Chapter 15.1: WI Life & Health State Laws

The Interstate Insurance Product Regulation Compact was formed to:

- Protect consumers of individual and group annuity, life insurance disability income, and long-term care insurance products - Develop uniform standards for insurance products covered by the compact - Establish a central clearinghouse to review insurance products and related advertisements - Give approval to product filings and advertisements according to uniform standard - Coordinate regulation between the member state insurance departments

The following course topics are examples of subjects that do not qualify for CE approval:

- Sales - Motivation - Prospecting - Psychology - Communication skills - Supportive office skills (typing, filing, telephone, computers) - Personnel management - Recruiting - Time management - Repair procedures - Cleaning techniques - Other subjects not related to the insurance industry - Agency management

Within 30 business days after receiving a written request from an individual to correct, amend, or delete any recorded personal medical information, an insurer must do either of the following:

1. Comply with the request 2. Notify the individual of all of the following: - That the insurer refuses to comply with the request - The reasons for the refusal - That the individual has a right to file a statement

What are the two types of insurance intermediaries?

1. reinsurance intermediary-broker 2. reinsurance intermediary-manager

License Requirements: The Commissioner considers, but is not limited to, the following criteria when assessing trustworthiness and competence of intermediaries:

- Criminal record and convictions - Regulatory actions and accuracy of application - Violation of orders of any state insurance commissioner - Misrepresentation or fraud in the application process or insurance practice - Owing delinquent income tax or child support - Using fraudulent, coercive, or dishonest practices, or demonstrating incompetence, untrustworthiness, or financial irresponsibility in the conduct of business

Record Keeping, Maintenance, and Duration: An intermediary must:

- Maintain records at the business address of the intermediary or the insurer - Update all intermediary records at reasonable intervals and maintain all financial records according to accepted accounting principles - Retain records of financial transactions and policyholder information (applications, coverage requests, claims, complaints, etc.) for 3 years - Retain records on compliance with suitability and replacement matters for at least 3 years after termination or lapse of the policy

A managing general agent must have a written contract with the insurer that contains the following minimum provisions:

- Upon written notice to the managing general agent, the insurer may terminate the contract or the managing general agent's claim settlement authority for cause. The managing general agent's underwriting and settlement authority may be suspended while any dispute regarding the cause for termination is resolved. - At least monthly, the managing general agent must render accounts to the insurer and remit all funds due - Funds are considered to be held for an insurer by the managing general agent in a fiduciary capacity. The financial institution in which funds are deposited must be part of the federal reserve system. No more than 3 months estimated claims payments and allocated loss adjustment expenses may be held at one time. Separate records must be maintained for business written for an insurer. All such records are subject to inspection and duplication by the insurer and the Commissioner at any time. - The contract must not be assignable. - Appropriate underwriting guidelines include, but are not limited to: 1. Maximum annual premium volume 2. The basis of rates 3. Types of risks that may be written 4. Maximum liability limits 5. Exclusions 6. Territorial limitations 7. Policy cancellation provisions 8. Maximum policy period - The insurer may cancel or nonrenew any policy subject to applicable laws and rules - Any claims settled on behalf of the insurer must be reported in a timely manner. A copy of the claim file must be sent to the insurer upon request, or if the claim: 1. May equal or exceed 0.5% of the insurer's latest annual policyholder surplus or a lower limit set by the insurer 2. Involves a coverage dispute 3. May exceed the managing general agent's claims settlement authority 4. Is open for more than 6 months 5. Is closed by payment of an amount equal to or greater than 0.5% of the insurer's latest annual policyholder surplus or lower amount set by the insurer - Claim files are the joint property of the insurer and managing general agent. Upon an order of liquidation of the insurer, the files become the sole property of the insurer or its estate, though the managing general agent may still have the right to access and copy files. - The managing general agent must transmit data from electronic claims files to the insurer on a timely basis - If interim profits are shared with the managing general agent and the managing general agent has the authority to determine the amount of those profits by establishing loss reserves or controlling claim payments, or in any other manner, the profits may not be paid to the managing general agent until they have been verified as required by law and until: 1. 1 year after they are earned for property insurance business 2. 5 years after they are earned for casualty business ____________________ - The managing general agent may not: --Bind reinsurance or retrocessions on behalf of the insurer, except for facultative reinsurance if the contract contains reinsurance underwriting guidelines including: 1. A list of reinsurers with which automatic agreements are in effect 2. The coverages and amounts or percentages that may be reinsured 3. Commission schedules -- Commit the insurer to participate in insurance or reinsurance syndicates -- Appoint any subproducer without assuring that the subproducer is lawfully licensed -- Pay or commit the insurer to pay a claim exceeding, net of reinsurance, 1% of the insurer's latest annual policyholder surplus, except with the insurer's prior approval -- Collect any payment from a reinsurer, or commit the insurer to any claim settlement with a reinsurer, without the insurer's prior approval and prompt reporting to the insurer -- Permit a subproducer to serve on the insurer's board of directors -- Jointly employ an individual employed by the insurer -- Appoint a submanaging general agent

Persons Required to be Licensed:

1. Insurance Marketing Intermediary 2. insurance broker 3. insurance agent 4. managing general agent 5. Surplus Lines Agent or Broker 6. Life Settlement Brokers and Providers 7. Firms as Agents 8. Reinsurance Intermediaries

how long are exam scores valid for?

30 days

What is a disclosure authorization?

A disclosure authorization is any form used in connection with an insurance transaction that authorizes the disclosure of personal medical information about an individual to an insurer

Firms as agents:

A firm (corporation, association, partnership, limited liability company, limited liability partnership, or other legal entity) may be licensed if, among other things: - It certifies that all acts required to be performed by licensed intermediaries are performed exclusively by natural persons who are so licensed - Partners, directors, or principle officers must meet standards of competence and trustworthiness that apply to licensed intermediaries or that apply to nonlicensed individuals - The initial licensing fee is $100, and the renewal fee is $35 for a resident and $70 for a nonresident, due biennially. Notices for renewal fees will be sent at least 60 days before February 15 of even-numbered years.

Unfair Marketing Practices: Misrepresentation

An intermediary may not make a communication relating to an insurance contract, the insurance business, any insurer, or any intermediary that contains false or misleading information, including information that is misleading because of incompleteness. Filing a report and, with intent to deceive, making a false entry in a record or willfully refraining from making a proper entry are considered communications.

Record Keeping, Maintenance, and Duration: Change of Address or Telephone Number

An intermediary must notify the Commissioner within 30 days of any change in the intermediary's name or business or residence address.

Commissioner's General Duties and Powers: Hearings

Any party aggrieved by an order of the Commissioner can apply for a hearing within 30 days of the date of the order. If no request for a hearing is made, the order is final. A hearing must be held not later than 60 days after an application for hearing is received unless a delay is requested by all persons named in the order. The Commissioner must hold a hearing prior to issuing any rule unless it is: - Procedural rather than substantive - An emergency rule - An exception listed elsewhere in the law No person is excused from testifying, producing any document before the Commissioner, or appearing in any proceeding instituted by the Commissioner on the ground that the testimony or evidence required from the person may tend to incriminate them. However, no one can be criminally prosecuted on account of their testimony or evidence after claiming privilege against self-incrimination, except for perjury, false swearing, or contempt committed in testifying.

Producer Regulation Fiduciary and Trust Account Responsibilities

Each intermediary must maintain, for at least 3 years, the following records: - Cash Receipts Record - Showing the name of the party who remitted the money, the date, and the reason for payment. - Cash Disbursed Record - Showing the name of the party to whom payment was made, date, and reason for payment. - Commission Statements - Showing the insured's name, policy number, premium, amount of commission, and date allocated or paid or both. - Policyholder Records - All records, applications, requests for changes, claims, and complaints associated with a policy generated by or through the intermediary. - Business Checking Account - Any account used by an intermediary for insurance-related transactions. - Personnel Records - Including dates of employment, position, description of principal duties, name of employee, and last known address and phone number of employee

Home Solicitation

Home solicitation occurs when the solicitation or sale is made away from the agent's regular place of business, for example at the residence or place of business or employment of the buyer. - Home solicitation selling includes solicitations made by telephone, person-to-person contact, or by written or printed communication, other than general advertising that indicates an intent to sell insurance or services at the agent's place of business. When engaged in home solicitation selling, every seller must, at the time of first contact with a purchaser of insurance and immediately after an initial greeting, clearly and expressly disclose: - The seller's individual name - The name of the business firm or organization represented - A statement that insurance is being sold or solicited - The identity of the insurer, if the solicitation is primarily for a single insurer - type of insurance being solicited A seller who receives a check or cash must give the buyer a receipt that includes the date of the sale, a description of the type of policy applied for, price paid, the name of the seller, and the name and mailing address of the insurer issuing the policy. No seller engaged in making a home solicitation sale can: - Use any false, deceptive, or misleading representations to induce a sale, or use any plan, scheme, or ruse which misrepresents that the person making the call is selling insurance, or fail to leave the premises at which a sales presentation is made promptly when requested to do so - Represent directly or by implication that the seller is making an offer to specially selected persons or that the buyer or prospective buyer has been specially selected, unless such representations are true and the specific basis for such representations is stated at the same time the representation is made - Represent that the seller is conducting a survey, test, or research project, or is engaged in a contest or other venture to win a cash award, scholarship, vacation, or similar prize, when in fact the principal objective is to make an insurance sale or obtain information to help identify sales prospects - Represent that the seller is conducting a special sales promotion campaign or making a special limited offer to a few persons only or for a limited period of time, or is authorized to sell the insurance in a few homes, unless the representations are true and the specific basis upon which representations are made is disclosed at the same time as the representations are made to the prospective buyer

Unfair Marketing Practices: Boycott, Coercion, Intimidation

Intermediaries may not enter into action resulting in an unreasonable restraint of, or monopoly in, the business of insurance. Restricting the choice of an insurer or agent when insurance coverage is required for a contract or other transaction is also prohibited.

Unfair Marketing Practices: Unfair (Illegal) Inducement

Intermediaries may not offer any special favor, benefit, or any valuable consideration not specified in the policy to induce a person to purchase insurance or terminate an existing insurance policy.

Unfair Marketing Practices: Discrimination Based on Sexual Orientation

It is unfair to use sexual orientation in the determination of insurability, premium, terms of coverage, or nonrenewal. Insurers may not inquire about the applicant's or insured's sexual orientation, or use other underwriting factors, such as marital status or medical history, to establish an applicant's or insured's sexual orientation.

Examination of Records:

Whenever the Commissioner deems it necessary in order to be informed about any matter related to the enforcement of the insurance code, they may examine the affairs and conditions of any licensee/applicant preparing to transact insurance business in this state, as well as any insurance advisory organization in this state. The Commissioner may examine the accounts, records, documents, or evidences of transactions, so far as they relate to the examinee, of any of the following: - An officer, manager, general agent, employee, or person who has executive authority over or is in charge of any segment of the examinee's affairs - A person controlling or having a contract under which the person has the right to control the examinee, whether exclusively or with others - A person who is under the control of the examinee, or a person who is under the control of a person who controls or has a right to control the examinee, whether exclusively or with others - An individual practice association which contracts with the examinee to provide health care services On demand, every examinee must make available for examination by the Commissioner any pertinent personnel, accounts, records, documents, or evidences of transactions, and any of those of the persons. Failure to do so is deemed to be concealment of records. The Commissioner must also be given access to the records of any agency of the state government or of any political subdivision that they may wish to consult in discharging these duties. The Commissioner must examine domestic insurers and every licensed rate service organization: - Whenever requested by a verified petition signed by 25 interested shareholders, policyholders, or creditors of an insurer alleging grounds for formal delinquency proceedings - Whenever requested by the board of directors of a domestic insurer - As otherwise required by law The reasonable costs of examinations must be paid by examinees unless the Commissioner finds that the cost would place an undue burden on the examinee. The Commissioner bills domestic insurers annually to fund the costs of administering examinations. The costs include the salaries and expenses of the examiners and any other expenses which may be directly apportioned to the examination. Payment is due 10 days after the examinee has been served a detailed account of the costs. The Commissioner or a duly appointed representative also may investigate and review all applications for approved prelicensing and continuing education courses and may investigate or examine previously approved programs, courses, and instructors. The method and timing of the reviews will be determined by the Commissioner in each case and may consist of the following: - Consideration of information available from state, federal, or local agencies; private organizations or agencies; or interested persons - Conferences with officials, representatives, and former students of the school involved - A public hearing respecting the noncredit program, course, or instructor involved, with adequate written notice to the school, instructor, or both - Investigation by visitation without notice to the noncredit program - Information furnished by the applicant with its application for approval - Any other information the Commissioner or representative deems relative to the investigation In addition to investigation or examination upon its own initiative, the Commissioner may investigate or examine any noncredit program or instructor upon receipt of a complaint from any person. As with other types of examinations, the cost of the examination is paid by the examinee.

The Commissioner may prescribe reasonable data handling standards and techniques to ensure that timely, reliable information will be available such as:

The Commissioner may prescribe forms for the reports, require verification of any report, and specify who must execute or certify them

Company Regulation: Producer Appointments/Terminations

The annual appointment renewal invoice will be made available to insurers every year. The invoice due is for every individual intermediary serving as an agent for the insurer. Payment is required once a year in March from each insurer.

What is considered as a prompt response?

Unless specified otherwise, the terms "prompt" or "promptly" mean that responsive action to a communication is rendered within 10 consecutive days after receiving a communication concerning a claim

reinsurance intermediary-manager

a person who has significant authority regarding assumed reinsurance of an insurer and acts as its agent

Where must an application for a permanent resident agent license or for adding a new line of authority be made?

online

A disclosure authorization must contain the following:

- A general description of the type(s) of information to be disclosed - A general description of the receiving parties, the purpose of disclosure, and how the information will be used - The name of the insurer - Length of time the authorization is valid, notice that the consumer or customer can revoke the authorization at any time, and the procedure for revocation - Identity of the individual who is the subject of the personal information - Notice that the individual, or an authorized representative of the individual, is entitled to receive a copy of the completed authorization form - Signature of the individual

The following are not managing general agents:

- A person who is not an intermediary - An employee of the insurer - A manager of the U.S. branch of an alien insurer

Record Keeping, Maintenance, and Duration: Reinstatement

- A resident individual intermediary whose license is revoked for failing to pay renewal fees, complete required continuing education, or pay delinquent taxes may apply to be relicensed within 12 months from the revocation date, without needing to complete prelicensing education or pass a written examination. Resident licensees who are required to complete continuing education must have all previous requirements met. - If a resident license has been revoked for more than 12 months, the intermediary must meet the examination and prelicensing education requirements for an initial license.

Record Keeping, Maintenance, and Duration: Reporting of Actions An intermediary must report any:

- Administrative action taken against the insurance producer's license in another jurisdiction or by another governmental agency in this state to the Commissioner within 30 days of the final disposition of the matter - Criminal conviction of the insurance producer taken in any jurisdiction to the Commissioner within 30 days after a criminal conviction

types of warranties:

- An affirmative warranty is a positive representation (implied or express) in the policy that verifies a fact at the time the policy goes into effect - A promissory warranty is a warranty that certain things will be done or not be done after the policy has taken effect SPECIFIC KNOWLEDGE No misrepresentation made by or on behalf of a policyholder and no breach of an affirmative warranty or failure of a condition constitutes grounds for rescission of, or affects an insurer's obligations under, an insurance policy if at the time the policy is issued, the insurer has either constructive knowledge of the facts or actual knowledge. If the application is in the handwriting of the applicant, the insurer does not have constructive knowledge merely because of the agent's knowledge. If after issuance of an insurance policy an insurer acquires knowledge of sufficient facts to constitute grounds for rescission of the policy or a general defense to all claims under the policy, the insurer may not rescind the policy and the defense is not available unless the insurer notifies the insured within 60 days after acquiring such knowledge of its intention to either rescind the policy or defend against a claim. If the insurer determines that it is necessary to secure additional medical information, the notice should be provided within 120 days.

A licensee must provide a notice that reflects its privacy policies and practices to:

- An individual who becomes the licensee's customer, not later than when the licensee establishes a customer relationship - A consumer, when the licensee request authorization to disclose any nonpublic personal financial information about the consumer to any nonaffiliated third party and for which no authorization is required

Record Keeping, Maintenance, and Duration: Agent Appointment

- An insurer must file a notice of appointment within 15 days after the contract is executed or the first application for insurance is submitted. An insurer must pay an annual appointment fee. - Every insurer is bound by acts of its agents that are within the scope of the agent's apparent authority. When the agency contract is terminated, the insurer must make reasonable efforts to recover from the agent its policy forms and other indicators of the agency relationship. An insurer is required to notify the Commissioner if an agent does not promptly comply with a written demand to do so. - An insurer who terminates an appointment, employment, or other relationship of an agent must notify the Commissioner within 30 days after the effective date of the termination. Within 15 days after notifying the Commissioner of termination of appointment, the insurer must mail a copy of the notification to the agent. - An insurer who terminates an appointment for one of the following reasons relating to competence or trustworthiness must include an explanation of that reason/reasons in its notice to the Commissioner if the agent: 1. Provided incorrect, incomplete, or otherwise misleading information in their license application 2. Violated any insurance law, regulation, subpoena, or order of the Commissioner of Wisconsin or another state 3. Attempted to get a license through misrepresentation or fraud Improperly withheld, misappropriated, or converted money received in the course of insurance business 4. Intentionally misrepresented the terms of an insurance contract or application for insurance 5. Was convicted of a felony or a misdemeanor substantially related to the holding of an insurance license 6. Committed an insurance unfair trade practice or fraud 7. Used fraudulent, coercive, or dishonest practices or demonstrated incompetence, untrustworthiness, or financial irresponsibility in conducting business 8. Had an insurance producer license denied, suspended, or revoked in any jurisdiction 9. Forged a signature on an application or other insurance document 10. Cheated on a license exam 11. Knowingly accepted insurance business from an individual who is not licensed 12. Failed to pay child support or state income tax 13. Forged/altered policies, defrauded, misappropriated, misrepresented, or failed to promptly submit applications or premiums, and the insurer knew about these violations - At dates established by the Commissioner, an insurer must report all agent appointments, including renewals and terminations, and pay the required fees.

The following are exempt from prelicensing education:

- Applicants for a nonresident license - Applicants for an original resident license who held a license within the previous 12 months as a resident insurance agent in another state for each of the lines applied for in Wisconsin - Applicants who have completed a 2-year Wisconsin vocational school degree in insurance - Applicants who have completed a 4-year college degree in business with an insurance emphasis - Applicants for the life line of authority who hold any of the following professional designations: 1. Certified Employee Benefit Specialist (CEBS) 2. Chartered Financial Consultant (ChFC) 3. Certified Insurance Counselor (CIC) 4. Certified Financial Planner (CFP) 5. Chartered Life Underwriter (CLU) 6. Fellow of the Life Management Institute (FLMI) 7. Life Underwriter Training Council Fellow (LUTCF) - Applicants for the accident & health line of authority who hold any of the following professional designations: 1. Registered Health Underwriter (RHU) 2. Certified Employee Benefit Specialist (CEBS) 3. Registered Employee Benefits Counselor (REBC) 4. Health Insurance Associate (HIA) - Applicants for a reinsurance intermediary-broker, reinsurance intermediary-manager, or managing general agent limited-line license

Continuing Education (CE) Requirements

- Each licensee in any of the major lines must complete 24 credit hours of CE biennially (every 2 years), with at least 3 hours covering ethics in insurance. - Resident licensees must complete the CE requirement before renewing their license or it will be revoked. - Excess CE credit hours accumulated during any renewal period do not carry forward to the next period. - At least 60 days prior to the reporting date of each reporting period, the Commissioner will notify each licensee who is short of the required CE credit hours.

Wisconsin's licensing requirements are designed to:

- Encourage professional competence of insurance intermediaries (persons who sell or advise about insurance) - Provide maximum freedom of marketing methods for insurance - Encourage competition at the consumer level - Limit the adverse effects of imperfect competition - Regulate insurance marketing practices

Record Keeping, Maintenance, and Duration: Change of Intermediary Status The following must be reported to the Commissioner:

- Every change in the members of a partnership/limited liability company or the principal officers of a corporation licensed as an intermediary - So far as it relates to competency or trustworthiness as an intermediary, every change in the status and relationships of a natural person licensed as an intermediary

Company Regulation: responsibilities of the insurer

- Every insurer is bound by any act of its agent performed in this state that is within the scope of the agent's apparent authority while the agency contract remains in force. - If a client requests a copy of an application (if one was not provided beforehand), the insurer must provide it within 15 days of receiving the request. - If an insurer gets information that provides the grounds to rescind the policy or defend a claim made against it, it must inform the insured within 60 days of its intent to either rescind the policy or defend a claim being made against it.

Company Regulation: rates

- Every insurer is required to file rates with the Commissioner within 30 days of when they become effective. This requirement applies to all lines of insurance written on risks in the state except ocean marine, Workers' Compensation, life insurance (other than credit life), annuities, and group and blanket accident and sickness insurance (other than credit accident and sickness). - If after a hearing, the Commissioner finds that the rate is excessive, inadequate, unfairly discriminatory, could destroy competition, or create a monopoly, they will order use of the rate be discontinued.

The prelicensing education requirement is:

- For a property, casualty, personal lines, life, or accident and health insurance license, at least 20 hours of a prelicensing educational program approved by the Commissioner - For a life settlement provider, an initial training course of at least 8 hours. At least 4 hours of continuing education must be completed every 24 months after the initial training course, at a rate of 2 hours per 12-month compliance period.

Company Regulation: solvency

- For an insurer organized or operating as a town mutual, insolvency is the inability to pay any loss within 30 days after the due date specified in the first assessment notice after the date of the loss, or any other uncontested debt as it becomes due, or the inability to replenish by timely assessment any required surplus. - For any other insurer, it is: 1. The inability to pay its debts or meet its obligations as they mature 2. Having assets that do not exceed its liabilities plus the greater of any capital and surplus required by law to be constantly maintained or its authorized and issued capital stock (for purposes of this definition, "assets" includes half of the maximum total assessment liability of the policyholders of the insurer, and "liabilities" includes reserves required by law)

Commissioner's General Duties and Powers: penalties

- If a person does not comply with an order issued within 2 weeks after the Commissioner has given the person notice of the Commissioner's intention to proceed, the Commissioner can issue a fine of up to $5,000 per day the violation continues after the commencement of the action until judgment is rendered. - Anyone who violates an effective order issued by the Commissioner must pay the state twice the amount of any profit gained from the violation, in addition to $1,000 for each violation. Each day the violation continues is a separate offense. - Anyone who violates a statute or rule, intentionally aids a person in doing so, or knowingly permits a person over whom they have authority to do so, must pay up to $1,000 for each violation. - Anyone who intentionally violates, intentionally permits a violation by any person over whom they have authority, or intentionally aids any person in violating any insurance statute, rule, or effective order of this state is guilty of a Class 1 felony. - A firm is liable to pay up to $1,000 per violation of a rule or order of the Commissioner that is committed by an insurance agent who works for the firm under an employment contract, or who is regularly used by the firm if the violation is in connection with an insurance policy or group certificate obtained or to be obtained from or through the firm.

An insurance company is deemed to know any fact material to the risk or which violates a condition of the policy:

- If the insurance company's agent who bound the company, issued the policy, or transmitted the application to the insurer knew the fact at the time they acted - If afterwards any of the company's agents learned of the fact during the course of dealing with the policyholder as an agent and knew that the fact pertained to the policy The insurance company is deemed to be notified if the company's authorized agent has been notified by or on behalf of the policyholder or insured and provided with sufficient information to identify the policy in question. If a policyholder or insured failed to perform a required act in the prescribed time or manner because of the agent's actions or statements, the failure does not affect the insurance company's obligations under the policy. This is the case whether or not the agent was within the actual scope of the agent's authority. However, if the agent and policyholder or insured acted together to deceive or defraud the insurance company, the insurer is not obligated under the policy. This is also the case if the policyholder or the insured knew the agent was acting beyond the scope of their authority.

License Requirements: The Commissioner will issue a license to act as an agent to any applicant who:

- Is competent and trustworthy - Pays the applicable fee ($75 for each line of authority sought; $100 for a surplus lines license) - Shows to the satisfaction of the Commissioner that they intend in good faith to do business as an intermediary; a corporation or partnership must have this intention spelled out in its articles of incorporation or association - If a corporation or partnership, spells out in its articles of incorporation/association its intention to do business in good faith - Passes the examination for the type of license they seek

License Requirements: A completed application consists of:

- The applicant's name - The current residence address of the applicant - An electronic confirmation of prelicensing education completion for the specific lines of authority (or an exemption form, if exempt) - An electronic confirmation of criminal history provided by the FBI - An electronic confirmation of criminal history provided from the Wisconsin Department of Justice Crime Information Bureau, completed not more than 180 days prior to the test date - Payment of the fees to the testing vendor - An electronic photograph of the applicant taken by the test service at the time of testing - Confirmation of previous license in another state, if applicable - Any documentation required in answer to questions on the application

As a general rule, a licensee establishes a customer relationship at the time the licensee and the consumer enter into a continuing relationship. When an existing customer obtains a new insurance product or service from a licensee, the licensee can satisfy the initial notice requirements as follows:

- The licensee can provide a revised policy notice that covers the customer's new insurance product or service - If the initial, revised, or annual notice that the licensee most recently provided to that customer was accurate with respect to the new insurance product or service, the licensee does not need to provide a new privacy notice

A licensee cannot disclose any nonpublic personal health information to any party, including affiliates, and cannot disclose any nonpublic personal financial information to a nonaffiliated third party unless:

- The licensee has provided the initial notice to the consumer - The licensee has provided an opt-out notice to the consumer - An authorization is obtained from the consumer whose nonpublic personal information is to be disclosed

An insurer or licensee must provide a notice of information practices to all applicants or policyholders as follows: & The notice must be in writing and contain the following information:

- With a written application, disclosure notice must be given at the time of delivery of the policy or at the time when the collection of personal information is taken from a source other than the applicant - In the case of a renewal policy, at least annually The notice must be in writing and contain the following information: - A statement that information can be collected from persons other than the individual who is to be insured - A list of the categories and types of information that can be collected - The types of disclosure - Policies and practices used to protect the confidentiality of personal information - A description of the insured's rights and how the rights can be exercised - The categories of affiliates and nonaffiliated third parties to whom nonpublic personal information can be disclosed

The following are not intermediaries:

-A regular salaried officer, employee, or other representative of an insurer or licensed intermediary who does work other than soliciting, negotiating, or placing insurance and whose compensation does not depend on the amount of insurance business obtained - A regular salaried officer or employee of an insurance consumer, other than for members of a risk purchasing group, who receives no compensation that is directly dependent upon the amount of insurance coverage procured - A person who gives incidental advice in their work (other than insurance consulting) if neither the person nor the person's employer receives compensation on account of any insurance transaction that results from that advice - A person who, without special compensation, performs incidental services for another at the other's request without providing advice or technical or professional services of a kind normally provided by an intermediary - A holder of a group insurance policy, or any other person involved in mass marketing, with respect to administrative activities in connection with such a policy if they are not compensated for this beyond actual expenses - A person who provides information, advice, or service for the principal purpose of reducing loss or the risk of loss - A person who gives advice or assistance without compensation, direct or indirect - A travel retailer that offers and disseminates travel insurance - A vendor selling portable electronics insurance - A person whose activities are limited to marketing, selling, or offering a warranty, maintenance agreement, or service contract

Disciplinary Actions License Termination, Suspension, or Revocation

- An intermediary's license remains in force until it is revoked or limited, suspended, surrendered, or until the licensee dies or is adjudicated incompetent. - A license can be revoked, suspended, or limited for any of the following: 1. Being found unqualified as an intermediary or not of good character 2. Repeatedly or knowingly violating an insurance statute or rule or a valid order of the Commissioner 3. Engaging in methods and practices in the conduct of business that endanger the legitimate interests of customers and the public 4. Not having enough financial resources to safeguard the interests of customers and the public 5. Failing to pay child support or to comply with subpoena or warrant 6. Providing false information in a statement submitted with the intermediary's application or at the time that the annual fee was paid 7. Changing state of residence (but the intermediary may be re-licensed by complying with the licensing requirements) 8. Failing to comply with CE requirements 9. Failing to pay delinquent taxes 10. Failing to pay a fee when due (The Commissioner will send to the mailing address and to the email address on file notice of fees due at least 60 days before the due date) - 5 years is the maximum time a licensee can be prevented from reapplying for licensure after revocation. If no time is specified in the revocation order, the intermediary cannot reapply for 5 years. - A disciplined person is any of the following: 1. An intermediary whose license is revoked or surrendered by order of the Commissioner 2. An affiliate of such an intermediary 3. A person in which such an intermediary has more than a 10% ownership interest 4. An agent or employee of such an intermediary - During the disciplinary period, the disciplined person may not be employed by, act as agent for, or be affiliated with, a person engaged in the business of an insurance intermediary. In addition, during the disciplinary period, no one is allowed to: 1. Pay or reimburse the expenses of the disciplined person for any services performed either by the disciplined person or anyone else as an intermediary 2. Seek or use information from the disciplined person to assist in the sale of insurance 3. Permit the disciplined person to be present at or assist in an insurance solicitation 4. Use an endorsement or referral from the disciplined person to solicit insurance

Continuing education requirements do not apply to:

- Any intermediary exclusively holding a limited line insurance license in the following lines: credit insurance, crop insurance, legal expense insurance, miscellaneous limited line, managing general agent, surety insurance, title insurance, or travel insurance - A nonresident intermediary whose state of residence grants similar exemptions to Wisconsin residents

Disciplinary Actions: Monetary Forfeiture

- Any intermediary whose license is suspended or revoked must pay all fees that would have been payable if the license had not been suspended or revoked, when the suspension ends or a new license is issued. If a resident individual intermediary's license is revoked for failing to pay fees, complete continuing education, or pay taxes, and the license is reinstated within 12 months without having to complete prelicensing education or examination requirements, the individual must pay twice the applicable license renewal fee.

Regulation of Specific Clauses in Insurance Contracts: Exemption From Mid-term Cancellation Requirements

- Any umbrella liability or excess liability insurance policy is exempt from the requirements for mid-term cancellations. - An insurer cancelling any umbrella liability policy or excess liability policy must notify the Commissioner of the grounds for such cancellation not later than the time at which the insurer notifies the policyholder. Insurers must provide notice to the insured at least 10 days after the 1st class mailing or delivery of a written notice to the policyholder. No mid-term cancellation of any war risks coverage contained in an aircraft insurance policy is effective until at least 7 days after the 1st class mailing or delivery of a written notice to the policyholder.

Who is the Commissioner required to refuse issuance of a license to?

The Commissioner is required to refuse to issue a license to an individual who fails to pay child support, fails to comply with a subpoena or warrant, or who is delinquent on state taxes.

Commissioner's General Duties and Powers: Duties

The Commissioner: - Administers and enforces the state insurance laws - Has rule-making authority, including the adoption of standards of the National Association of Insurance Commissioners (NAIC) or acting on a petition for rulemaking submitted by the public - Holds informal hearings and public meetings for the purposes of investigation, the ascertainment of public sentiment, or informing the public - Issues such prohibitory, mandatory, and other orders as are necessary to secure compliance with the law Generally, the Commissioner may revoke, suspend, or limit a permanent license of an intermediary or navigator only after a hearing and an opportunity for judicial review. However, an intermediary's or navigator's license may be suspended prior to a hearing if: - The Commissioner finds that public health, safety, and welfare requires emergency action - The intermediary or navigator fails to pay a fee when due - A person fails to comply with continuing education standards Any officer, manager, or general agent of any insurer must reply promptly to any written inquiry from the Commissioner.

Commissioner's General Duties and Powers: Wisconsin Insurance Security Fund

The Wisconsin Insurance Security Fund provides protection to policyowners and beneficiaries in the event of insurer impairment or insolvency. All insurers authorized to transact life and health insurance in Wisconsin are required to be members of the Fund. If a member insurer becomes impaired or insolvent, an assessment will be made against the other members to provide money for the claims of the insolvent insurer. The Fund's liability is generally limited to $300,000 for any one risk, loss, or loss of life. However, for property insurance, liability insurance, and disability insurance, the Funds may pay up to $500,000.

Company Regulation: Notice of Right to File Complaint

When a policy is issued, every insurer must provide notice to its policyholders and its insureds of the right to file a complaint with the insurer. Every insurer must disclose the insured's right to contact the Office of the Commissioner regarding an insurance problem. The notice must: - Include the issuer's address, toll free phone number (if available), and phone number in no less than 12-point type and bold print - Use no less than 10-point type for the body of the notice - Have the phrases "KEEP THIS NOTICE WITH YOUR INSURANCE PAPERS," "PROBLEMS WITH YOUR INSURANCE?" in Appendix I, and "The OFFICE OF THE COMMISSIONER OF INSURANCE" in Appendices I and 2, capitalized and in bold lettering

Regulation of Specific Clauses in Insurance Contracts: Cancellation

With a few exceptions, insurance policies can only be canceled early (that is, before their expiration date or less than one year from their effective date, whichever is sooner) for the following reasons: 1. Failure to pay a premium when it is due 2. Grounds for cancellation that are stated in the policy and included within the following classes: - Material misrepresentation - Substantial change in the risk assumed, except to the extent that the insurer should have reasonably foreseen the change or contemplated the risk in writing the contract - Substantial breaches of contractual duties, conditions, or warranties - Attainment of the age specified as the terminal age for coverage, in which case the insurer may cancel by notice accompanied by a pro rata return of the premium The only exceptions to this rule are: -New policies - Umbrella or excess liability policies - War risks coverage in an aircraft policy The permissible grounds for mid-term cancellation and the notice requirements just described do not apply to any new insurance policy that has been in effect less than 60 days at the time the notice of cancellation is mailed or delivered. No cancellation is effective until at least 10 days after the first class mailing or delivery of a written notice to the policyholder. This cancellation notice need not contain information about the grounds for cancellation unless it is a health insurance policy.

reinsurance intermediary-broker

a person who places ceded reinsurance and has an office in Wisconsin or places business in Wisconsin from an office outside the state and is not licensed as a reinsurance intermediary in that state

Company Regulation: readability

Insurance policy text must be readable and understandable, meeting the following standards: - The text must achieve a minimum score of 50 on the Flesch reading ease test for Medicare Supplement policies and a score of 40 for all other policies - The text must be printed, except for specification pages, schedules and tables, in not less than 10 point type, 1 point leaded - The policy must be appropriately divided and captioned, presented in a meaningful sequence, and contain a table of contents or an index of the principal sections if the policy contains more than 3,000 words or if the policy has more than 3 pages - Exclusions must be given at least equal prominence as other sections - The policy must define words and expressions that are not commonly understood The readability requirements do not apply to: - Any policy that is a security subject to federal jurisdiction - Any group policy, except it does apply to certificates issued pursuant to a group policy - Any group annuity contract serving as a funding vehicle for pension, profit sharing, or deferred compensation plans - Renewal policies whose terms are not altered in any way. Changes in premium, monetary limits, or language required by federal and state laws and regulations are not considered alterations of terms.

Producer Regulation: Proper Exchange of Business

No agent can properly exchange business with another agent, unless: - The agent forwarding the business is licensed for the lines of business that are being exchanged - The agent who receives the business and agrees to place it is licensed in the line or lines of insurance involved in the exchange - Both the agent forwarding the business and the agent who places the business sign the insurance application, or if no application is completed, the names of the agents involved in the transaction appear on the policy issued Agents are presumed to have exceeded the occasional exchange of business rules if they place more than 5 insurance risks per calendar year with any single insurer with which they are not listed as an agent, or exchange more than 25 insurance risks per calendar year.

Record Keeping, Maintenance, and Duration: assumed name

No intermediary or insurer may use any business name, slogan, emblem, or related device that is misleading or likely to cause the intermediary or insurer to be mistaken for another insurer or intermediary already in business

Company Regulation: use of policy forms

No policy form can be used unless it has been filed with and approved by the Commissioner. A policy form is deemed approved if it is not disapproved within 30 days after filing, or within a 30-day extension of that period ordered by the Commissioner prior to the expiration of the first 30 days. This process is called file-and-use. File-and-use does not apply to: - Health care coverage - Workers' Compensation - Medicare Supplement insurance - Long-term care insurance, including nursing home and home health care - Service contracts - Warranty contracts The Commissioner can by rule exempt certain classes of policy forms from prior filing and approval. The Commissioner can disapprove a form upon a finding that it is inequitable, unfairly discriminatory, misleading, deceptive, obscure, or encourages misrepresentation. Whenever the Commissioner finds, after a hearing, that a form approved or deemed to be approved should be disapproved, the Commissioner may order that on a date 30-90 days after the order, the use of the form must be discontinued or appropriate changes must be made.

General Statutes, Rules, and Regulations Affecting Insurance Contracts (continued) Misrepresentations/Warranties:

No statement, representation, or warranty made by a person other than the insurer or an agent of the insurer in the negotiation for an insurance contract affects the insurer's obligations under the policy unless it is stated in any of the following: - The policy - A written application signed by the person, provided that a copy of the written application is made a part of the policy by attachment or endorsement - A written communication provided by the insurer to the insured within 60 days after the effective date of the policy No misrepresentation and no breach of an affirmative warranty, made by a person other than the insurer or an insurer's agent in the negotiation for or procurement of an insurance contract, constitutes grounds for rescission of, or affects the insurer's obligations under, the policy. Exceptions are made for misrepresentations if the person knew or should have known that the representation was false, and if any of the following applies: - The insurer relies on the misrepresentation or affirmative warranty, and the misrepresentation or affirmative warranty is either material or made with intent to deceive - The fact misrepresented or falsely warranted contributes to the loss No misrepresentation and no breach of an affirmative warranty, made by a person other than the insurer or an insurer's agent in the negotiation for or procurement of an insurance contract, constitutes grounds for rescission of, or affects the insurer's obligations under, the policy. Exceptions are made for misrepresentations if the person knew or should have known that the representation was false, and if any of the following applies: The insurer relies on the misrepresentation or affirmative warranty, and the misrepresentation or affirmative warranty is either material or made with intent to deceive The fact misrepresented or falsely warranted contributes to the loss Except as otherwise provided, general contract law applies to mistakes in insurance contracts. Such a mistake does not constitute a defense for the insurance company unless the mistake was due to misrepresentation or concealment by the owner of the property or their representative, or unless the company would not have issued or continued the policy if it had known the truth.

General Statutes, Rules, and Regulations Affecting Insurance Contracts: Certificates of Insurance

No statement, representation, or warranty made by or on behalf of a particular certificate holder under a group life or disability insurance policy affects the insurer's obligations under the certificate unless it is stated in the certificate, or in a written document signed by the certificate holder, a copy of which is supplied to the certificate holder or the beneficiary whose rights would be affected.

Regulation of Specific Clauses in Insurance Contracts: Notice and Proof of Loss

Notice/proof of loss must be provided as soon as reasonably possible and within 1 year of the time required by the policy. Failure to provide notice or proof within this time period will not invalidate or reduce a claim unless it is established that the failure to be timely was due to carelessness or neglect on the claimant's part. The use of first-class mail with loss information and documentation contained in an envelope is sufficient method of notice. Specialized delivery agency (overnight, express) is not required. The Commissioner can approve reasonable policy clauses requiring the fastest delivery methods of notice. An insurer is not waiving its right to defend against a claim when it: - Acknowledges the receipt of notice or proof of loss - Furnishes the forms for filing proofs of loss - Accepts proofs of loss - Investigates a claim

Regulation of Specific Clauses in Insurance Contracts: Timely Payment of Claims

An insurer must promptly pay every insurance claim (except property & casualty and Workers' Compensation). A claim is overdue if not paid within 30 days after the insurer is furnished written notice of a covered loss and of the amount of the loss. If a written notice is not furnished to the insurer, any partial amount supported by the written notice is overdue if not paid within 30 days after a notice is furnished to the insurer. Any part or all of the remainder of the claim is overdue if not paid within 30 days after written notice is furnished. All overdue claim payments must include simple interest of 7.5% per year. When 2 or more policies promise to indemnify an insured against the same loss, no Other Insurance provisions of the policy may reduce the aggregate protection of the insured below the lesser of the actual insured loss suffered by the insured or the total indemnification promised by the policies if there were no Other Insurance provisions. In any insurance policy, an insurer may include a provision that no change in the policy is valid unless approved by an executive officer of the insurer, or unless the approval is endorsed or attached to the policy, or both. A provision may also be included stating that no agent has authority to change the policy or waive any of its provisions.

Producer Regulation: Compensation of Agents

An intermediary cannot accept compensation from an insured due to the insured's purchase of insurance unless the intermediary discloses the following: - The amount of compensation to be paid by the insured, excluding commissions paid by the insurer - If compensation will be paid by another source, the fact that the intermediary will also receive compensation from the other source A license is required to accept a commission, service fee, brokerage, or other valuable consideration for selling, soliciting, or negotiating insurance in this state. An insurer or producer cannot pay a commission, service fee, brokerage, or other valuable consideration to a person for selling, soliciting, or negotiating insurance in this state unless that person is licensed. The law does not prohibit the payment of deferred commissions to formerly licensed agents or brokers or their assignees.

Producer Regulation: Controlled Business

An intermediary cannot receive compensation from an insurer for controlled business (insurance on their own property, life, or other risk) unless they had aggregate premiums of other insurance with the same insurer that exceeded the premiums of their risks throughout the last 12 months.

What are some common examples of who is an intermediary?

An intermediary may be an individual agent, broker, or producer, or an entity such as a partnership or corporation

Life Settlement Brokers

A life settlement broker is a person who, for compensation, negotiates life settlement contracts between an owner and one or more buyers on behalf of the owner of a life insurance policy - The definition does not include an attorney or certified public accountant (CPA) who represents an owner and is not paid by the buyer. - Life settlement brokers must apply for a license annually, maintain professional liability insurance, and complete an initial life settlements training course of at least 8 hours

Life Settlement Providers

A life settlement provider is a person other than an owner that enters into a life settlement contract with an owner. - Life settlement providers must apply for a license annually and demonstrate evidence of financial responsibility in the amount of $250,000 through: 1. A surety bond 2. A deposit of cash, certificates of deposit, or securities

Managing General Agent

A managing general agent is a person who: - Acts as an agent for the insurer - Manages all or part of the insurance business of an insurer or manages a separate division, department, or underwriting office - Produces and underwrites in any one quarter or year an amount of gross direct written premium equal to 5% or more of the insurer's annual policyholder surplus - Adjusts or pays claims in any one quarter or year in excess of 3% of the insurer's latest annual policyholder surplus or negotiates reinsurance on behalf of the insurer

what is considered to be a material misrepresentation?

A material misrepresentation is an untrue statement made by an applicant that would influence a prudent insurer in determining whether to accept the risk or in fixing the amount of the premium in the event of such acceptance.

Producer Regulation Place of Business/Records Maintenance

Each intermediary must maintain, for at least 3 years, the following records: - Cash Receipts Record - Showing the name of the party who remitted the money, the date, and the reason for payment. - Cash Disbursed Record - Showing the name of the party to whom payment was made, date, and reason for payment. - Commission Statements - Showing the insured's name, policy number, premium, amount of commission, and date allocated or paid or both. - Policyholder Records - All records, applications, requests for changes, claims, and complaints associated with a policy generated by or through the intermediary. - Business Checking Account - Any account used by an intermediary for insurance-related transactions. - Personnel Records - Including dates of employment, position, description of principal duties, name of employee, and last known address and phone number of employee The intermediary must keep these records at their business address recorded with the Commissioner or at another location only if written notice of that location is provided to the Commissioner.

Regulation of Specific Clauses in Insurance Contracts: Renewal/Nonrenewal

A policyholder has the right to have their policy renewed, on the terms applied by the insurer to similar risks, for an additional period of time equal to the last term (if the last term was 1 year or less) or for 1 year (if the last term was longer than 1 year), subject to the statutory requirements for mid-term and anniversary cancellations. The policy must be renewed unless a notice of nonrenewal is mailed or delivered to the policyholder at least 60 days before the expiration date. To be effective, the notice of nonrenewal must state with reasonable precision the fact on which the insurer's decision is based. To effectively terminate coverage at renewal because the policyholder did not pay the renewal premium on time, the insurer must give written notice to the policyholder 10-75 days before the premium is due, and the notice must clearly state the effect of nonpayment of premium by the due date. An insurer may alter the terms or premium of a policy issued for a term longer than 1 year on the anniversary date only if notice of less favorable terms or the premium is delivered to the policyholder at least 60 days prior to the anniversary date. If the insurer notifies the policyholder, the new terms or premiums do not take effect until 60 days after the notice is mailed or delivered. This rule does not apply if the only change is a rate increase of less than 25% that either is generally applicable to the class of business to which the policy belongs or results from a classification change based on the altered nature or extent of the risk insured against. The insurer is prohibited from issuing or renewing a policy that is less favorable to the insured, or cancelling or nonrenewing a policy because of any accident that occurs in the course of the insured's business or employment, unless the policy covers the insured for liability that arises in the course of their employment or business. If a risk-sharing plan exists for the kind of coverage being cancelled, the notice of nonrenewal is not effective unless it contains adequate instructions to the policyholder on how to apply for coverage in the plan. This requirement does not apply if the ground for cancellation or nonrenewal is nonpayment of the premium or if the policy is in a mandatory health care liability risk-sharing plan.

Surplus Lines Agent or Broker

A surplus lines agent or broker is a person licensed to place insurance with unauthorized insurers - Unauthorized insurers may do business in the state if they meet the requirements for surplus lines insurance, but insureds must be notified that the issuing insurer does not have a certificate of authority to do business in the state - Domestic insurance corporations are authorized to provide surplus lines insurance in Wisconsin, subject to their own requirements - The Commissioner may prohibit certain insurers from issuing surplus lines insurance if they have violated the law or are not financially sound - While insurers may not advertise the availability of surplus lines insurance, agents and brokers may if they meet certain rules. - Generally, surplus lines cannot be written for types of coverage that the Commissioner finds an adequate and reasonably priced market among authorized insurers.

warranty:

A warranty is a statement made in an insurance contract by the insured when the validity of the insurance contract depends on the literal truth of the statement. The parties to the contract mutually intend that the policy will not be binding unless the statement is true.

Unfair Marketing Practices: False Advertising

Advertisements and representations must be truthful, and not misleading, and must accurately describe the policy to which they apply. In addition, the content, form, and method of dissemination of all advertisements, regardless by whom designed, created, written, printed, or used, are the responsibility of the insurer whose policy is advertised. Insurers must require agents to submit all proposed disability advertising to them prior to use.

Producer Regulation: Shared Commissions

Agents can forward insurance business to another licensed agent if, after due consideration, they cannot place the business with any of their listed insurers because of capacity problems or the refusal of the company to accept the risk. The agent forwarding the business is entitled to split the commission.

Unfair Marketing Practices: Refusal to Return Indicia of Agency

An agent cannot refuse or fail to return promptly all indicia of agency (signs, promotional materials, etc.) to the principal on demand.

insurance agent

An insurance agent is defined as an intermediary who is not a broker. - Agents act on behalf of insurers rather than insureds.

insurance broker

An insurance broker is an intermediary who procures insurance on behalf of an insured. - A broker does not act on behalf of the insurer, except in collecting premiums.

Any disclosure by an insurer of personal medical information must be consistent with the individual's signed disclosure authorization form, unless the disclosure satisfies any of the following:

- Is otherwise authorized by the individual, or by a person who is authorized to consent on behalf of an individual who lacks the capacity to consent - Is related to the protection of the insurer's interests in the assessment of causation, fault, or liability, or in the detection or prevention of criminal activity, fraud, material misrepresentation, or material nondisclosure - Is made to an insurance regulatory authority or in response to an administrative or judicial order, including a search warrant or subpoena - Is otherwise permitted by law - Is made for purposes of pursuing a contribution or subrogation claim - Is made to a professional peer review organization, bill review organization, health care provider, or medical consultant or reviewer for the purpose of reviewing the services, fees, treatment, or conduct of a medical care institution or health care provider - Is made to a medical care institution or health care provider for purposes of verifying coverage, audits, or coordination of health care under a network plan - Is made for purposes of enabling business decisions to be made regarding the purchase, transfer, merger, reinsurance, or sale of all or part of an insurance business - Is made for purposes of actuarial or research studies, accreditation, or auditing - Is made to the insurer's legal representative for purposes of claims review or legal advice or defense

The following course topics are examples of subjects that qualify for CE approval:

- Principles of property insurance - Principles of casualty insurance - Principles of life insurance - Principles of accident and health insurance - Estate planning/taxation - Ethics in insurance - Legal, legislative, regulatory matters in insurance - Wisconsin insurance code and administrative rules - Insurance policy contents - Proper use of insurance products - Accounting/actuarial considerations in insurance - Principles of risk management - Provisions/differences in insurance policy contracts - Tax laws (specifically related to insurance) - Wills and trusts - Multiple Employer Welfare Arrangements/Unauthorized Insurers - Legal structuring of life settlements - Legal relationships among the parties to a life settlement - Required disclosures and privacy requirements in life settlements - Ethical considerations in selling, soliciting, and negotiating life settlements - Life settlement contract requirements - Advertisements of life settlements - Life settlement remedies - Life settlement licensing requirements

Unfair Marketing Practices: rebating

- Rebating is the act of giving something of value to an applicant by the agent/broker in return for purchasing a life insurance policy. - Rebating is illegal. - This does not prohibit reducing premiums by reason of expense savings, including commission reductions, resulting from any form of mass marketing.

Personal medical information is information concerning an individual that:

- Relates to the physical health, mental health, medical history, or medical treatment of an individual - Is obtained from a health care provider, medical care institution, the individual, or the individual's spouse, parent, or legal guardian

Record Keeping, Maintenance, and Duration: renewal fees

- Renewal fees (regulation fees) are due on the last day of an intermediary's birth month every other year. - Renewal fees are $35 for resident agents and $70 for nonresident agents. - Surplus lines intermediaries must pay an annual renewal fee of $100.

In insurance marketing, an intermediary is a person who helps another do any of the following:

- Solicit, negotiate, or place insurance or annuities on behalf of an insurer or a client - Advise others about insurance needs and coverage

The Commissioner may reasonably require the following from any person subject to Wisconsin insurance law:

- Statements, reports, answers to questionnaires, and other information in whatever form and by whatever deadlines the Commissioner designates - Full explanation of the programming of any data processing system, computer, or any other information storage system or communication system in use

Record Keeping, Maintenance, and Duration: Temporary License

- The Commissioner can issue a temporary insurance producer license for a period not exceeding 12 months to a personal representative of a licensee who dies or becomes mentally disabled or to a person designated by an individual who is disabled or entering active military duty for the purpose of: 1. Winding up or selling the business 2. Pending the recovery of the licensee or return from active duty 3. Training new personnel for the business - The fees are the same as for a permanent license, and the temporary licensee can act in the same capacity as a permanent licensee and same line of insurance. - The Commissioner can require a temporary licensee to have a sponsor who is either a licensed intermediary or insurer, and who is willing to assume full legal responsibility of the temporary licensee's actions.

Company Regulation: Prohibition of Discrimination Based on Sex

It is an unfair trade practice for an insurer to: - Refuse or cancel coverage or deny benefits on the basis of the sex of the applicant or insured - Restrict, modify, or reduce the benefits, term, or coverage on the basis of the sex of the applicant or insured Examples of unfair trade practices prohibited by this rule are: - Denying coverage to women gainfully employed at home, employed part-time, or employed by relatives when coverage is offered to men similarly employed - Denying benefits offered by policy riders to women when the riders are available to men - Denying, under group contracts, dependent coverage to husbands of female employees, when dependent coverage is available to wives of male employees - Denying disability income coverage to employed women when coverage is offered to men similarly employed - Treating complications of pregnancy differently from any other illness or sickness under a contract - Restricting, reducing, modifying, or excluding benefits payable for treatment of the genital organs of only one sex - Offering lower maximum monthly benefits to women than to men who are in the same underwriting, earnings, or occupational classification under a disability income contract - Offering more restrictive benefit periods and more restrictive definitions of disability to women than to men in the same underwriting, earnings, or occupational classification under a disability income contract - Establishing different conditions by sex under which the policyholder may exercise benefit options contained in the contract

Unfair Marketing Practices: Unfair Discrimination

It is illegal to permit individuals of the same class to be charged different rates for insurance or to be given different terms of coverage. Insurers may not refuse to insure or charge a different rate to an individual based solely on mental or physical impairment. For example: - Refusing to insure or refusing to continue to insure; limiting the amount, extent, or kind of coverage available to an individual; or charging a different rate for the same coverage solely because of physical or mental impairment, except where the refusal, limitation, or rate differential is based on sound actuarial principles or is related to actual or reasonably anticipated experience - Refusing to insure or refusing to continue to insure; limiting the amount, extent, or kind of coverage available to an individual; or charging an individual a different rate for the same coverage solely because of blindness or partial blindness - Making or permitting any unfair discrimination between individuals or risks of the same class and of essentially the same hazards by refusing to issue, refusing to renew, cancelling, or limiting the amount of insurance coverage on a property or casualty risk because of the geographic location or age of the risk, unless the action is: 1. For a business purpose which is not a mere pretext for unfair discrimination 2. Required by law or regulatory mandate

Privacy of Consumer Information

Personal medical information does not include information that is obtained from the public records of a governmental authority and that is maintained by an insurer or its representatives for the purpose of insuring title to real property located in this state. An individual or their personal representative can have access to recorded personal medical information within 30 days of request. If an insurer receives personal medical information from a health care provider or a medical care institution with instructions restricting disclosure of the information, the insurer cannot disclose the personal medical information to the individual, but should disclose the identity of the health care provider or a medical care institution that provided the information to the individual. Persons who knowingly obtain information about an individual from an insurer or insurance support organization under false pretenses can be fined up to $25,000, imprisoned for up to 9 months, or both. They are liable to the individual for actual damages, plus exemplary damages of not more than $25,000, costs, and reasonable actual attorney fees. Other than to a consumer reporting agency, a licensee cannot disclose a policy number or account number to any nonaffiliated third party for use in telemarketing, direct mail marketing, or other marketing through electronic mail to the consumer. A licensee must retain the authorization (or a copy of the authorization) in the record of the individual who is the subject of nonpublic personal information. A licensee cannot unfairly discriminate against any consumer because that consumer has not granted authorization for the disclosure of their nonpublic personal information.

Company Regulation: Unfair Claims, Methods, and Practices

The following are considered acts constituting improper claim settlement practices: - Failing to promptly acknowledge communications pertinent to a claim - Failing to start and finish a claims investigation with reasonable speed - Failure to promptly provide necessary claims forms, instructions, and reasonable assistance to insureds and claimants - Failing to attempt to promptly and fairly settle claims in which liability is clear - Failing to promptly explain the denial of a claim or an offer of compromise in relation to the facts and applicable law - Misrepresenting to claimants pertinent facts or provisions in the insurance policy that relate to any coverage at issue - Failing to affirm or deny coverage on a claim within a reasonable time after receiving a proof of loss - Failing to promptly settle claims (where liability is clear) under one section of the policy coverage in order to influence settlements under other sections - Failure to offer settlement under applicable first-party coverage on the basis that responsibility for payment should be assumed by other persons or insurers - Compelling an insured to file suit by offering substantially less than what a lawsuit would award - Refusing to pay claims without conducting a reasonable investigation - Failure, where appropriate, to make use of arbitration procedures authorized or permitted under any insurance policy - Making known to claimants a policy of appealing arbitration awards that favor claimants, for the purpose of compelling them to accept a lesser settlement than that awarded - Failure to make provision for adequate staff, systems, and procedures to effectively handle claims - Failing to use reasonable standards in the prompt investigation of claims