Chapter 10 Insurance Regulation

Licensing

Insurance professionals must be properly licensed for a specific line of authority in order to transact insurance. The purpose of licensing is to ensure that a producer meets educational and ethical standards to fulfill producer's responsibilities to the

Producer

Insurance producer means an insurance agent, insurance broker, intermediary, excess lines broker, or any other person required to be licensed under the laws of this state to sell, solicit, or negotiate insurance.

Home State

means any state, district, or territory of the US in which a producer maintains his principal placer of residence or business and is licensed to act as an producer.

Negotiate

means the act of directly conferring with or offering advice to a purchaser or potential purchaser of a particular insurance contract
concerning any of the substantive benefits, terms or the conditions of the contract, provided that the person engaged in

Sell

or sale means to exchange the contract of insurance by any means, for money or its equivalent, on behalf of a licensed insurer, fraternal benefit society or HMO.

Solicit

means attempting to sell insurance or asking or urging people to apply for a particular type of insurance from a particular licensed insurer, fraternal benefit society, or HMO

Qualifications for an insurer license

1. be a resident of NY state
2. be at least 18
3. have no felony convictions
4. fulfill the prelicensing education requirement of classroom work or equivalent in correspondence work of similar instruction (20 hours a single line of authority agent or brok

Licensing Exam Exemptions

DO NOT HAVE TO TAKE THE WRITTEN EXAM
ticket selling agents or representatives (bus, train, or sea) for a one time issuance of baggage or accident insurance
Any individual whose license has been revoked or suspended (at the discretion of the Superintendent

Refuse to Issue a License

The Superintendent may refuse to issue any insurance agent's license if the proposed licensee is found not to be trustworthy and competent, or has not complied with any prerequistes.

Exemption from Licensing

An insurance producer license is not required of any officer, director, or employee of an insurer or organizations employed by insurers, provided that they are not directly or indirectly involved with the actual sale of an insurance contract and do not re

Types of Licenses

These types can be issued in NY State
Insurance Agent
Insurance Broker
Business Entity
Consultant
Adjuster
Non resident
Temporary

Insurance Agents

an individual who represents an insurance agency/company
The agent represents the insurer, not the insured
May work for multiple insurance companies

Insurance Broker

an individual who represents the insured , not the insurer and acts on the best interest of the insured

Consultants

Insurance consultants offer advice to the public about the benefits, advantages, and disadvantages of insurance policies for a fee.

Adjusters

An independent adjuster is any person, firm, or corporation, who, for a commission acts on behalf of an insurer in the work of investigating and adjusting claims. Works for the insurance company.

Public adjuster

a public adjuster is any person, firm, association or corporation, who for a commission, acts on behalf of the insured in negotiating a settlement or claim for loss or damage to property. Works for the insured.

Who is not a public adjuster

A public adjuster is not an employee, agent , broker or other representative of any insurer or attorney at law.

Needs of ALL adjusters

All adjusters must file and pay a surety bond of 1,000 to the Superintendent before a license is issued or renewed. A requirement of 15 hours continuing education must be completed before an adjuster's license may be renewed.

Non resident

a nonresident insurance agent or nonresident insurance broker is an individual who is a resident of another state, who is authorized to act as an agent or broker in the state of NY. If a person licensed in another state moves to NY and wants to become a r

Business entities

A business entity is a corporation, association, partnership, limited liability company, limited liability partnership or other legal entity. Before any original insurance agent's license is issued, the prospective licensee must apply to the Superintenden

Temporary

A temporary license may only be used to service existing business, not to solicit, negotiate, or procure new business.

Who is eligible for a temporary license?

The Superintendent may issue a temporary license to an agent or broker or both without requiring an examination, in the following cases:
To the surviving spouse, next of kin or court appointed personal representative of an agent who dies, or becomes menta

How long is the temporary license?

The temporary license may be issued for a term of not more than 90 days unless the Superintendent renews additional 90 day terms, not to exceed an aggregate of 15 months. In the case of military service, the temporary license may continue up to 60 days af

Renewal

Insurance agent 's or broker's license must be renewed every 2 years. On birthday of odd/even birth year. An agent must file an application for renewal of license with the Superintendent at least 60 days before the license expires. If submitted late, the

Continuing education

To renew a license, any resident or non resident must complete 15 hours of instruction by an approved provider of continuing education every 2 years. Excess credit hours accumulated during a 2 year licensing period cannot be carried over the next period f

Assumed names

Every licensee must notify the Superintendent upon changing of legal name. So if you name is Bob but every calls you Frank , Bob is on your license unless it is a legal name change.

Change of address

The department of insurance must be notified within 30 days of any change of address: residence, business, or email. 500 fine if not.

Reporting of Actions

A licensee must report any administrative action taken against him in another jurisdiction or state within 30 days of the final disposition of the matter. The report, filed with the Superintendent must include a copy of any relevant legal documents. 500.0

Superintendent

Doe not hold a license and is nominated by the Governor (nepotism) The Superintendent is appointed by the Governor and continues in office until the end of the Governor's term. The Superintendent has very broad powers, both expressed and implied with the

Superintendent notification

When the Superintendent grants an approval, authorization, permission or any other order that affects the insurer, insurance agent, or broker the order will not be effective unless it is in writing and signed by the Superintendent. The notice will be cons

Examination of Books and Records

The Superintendent may examine books and records of any insurer, any pension fund, retirement system, or organization authorized in the state of NY as often as deemed necessary for the protection of the public.

The Superintendent will make an examination of insurers as follows:

Every domestic fraternal benefit society and domestic property/casualty insurance company at least every 3 years. If the Superintendent determines that every 3 years is not necessary for property/casualty it can be changed to 5 years.
Every domestic life

Law and Regulations concerning records

An insurer must keep records for 6 years or until the filing of a review of record whichever is longer. Anything and all retentions 6 years.

Certificate of Authority

No person, firm, association, corporation, or joint stock company may conduct insurance business unless authorized by a Certificate of Authority, issued by the state. Certificate of Authority states that a company may do business in NY state. Penalty of 1

Solvency

An insurer is considered solvent if it has the assets to meet it financial obligations. The Superintendent makes sure that you are solvent and have money to continue business. Each entity transacting insurance in NY must file with the office of Superinten

Guaranty Association

The association will pay covered claims up to certain limits set by the law. The Association is funded by its members(through assessment). All authorized insurers, which are required to be the members of the Association, contribute to a fund to provide th

Unfair trade practice

to make any statement that an insurer's policies are guaranteed by the existence of the Insurance Guaranty Association. You can't tell an client to buy cheaper insurance because if that company goes under they are protected. But if a client asks about a c

Unfair Claims Settlement Practices

The following are improper claims practices if committed in conscious disregard to the law or is committed with such frequency as to indicate a general business practice to engage in that type of conduct:
Misrepresenting to insured pertinent facts or poli

Agent Appointment

Every insurer, fraternal benefit society or HMO in NY must file a certificate of appointment for its agents with the Superintendent. The certificate states that the appointed agent is trustworthy and competent to transact insurance business. To appoint an

Certificates of Appointment are valid

until the license is terminated by the appointing insurer after termination in accordance with the provisions in the agency contract
the license is suspended or revoked by the Superintendent or
the license is expired and is not renewed

Termination of an Agent Appointment

When an insurer or HMO terminates an agent's certificate of appointment, it must file a statement to the Superintendent within 30 days explaining the cause of termination and facts surrounding it. The insurer and HMO must also provide a copy of this notic

Insurer

appoints producer to act as agent and files notice of agent appointment and pays related fees with the Department of Insurance

Controlled business

Controlled business is any coverage written on a producer's own life, health, and or that of the producer's immediate family or business associates. No more than 10 percent of business can be on friends and family a year or 12 moths period.

Sharing Commissions

An insurer or fraternal benefit society may not pay commission to any person or organization that is not licensed in NY. Commissions may be split among agent/brokers provided that the agents and brokers are licensed with the same insurer for the designate

Fiduciary Responsibility

Agents, brokers and reinsurance intermediaries have a fiduciary relationship, a position of financial trust because they are handling money so they have financial responsibilities.

License Display

License has to be visible always on prominent display.

Commissions and Compensation

insurers and agents may not pay a commission or compensation to a person or organization not licensed in NY. anything of value example a vacation or dinner

Termination and Responsibilities of a producer

After producers receive the notice of termination, they have 30 days to file written comments concerning the content of notice with the Superintendent. The producer must also send a copy to the insurer at the same time.

Reporting

Any licensee that believes that fraudulent insurance transaction has taken place or is about to take place has 30 days from the point of determination to submit the transaction to the Superintendent.

Hearing

Because the Superintendent's role is to enforce insurance laws to protect the public if the Superintendent suspects an insurer or agent has committed a violation or is engaged in unfair trade practice the Superintendent may issue a statement of charges an

Hearing

At the hearing the aggrieved party has the opportunity to appear in person or by counsel
give evidence why an order shall not be made
inspect all documentary evidence and witnesses
obtain witnesses on the person's behalf
All hearings will be open to the p

Cease and desist

If the Superintendent finds that the licenses is in violation of an unfair method of competition, claim, act of practice, the Superintendent will issue a cease and desists. This means the person must stop doing whatever the Superintendent suspects is in v

Suspension, Revocation, and Non Renewal

Anything wrong concerning money or fraud signing someone's name lose your license. An individual, corporation, firm or association whose license has been revoked can not obtain any license for a period of one year after such revocation or if such revocati

Penalties

If a licensee is in violation of insurance licensing laws, the Superintendent may issue a penalty in lieu of revoking or suspending the person's license. The penalty may be up to 500 for each offense and up to 2500 aggregate for all offense. Unless the co

Prohibitions

In addition to any criminal liability, the Superintendent may levy a civil penalty up to 5,000 and the amount of the claim for each violation upon any person who committed fraudulent insurance act or knowingly and with the intent to defraud.

Aiding Unauthorized Insurer

Neither a person nor a corporation may act as an agent or broker for an insurer that is not licensed to solicit, sell, negotiate, or effect any insurance or annuity contract, or aid any such insurer in effecting any insurance transaction. Any person who v

Unfair and Prohibited Practices

It is considered an unfair trade practice to knowingly commit and unfair trade method of competition or to engage in such actions with enough frequency that the commission of unfair marketing practices indicates a general business practice.

Misrepresentation

It is illegal for an agent to show an incomplete comparison of policies to induce a presto to lapse, forfeit, or surrender a policy. example a 10 page document has to have all 10 pages. It is fraud and Insurance fraud is a felony.

False advertising

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