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Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 179 - Regulation 118-Requirements in the Event of a Declared Emergency › Section XIII-17913 - Benefits, Entitlements, Protections and Applicable Parishes

Current through Register Vol. 50, No. 6, June 20, 2024
A. The benefits,
				entitlements and protections of the Emergency Rule shall be applicable to
				insureds, policyholders, members, subscribers, enrollees and certificate
				holders (hereinafter "insureds") who, as of 12:01 a.m. on the effective date of
				the Emergency Rule, have an insurance policy, insurance contract, or
				certificate of coverage for any of the kinds of insurance enumerated in §17915,
				as delineated below, and who meet one of the following criteria.
1. Any person who, as of the effective date
				of the Emergency Rule, resided in the geographic area specified in the
				Emergency Rule. Said person is entitled to the protections of the Emergency
				Rule for the kinds of insurance enumerated in §17915.A and B.
2. For the kinds of insurance enumerated in
				§17915 B, any person whose primary place of employment was in, or whose
				permanent employer had assigned said person to a business located in the
				geographic area specified in §17913.A 1, shall be eligible for the benefits,
				entitlements and protections of the Emergency Rule if said person verifies such
				employment status by written documentation to his health insurance issuer. No
				health insurance issuer shall unreasonably withhold eligibility to insureds
				upon receipt of such written documentation.
3. For the kinds of insurance enumerated in
				§17915 A, any insured who does not reside in the geographic area specified in
				§17913.A 1, but has filed with an authorized insurer or surplus lines insurer a
				notice of loss on a property claim for damage caused by the disaster or
				emergency and its aftermath to property located in the geographic area
				specified in §17913 A, shall be entitled to contact the insurer and request the
				benefits, entitlements, and protections of the Emergency Rule. These insurers
				are directed to work with their insureds who have filed a notice of loss on a
				property claim for damage caused by the disaster or emergency and its aftermath
				and provide accommodation as applicable, relevant and appropriate.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 179 - Regulation 118-Requirements in the Event of a Declared Emergency › Section XIII-17915 - Applicability and Scope

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				Emergency Rule shall apply to any and all kinds of insurance set forth in
				R.S.
				22:47, including, but not limited to, life,
				vehicle, liability, workers' compensation, burglary and forgery, fidelity,
				title, fire and allied lines, steam boiler and sprinkler leakage, crop, marine
				and transportation, miscellaneous, homeowners', credit life, credit health and
				accident, credit property and casualty, annuity, surety, and industrial fire.
				The applicability of the Emergency Rule to health and accident insurance is
				specified in §17915 B
B. The
				Emergency Rule shall apply to any and all kinds of health and accident
				insurance, including, but not limited to, group and individual health and
				accident insurance, limited benefit insurance, Medicare supplement insurance,
				Medicare select insurance, HMOs, PPOs, MCOs except those subject only to
				licensure and financial solvency regulation pursuant to
				R.S.
				22:1016, excess loss insurance, stop loss
				insurance, disability income insurance, short-term health insurance, long-term
				care insurance, and any and all other health insurance.
C.
									Sections 17917 & C of the
				Emergency Rule shall apply to only those kinds of insurance provided for in
				§17915.A and those types of insurers specified in §17913 B
D.
									Sections 17925 A, 17943, 17945, and 17947 of the Emergency Rule shall apply only to
				those kinds of insurance provided for in §17915.B and those health insurance
				issuers specified in §17913 C
E.
				All provisions of the Emergency Rule not expressly limited in §17915.C and D
				shall apply to all types of insurers and all kinds of insurance as defined in
				§17913 and §17915
F. Nothing in
				§17915 shall be interpreted to apply the provisions of the Emergency Rule to
				policies of insurance issued for the benefit of insureds not subject to the
				benefits, entitlements, and protections enumerated in §17913
AUTHORITY
				  NOTE: Promulgated in accordance with
				  R.S.
				  22:11(C).
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 179 - Regulation 118-Requirements in the Event of a Declared Emergency › Section XIII-17917 - Cancellation, Nonrenewal, and Nonreinstatement

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Emergency Rule hereby suspends any
				notice of cancellation, notice of nonrenewal, nonreinstatement or any other
				notice related to any of the types of insurance enumerated in §17915 that was
				in force and effect at 12:01 a.m. on the effective date of the Emergency Rule,
				and any such notice shall be null and void and have no force or effect.
				Furthermore, any such notice shall be reissued de novo to the insured in
				accordance with existing statutory requirements after the expiration of the
				Emergency Rule.
B. Insurers may
				issue a notice of cancellation for nonpayment of premium during the pendency of
				the Emergency Rule. When any such notice is issued during the pendency of the
				Emergency Rule, the applicable notice period required by statute or the policy
				may begin to run, but in no event may the insurer cancel the insurance policy
				for nonpayment of premium until after the expiration of the Emergency
				Rule.
C. No policy shall be
				cancelled or nonrenewed solely because of a claim that is filed during, or is
				caused by, the disaster or emergency or its aftermath.
D. Unless otherwise expressly authorized in
				writing by the commissioner, the cancellation, nonrenewal or nonreinstatement
				of any insurance policy related to any of the types of insurance enumerated in
				§17915 is hereby suspended and shall not be allowed until after the expiration
				of the Emergency Rule as provided for in §17961
E. All cancellation, nonrenewal, or
				nonreinstatement provisions, including, but not limited to,
				R.S.
				22:272,
				22:887,
				22:977,
				22:978,
				22:1068,
				22:1074,
				22:1266,
				22:1267,
				and
				22:1335
				are hereby suspended, except to the extent such provisions apply to acts or
				practices constituting fraud or intentional misrepresentations of material
				fact.
F. As set forth in §17949,
				the Emergency Rule shall not prevent an insurer from cancelling or terminating
				an insurance policy for fraud or material misrepresentation on the part of the
				insured.
G. Any temporary
				postponement of cancellation or nonrenewal pursuant to the Emergency Rule shall
				not remain in effect beyond 60 days unless presented by the commissioner to the
				Senate Insurance Committee and House Insurance Committee for review and
				approval by either committee prior to any extension.
AUTHORITY
				  NOTE: Promulgated in accordance with
				  R.S.
				  22:11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 179 - Regulation 118-Requirements in the Event of a Declared Emergency › Section XIII-17919 - Renewal

Current through Register Vol. 50, No. 6, June 20, 2024
A. The renewal
				conditions of all kinds of insurance enumerated in §17915 that are subject to
				renewal after the effective date of the Emergency Rule are suspended and shall
				be deferred until the expiration of the Emergency Rule as provided for in
				§17961 All policies subject to renewal after the effective date of the
				Emergency Rule shall continue in full force and effect at the previously
				established premium until the expiration of the Emergency Rule as provided for
				in §17961 The previously established premium for renewals by authorized
				insurers shall be based on the rate structure, rating plan and manual rules
				that are approved by the commissioner, regardless of whether their effective
				date was before or during the Emergency Rule. The previously established
				premium by authorized insurers for renewals of commercial deregulated insurance
				policies shall be based on the rate structure, rating plan and manual rules set
				forth in any filing submitted to the commissioner before or during the
				Emergency Rule.
AUTHORITY
				  NOTE: Promulgated in accordance with
				  R.S.
				  22:11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 179 - Regulation 118-Requirements in the Event of a Declared Emergency › Section XIII-17921 - Written Request for Cancellation by Insured

Current through Register Vol. 50, No. 6, June 20, 2024
A. Except as provided for in §17949 herein, a
				cancellation shall not occur prior to the expiration of the Emergency Rule
				unless upon the documented written request or written consent of the insured.
				This written consent may be in electronic format.
AUTHORITY
				  NOTE: Promulgated in accordance with
				  R.S.
				  22:11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 179 - Regulation 118-Requirements in the Event of a Declared Emergency › Section XIII-17923 - New Policies

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				Emergency Rule shall not apply to any new insurance policy for any of the kinds
				of insurance enumerated in §17915 if said insurance policy is issued on or
				after the effective date of the Emergency Rule.
AUTHORITY
				  NOTE: Promulgated in accordance with
				  R.S.
				  22:11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 179 - Regulation 118-Requirements in the Event of a Declared Emergency › Section XIII-17925 - Claims Notification

Current through Register Vol. 50, No. 6, June 20, 2024
A. All
				claims notification procedures, including, but not limited to,
				R.S.
				22:975(A)(3)-(5), Regulation
				33, and Regulation 74, are suspended.
AUTHORITY
				  NOTE: Promulgated in accordance with
				  R.S.
				  22:11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 179 - Regulation 118-Requirements in the Event of a Declared Emergency › Section XIII-17927 - Premium Offset

Current through Register Vol. 50, No. 6, June 20, 2024
A. All insurers
				subject to the Emergency Rule receiving a claim from an insured owing a premium
				may offset the premium owed by the insured against any claim payment made to
				the insured under the insurance policy. §17927 shall not apply to health
				insurance issuers as defined in §17913.C
AUTHORITY
				  NOTE: Promulgated in accordance with
				  R.S.
				  22:11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 179 - Regulation 118-Requirements in the Event of a Declared Emergency › Section XIII-17929 - Obligation of Insured to Pay Premium

Current through Register Vol. 50, No. 6, June 20, 2024
A. Unless otherwise cancelled in accordance
				with the provisions of §17921 herein, nothing in the Emergency Rule shall be
				construed to exempt or excuse an insured from the obligation to pay the
				premiums otherwise due for actual insurance coverage provided.
B. Those insureds entitled to the benefits,
				entitlements and protections of the Emergency Rule are advised that this
				suspension is not a waiver, but only an extension or grace period to facilitate
				payment of the premium.
C. Insurers
				are directed to work with and assist their affected insureds who reside in the
				impacted parishes with the payment of the premium that would have become due
				during this moratorium period by either establishing for the insured a payment
				plan for the unpaid premium or providing to the insured a further extension for
				the payment of the unpaid premium.
AUTHORITY
				  NOTE: Promulgated in accordance with
				  R.S.
				  22:11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 179 - Regulation 118-Requirements in the Event of a Declared Emergency › Section XIII-17931 - Timely Payment of Health Claims

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				Only to the extent necessary to permit the pending of claims during a premium
				payment delinquency by the insured, the provisions of R.S. 22:1832-1834 and
				Regulation 74 related to timely payment of claims are hereby
				suspended.
B. For any policy of
				insurance described in §17915.B which, as a result of nonpayment of premium,
				would be subject to cancellation or termination but for the suspension ordered
				in §17917, the health insurance issuer may pend all claims for services
				rendered to the insured for the remainder of the suspension provided for in
				§17917 until the health insurance issuer receives the delinquent premium
				payment or until such time the health insurance issuer is subsequently entitled
				to cancel or terminate the policy for nonpayment of premium.
C. The health insurance issuer shall notify
				providers of the possibility for denied claims when an insured is in the grace
				period.
D. Once a health insurance
				issuer receives the delinquent premium payment during the grace period, all
				pending claims associated with the time period to which such payment applies
				shall be processed and adjudicated. The health insurance issuer shall notify
				the health care provider that the claim is no longer pending and is being
				processed and adjudicated for payment. Furthermore, the suspension provided for
				in §17931.A shall be automatically lifted and all applicable timely payment
				requirements reinstated upon the date of the payment of premium.
AUTHORITY
				  NOTE: Promulgated in accordance with
				  R.S.
				  22:11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 179 - Regulation 118-Requirements in the Event of a Declared Emergency › Section XIII-17933 - Nonpayment of Health Claims

Current through Register Vol. 50, No. 6, June 20, 2024
A. In the
				event a health insurance issuer pends a claim, as permitted pursuant to §17931,
				and is subsequently entitled to cancel or terminate a policy for nonpayment of
				premium, the health insurance issuer shall pay any remaining claims for which
				payment is required under §17931.B The health insurance issuer may deny payment
				on pended claims for services rendered to the insured during the period of
				nonpayment after the first month.
AUTHORITY
				  NOTE: Promulgated in accordance with
				  R.S.
				  22:11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 179 - Regulation 118-Requirements in the Event of a Declared Emergency › Section XIII-17935 - Insured's Obligation to Cooperate in Claim Process

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Emergency Rule shall not relieve an
				insured who has filed a claim before or during the pendency of the Emergency
				Rule from compliance with the insured's obligation to provide information and
				cooperate in the claim adjustment process relative to the claim.
AUTHORITY
				  NOTE: Promulgated in accordance with
				  R.S.
				  22:11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 179 - Regulation 118-Requirements in the Event of a Declared Emergency › Section XIII-17937 - Physician Credentialing

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				commissioner hereby suspends physician credentialing pursuant to
				R.S.
				22:1009 such that there are no credentialing
				requirements with regard to any and all licensed physicians who provide medical
				services to insureds identified in §17913.A or §17913.B between 12:01 a.m. on
				the effective date of the Emergency Rule and the expiration of the Emergency
				Rule as provided for in §17961
AUTHORITY
				  NOTE: Promulgated in accordance with
				  R.S.
				  22:11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 179 - Regulation 118-Requirements in the Event of a Declared Emergency › Section XIII-17939 - New Rate or Premium

Current through Register Vol. 50, No. 6, June 20, 2024
A. For all
				health insurance issuers specified in §17913 C, any rate increases that were to
				take effect after the effective date of the Emergency Rule are suspended and
				shall be deferred until the expiration of the Emergency Rule as provided for in
				§17961
B. For all other insurers,
				as specified in §17913 B, the Emergency Rule shall not affect the right of any
				insurer to file for and/or implement a new rate or premium for any insurance
				policy for the types of insurance enumerated in §17915.A if the new rate or
				premium has been approved by the commissioner.
AUTHORITY
				  NOTE: Promulgated in accordance with
				  R.S.
				  22:11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 179 - Regulation 118-Requirements in the Event of a Declared Emergency › Section XIII-17941 - Imposition of Interest, Penalty, or Other Charge

Current through Register Vol. 50, No. 6, June 20, 2024
A. The commissioner hereby suspends the
				imposition of any interest, penalty, or other charge and declares that no
				interest, penalty, or other charge shall accrue or be assessed against any
				insured as the result of the suspensions ordered in the Emergency
				Rule.
AUTHORITY
				  NOTE: Promulgated in accordance with
				  R.S.
				  22:11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 179 - Regulation 118-Requirements in the Event of a Declared Emergency › Section XIII-17943 - Continuation of Health Coverage

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				The commissioner hereby suspends
				R.S.
				22:1046. In furtherance thereof, a health
				insurance issuer who has issued a group health insurance policy shall provide
				to all members or certificate holders under said group policy the option for
				the continuation of coverage, which said option shall begin on the day after
				the end the expiration of the Emergency Rule as provided for in §17961 This
				section is only applicable in those situations where the employer to whom the
				group policy had been issued remains in business and continues to offer said
				group health insurance to active employees for the duration of the Emergency
				Rule.
AUTHORITY
				  NOTE: Promulgated in accordance with
				  R.S.
				  22:11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 179 - Regulation 118-Requirements in the Event of a Declared Emergency › Section XIII-17945 - Prescription Drug Coverage

Current through Register Vol. 50, No. 6, June 20, 2024
A. Health
				insurance issuers shall allow insured individuals to obtain refills of their
				prescriptions even if the prescription was recently filled, consistent with
				approval from patients' health care providers and/or pharmacists. This
				provision does not apply to prescription drugs with a high likelihood of abuse,
				such as opioids that are restricted to 7-day prescriptions.
B. The commissioner hereby suspends any
				provisions in the Louisiana Insurance Code which place restrictions on
				replacement prescriptions pertaining to mail order prescriptions. Mail order
				prescriptions shall be mailed to an alternate address if requested by the
				insured.
C. All health insurance
				issuers shall waive any and all restrictions relative to out-of-network access
				to pharmacy services or prescriptions.
AUTHORITY
				  NOTE: Promulgated in accordance with
				  R.S.
				  22:11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 179 - Regulation 118-Requirements in the Event of a Declared Emergency › Section XIII-17947 - Telemedicine Access

Current through Register Vol. 50, No. 6, June 20, 2024
A. Health
				insurance issuers shall waive any coverage limitations restricting telemedicine
				access to providers included within a plan's telemedicine network.
B. Health insurance issuers shall waive any
				requirement that the patient and provider have a prior relationship in order to
				have services delivered through telemedicine.
C. Health insurance issuers shall cover
				mental health services provided by telemedicine consultation to the same extent
				the services would be covered if provided through an in-person consultation.
				This shall not be interpreted to require coverage of telemedicine services that
				cannot be appropriately provided remotely.
D. Health insurance issuers shall waive any
				requirement limiting coverage to provider-to-provider consultations only and
				shall cover telemedicine consultations between a patient and a provider to the
				extent the same services would be covered if provided in person.
AUTHORITY
				  NOTE: Promulgated in accordance with
				  R.S.
				  22:11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 179 - Regulation 118-Requirements in the Event of a Declared Emergency › Section XIII-17949 - Fraud or Material Misrepresentation

Current through Register Vol. 50, No. 6, June 20, 2024
A. The Emergency Rule shall not prevent an
				insurer from cancelling or terminating an insurance policy for fraud or
				material misrepresentation on the part of the insured.
AUTHORITY
				  NOTE: Promulgated in accordance with
				  R.S.
				  22:11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 179 - Regulation 118-Requirements in the Event of a Declared Emergency › Section XIII-17951 - Exemption from Compliance

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				Notwithstanding any other provision contained herein, the commissioner may
				exempt any insurer from compliance with the Emergency Rule upon a written
				request by the insurer setting forth in detail each and every reason for the
				exemption and then only if the commissioner determines that compliance with the
				Emergency Rule may be reasonably expected to result in said insurer being
				subject to undue hardship, impairment, or insolvency.
AUTHORITY
				  NOTE: Promulgated in accordance with
				  R.S.
				  22:11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 179 - Regulation 118-Requirements in the Event of a Declared Emergency › Section XIII-17953 - Sanctions for Violations

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				commissioner retains the authority to enforce violations of the Emergency Rule.
				Accordingly, any insurer enumerated in the Emergency Rule or any other entity
				doing business in Louisiana and/or regulated by the commissioner who violates
				any provision of the Emergency Rule shall be subject to regulatory action by
				the commissioner under any applicable provisions of the Louisiana Insurance
				Code.
AUTHORITY
				  NOTE: Promulgated in accordance with
				  R.S.
				  22:11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 179 - Regulation 118-Requirements in the Event of a Declared Emergency › Section XIII-17955 - Sixty Day Period to Initiate Adjustment of Property Claims

Current through Register Vol. 50, No. 6, June 20, 2024
A. In accordance
				with
				R.S.
				22:1892(A)(3), the disaster
				or emergency and its aftermath qualifies as a catastrophic loss event that
				requires insurers to initiate loss adjustment of a property damage claim within
				thirty (30) days after notification of loss by the insured.
B. In furtherance of
				R.S.
				22:1892(A)(3), the severity
				of the devastation caused by the disaster or emergency and its aftermath
				qualifies for an additional 30 days for insurers to initiate loss adjustment of
				a property claim after notification of loss by the insured.
C. Therefore, insurers shall have a total of
				60 days to initiate loss adjustment of a property damage claim after
				notification of loss by the insured.
D. This declaration is based on the
				representation that the additional time period is necessary due to the large
				volume of claims resulting directly from the disaster or emergency and its
				aftermath, and with the admonition that insurers will promptly identify,
				evaluate, and resolve these claims. Insurers must continue to provide timely
				service to their insureds by promptly acknowledging receipt of claims and
				making appropriate assignments for the adjustment of claims.
AUTHORITY
				  NOTE: Promulgated in accordance with
				  R.S.
				  22:11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 179 - Regulation 118-Requirements in the Event of a Declared Emergency › Section XIII-17957 - Authority

Current through Register Vol. 50, No. 6, June 20, 2024
A. The commissioner
				reserves the right to extend or rescind all or any portion of the Emergency
				Rule.
AUTHORITY
				  NOTE: Promulgated in accordance with
				  R.S.
				  22:11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 179 - Regulation 118-Requirements in the Event of a Declared Emergency › Section XIII-17959 - Severability Clause of Emergency Rule

Current through Register Vol. 50, No. 6, June 20, 2024
A. If any section or provision of the
				Emergency Rule or its application to any person or circumstance is held
				invalid, such invalidity or determination shall not affect any other section or
				provision or the application of the Emergency Rule to any person or
				circumstance that can be given effect without the invalid section or provision
				or application, and for these purposes the sections and provisions of the
				Emergency Rule and the application to any persons or circumstances are
				severable.
AUTHORITY
				  NOTE: Promulgated in accordance with
				  R.S.
				  22:11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 179 - Regulation 118-Requirements in the Event of a Declared Emergency › Section XIII-17961 - Effective Date of Emergency Rule

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				The Emergency Rule shall become effective at 12:01 a.m. on the effective date
				specified and shall continue in full force and effect until either 11:59 p.m.
				on the cessation date of the Governor's declaration of emergency, inclusive of
				any renewal thereof, or the termination date specified in the Emergency Rule,
				inclusive of any renewal thereof approved pursuant to the requirement in
				R.S.
				22:11(C), whichever occurs
				first.
AUTHORITY
				  NOTE: Promulgated in accordance with
				  R.S.
				  22:11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 179 - Regulation 118-Requirements in the Event of a Declared Emergency › Section XIII-17963 - Severability of Regulation 118

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				If any provision of this regulation, or the applicability thereof, is held
				invalid, such invalidity shall not affect other provisions, items, or
				applications of the regulation which can be given effect without the invalid
				provision, item, or application.
AUTHORITY
				  NOTE: Promulgated in accordance with
				  R.S.
				  22:11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 179 - Regulation 118-Requirements in the Event of a Declared Emergency › Section XIII-17965 - Effective Date of Regulation 118

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				Regulation 118 shall become effective upon final promulgation in the Louisiana
				Register.
AUTHORITY
				  NOTE: Promulgated in accordance with
				  R.S.
				  22:11.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 181 - Regulation Number 120-Administrative and Agency Proceedings Instituted Against a License › Section XIII-18101 - Authority

Current through Register Vol. 50, No. 6, June 20, 2024
A. This regulation
				is promulgated on behalf of the Department of Insurance by the Commissioner of
				Insurance pursuant to the authority granted under Title 22.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:18,
				  22:2191, et
				  seq., and the Administrative Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 181 - Regulation Number 120-Administrative and Agency Proceedings Instituted Against a License › Section XIII-18103 - Purpose

Current through Register Vol. 50, No. 6, June 20, 2024
A. The purpose of
				this regulation is to establish procedures for governing the institution of
				administrative and agency proceedings resulting in administrative action with
				respect to a license in accordance with
				R.S. 22:2191,
				et seq.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:18,
				  22:2191, et
				  seq., and the Administrative Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 181 - Regulation Number 120-Administrative and Agency Proceedings Instituted Against a License › Section XIII-18105 - Scope and Applicability

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				Regulation 120 sets forth procedures and time delays that govern the
				institution of administrative and agency proceedings resulting in
				administrative action instituted against any licensee.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:18,
				  22:2191, et
				  seq., and the Administrative Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 181 - Regulation Number 120-Administrative and Agency Proceedings Instituted Against a License › Section XIII-18107 - Severability

Current through Register Vol. 50, No. 6, June 20, 2024
A. The provisions
				of this Subpart are severable. If any provision or item of this Subpart, or
				application thereof, is held invalid, such invalidity shall not affect other
				provisions, items, or applications of this Subpart which are to be given effect
				without the invalid provision, item, or application of the Subpart.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:18,
				  22:2191, et
				  seq., and the Administrative Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 181 - Regulation Number 120-Administrative and Agency Proceedings Instituted Against a License › Section XIII-18109 - Definitions

Current through Register Vol. 50, No. 6, June 20, 2024
A. Strictly for
				purposes of Regulation 120, the following terms are defined as follows.
License
-any and all authorizations,
				  certificates of authority, licenses, registrations, or other written
				  instruments, acknowledgements, or statutory decrees, establishing that a person
				  or entity is authorized to conduct the business of insurance in accordance with
				  Title 22.
Licensee
-all persons and entities issued a
				  "license" by the Department of Insurance or otherwise authorized by statute to
				  conduct the business of insurance in this state. Additionally, the term
				  "licensee," as used in this regulation, includes approved unauthorized
				  insurers, as defined in Chapter 2 of the Louisiana Insurance Code.
Administrative Proceedings
-proceedings in an
				  administrative tribunal adjudicated by an administrative law judge and
				  conducted in accordance with Chapter 12 of the Louisiana Insurance Code,
				  R.S. 22:2191,
				  et seq. and the Administrative Procedure Act,
				  R.S.
				  49:950, et seq.
Agency Proceedings
-proceedings instituted or
				  conducted by the Commissioner of Insurance.
Commissioner
-the Commissioner of Insurance,
				  his deputy, or the Department of Insurance, as appropriate.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:18,
				  22:2191, et
				  seq., and the Administrative Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 181 - Regulation Number 120-Administrative and Agency Proceedings Instituted Against a License › Section XIII-18111 - Actions Against License; Notice of Wrongful Conduct; Opportunity to Show Compliance

Current through Register Vol. 50, No. 6, June 20, 2024
A. Prior
				to the institution of an agency proceeding regarding the revocation,
				suspension, annulment, or withdrawal of a license, the Commissioner shall give
				the licensee notice of the wrongful conduct alleged and an opportunity to show
				compliance with all lawful requirements for the retention of the license in
				accordance with
				R.S.
				49:950 et seq. The notice of wrongful conduct
				shall be in writing, mailed or delivered personally to the licensee at the last
				known address or principal place of business identified in the Department's
				database for the licensee, and it must include the particulars set forth under
				Subpart B. herein.
B. The notice of
				wrongful conduct shall include a statement of the legal authority and alleged
				facts or conduct under which the Department's enforcement action is based. The
				notice of wrongful conduct shall also include references to the applicable
				provisions of Title 22 and regulations promulgated by the Department, and it
				shall advise the licensee of the opportunity to show compliance with all lawful
				requirements for retention of the license.
C. The licensee shall have 20 calendar days
				from the mailing or personal delivery of the notice of wrongful conduct by the
				Commissioner to demonstrate compliance with all lawful requirements for
				retention of the license as specified in the notice of wrongful conduct, unless
				the Commissioner determines that an extension of time is warranted.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:18,
				  22:2191, et
				  seq., and the Administrative Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 181 - Regulation Number 120-Administrative and Agency Proceedings Instituted Against a License › Section XIII-18113 - Notice of Regulatory Action

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				If the licensee fails to demonstrate compliance with all lawful requirements of
				Title 22 for retention of the license to the satisfaction of the Commissioner
				within 20 calendar days of the mailing or personal service of the notice of
				wrongful conduct, or within any extension of time approved by the Commissioner,
				a notice of regulatory action may be issued. The notice shall be in writing and
				issued via mail or by personal delivery to the last known address or principal
				place of business identified in the Department's database for the licensee. The
				revocation, suspension, annulment, or withdrawal of a license shall take effect
				10 calendar days from the date of issuance of the notice of regulatory action,
				unless otherwise provided in Title 22. The licensee shall have the right to
				timely demand an administrative hearing to contest the notice of regulatory
				action in accordance with
				R.S. 22:2191,
				et seq.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:18,
				  22:2191, et
				  seq., and the Administrative Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 181 - Regulation Number 120-Administrative and Agency Proceedings Instituted Against a License › Section XIII-18115 - Notice of Summary Suspension or Order

Current through Register Vol. 50, No. 6, June 20, 2024
A. Notwithstanding any other provision of
				this regulation, if the Commissioner finds that the public health, safety, or
				welfare of Louisiana citizens imperatively requires emergency action, the
				Commissioner may issue a notice of summary suspension or order to the licensee,
				setting forth the basis for such a finding. The notice of summary suspension or
				order shall be in writing, mailed or delivered personally to the licensee at
				the last known address or principal place of business identified in the
				Department's database for the licensee, and it may be issued while agency
				proceedings for license revocation or other adverse actions authorized by
				R.S.
				49:961(C) are pending,
				unless otherwise provided in Title 22. The licensee shall have the right to
				timely demand an administrative hearing to contest the notice of summary
				suspension or order in accordance with
				R.S. 22:2191,
				et seq.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:18,
				  22:2191, et
				  seq., and the Administrative Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 181 - Regulation Number 120-Administrative and Agency Proceedings Instituted Against a License › Section XIII-18117 - Stay of Action

Current through Register Vol. 50, No. 6, June 20, 2024
A. A demand for
				an administrative hearing shall not operate as an automatic stay of any order
				issued by the Commissioner or any action taken or proposed to be taken by the
				Commissioner unless such relief is granted by the Division of Administrative
				Law pursuant to
				R.S.
				22:2204 and the Administrative Procedure Act,
				R.S.
				49:950, or as otherwise provided in Title 22.
				All demands for hearing and requests for a stay of action shall be filed in
				accordance with Chapter 12 of the Louisiana Insurance Code,
				R.S. 22:2191,
				et seq. and held in accordance with the Administrative Procedure Act,
				R.S.
				49:950, et seq.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:18,
				  22:2204,
				  and the Administrative Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 181 - Regulation Number 120-Administrative and Agency Proceedings Instituted Against a License › Section XIII-18119 - Effective Date

Current through Register Vol. 50, No. 6, June 20, 2024
A. This
				regulation shall become effective upon final publication in the Louisiana
				Register.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:2,
				  22:11,
				  22:18,
				  22:2191, et
				  seq., and the Administrative Procedure Act,
				  R.S.
				  49:950, et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 182 - Regulation Number 126-Louisiana Fortify Homes Program › Section XIII-18201 - Purpose

Current through Register Vol. 50, No. 6, June 20, 2024
A. The purpose of
				Regulation 126 is to set forth rules and requirements governing the
				administration of the Louisiana Fortify Homes Program (LFHP) and eligibility
				criteria for LFHP grants in accordance with Act No. 554 of the 2022 Regular
				Session.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.22:11 and
				  R.S.
				  22:1483.1(A).
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 182 - Regulation Number 126-Louisiana Fortify Homes Program › Section XIII-18202 - Definitions

Current through Register Vol. 50, No. 6, June 20, 2024
A. As used in
				Regulation 126, the following terms shall have the meanings herein specified.
1.
Evaluator
-an independent
				third party certified by the Insurance Institute for Business and Home Safety
				(IBHS) as a fortified evaluator for hurricane and high wind and hail who can
				verify that a home meets the fortified roofing construction standard.
				Homeowners can find a list of certified evaluators at
www.ldi.la.gov/fortifyhomes
.
2.
Insurance Institute for Business
				and Home Safety (IBHS)
-a non-profit research and communications
				organization of the property and casualty insurance industry that defines the
				FORTIFIED roofing construction standard for homes, information for which can be
				found at
www.fortifiedhome.org
.
3.
Louisiana Fortify Homes Program
				(LFHP)
-a program, enacted by Act No. 554 of the 2022 Regular Session,
				to be administered by the Louisiana Department of Insurance through its Office
				of Policy, Innovation and Research, to make financial grants to retrofit roofs
				of insurable property, as defined in
				R.S.
				22:1483(C)(9), with a
				homestead exemption, to resist loss due to hurricane, tornado, or other
				catastrophic windstorm events and to meet or exceed the fortified roof standard
				of the Insurance Institute for Business and Home Safety, information for which
				can be found at
www.ldi.la.gov/fortifyhomes
.
4.
National Flood Insurance Program
				(NFIP)
-a program enacted by the National Flood Insurance Act of 1968
				(P.L.
				90-448), which the Federal Emergency Management
				Agency (FEMA) administers, through its Federal Insurance and Mitigation
				Administration (FIMA) division, to provide an insurance alternative to disaster
				assistance to meet the escalating costs of repair damage to buildings and their
				contents caused by floods. The NFIP designates flood zones and flood maps,
				which illustrate a community's flood risk, information for which can be found
				at
www.floodsmart.gov
.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 182 - Regulation Number 126-Louisiana Fortify Homes Program › Section XIII-18203 - Contractor Eligibility Requirements and Conflicts of Interest

Current through Register Vol. 50, No. 6, June 20, 2024
A. Contractor
				Eligibility Requirements. To be eligible to work as a Louisiana Fortify Homes
				Program contractor (LFHP-approved contractor), the contractor must meet all of
				the following program requirements:
1. submit
				and maintain a current copy of all certificates, licenses and proof of
				insurance coverages with the LFHP;
2. hold a valid residential license or home
				improvement registration issued by the Louisiana State Licensing Board for
				Contractors (LSLBC) and must be in good standing with the LSLBC;
3. hold any other valid state or
				jurisdictional business licenses or work permits required by law in
				Louisiana;
4. maintain a general
				liability policy with $1,000,000 in liability coverage;
5. maintain a workers' compensation policy in
				compliance with Louisiana law;
6.
				provide a certificate of successful completion of the fortified roof for high
				wind and hail and hurricane training issued by the Insurance Institute for
				Business and Home Safety (IBHS) or its successor. The training may be offered
				as separate courses, and the contractor is responsible for paying all fees
				associated with the training;
7. be
				in compliance with all regulatory and tax laws regulating businesses in the
				state of Louisiana;
8. maintain
				internet access and have a valid, active email address on file with the LFHP
				for communication with the LFHP;
9.
				avoid conflicts of interest in any work performed on projects funded by LFHP
				grants;
10. agree to follow the
				LFHP procedures and rules as established by the Commissioner of the Department
				of Insurance.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 182 - Regulation Number 126-Louisiana Fortify Homes Program › Section XIII-18204 - Evaluator Eligibility Requirements and Conflicts of Interest

Current through Register Vol. 50, No. 6, June 20, 2024
A. Evaluator
				Eligibility Requirements. To be eligible to work on the Louisiana Fortify Homes
				Program (LFHP), an evaluator must meet all of the following program
				requirements:
1. submit and maintain a copy
				of all current certificates and licenses with the LFHP;
2. be in good standing with the Insurance
				Institute for Business and Home Safety (IBHS) and maintain an active
				certification as a fortified home evaluator for hurricane and high wind and
				hail, issued by the IBHS or its successor;
3. possess all necessary business licenses to
				perform the work required;
4. be in
				compliance with all regulatory and tax laws regulating businesses in the state
				of Louisiana;
5. avoid conflicts of
				interest in any work performed on projects funded by LFHP grants.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 182 - Regulation Number 126-Louisiana Fortify Homes Program › Section XIII-18205 - Louisiana Fortify Homes Program Grants

Current through Register Vol. 50, No. 6, June 20, 2024
A. Grant Eligibility. To be eligible for a
				Louisiana Fortify Homes Program (LFHP) grant, an applicant must meet the
				following requirements.
1. The home must be
				an owner-occupied, single-family, primary residence with a homestead exemption
				and cannot be a condominium or mobile home.
2. The home must be in good repair unless
				damaged by a hurricane, non-hurricane wind, or hail.
3. The homeowner must fortify the home's roof
				to meet the Insurance Institute for Business and Home Safety (IBHS) fortified
				roof standard.
4. The homeowner
				must provide the LFHP proof of a wind insurance policy on the home.
				Additionally, if the home is in a designated National Flood Insurance Program
				(NFIP) flood zone, the homeowner must provide the LFHP proof of a flood
				insurance policy on the home.
5.
				The homeowner must obtain and pay for all permits required by law or ordinance
				for the construction.
6. The
				homeowner must arrange and pay for inspections required by law or ordinance and
				the terms of the grant, which shall include inspection pursuant to
				R.S.
				22:1483(C)(3).
7. The work must comply with applicable
				building codes.
8. The LFHP project
				must be completed within three months of the date of the grant award
				notification, which will be delivered to the applicant through electronic
				means. Failure to timely complete the LFHP project may result in a forfeiture
				of the grant.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 182 - Regulation Number 126-Louisiana Fortify Homes Program › Section XIII-18206 - Severability

Current through Register Vol. 50, No. 6, June 20, 2024
A. If any rule or
				portion of a rule or its applicability to any person or circumstance is held
				invalid by any court, the remainder of this Chapter or the applicability of the
				provision to other persons or circumstances shall not be affected.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.22:11 and
				  R.S.
				  22:1483.1(A).