not limited to, mold or mildew, by removing and disposing of wet drywall, insulation, carpet, cabinetry, or other fixtures on or within the property.
What prominently appears on all proof of loss statements
Pursuant to s. 817.234, Florida Statutes, any person who, with the intent to injure, defraud, or deceive any insurer or insured, prepares, presents, or causes to be presented a proof of loss or estimate of cost or repair of damaged property in support of a claim under an insurance policy knowing that the proof of loss or estimate of claim or repairs contains any false, incomplete, or misleading information concerning any fact or thing material to the claim commits a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084, Florida Statutes." For reference: ◾817.234 - False and Fraudulent Insurance Claims ◾775.082 - Imprisonment not exceeding 5 years ◾775.083 - Fine up to $5,000 ◾775.084 - Imprisonment not exceeding 10 years as a habitual felony offender as of the third felony conviction
Sinkhole Loss
Structural damage to the covered building, including the foundation, caused by sinkhole activity. Contents coverage and additional living expenses apply only if there is structural damage to the covered building caused by sinkhole activity.
Who investigate authorized mitigation specialists suspected of providing fraudulent statements on an inspection form, and what is the penalty for providing such fraudulent statements?
The Division of Insurance Fraud will investigate authorized mitigation inspector suspected of completing inspections that are intentionally false or include fraudulent statements in the inspection form, and if convicted, charged a 1st degree misdemeanor
Florida Insurance Guaranty Association
The Florida Insurance Guaranty Association is a nonprofit legal entity. All insurers authorized to conduct business in Florida must be members of the association. Further, as a condition of such authority, an insurer agrees to reimburse the association for all claim payments the association makes on said insurer's behalf if such insurer is subsequently rehabilitated.
Mold Remediation
The removal, cleaning, sanitizing, demolition, or other treatment, including preventive activities, of mold or mold-contaminated matter of greater than 10 square feet that was not purposely grown at that location.
After an insurer receives a notice of claim, how long do they have to send claimant forms for filing proof of loss?
When an insurer receives the notice of claim, within 15 days it will send the claimant forms for filing proof of loss. If these forms are not given to the claimant within 15 days, the claimant may meet the proof of loss requirements by giving the insurer a written statement of the nature and extent of the loss within the time limit.
Wind Mitigation/Code Issues
When the policy covers the peril of Windstorm or Hail, a risk may be eligible for a credit to the wind portion of the premium if the dwelling has been built or retrofitted in conformance with the windstorm mitigation elements of the 2001 Florida building code.
What happens when a policy holder takes appropriate hurricane mitigation measures?
the insurer will provide the insured the option of selecting an appropriate reduction in the policy's hurricane deductible or selecting the appropriate discount credit or other rate differential. The insurer must provide the policyholder with notice of the options available.
Does content coverage apply for catastrophic ground cover collapse?
YES
What is a premium finance agreement?
a promissory note or other written agreement by which an insured promises or agrees to pay a premium finance company the amount to be advanced under the agreement to an insurer or to an insurance agent, in payment of premiums on an insurance contract, together with a service charge as authorized and limited by law.
What is the maximum amount of any unit owner's loss assessment coverage that csan be assessed for any loss?
an amount equal to the unit owner's loss assessment coverage limit in effect one day before the date of the occurrence. Every individual unit owner's residential property policy must contain a provision stating that the coverage afforded by such policy is excess coverage over the amount recoverable under any other policy covering the same property.
Under what circumstances can windstorm or hail (Hurricane)coverage be excluded from a policy
if the property is eligible for coverage from the Citizens Property Insurance Corporation (CPIC), unless specific prior approval is received from the Company ◾When the policyholder is a natural person, the policyholder personally writes and provides to the insurer the following statement in his or her own handwriting and signs his or her name, which must also be signed by every other named insured on the policy, and dated: "I do not want the insurance on my (home/mobile home/condominium unit) to pay for damage from windstorms. I will pay those costs. My insurance will not." ◾When the policyholder is other than a natural person, the policyholder provides to the insurer on the policyholder's letterhead the following statement that must be signed by the policyholder's authorized representative and dated: "(Name of entity) does not want the insurance on its (type of structure) to pay for damage from windstorms. (Name of entity) will be responsible for these costs. (Name of entity's) insurance will not."
What is the Florida Insurance Guaranty Association's liability for the contractual obligations of the insolvent insurer?
in excess of $100 and does not exceed: ◾$300,000 per policy per claim. ◾$200,000 is additional for the portion of a covered homeowner's insurance claim which relates only to damage to the structure and contents. In no event is the association liable for any penalties or interest.
What happens if an insurer does not pay a claim within 20 days of a settlement being reached?
it must bear interest at a rate of 12% per year from the date of the agreement. If the payment is conditioned upon the execution of a release, the interest will not begin to accrue until the executed release is given to the insurer.
How does the Florida Insurance Guaranty Association pay covered claims of insolvent insurers?
levies assessments in the proportion that each insurer's net direct written premiums in Florida in the class protected by the account bears to the net total written premiums received from all respective insurers the previous year, not to exceed 2% of each insurer's net total written premium. Emergency assessments will be levied for the direct payment of covered claims of insolvent insurers by the effects of a hurricane
What is the maximum deductible for a policy with a risk valued at less than $500,000?
may not have a hurricane deductible in excess of 10% of the policy dwelling limits, unless the policyholder provides the insurer with a handwritten statement: "I do not want the insurance on my home to pay for the first (specify dollar value) of damage from hurricanes. I will pay those costs. My insurance will not."
What may the insurer require regarding Catastrophic Ground Collapse
may require an inspection of the property before issuance of sinkhole loss coverage The insurer may restrict catastrophic ground cover collapse and sinkhole loss coverage to the principal building.
What must accompany the denial of application for an insurance policy or notice of non-renewal or cancelation?
must be accompanied by the specific reasons for denial, including the specific underwriting reasons.
What must be included in rate filings regarding wind mitigation and residential property insurance?
must include actuarially reasonable discounts, credits, or other rate differentials, or appropriate reductions in deductibles for the insured who installs or implements windstorm damage mitigation techniques, alterations, or solutions to prevent windstorm losses.
Loss Assessment requirements for HO-6
must include at least $2,000 in property loss assessment coverage. It must be due to a direct loss to the property. The direct loss must be the type of loss covered by the unit owner's residential property insurance policy. The unit owner's loss assessment coverage must include a deductible of no more than $250 per direct property loss, or $0 deductible if the unit owner suffered damage from the same direct loss to owned property for which the deductible was paid. All owner/members of The Guaranty Association are assessed.
What must an insurer do if they are providing a policy that doesn't include Windstorm and Hail protection
must provide a notice to the mortgage holder or lienholder indicating the policyholder has elected coverage that does not cover wind.
What must the insurer require of the insured regarding wind loss mitigation features?
must require proof of the existence of the loss mitigation features. The Financial Services Commission developed a uniform mitigation verification inspection form that will be used by all insurers. The inspection will be completed by authorized mitigation inspectors. misdemeanor.
In order to avoid churning, what forms should be used?
must use disclosure forms which include disclosure of the premium, the death benefit of the proposed replacing or additional policy, and the date when the policy values of the existing policy or contract will be insufficient to pay the premiums of the replacing or additional policy or contract.
What must an insurer do if they deny private passenter auto insurance or personal lines residential property insurance due to an underwriting report or consumer report?
notify the applicant of his right under the federal Fair and Accurate Credit Transactions Act to obtain a copy of the report from the consumer reporting agency.
What must the insurer notify the insured of regarding Wind Mitigation
of any personal lines residential property insurance policy, at the time of the issuance of the policy and at each renewal, the availability and combinations of premium discount, credit, other rate differential, or reduction in deductibles for properties on which fixtures or construction techniques demonstrated to reduce the amount of loss in a windstorm have been installed or implemented.
When changes to the deductible percentage may be implemented on a policy?
only as of the renewal date.
Churning
policy values (such as cash value) in an existing life insurance policy, annuity contract, and/or any riders, are used to purchase another insurance policy or annuity contract with that same insurer for the purpose of earning additional premiums, fees, commissions, or other compensation.
What must an insured provide an insurer if they have a lein on their property and they elect not to have Windstorm or Hail coverage
policyholder must provide the insurer with a written statement from the mortgage holder or lienholder indicating that the mortgage holder or lienholder approves the policyholder electing to exclude windstorm coverage or hurricane coverage from his or her or its property insurance policy.
Boycott, Coercion, and Intimidation
stating an untrue fact
What must happen before an insurer pays any claims for a total loss on an auto?
the insurer must first search the Department of Highway Safety and Motor Vehicles records to determine whether the damaged vehicle is subject to any liens. If there is a lien, payment of the claim will be made jointly to the owner of the damaged vehicle and the first lienholder of record.
What are hurricane deductibles for personal lines residential property insurance?
the insurer must offer alternative deductible amounts applicable to hurricane losses equal to $500, 2%, 5%, or 10% of the policy dwelling limits, unless the specific percentage deductible is less than $500. - The insurer must provide the written notice in conjunction with each renewal of the policy. - Failure to provide notice constitutes a violation of the Insurance Code, but does not affect the coverage provided under the policy.
Controlled Business
the practice of an agent selling policies or annuity contracts to: ◾Himself/herself or family members. ◾Officers, directors, stockholders, partners, or employees of a business in which he or a family member is engaged. ◾The debtors of a firm, association, or corporation of whom he or she is an officer, director, stockholder, partner, or employee.
How long does a claimant have to provide proof of loss if the policy provides for periodic payment for a continuing loss?
written proof of loss must be given to the insurer within 90 days after the end of each period for which the insurer is liable.
After 90 Days, what are the reasons an insurer may cancel a policy?
◾A a material misstatement. ◾Nonpayment of premium. ◾Failure to comply with underwriting requirements established by the insurer within 90 days of the effective date of coverage. ◾A substantial change in the covered risk. ◾The cancellation is for all insureds under the policies for a given class of insureds.
Misrepresentation
◾An agent failing to make the prospect aware of relevant facts is guilty of misrepresentation. This occurs if statements are false, incomplete or misleading. If it was a material fact, the contract can be considered void even though the agent's misstatement may have been innocent. On the other hand, a purposeful misstatement of an irrelevant fact will not result in a voided contract. ◾A sales person who knowingly makes a false statement can be found guilty of a 2nd degree misdemeanor. ◾Agents can only make accurate statements regarding their carrier's financial strength. Additionally, representatives may not use misleading titles that tend to conceal the fact that they are insurance agents.
Fraud
◾Any action involving intentional deception that results in injury to another party, and concealment, misrepresentation, misleading behavior, or nondisclosure of a material fact. ◾Knowingly submitting a PIP claim for medical expenses at a clinic that falsely submitted, a fraudulent license application
How are "Abuse" and "domestic violence" defined
◾Attempting or committing assault, battery, sexual assault, or sexual battery. ◾Placing another in fear of imminent serious bodily injury by physical menace. ◾False imprisonment. ◾Physically or sexually abusing a minor child. ◾An act of domestic violence resulting in physical injury or death of one family or household member by another family or household member.
What are the two separate accounts maintained by the Florida Insurance Guaranty Association?
◾Auto liability and auto physical damage account. ◾All other eligible insurance account
CPCU: Canons of the Code of Professional Ethics for CPCU
◾Clearly communicates the minimum standards of conduct expected for CPCUs and for those who are candidates for this designation. ◾Disciplinary process includes investigation of violations of the Code. ◾The 3 requirements of the CPCU designation are education, experience, and ethics. Note: Agent Ethics can be summarized by the principle in the Golden Rule: "Conduct business with a client as you would want business to be conducted with you."
What type of insurers are not eligible for coverage through the Florida Insurance Guaranty Association?
◾Life, annuity, health, disability ◾Protection against investment risks ◾Fidelity and surety bonds ◾Creditor-debtor transactions ◾Warranty ◾Ambulance service, health care, funeral merchandise or service ◾Optometric, pharmaceutical, or dental service ◾Legal expense ◾Ocean marine or wet marine ◾Self-insurance ◾Title ◾Surplus lines ◾Workers' Compensation and employer liability ◾Transfer of investment or credit risk ◾Government guaranteed
What are the criteria for Premium Financing by the Insurer?
◾Must file premium finance agreement forms, related forms, and service charge or interest rate plan separately from rates and filings. ◾May finance property, casualty, surety, and marine insurance policies issued or produced by that insurer or its agent. The service charge may not be more than 50% of the additional charge by premium finance companies.
Sliding
◾Representing to the applicant that a specific coverage or product is: - Required by law in conjunction with the purchase of insurance when such coverage or product is not required. - Freely included in the policy when in fact there is a charge required. ◾Charging an applicant for a specific coverage or product, in addition to the cost of the insurance coverage applied for, without the informed consent of the applicant.
What parts of a structure do the wind mitigation techniques apply for to receive a credit?
◾Roof Covering ◾Roof Deck Attachment ◾Roof-Wall Connection ◾Opening Protection ◾Roof Shape ◾Secondary Water Resistance
What are considered unfair claims settlement tactics?
◾Settling claims based on an application altered without the insured's consent ◾Misstating terms of the policy in an attempt to obtain an unjust settlement ◾Not making a proper investigation ◾Making a misrepresentation to the insured ◾Not responding to communications from the client ◾Denying a claim without a reasonable investigation ◾Not giving claim affirmation or denial after receiving proof of loss ◾Failure to give proper explanation of a claim denial ◾Not outlining the allocation of a claim payment ◾Offering a settlement so low that the claimant must resort to a lawsuit to be fairly compensated ◾Failure to pay PIP claims within 30 days after the insurer is furnished written notice
What are four stipulations when applying a hurricane deductible?
◾The hurricane deductible applies on an annual basis to all covered hurricane losses that occur during the calendar. ◾If a hurricane deductible applies separately to each of one or more structures insured under a single policy, these requirements apply with respect to the deductible for each structure. ◾If there are 2 or more hurricanes during the calendar year, the insurer may apply a deductible to a subsequent hurricane which is the greater of the remaining amount of the hurricane deductible or the amount of the deductible that applies to perils other than a hurricane. ◾If there are hurricane losses in a calendar year on more than one policy issued by the same insurer, the hurricane deductible will be the highest amount stated in any one of the policies.
What is not considered Churning
◾There is an objectively reasonable basis for believing that the replacement or extraction will result in an actual and demonstrable benefit to the policyholder. ◾There are no fraudulent, deceptive, misleading or otherwise deceptive omissions. ◾The applicant is informed that the policy values including cash values, etc., will be reduced, forfeited, or used in the purchase of the replacing or additional policy or contract. ◾The applicant is informed that the replacing or additional policy or contract will not be a paid-up policy or that additional premiums will be due, if this is the case.
What are the exceptions that would allow an insurer to cancel a policy before 90 days during an declared emergency?
◾Upon 10 days' notice for nonpayment of premium. ◾Upon 45 days' notice: ◾For a material misstatement or fraud related to the claim. ◾If the insurer determines that the insured has unreasonably caused a delay in the repair of the dwelling. ◾If the insurer has paid policy limits.
What are exceptions to how long of a notice an insurer must provide when cancelling a policy for reasons other than non-payment?
◾When cancellation occurs during the first 90 days for reasons other than nonpayment of premium, at least 20 days' written notice, except: ◾There has been a material misstatement or misrepresentation. ◾Failure to comply with the underwriting requirements established by the insurer.
What are three other factors that can effect credits for wind mitigation features?
◾Whether the construction of the dwelling is new or existing. ◾Location of dwelling. ◾Community participation in the ISO Building Code Effectiveness Grading program.
