North Carolina Statutes and Regulations Pertinent to Accident and Health

Insurance Producer

-A person required to be licensed under the laws of this state to sell, solicit, or negotiate insurance

General Rules and Broad Powers

-Advises the Governor on insurance matters and is responsible for organizing, administering and carrying out the general duties and broad powers of the department.

Contract of Insurance

-Agreement that obligates an insurer to compensate an insured upon the destruction, loss, or injury of something in which the insured has an interest.

Records Maintenance/Inspections

-All companies, agents, or brokers doing any kind of insurance business in NC must make and keep a full and correct record of their businesses for 3 years.

Domestic Company

-Any company incorporated or organized under the laws of North Carolina (Get permit: Certificate of Authority)

Alien Company

-Any company incorporated or organized under the laws of any jurisdiction outside of the United States of America (Get permit: Certificate of Authority)

Foreign Company

-Any company incorporated or organized under the laws of the United States or any of its jurisdictions other than the laws of NC (Get permit: Certificate of Authority)

Insurance Company/Insurer

-Any corporation, association, partnership, society, order, individual or group of individuals engaging, proposing or attempting to engage as principals in any kind of insurance business.

Insolvency

-Any person working in or for the insurance business must notify the Commissioner if he knows or has reason to believe that an insurance entity licensed by the Commissioner is financially impaired. -Notifications should include all relevant facts and circumstances -Person notifying the Commissioner will be free of any liability, as long as the notification is without malice or deception.

To Obtain an Agent License

-Be at least 18 years old -Complete at least 20 hours of prelicensing education. -In addition applicants for Medicare and Long-Term Care licensure must complete 10 hours of instruction -Pass a written licensing examination -Pay any appropriate fees -Have NOT committed any act that would ground for license denial

Election and Term of Office

-Commissioner is elected by residents of North Carolina for a 4 year term -If Commissioner's office becomes vacant, Governor must act as Commissioner for the unexpired portion of the term -Appoints and may remove a Deputy Chief Commissioner who has the authority to act with all powers vested in the Commissioner in their absence, death, resignation,disability or disqualification.

General Regulation for Insurance

-Insurer may not charge different rates for: --Auto insurance based on the insured's age or gender --For life or health insurance solely because of blindness or deafness --Because of race, color, nationality, or ethnicity --For persons of same class and risk or hazard -Group life and group health policies are prohibited from requiring proof that a loss is accidental. -An insurer must provide claim forms to a claimant within 15 days of receiving notice of loss

Commissioners Primary Duties Involve

-Issuing, refusing, suspending, or revoking Certificates of Authority to insurers and licenses to insurance agents. -Establishes rules and regulations to fulfill NC insurance laws -Conducts exams, investigations and hearings to administer state insurance laws -Reports to Attorney General violations of laws relative to insurance companies and overall business expense -Providing insurance Policy or contract summaries upon request to state residents. -Providing a list of insurance policies or contract rates to the public -Administering oaths -Arresting any person suspected of violating insurance of law if holding evidence -Seeking restraining orders, from appropriate superior court, against person violating, or whom the Commissioner believes might violate, insurance law. Order may be granted regardless of whether criminal prosecution is instituted under any provision of law. -Ordering a stay of the reporting times for proof of loss as established by insurance policies, in the event that the state or a portion of this state is declared a disaster area. Shall not exceed later of 45 days or the expiration of the declaration of disaster. -CAN NOT make insurance laws up to state legislature

Notice to Commissioner/Address Change

-License applicant must notify the Commissioner in writing within 10 days of a change in residential address or of being convicted of a crime other than an auto misdemeanor.

NAIC

-National Association of Insurance Commissioners -All states get together 4 times a year

Agent

-Person licensed to solicit insurance applications or negotiate polices. An agent is deemed to represent an insurer

Resident

-Person living in NC

Nonresident Agent License

-Person must be currently licensed and in good standing as a resident agent in his/her home state -Keep up with continuing education -Person previously licensed for the same kind of insurance in his/her former state is exempt from education, experience, and exam requirements if he/she is in good standing in the former state and the license application is received within 90 days after persons license in the former state is cancelled -If non-resident licensee moves to NC and wants a license, they must apply within 90 days of establishing legal residence -None resident must report to States commissioner any administrative action taken against him or her by an agency in his own state -Notification must be provided within 30 days after the matters final disposition

Investigation of Complaints

-Person must report and Commissioner must investigate suspected insurance fraud or a licensee's financial impairment. -Person acting without malice is immune from liability -In Investigation Commissioner may examine the insurer's books, records, and documents -Commissioner may request information for an investigation from any person. If complaint is justified the insurer is required to pay investigation expenses and any appropriate fines -Insurer or agent must keep records of all written complaints for 5 years after the complains final disposition, until commissioner adopts a final report of a general examination that contains review of these records, whichever is later -Records may be subject to inspection and should contain at a minimum: --Insured's name --Nature of the complaint --Policy/Claim number of the insured --Final disposition of the complaint

Broker

-Represents client and must have a bond -Places insurance with an authorized insurer that has not appointed the person

Commissioner

-The Commissioner of Insurance of North Carolina, or an authorized designee of the Commissioner. -Makes sure laws are being followed.

Change of Address

A resident licensee must return to his/her license to the commissioner within 30 days after terminating residency in the state

The incontestable period for any insurance policy is which of the following:

After the policy has been in force for 2 years after its date of issue

False Statement/Embezzlement

Any person willfully misstating information is guilty of Class I felony and entity on whose behalf the person willfully provided information known to be wrong is guilty of a felony

Twisting

Insurer willfully misrepresents or incompletely compare, terms, conditions, or benefits of any insurance policy to induce a policy holder to replace an existing policy

An insured's accident policy uses the phrase "accidental bodily injury" to define what constitutes accidental injury and/or resulting death. This phrase

Is less restrictive than the phrase "accidental means."

An insurance agent will provide all applicants and policy holders with a clear and prominent notice disclosing the agent' and insurer's disclosure practices within what time frame?

Prior to the initial disclosure of personal information or at the time of delivery of the insurance policy or certificate.

A company is domiciled

in the state where its home office is located