Testimony 

Before the Subcommittee on Oversight 

and Investigations, Committee on 

Financial Services, House of 

Representatives

United States General Accounting Office 

GAO

For Release on Delivery 

Expected at 3:00 p.m. EDT 

Tuesday, May 6, 2003 INSURANCE REGULATION 

Preliminary Views on 

States’ Oversight of 

Insurers’ Market Behavior 

Statement of Richard J. Hillman 

Director, Financial Markets and 

 Community Investment 

GAO-03-738T 
Page 1 GAO-03-738T 

Madam Chairwoman and Members of the Subcommittee: 

I appreciate the opportunity to provide you with preliminary observations 

from our work on state insurance regulators’ oversight of market activities 

in the insurance industry. As you know, Chairman Oxley requested that we 

review the market conduct activities of state insurance regulators. We are 

nearing completion of this work, and we plan to issue a report on this 

subject in the near future. 

As you requested, this testimony provides information on two important 

tools state insurance regulators use to oversee the market activities of 

insurance companies—market analysis and market conduct examinations. 

Market analysis is generally done in the state insurance departments. It 

consists of gathering and integrating information about insurance 

companies’ operations in order to monitor market behavior and identify 

potential problems at an early stage. Market conduct examinations, which 

are generally done on site, are a review of an insurer’s marketplace 

practices. The examination is an opportunity to verify data provided to the 

department by the insurer and to confirm that companies’ internal 

controls and operational processes result in compliance with state laws 

and regulations. My focus today is on (1) the states’ use of market analysis 

and examinations in market regulation, and (2) the effectiveness of the 

National Association of Insurance Commissioners’ (NAIC) efforts to 

improve these oversight tools and encourage the states to use them.1

To address these objectives, we collected data and interviewed officials 

from nine state insurance departments—Arkansas, California, Indiana, 

Maryland, Michigan, Missouri, New Mexico, Ohio, and Oregon, and at 

NAIC’s Kansas City Headquarters. We also reviewed NAIC’s past and 

current efforts to improve the market regulation program. We collected 

and analyzed data from NAIC on all states, including the number of 

licensed companies in each state, the number and types of examinations 

conducted, and the resources allocated to these activities. We also asked 

40 companies, 20 each from among the largest 300 property and casualty 

firms (based on direct written premiums) and the largest 300 life 

 1

The National Association of Insurance Commissioners is comprised of the insurance 

commissioners of the 50 states plus the District of Columbia, Puerto Rico, and the United 

States Territories. The commissioners promulgate model (recommended) laws and 

regulations for consideration by the states and provide support services for the state 

insurance departments. NAIC meetings also provide a venue for discussion of issues that 

are of interest to all. 
Page 2 GAO-03-738T 

companies (based on asset size) about their market conduct examination 

experiences between 1999 and 2001. Most of these companies are national 

companies, selling in most or all of the states. However, because our 

sample was not statistically valid, our results cannot be projected to all 

insurers. 

In summary, we found that while all states do some level of market 

analysis, few states have established formal market analysis programs to 

maintain a systematic and rigorous overview of companies’ market 

behavior and to more effectively identify problem companies for more 

detailed review. The way state insurance regulators approach and perform 

market conduct examinations also varied widely across the states. While 

NAIC has developed a handbook for market conduct examiners, states are 

not required to use it, and we found that it is not consistently applied 

across states. Moreover, the handbook is not intended to provide guidance 

for some important aspects of market conduct examinations—for 

example, how often examinations should be performed or what criteria 

states should use to select companies to examine. We also found that the 

number of market conduct examiners differed widely among states and 

that there were no generally accepted standards for training and certifying 

examiners. These differences make it difficult for states to depend on 

other states’ oversight of market activities. Most of the states that we 

visited told us that they felt responsible for regulating the behavior of all 

companies that sold insurance in their state. With anywhere from 900 to 

2,000 companies operating within each state, the pool of companies is 

simply too large for any one insurance department to handle. Attempts to 

do so are neither efficient nor effective. Moreover, since many states do 

not coordinate their examinations with other states, some large multistate 

insurance companies reported being examined by multiple states, while 

other companies were examined infrequently or never. 

We also found that since the mid 1970s, NAIC has taken a variety of steps 

to improve the consistency and quality of market conduct examinations. 

However, despite the NAIC’s long-standing efforts and some limited 

successes, progress toward a more effective process has been slow. 

Recently, NAIC has increased the emphasis it places on market analysis 

and market conduct examinations as regulatory tools that could improve 

states’ ability to oversee market conduct. With more consistent 

implementation of routine market analysis, states should be better able to 

use the resources they already have available to target companies 

requiring immediate attention. Also, by consistently applying common 

standards for market conduct examinations, states should be able to rely 

on regulators in other states for assessments of an insurance company’s 
Page 3 GAO-03-738T 

operations. These improvements should in turn increase the efficiency of 

the examination process and improve consumer protection by reducing 

existing overlaps and gaps in regulatory oversight. However, if NAIC 

cannot convince the various states to adopt and implement common 

standards for market analysis and examinations, current efforts to 

strengthen these consumer protection tools are unlikely to result in any 

fundamental improvement. 

While we focus on the states’ use of market analysis and market conduct 

examinations, market regulation includes several other important 

regulatory tools, including complaint handling and investigation, policy 

rate and form review, agent and company licensing, and consumer 

education. Most states have functioning programs addressing each of 

these four regulatory areas. Ideally, all regulatory tools, including market 

analysis and market conduct examinations, should work together in an 

integrated and interrelated way. 

In the absence of generally accepted standards, individual states decide 

how they will do market analysis and perform market conduct 

examinations. While all states do market analysis in some form, few have 

established formal programs that look at companies in a consistent and 

routine manner. States also have no generally agreed upon standards for 

how many examinations to perform, which companies to examine and 

how often, and what the scope of the examination should be. As a result of 

the lack of common standards for market analysis and the lack of 

consistency in the application of the guidelines for examinations, states 

find it difficult to depend on other states’ oversight of companies’ market 

behavior. 

NAIC and some states have a growing awareness that better market 

analysis can be a significant tool for monitoring the marketplace behavior 

of insurance companies and deciding which insurers to examine. All states 

perform some type of market analysis. In many states, however, it consists 

largely of monitoring complaints and complaint trends; and reacting to 

significant issues that arise. Three states that we visited—Missouri, Ohio, 

and Oregon—have established a proactive market analysis program. These 

programs for market analysis have established processes for monitoring 

company behavior to identify trends, companies that vary from the norm 

(outliers), and potential market conduct problems. In general, an 

Lack of General 

Agreement on 

Standards for Market 

Analysis and Market 

Conduct 

Examinations Results 

in Wide Variations 

Among States 

Few States Do Systematic 

and Routine Market 

Analysis 
Page 4 GAO-03-738T 

established program would have dedicated staff and protocols for 

gathering data and conducting analysis at the department offices. 

Each of the three states with an analysis process that we visited 

approached market analysis in a different way. Ohio’s program consisted 

of special data calls to obtain extensive information from selected 

company files, and using computerized audit tools to analyze specific 

aspects of companies’ operations relative to norms identified by peer 

analysis and to state law. For example, Ohio did 184 “desk audits” in 2001 

using data requested from companies doing business in the state.2

 Missouri 

relied on routinely collecting market data from all licensed companies. 

Missouri has developed a market data report that companies submit as a 

supplement to their annual financial reports. This data is then used to 

evaluate market trends and conditions, as well as to identify individual 

companies that were outliers. Oregon’s newly established program 

involved maintaining files on companies in which all available data was 

collected to facilitate a broad and ongoing review of company behavior. 

Both Ohio and Oregon told us that their market analysis programs were 

still in an experimental stage of development. 

When properly done, market analysis can allow states to focus attention 

on the high-risk companies rather than selecting companies for 

examination based primarily on criteria such as market share, which does 

not directly correlate to market behavior problems. Missouri officials 

added that market analysis is not a substitute for market conduct 

examinations but should interact and be integrated with the examination 

process. 

Each state has between 900 and 2,000 licensed insurance companies. 

Because in general states do not currently depend upon other states’ 

regulation of companies’ market behavior, most states feel a responsibility 

for overseeing all the companies selling in their state.3

 The impossibility of 

examining so many companies requires regulators to identify and 

 2

A desk audit involves a review of company files at the department without physically going 

to the company. 

3

Not all licensed companies in a state are actively selling insurance. For example, some 

companies with existing business may be going out of business although still servicing 

existing customers (in run-off) or in liquidation. These companies may still have some 

active policies in the state, but are not selling any new business. 

We Found Variations in the 

Way States We Visited 

Performed Examinations 
Page 5 GAO-03-738T 

prioritize which companies they will examine. The states we visited used a 

variety of factors to choose companies for a market conduct examination. 

The most commonly used factors for choosing from among the companies 

deemed eligible for a market conduct examination were complaints, 

market share, and time since the last examination. 

Some states chose to do market conduct exams for only a subset of 

licensed companies, even though other companies could comprise a 

majority of the insurers selling in the state.4

 For example, of the states we 

visited, Arkansas focused primarily on domestic companies—that is, on 

companies chartered in their state. In Arkansas, 245 of 1,668 licensed 

companies in 2001 were domestic. As a consequence, 1,423 non-domestic 

companies, or 85 percent of all the companies licensed in Arkansas in 

2001, were not examined in Arkansas in spite of the fact that they may or 

may not have been examined by some other state. 

All the states we visited limited the scope of their examinations to 

customers from within their particular state. That is, examiners looked 

only at files of state residents. Moreover, most states further limited the 

scope of their examinations by focusing on only one or a few of a 

company’s area of operations. While some states still do comprehensive 

market conduct examinations, the trend is to conduct targeted 

examinations of limited scope and in a specific area of concern. State 

officials we interviewed indicated that targeted examinations are being 

used more often because these examinations do not take as long as 

comprehensive examinations, allowing states to conduct more. Of the 9 

states we visited, Arkansas, Missouri, and New Mexico continued to 

conduct some comprehensive examinations as well as targeted 

examinations. 

Arkansas officials told us that they believed comprehensive examinations 

were important because such examinations provided the greatest 

assurance that companies were complying with insurance laws and 

regulations. According to NAIC, 49 states and the District of Columbia 

reported performing some market conduct activities in 2001. Of these, 15 

completed only targeted examinations, 4 did only comprehensive 

examinations, and 22 completed some of both types of examination. The 

 4

States generally have the authority to do a market conduct examination on any company 

that sells insurance in the state. 
Page 6 GAO-03-738T 

remaining nine did not complete any market conduct examinations in 

2001. 

The requirements for and level of training for examiners also varied widely 

among the states. Each of the states we visited provided some type of 

training for their examiners. However, there are no generally accepted 

standards for what constitutes adequate training for a market conduct 

examiner across the states. Several levels of certifications for market 

conduct examiners are available, but only 2 of the states we visited, 

Oregon and New Mexico, required their examiners to certify or become 

certified in a specified period. 

As can be seen in table 1, there is considerable variation in the number of 

examinations completed in 2001 by the states we visited. Variation in the 

number of examinations consistent with the size of the insurance market 

would be expected. However, as shown in the table, the number of 

examinations completed bore little relationship to the size of the 

insurance market in each state. This comparison should not necessarily be 

taken as an indicator of the relative regulatory performance of the nine 

states we visited, because during another year the ranking of the states 

could be different. However, together with the variations in how states 

select companies for examinations and how they do them, this added 

variability helps further explain why the states may be reluctant to depend 

on other states to examine companies selling insurance to their citizens. 

States Vary in the 

Emphasis Given to Market 

Conduct Examinations 
Page 7 GAO-03-738T 

Table 1: Market Conduct Examinations Completed in 2001 Relative to Various Measures of the Size of the Insurance Market in 

Each State 

State 

Market conduct 

examinations 

 completed in 2001 

Total premium volume 

in 20011

 ($ in millions) 

Total number of 

licensed agents and 

brokers in 2001 

Estimated state 

population in 2001

(In thousands)

California 80 95,368 220,506 34,600

Ohio 5 39,663 154,100 11,390

Michigan 02 37,840 86,739 10,006

Missouri 29 20,656 91,695 5,637

Maryland 26 20,517 72,039 5,386

Indiana 43 19,208 83,277 6,127

Oregon 15 10,750 46,573 3,473

Arkansas 194 6,919 41,268 2,695

New Mexico 8 6,045 28,910 1,831

Sources: State Insurance Departments. 

 NAIC’s 2001 Insurance Department Resources Report. 

 U.S. Census. 

Note: Does not include follow-up exams or desk audits. 

1

Total premium volume for life, health, and property/casualty insurance. 

2

Michigan did a limited review of market conduct issues as part of its 37 financial examinations. 

3

Three of these were multistate examinations. 

4

Arkansas also examined 65 funeral homes that sold prepaid funeral insurance. 

In addition to the variation in examinations completed, some states have 

dedicated very few resources to market analysis and market conduct 

examinations. NAIC’s 2001 Insurance Department Resources Report does 

not even break out department staff assigned to market analysis, although 

financial analysts are separately identified. In addition, 14 states, or 27 

percent, did not report having any market conduct examiners on staff, 

although 4 of the 14 did report using full-time contract examiners. Ten 

states, or nearly 20 percent of all states, did not report having any market 

conduct examiners at all. 

Our review of the nine states indicated that the practice of sharing 

examination information with other states, when it occurred, varied 

substantially from state to state. Some states coordinate their examination 

plans with other states or review other states’ examination reports prior to 

going into a company, while other states do not. Even in states where 

some coordination occurs, other states’ examination results do not 

generally affect examination plans. Oregon officials told us that there is a 

need for more interstate collaboration and reliance on examination results 

from other states. More coordination of market conduct examination 

Interstate Coordination 

and Communication Is 

Inconsistent and 

Infrequent 
Page 8 GAO-03-738T 

plans, efforts, and results could improve regulation and, at the same time, 

reduce the regulatory burden on companies. Many insurance companies, 

particularly the largest ones, report that they undergo frequent, sometimes 

simultaneous, market conduct examinations. We asked 40 of the largest 

national insurance companies to provide information about their market 

conduct examination experience for the years 1999 to 2001. Of the 25 

companies that responded, 19 were examined a total of 130 times by 

multiple insurance regulators during the 3-year period. Six were examined 

once or twice during the period, and just over half the responding 

companies were examined between one and five times. However, three 

companies were each examined 17 or more times during the 3 years, with 

one company receiving 20 examinations—an average of seven nearly every 

year.5

These results appear to be consistent with concerns expressed by the 

insurance industry about excessively frequent and possibly duplicative 

market conduct examinations. One of the most common complaints from 

the 25 insurers that responded to our questionnaire was that states did not 

coordinate their examinations with other states. Some companies reported 

that, on occasion, multiple states had conducted on-site examinations at 

the same time. The companies told us that such examinations create 

difficulties for them and limited the resources they had available to assist 

the examiners. For example, one insurer wrote, “It takes an insurer a 

tremendous amount of effort to prepare for and deal with individual state 

insurance department’s exams (every one is different, plus states generally 

do not accept others exams in place of another similar exam being done). 

The duplication of effort is wasteful by the states.” 

In contrast, six companies, or nearly one-quarter of those responding, had 

not been examined by any state during the period. Of these six companies, 

two were last examined in 1997 and the other four did not report having 

any market conduct examinations. These companies—like others that 

reported—are large multi-state insurance companies. Since in many states 

a primary criterion for selecting a company for examination is market 

share, these responses suggest that the proportion of medium-size and 

small insurers that rarely, if ever, receive a market conduct examination 

may be much higher. 

 5

We did not verify the companies’ responses with state regulators. Moreover, we have no 

basis for evaluating the states’ reasons for selecting specific companies to examine. 
Page 9 GAO-03-738T 

Groups of states, as well as NAIC, have taken actions to improve the 

coordination and efficiency of the market conduct examination process. 

One effort involves improving the sharing of examination information by 

providing notice of upcoming examinations and sharing results through 

NAIC’s Examination Tracking System. However, the Examination 

Tracking System is incomplete and often ignored by the state regulators, in 

part, because it has been inconvenient and difficult to use for scheduling 

and reporting the results of market conduct examinations. As a result, 

states are not fully utilizing the system. NAIC’s survey of states’ use of the 

Examination Tracking System concluded that no more than 66 percent of 

the states, or 36 states, consistently reported their market conduct or 

combined market conduct/financial examination schedules to NAIC. 

Moreover, only 31 percent of the states reported back to NAIC when the 

examination had been completed. 

Another avenue of coordination being pursued by NAIC and some states is 

joint, or collaborative, examinations. Based on our review of nine states 

and of NAIC information, some states do conduct collaborative 

examinations. For example, Ohio officials told us that they had started to 

conduct collaborative examinations with Illinois, Nebraska, and Oregon. 

Indiana officials indicated that they had recently completed an 

examination of a large insurer jointly with another state. Such efforts, 

however, have not been consistent among states, nor is there a policy or 

standard procedure about when or how such examinations should occur. 

Furthermore, while collaborative examinations could reduce the total 

number of duplicative exams and may result in somewhat more efficient 

use of regulatory resources, they still require that each state send 

examiners into the company. In effect, collaborative examinations are a 

way for multiple states to do a market conduct examination of a company 

at the same time. Such an examination may be to the benefit of the 

company. However, if each state’s examiners still ask for samples of files 

for only their own state’s insurance consumers, the benefit may be 

reduced. 
Page 10 GAO-03-738T 

The NAIC identified the need for uniformity in market conduct regulation 

as early as the 1970s. Since then NAIC has launched a number of market 

conduct efforts intended to identify and address the issues and concerns 

caused by the lack of uniformity in states’ market conduct examination 

processes, and more recently in the market analysis area. Although 

progress has been slow in establishing more uniformity in market conduct 

regulation, NAIC has had some successes. One of the earliest was the 

development of the market conduct examination handbook containing 

guidance on conducting and reporting examination results. In general, 

most states use the handbook as an examination guide, but they can still 

choose not to follow the handbook in an examination or to modify it. For 

example, although the handbook lays out the steps for conducting an 

exam, such as notice of an exam, use of sampling techniques, and 

preparation of an examination report, each state can go about those steps 

differently. Moreover, the handbook in not intended to cover some aspects 

of examinations, including examination frequency and company selection 

criteria. 

One challenge to establishing voluntary uniform national standards for 

examinations and examination processes is that states are free to adopt 

the NAIC’s model laws, regulations, and procedures; to modify them to 

meet their perceived needs and conditions; or even to ignore them 

entirely. Once NAIC as an organization agrees on recommendations that 

would create more uniform regulatory statutes, two additional challenges 

to uniformity remain. First, when proposed changes affect state law, state 

legislatures must approve the recommendations without significant 

changes. Second, each state insurance department must successfully 

implement the recommendations. These challenges to establishing 

voluntary uniform national standards for examinations can clearly be seen 

in the number of states adopting the model laws and regulation that NAIC 

identified in 1995 as the essential elements for a market conduct 

examination program. By 2003, only nine models had been adopted by 

more than half the states, while two models had been adopted by five or 

fewer states. 

Achieving uniformity in market regulation will be a difficult process for 

NAIC and the states. However, a similar problem that existed in solvency 

regulation over a decade ago was solved by creating the Financial 

Regulation Standards and Accreditation Program. The program’s overall 

goal was to achieve a consistent, state-based system of solvency regulation 

throughout the country. The program was designed to make monitoring 

and regulating the solvency of multistate insurance companies more 

consistent by ensuring that states adopt and adhere to agreed-upon 

NAIC Has Identified 

Market Analysis and 

Examinations as 

Areas Needing 

Significant 

Improvement 
Page 11 GAO-03-738T 

standards, which establish the basic recommended practices for an 

effective regulatory department. To be accredited, states had to show that 

they had adopted specific solvency laws and regulations that protected 

insurance consumers, established defined financial analysis and 

examination processes, and used appropriate organizational and 

personnel practices. While the quality of regulation is still not consistent, 

the Accreditation Program has improved financial regulation across the 

states. As a result, states are now willing, in most cases, to depend on the 

solvency regulation of other states. 

While the process used by state insurance regulators to oversee solvency 

could provide a model for oversight of market conduct as well, there are 

structural differences in market regulation that will undoubtedly affect the 

ultimate design of an improved market conduct oversight system. These 

differences will have to be addressed by NAIC and the states in order to 

move forward. First, market conduct oversight involves many different 

activities and operations of insurance companies. This fact has broad 

implications for regulatory consistency and mutual dependence, including 

requirements for the necessary training of market conduct examiners and 

analysts. 

Second, regulators told us that life insurers tend to use a company-wide 

business plan and organizational structure. That is, a life company’s 

operations tend to be relatively consistent across the entire company. 

Property-casualty insurers, on the other hand, tend to use a regional 

business model and organizational structure. As a result, a propertycasualty insurer’s operations could differ, perhaps substantially, from 

region to region. Clearly, the life insurer model is more directly amenable 

to domiciliary-state oversight than the property-casualty model. However, 

any regional or state-by-state variances in a company’s operations and 

procedures would reduce the effectiveness of domiciliary-state oversight. 

Some aspects of market conduct oversight will always be state (or region) 

specific because of the differences between life and property-casualty 

insurers, but also because there will always be differences between some 

of the specific laws and requirements of individual states. As a result, even 

when greater uniformity of regulatory oversight is achieved, it is likely that 

states will always have to devote some attention to the activities of 

insurers not domiciled in their state. Nevertheless, if a state insurance 

department knew that the domiciliary state was doing consistent market 

oversight on the company with agreed-upon processes, appropriate scope, 

and well-trained examiners and analysts, the level of attention needed, 

even for a property-casualty company, could be substantially lessened. 

Finally, even to the extent that properly designed and competently 
Page 12 GAO-03-738T 

performed market conduct oversight can effectively monitor and regulate 

insurance company practices, it will extend to the sales practices of 

insurance agents only to the extent that the company takes responsibility 

for and exercises control of the behavior of the agents that sell its 

products. 

In the current environment of market regulation, most insurance 

regulators believe they need to oversee the market behavior of all 

companies selling insurance in their state because they cannot depend on 

the oversight of the other states. State regulators think this way in part 

because important elements of market regulation are characterized by a 

lack of even the most fundamental consistency. Formal and rigorous 

market analysis is in its infancy among state regulators, and whether, 

when, and how states do market conduct examinations vary widely. As a 

result, state regulators are now using the resources that they have in the 

area of market analysis and examinations inefficiently. Regulators from 

different states examine some insurers often, while other insurers are 

examined infrequently or not at all. More importantly, because market 

analysis is weak, regulators may not be finding and focusing on the 

companies that most need to have an examination. 

We support the goal of increasing the effectiveness of market conduct 

regulation through the development and implementation of consistent, 

nationwide standards for market analysis and market conduct 

examinations across the states in order to better protect insurance 

consumers. The emphasis placed on these issues by NAIC has increased 

substantially over the last 3 years. We believe that NAIC has taken a first 

step in the right direction. Much work, however, remains, as NAIC and the 

states have not yet identified or reached agreement on appropriate laws, 

regulations, processes, and resource requirements that will support the 

goal of an effective, uniform market oversight program. Such a program, 

consisting of strong market analysis and effective market conduct 

examinations, will facilitate the development of an atmosphere of 

increasing trust among the states. However, at present it remains 

uncertain whether the NAIC and the states can agree on and implement a 

program that will accomplish this goal. 

Madam Chairwoman, this concludes my statement. I would be pleased to 

answer any questions you or other members of the subcommittee may 

have at this time. 

Preliminary 

Observations 

(250141) 
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