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Wolters Kluwer Financial Services Identifies
Top 10 Criticisms on Insurance Market Conduct Exams
Helps Property/Casualty, Life/Health Insurers Prevent Noncompliance Violations
WALTHAM, Mass. – (June 27, 2007) – Wolters Kluwer Financial Services’ Insurance Compliance Solutions group has identified the top 10 reasons insurers are found to be out of compliance during market conduct exams. In order to help insurers avoid the noncompliance violations that are most prevalent in their business area, Wolters Kluwer Financial Services has provided top 10 lists for property and casualty insurance, as well as life and health insurance.
Wolters Kluwer Financial Services’ industry research shows that the top
10 most common market conduct compliance criticisms for property and
casualty insurance are:
- Failure to properly terminate a policy
- Failure to acknowledge, pay, or deny claims within specified time frames
- Using unapproved or unfiled rates
- Failure to communicate a delay in the settlement of claims in writing
- Failure to notify of producer appointments or terminations
- Improper documentation of underwriting policies
- Improper documentation of claims policies
- Using unapproved or unfiled forms
- Failure to produce requested records for an examination
- Failure to provide required disclosures (such as selection/rejection issues or notices in the claims process)
The top 10 most common criticisms for life and health insurance are:
- Failure to acknowledge, to pay, or deny claims within specified time frames
- Using unapproved or unfiled forms
- Failure to adhere to advertising requirements
- Failure to adhere to replacement requirements
- Failure to notify of producer appointments or terminations
- Using unapproved or unfiled rates
- Failure to adhere to grievance and appeals requirements
- Failure to provide required disclosures
(such as Explanation of Benefits or guaranty fund notices) - Improper documentation of claims policies
- Failure to properly terminate a policy
“Every department within an insurance organization—whether its claims, customer service, human resource or sales—is affected by compliance regulations,” said David Evans, general manager of Insurance Compliance Solutions at Wolters Kluwer Financial Services. “This means that insurers must identify potential risks before problems occur in order to protect their reputation and revenues, and most importantly, their customers.” Wolters Kluwer Financial Services reviews and analyzes the content in market conduct examinations from across the United States, assigning all of the criticisms to various categories. The categories with the most criticisms comprise the top ten lists, which are compiled to help insurers steer clear of noncompliance. “This research allows us to help insurers prevent costly mistakes,” explained Evans. “Market conduct exams can have a dramatic impact on an organization. By identifying the common problem areas, insurers can evaluate their compliance practices and educate their employees to help ensure their exams have positive outcomes.”
About Wolters Kluwer Financial Services
Wolters Kluwer Financial Services provides best-in-class compliance, content, and technology solutions and services that help
financial organizations manage risk and improve efficiency and effectiveness across their enterprise. The organization’s prominent brands
include Bankers Systems, VMP® Mortgage Solutions, PCi, GulfPak, Desert Document Services®, AppOne®, GainsKeeper®, CCH® Capital
Changes, NILS, AuthenticWeb™, Uniform Forms™ and CCH® Wall Street.
Wolters Kluwer Financial Services’ solutions include integrated and stand-alone compliance and workflow tools, documentation, analytics,
authoritative information and professional services. Customers include banks, credit unions, mortgage lenders, and securities and
insurance organizations of all sizes throughout the United States. For more information on Wolters Kluwer Financial Services, visit www.WoltersKluwerFS.com.
Wolters Kluwer is a leading global information services and publishing company. The company provides products and services globally
for professionals in the health, tax, accounting, corporate, financial services, legal and regulatory sectors. Wolters Kluwer has
annual revenues (2007) of €3.4 billion ($4.8 billion), maintains operations in over 33 countries across Europe, North America and Asia Pacific and employs approximately 19,500 people worldwide. Wolters Kluwer is headquartered in
Amsterdam, the Netherlands. Visit www.WoltersKluwer.com for information about our market positions, customers, brands and organization.
