Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 90 - Regulation 72-Commercial Lines Insurance Policy Form Deregulation › Section XIII-9015 - Disclosure Requirements and Certification Form

Current through Register Vol. 50, No. 6, June 20, 2024
A. When soliciting, negotiating or procuring
				a policy of insurance with an exempt commercial policyholder the agent or
				broker, or the insurer in cases of direct placement, shall disclose to the
				policyholder and the policyholder's risk manager, if any, on a form created by
				the insurer, that a policy form may be used which is exempt from the form
				filing requirements of the Louisiana Insurance Code.
B. When a policy of insurance is issued or
				delivered to an exempt commercial policyholder, the insurance agent or broker,
				or the insurer in cases of direct placement, shall obtain from the policyholder
				a written certification on the form prescribed below. The certification form
				must be in not less than 10-point type, and it must be dated and signed by a
				senior officer or manager of the policyholder and the policyholder's risk
				manager, if any.
Louisiana Certification of
Exempt Commercial Policyholder Status
Pursuant to Louisiana Regulation 72
The undersigned ________________________________, (the
				  Insured) certifies to ____________________________ (the Insurer) that the
				  Insured meets the criteria below and is an Exempt Commercial Policyholder under
				  Louisiana law. The Insurer may issue a commercial risk insurance policy to an
				  Exempt Commercial Policyholder without filing the policy form with the
				  Louisiana Department of Insurance and the Insurer by signing below certifies
				  that it has the necessary expertise to negotiate its own policy language. The
				  policy must still comply with Louisiana law, and complaints or questions about
				  compliance may be directed to the Louisiana Department of Insurance
				  (1-800-259-5300).
In order to be an Exempt Commercial Policyholder, the Insured
				  must:
1. Execute this Certification
				Form and return it to the Insurer.
2. Acquire the insurance policy through an
				insurance agent licensed in Louisiana.
3. Meet the following requirements:
__ Have and maintain aggregate annual commercial risk
				  insurance premiums, excluding workers compensation and employer's liability and
				  professional liability insurance premiums of more than two hundred thousand
				  ($200,000) dollars in the preceding fiscal year. In determining whether this
				  threshold has been met, premiums paid to one or more insurers are to be added
				  together to reach the total aggregate.
__ At the time the policy is issued the policyholder must
				  have (a) if a single company not less than fifty (50) employees; (b) if a
				  member of an affiliated group not less than one hundred (100) employees
				  collectively; (c) if a municipality a population of not less than fifty
				  thousand (50,000); and, (d) if a public entity an operating budget of not less
				  than twenty ($20,000,000) million dollars for the most recently completed
				  calendar or fiscal year whichever applies.
Signed:_______________________________________
Date:_________________________________________
Printed:_______________________________________
Title:_________________________________________
Risk Manager:_________________________________