reglab/statecodes huggingface dataset:
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 124 - SURPLUS LINES INSURANCE › Section 124.10 - Eligible surplus lines insurer filing requirements

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A request to consider a foreign insurer
				for placement on the Department's eligible surplus lines insurer list under
				section 1605(b) of the act (40 P. S. §
										991.1605(b)) shall be made
				in writing by or on behalf of an insurer and include the following:
(1)
Certificate of authority.
A copy of the certificate of authority of the insurer or similar
				document setting forth its authority to issue policies and insure risks in the
				jurisdiction in which the insurer is incorporated, formed or
				organized.
(2)
Financial
				statement.
A copy of the jurat page from the latest annual financial
				report or statement of the insurer signed by the officers of the insurer and
				filed with the insurance regulatory authority or other governmental authority
				in the jurisdiction in which the insurer is incorporated, formed or organized.
				If the Department is unable to determine from the jurat page of the latest
				annual financial report or statement whether the insurer meets the requirements
				of section 1605(a) of the act, the insurer shall, upon request, forward to the
				Department:
(i) A copy of the entire annual
				financial report or statement. The copy must include all supplemental reports,
				exhibits and schedules required as part of the annual statement
				filing.
(ii) A copy of each
				subsequent quarterly financial report or statement of the insurer signed by the
				officers of the insurer and filed with the insurance regulatory authority or
				other governmental authority in the jurisdiction in which the insurer is
				incorporated, formed or organized.
(3)
Kind of insurance.
A
				written statement by an officer of the insurer identifying the kinds of
				insurance coverages the insurer intends to write and the types of risks the
				insurer intends to insure in this Commonwealth.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 124 - SURPLUS LINES INSURANCE › Section 124.11 - Exempt commercial purchaser

Current through Register Vol. 54, No. 28, July 13, 2024
For the Department to determine whether a surplus lines
				  licensee has placed business for an exempt commercial purchaser under section
				  1610(a.1) of the act (40 P. S. §
										991.1610(a.1)), the surplus lines licensee
				  shall file, with the Department or its designee, a written declaration
				  reporting the transaction on a form prescribed by the
				  Department.
The provisions of this §
											124.11 issued under sections 206,
					 506, 1501 and 1502 of The Administrative Code of 1929 (71 P. S.
					 §§
												66,
					 186,
					 411 and
					 412); and Article XVI of The
					 Insurance Company Law of 1921 (40 P. S. §§
												991.1601-991.1626).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 125 - TITLE INSURANCE REBATES › Section 125.1 - Prohibited rebates and inducements

Current through Register Vol. 54, No. 28, July 13, 2024
A title insurance company or agent or approved attorney of a
				  title insurance company may not pay to an approved attorney, real estate
				  broker, real estate salesman, attorney at law or other person, partnership or
				  corporation, who or which, from time to time, apply to a title insurance
				  company or to an agent of a title insurance company for title insurance and who
				  at the time of the application are not licensed agents for a title insurance
				  company, compensation, consideration, benefit or remuneration directly or
				  indirectly.
The provisions of this §
											125.1 amended under the authority
					 of sections 206, 506, 1501 and 1502 of The Administrative Code of 1929
					 (71
					 P. S. §§
												66,
					 186,
					 411 and
					 412); sections 701(4) and 731
					 of The Insurance Company Act of 1921 (40 P. S. §§
												910-1(4) and
					 910-31); and sections 635 and
					 636 of The Insurance Department Act of 1921 (40 P. S. §§
												275 and
					 276).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 125 - TITLE INSURANCE REBATES › Section 125.2 - Charges required for title reports and others

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The issuance without charge of a title
				report, commitment to insure, guaranteed general search, information
				certificate or title insurance policy is an illegal rebate and
				inducement.
(b) The charge for the
				title report, commitment to insure, guaranteed general search or information
				certificate shall have a reasonable relation to the cost of production, but in
				no event may it be less than the rate for a minimum title insurance policy as
				set forth in the rate schedule of the title insurance company filed with the
				Insurance Department.
(c) The
				provisions of subsection (a) does not preclude the crediting of the amount paid
				for the title report, commitment to insure or information certificate to the
				charge or premium for the final policy of title insurance issued on the basis
				of the title report, commitment to insure or information certificate.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 125 - TITLE INSURANCE REBATES › Section 125.3 - Increasing the charge or fee

Current through Register Vol. 54, No. 28, July 13, 2024
Increasing the charge or fee for a title insurance policy by
				  an amount and returning any or all of the added amount to any person is an
				  illegal rebate and inducement.
The provisions of this §
											125.3 amended under the authority
					 of sections 206, 506, 1501 and 1502 of The Administrative Code of 1929
					 (71
					 P. S. §§
												66,
					 186,
					 411 and
					 412); sections 701(4) and 731
					 of The Insurance Company Act of 1921 (40 P. S. §§
												910-1(4) and
					 910-31); and sections 635 and
					 636 of The Insurance Department Act of 1921 (40 P. S. §§
												275 and
					 276).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 125 - TITLE INSURANCE REBATES › Section 125.4 - Participation in fees

Current through Register Vol. 54, No. 28, July 13, 2024
Participation by a person in any of the fees charged by a
				  title insurance company or agent thereof for title insurance, including, but
				  not limited to, charges for special insurance, is an illegal rebate and
				  inducement.
The provisions of this §
											125.4 amended under the authority
					 of sections 206, 506, 1501 and 1502 of The Administrative Code of 1929
					 (71
					 P. S. §§
												66,
					 186,
					 411 and
					 412); sections 701(4) and 731
					 of The Insurance Company Act of 1921 (40 P. S. §§
												910-1(4) and
					 910-31); and sections 635 and
					 636 of The Insurance Department Act of 1921 (40 P. S. §§
												275 and
					 276).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 126 - OWNER-MORTGAGEE TITLE INSURANCE › Section 126.1 - General

Current through Register Vol. 54, No. 28, July 13, 2024
Title insurance companies and agents of title insurance
				  companies, issuing mortgagee's title insurance upon a loan made simultaneously
				  with the purchase of all or a part of the real estate securing the loans, where
				  no owner's title insurance policy has been ordered; shall, prior to the
				  disbursement of the loan funds or the issuance of the mortgagee's title policy,
				  cause the mortgagor to be advised in writing of the fact that a mortgagee's
				  title insurance policy is to be issued, of the fact that the policy does not
				  afford title insurance protection to the owner-mortagor, and of the
				  owner-mortgagor's right to obtain title insurance in his own favor; and if the
				  mortgagor elects not to purchase owner's title insurance, the title insurance
				  company shall obtain from the mortgagor a statement in writing that the
				  mortgagor has received the notice and that the mortgagor waives the right to
				  purchase owner's title insurance. The form of the written notice and waiver
				  shall be as follows:
Re No.
Premises
Pursuant to the requirement of the Pennsylvania Insurance
				  Department, notice is hereby given that a mortgagee's title insurance policy is
				  to be issued to your mortgage lender and that such policy does not afford title
				  insurance protection to you in the event of a defect in the title to the real
				  estate which you are acquiring (including but not limited to unpaid bills for
				  labor and material, forgeries, missing heirs, unpaid taxes, etc.). You are
				  hereby advised of your right and opportunity to obtain an owner's title
				  insurance policy in your favor for the amount of your purchase price (or the
				  amount of your purchase price, plus the cost of any improvements which you
				  anticipate making).
The said requirement directs that you sign the statement
				  below if you do not wish to purchase this protection. Name of company issuing
				  policy by title.
This is to certify that the foregoing notice of right to
				  purchase owner's title insurance policy for the protection of the undersigned
				  purchaser has been received and the undersigned purchaser hereby waives such
				  right. It is understood and agreed that (name of company) shall have no
				  responsibility to the undersigned purchaser for the status of the title to the
				  real estate being acquired or for any loss by reason of a complete or partial
				  failure of title. Signature of mortgagor/purchaser.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 126 - OWNER-MORTGAGEE TITLE INSURANCE › Section 126.2 - Filing requirements

Current through Register Vol. 54, No. 28, July 13, 2024
The original of the executed notice waiver shall be filed
				  with the title insurance company insuring the title to the mortgagee and kept
				  on file for a period of not less than 20 years after the policy of title
				  insurance issued to the mortgagee lender has been issued. In lieu of retaining
				  the original copy, the title insurance company may in the regular course of
				  business, establish a system whereby the executed notice and waiver be copied
				  or reproduced by any photographic, photostatic, microfilm, miniature
				  photographic or other process which accurately reproduces or forms a durable
				  medium for reproducing the original.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 127 - MANAGEMENT CONTRACTS OR EXCLUSIVE GENERAL AGENCY AGREEMENTS › Section 127.1 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
The following words and terms, when used in this chapter,
				  have the following meanings, unless the context clearly indicates otherwise:
Company
-A domestic insurance company.
Contract
-A management contract or an
				  exclusive general agency agreement entered into between a licensee and a
				  company.
Department
-The Insurance Department of the
				  Commonwealth.
Licensee
-An individual, corporation or
				  copartnership licensed or subject to licensing by the Insurance Commissioner as
				  a manager or exclusive general agent of a domestic insurance company under
				  section 651 of The Insurance Department Act of 1921 (40 P. S. §
										291) and this chapter.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 127 - MANAGEMENT CONTRACTS OR EXCLUSIVE GENERAL AGENCY AGREEMENTS › Section 127.2 - Purpose

Current through Register Vol. 54, No. 28, July 13, 2024
This chapter is to facilitate the licensing of managers or
				  exclusive general agents of domestic insurance companies by outlining certain
				  conditions and provisions which should be contained in management contracts and
				  exclusive general agency agreements, and setting forth the principles under
				  which the contracts and agreements will be reviewed by the
				  Department.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 127 - MANAGEMENT CONTRACTS OR EXCLUSIVE GENERAL AGENCY AGREEMENTS › Section 127.3 - Application and supporting documents

Current through Register Vol. 54, No. 28, July 13, 2024
Each application for a manager's or exclusive general agent's
				  license, or for renewal of a license, shall be accompanied by an executed copy
				  of the contract and a certified copy of a resolution of the board of directors
				  of the company approving the contract, for review by the Insurance Commissioner
				  prior to the issuance of a license or renewal thereof.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 127 - MANAGEMENT CONTRACTS OR EXCLUSIVE GENERAL AGENCY AGREEMENTS › Section 127.4 - General contract requirements

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
				Contracts shall be fair and equitable and shall be the result of an arm's
				length negotiation between the licensee and the company.
(b) The effect of a contract may not be to
				delegate virtually complete supervision and control over functions of the
				company to the licensee, thereby effectively substituting the licensee for the
				board of directors of the company.
(c) Contract provisions shall be consistent
				with the articles of incorporation and bylaws of the company.
(d) The rights, obligations and duties of the
				parties to the contract shall be specifically and clearly set forth.
(e) Contracts shall avoid conflict of
				interests between the company, the licensee and officers or directors of the
				company.
(f) Contracts shall also
				contain the following:
(1) Clear and precise
				termination provisions, specifying a termination date not later than 5 years
				after the date of execution, and may not provide for automatic
				renewal.
(2) A provision stating
				that duties not specifically delegated to the licensee are retained by the
				company.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 127 - MANAGEMENT CONTRACTS OR EXCLUSIVE GENERAL AGENCY AGREEMENTS › Section 127.5 - Compensation of licensees

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The
				total compensation of a licensee under a contract, including deferred
				compensation, shall bear a reasonable relationship to the actual services which
				he renders to the company.
(b) A
				net override commission or fee may not exceed 10% of the gross premiums written
				by the company.
(c) Compensation
				provisions shall, through a reasonable service fee formula or by other
				appropriate means, avoid an arrangement which may encourage the under-reserving
				of claims, improper underwriting practices or other results detrimental to the
				best interests of the policyholders of the company, claimants or of the general
				public.
(d) Forms of compensation
				or income intended to be received by or accrued to the benefit of the licensee,
				directly or indirectly from the company, shall be set forth in the contract.
				The sources of income shall include, but are not necessarily limited to, the
				following:
(1) Salaries or fees paid to the
				licensee or to officers or directors of the licensee.
(2) Insurance agents' commissions.
(3) Rental payments for real or personal
				property leased from the licensee by the company or profits realized on sales
				by the licensee to the company.
(4)
				Value of services or facilities furnished by the company to the
				licensee.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 127 - MANAGEMENT CONTRACTS OR EXCLUSIVE GENERAL AGENCY AGREEMENTS › Section 127.7 - Penalties

Current through Register Vol. 54, No. 28, July 13, 2024
Failure to comply with this chapter shall subject a licensee,
				  following notice and hearing in accordance with
				  2
				  Pa.C.S. §§
										501-508 and
				  701-704 (relating to
				  Administrative Agency Law) to revocation of license; in addition thereto, a
				  failure to comply with this chapter shall constitute a violation of the laws of
				  the Commonwealth and shall subject a company or licensee so failing to comply
				  to the penalties provided by law.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 127 - MANAGEMENT CONTRACTS OR EXCLUSIVE GENERAL AGENCY AGREEMENTS › Section 127.8 - Severability

Current through Register Vol. 54, No. 28, July 13, 2024
If a provision or clause of this chapter or the application
				  thereof to a person or situation is held invalid, the invalidity may not affect
				  another provision or application of this chapter which may be given effect
				  without the invalid provision or application, and to this end the provisions of
				  this chapter are severable.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 129 - SUPPLEMENTAL AND INCOMPLETE RATE FILING › SUPPLEMENTARY INFORMATION › Section 129.1 - Information to be filed

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The
				  rate filings for all lines of personal insurance, such as homeowner,
				  automobile, dwelling, fire and to the extent relative, Blue Cross and Blue
				  Shield rate filings, shall, if the filing affects 5% or more of the market for
				  that particular line of insurance in this Commonwealth, include the following
				  information:
(1) Whether deductible coverage
				  is to be offered, whether higher deductibles are feasible, and what steps will
				  be taken to facilitate the selling of deductibles by agents and
				  brokers.
(2) Steps being taken to
				  modernize and update coverage. For example, whether medical payments protection
				  in an auto policy will be offered in amounts exceeding $5,000, or only up to
				  $5,000, the usual amount now available. Also, what consideration has been given
				  to otherwise updating the scope of protection.
(3) Steps being taken to provide prompt and
				  equitable claims settlements. For example, to what extent advance payments are
				  utilized in automobile liability coverage, what limitations apply to the making
				  of the payments, and what percentage of claims are settled in this manner.
				  Also, company policy on time period to acknowledge or answer inquiries relating
				  to claims.
(4) Whether nature of
				  loss prevention programs are being utilized and planned, including information
				  and statistics on successful as well as unsuccessful programs. For example,
				  revisions necessary to make safe driver insurance plans equitable and useful.
				  Also, what steps are being taken to educate the public regarding the causes of
				  accidents and to promote public action to seek solutions.
(5) The extent to which the particular rating
				  structure of the company appropriately exerts leverage to discourage unsafe
				  conditions and products and unreasonably fragile products, such as damage-prone
				  automobiles. Also, other ways in which the leverage of rates might be utilized
				  to promote safety.
(6) All steps
				  being taken by the insurer in addition to compliance with act of June 5, 1968
				  (P. L. 140, No. 78) (40 P. S. §§
												1008.1-1008.11) regarding automobile
				  insurance, to prevent arbitrary cancellations, nonrenewals and refusals to
				  write in all personal lines of insurance.
(7) The intended and actual impact of prior
				  rate increases in eliminating restrictive and discriminatory underwriting
				  practices, and the likely impact of the requested increases on existing
				  practices as evidenced by company manuals and other available
				  evidence.
(8) The extent to which
				  the company has initiated agency terminations, plans for the rehabilitation of
				  agents and the expansion of its agency forces.
(9) Other appropriate steps being considered
				  or proposed to lower costs and increase the quality of service.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 129 - SUPPLEMENTAL AND INCOMPLETE RATE FILING › INCOMPLETE RATE FILINGS › Section 129.11 - Additional information

Current through Register Vol. 54, No. 28, July 13, 2024
If, within the first 30 days following the receipt of a
					 rate filing, the Department finds that without additional information it is
					 unable to determine whether the filing meets the requirements of the applicable
					 rate regulatory act, the insurer will be requested to submit the additional
					 information within 30 days from the date of the request. Upon receipt of the
					 information, the rate filing will be reviewed by the Department within the
					 number of days which remain in the initial 30-day waiting period. In addition
					 thereto, the Department may, by written notice, extend the initial 30-day
					 waiting period for an additional period which will not exceed 30 days, in
					 accordance with the provisions of the Fire, Marine and Inland Marine Rate
					 Regulatory Act (40 P. S. §§
											1221-1238) and the Casualty and Surety Rate
					 Regulatory Act (40 P. S. §§
											1181-1199).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 129 - SUPPLEMENTAL AND INCOMPLETE RATE FILING › INCOMPLETE RATE FILINGS › Section 129.12 - Failure to provide information

Current through Register Vol. 54, No. 28, July 13, 2024
If the company fails to provide the Department with the
					 requested information within 30 days from the date of the request or fails to
					 offer a satisfactory written explanation as to why the information was not made
					 available, the captioned filing will be deemed to have been withdrawn and the
					 company will be so notified.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 130 - REQUIREMENTS FOR FILING FOR A DECREASE IN CURRENTLY APPROVED RATES › Section 130.1 - Purpose

Current through Register Vol. 54, No. 28, July 13, 2024
This chapter is to promote competition among insurers for the
				  benefit of the insurance consuming public by permitting insurers subject to the
				  Fire and Marine Rate Act or the Casualty and Surety Rate Act, or both, to
				  effect expeditiously certain decreases in a rate filing currently approved by
				  the Department when, in an insurer's judgment economic or competitive reasons
				  or conditions warrant such a decrease. A further purpose is to enable an
				  insurer to return to the currently approved rate level without delay or
				  regulatory review when, in its judgment, the conditions or reasons for the
				  decrease no longer pertain.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 130 - REQUIREMENTS FOR FILING FOR A DECREASE IN CURRENTLY APPROVED RATES › Section 130.2 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
The following words and terms, when used in this chapter,
				  have the following meanings unless the context clearly indicates otherwise:
Bureau
-The Bureau of Regulation of Rates and
				  Policies of the Department.
Casualty and Surety Rate Act
-The Casualty
				  and Surety Rate Regulatory Act (40 P. S. §§
										1181-1199).
Commissioner
-The Insurance Commissioner of
				  the Commonwealth.
Department
-The Insurance Department of the
				  Commonwealth.
Director
-The Director of the Bureau.
Fire and Marine Rate Act
-The Fire, Marine
				  and Inland Marine Rate Regulatory Act (40 P. S. §§
										1221-1238).
Insurer
-An insurance company, association or
				  exchange authorized to transact insurance business in this Commonwealth which
				  files its rates independently under the Fire and Marine Rate Act or the
				  Casualty and Surety Rate Act, or both; a member or subscriber of a rating
				  organization on whose behalf rate filings are made under the aforesaid acts by
				  a rating organization; or a rating organization itself licensed under either or
				  both of the aforesaid acts.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 130 - REQUIREMENTS FOR FILING FOR A DECREASE IN CURRENTLY APPROVED RATES › Section 130.3 - Filing requirements

Current through Register Vol. 54, No. 28, July 13, 2024
An insurer subject to the Fire and Marine Rate Act or the
				  Casualty and Surety Rate Act, or both, to effect a decrease in rates currently
				  approved by the Department, shall comply with the following filing
				  requirements:
(1) The insurer by a
				rate filing shall notify the Director; Bureau of Regulation of Rates and
				Policies; Insurance Department; Harrisburg, Pennsylvania 17120 at least 30 days
				prior to the date it wants to put into effect a decrease in rates currently
				approved for it by the Department. In the rate filing, the insurer shall state
				the basis for the decrease in rates and its agreement that the decrease in rate
				filing shall remain in effect for at least 3 months from the effective date.
				Within a 15-day period following the filing of a proposed decrease in rates,
				the Commissioner will notify the insurer of the unacceptability of the filing
				for a decrease in rates. The Commissioner will only find unacceptable a
				decrease in rate filing if, in his opinion, the decrease in rates may have a
				tendency or capacity to imperil the financial condition of the filing
				insurer.
(2) The decrease in rate
				filing may be up to 10% from the currently approved rates and shall apply to
				policyholders either by coverage or line of insurance.
(3) After a filing has been in effect for 3
				months or more, an insurer may automatically withdraw its decrease or a portion
				thereof by so notifying the Director; Bureau of Regulation of Rates and
				Policies; Insurance Department; Harrisburg, Pennsylvania 17120 at least 30 days
				prior to the withdrawal date.
This section cited in 31 Pa. Code §
											153.3 (relating to simplified
					 review of company merger, assumption or name change form and rate
					 filings-statement of policy).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 145 - ELIMINATION OF UNFAIR SEX OR MARITAL STATUS DISCRIMINATION IN ALL INSURANCE CONTRACTS › Section 145.1 - Purpose

Current through Register Vol. 54, No. 28, July 13, 2024
This chapter prohibits insurers from denying benefits or
				  coverage to individuals on the basis of unfair sex or marital status
				  discrimination in the terms or conditions of insurance contracts and in the
				  underwriting criteria of insurers. This chapter does not prohibit insurers from
				  differentiating in premium rates between sexes where there is sound actuarial
				  justification.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 145 - ELIMINATION OF UNFAIR SEX OR MARITAL STATUS DISCRIMINATION IN ALL INSURANCE CONTRACTS › Section 145.2 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
The following words and terms, when used in this chapter,
				  have the following meanings, unless the context clearly indicates otherwise:
Contract
-An insurance policy, subscriber
				  agreement, certificate, plan or written agreement for or effecting insurance by
				  whatever name called, including but not limited to clauses, riders or
				  endorsements offered by a person or entity engaged in the business of insurance
				  in this Commonwealth.
Department
-The Insurance Department of the
				  Commonwealth.
Insurer
-An insurance company, association,
				  reciprocal or interinsurance exchange, nonprofit hospital or professional
				  health service plan, health maintenance organization, fraternal benefit
				  society, beneficial association or other person, corporation, company,
				  partnership, association or other entity acting as an
				  insurer.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 145 - ELIMINATION OF UNFAIR SEX OR MARITAL STATUS DISCRIMINATION IN ALL INSURANCE CONTRACTS › Section 145.3 - Applicability and scope

Current through Register Vol. 54, No. 28, July 13, 2024
This chapter applies to contracts delivered or issued for
				  delivery in this Commonwealth by an insurer on or after the effective date of
				  this chapter and to existing group contracts which are either amended or
				  renewed on or after the effective date of this chapter.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 145 - ELIMINATION OF UNFAIR SEX OR MARITAL STATUS DISCRIMINATION IN ALL INSURANCE CONTRACTS › Section 145.4 - Availability requirements

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
				Availability of an insurance contract may not be denied to an insured or
				prospective insured on the basis of the sex or marital status of the insured or
				prospective insured. The amount of benefits payable or a term, condition or
				type of coverage may not be restricted, modified, excluded or reduced solely on
				the basis of sex or marital status of the insured or prospective insured. The
				preceding sentence may not be construed to preclude a person from requesting
				restrictions, modifications, exclusions or reductions of the benefits payable
				or of a term, condition or type of coverage of his individual policy. The
				requirements that the amount of benefits may not be restricted, modified,
				excluded or reduced solely on the basis of sex or marital status does not apply
				in the following instances:
(1) The
				calculation of the amount of the insurance that can be purchased for a given
				amount of premium.
(2) The
				calculation of settlement options or nonforfeiture benefits under a life
				insurance policy.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 146 - UNFAIR INSURANCE PRACTICES › Subchapter A - UNFAIR CLAIMS SETTLEMENT PRACTICES › Section 146.1 - Scope

Current through Register Vol. 54, No. 28, July 13, 2024
This chapter defines certain minimum standards which, if
					 violated with a frequency that indicates a general business practice, will be
					 deemed to constitute unfair claims settlement practices. This chapter applies
					 to persons and to insurance policies and insurance contracts except policies of
					 workers' compensation insurance and fidelity, surety and guaranty bonds. This
					 chapter is not exclusive, and other acts, not herein specified, may also be
					 deemed to be a violation of sections 4 and 5(10) of the Unfair Insurance
					 Practices Act (40 P. S. §§
											1171.4 and
					 1171.5(10)).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 146 - UNFAIR INSURANCE PRACTICES › Subchapter A - UNFAIR CLAIMS SETTLEMENT PRACTICES › Section 146.2 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The definitions
				  of "person" and of "insurance policy or insurance contract" contained in
				  section 2 of the Unfair Insurance Practices Act (40 P. S. §
											1171.2) applies to this chapter.
(b) The following words and terms, when used
				  in this chapter, have the following meanings, unless the context clearly
				  indicates otherwise:
Agent
-An individual, corporation,
					 association, partnership or other legal entity authorized to represent an
					 insurer with respect to a claim.
Claim
-A demand for payment by a claimant
					 and not an inquiry concerning coverage.
Claimant
-Except as provided in §
											146.10 (relating to written notice
					 to claimants of payment of claim in third-party settlements), either a
					 first-party claimant, a third-party claimant, or both, and including the
					 claimant's attorney and a member of the claimant's immediate family designated
					 by the claimant.
Commissioner
-The Insurance Commissioner of
					 the Commonwealth.
Department
-The Insurance Department of
					 the Commonwealth.
First-party claimant
-An individual,
					 corporation, association, partnership or other legal entity asserting a right
					 to payment under an insurance policy or insurance contract arising out of the
					 occurrence of the contingency or loss covered by such policy or contract.
Insured
-A natural person, association,
					 corporation, partnership or other legal entity who is insured under an
					 insurance policy or insurance contract issued in this Commonwealth.
Insurer
-A person licensed to issue or who
					 issues an insurance policy or insurance contract in this Commonwealth.
Investigation
-Activities of an insurer
					 directly or indirectly related to the determination of liabilities under
					 coverages afforded by an insurance policy or insurance contract and settlement
					 of claims or losses thereunder.
Notification of claim
-A notification,
					 whether in writing or other means acceptable under the terms of an insurance
					 policy or insurance contract, to an insurer or its agent, by a claimant or
					 insured, which reasonably apprises the insurer of the facts pertinent to a
					 claim.
Third-party claimant
-An individual,
					 corporation, association, partnership or other legal entity asserting a claim
					 against an individual, corporation, associa-tion, partnership or other legal
					 entity insured under an insurance policy or insurance contract of an
					 insurer.
(c) The term
				  "worker's compensation," in this chapter, includes but is not limited to
				  Longshoremen's and Harbor Worker's Compensation.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 146 - UNFAIR INSURANCE PRACTICES › Subchapter A - UNFAIR CLAIMS SETTLEMENT PRACTICES › Section 146.3 - File and record documentation

Current through Register Vol. 54, No. 28, July 13, 2024
The claim files of the insurer shall be subject to
					 examination by the Commissioner or by his appointed designees. The files shall
					 contain notes and work papers pertaining to the claim in the detail that
					 pertinent events and the dates of the events can be
					 reconstructed.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 146 - UNFAIR INSURANCE PRACTICES › Subchapter A - UNFAIR CLAIMS SETTLEMENT PRACTICES › Section 146.4 - Misrepresentation of policy provisions

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
				  An insurer or agent may not fail to fully disclose to first-party claimants
				  pertinent benefits, coverages or other provisions of an insurance policy or
				  insurance contract under which a claim is presented.
(b) An insurer or agent may not fail to fully
				  disclose to first-party claimants benefits, coverages or other provisions of an
				  insurance policy or insurance contract when the benefits, coverages or other
				  provisions are pertinent to a claim.
(c) An insurer may not deny a claim for
				  failure to exhibit the property without proof of demand and refusal by a
				  claimant to do so.
(d) An insurer
				  may not, except where there is a time limit specified in the policy, make
				  statements-written or otherwise-requiring a claimant to give written notice of
				  loss or proof of loss within a specified time limit and which seek to relieve
				  the company of its obligations if a time limit is not complied with unless the
				  failure to comply with the time limit prejudices the rights of the
				  insurer.
(e) An insurer may not
				  request a first-party claimant to sign a release that extends beyond the
				  subject matter that gave rise to the claim payment.
(f) An insurer may not issue checks or drafts
				  in partial settlement of a loss or claim under a specific coverage which checks
				  or drafts contain language which expressly or impliedly releases the insurer or
				  its insured from its total liability.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 146 - UNFAIR INSURANCE PRACTICES › Subchapter A - UNFAIR CLAIMS SETTLEMENT PRACTICES › Section 146.5 - Failure to acknowledge pertinent communications

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Every insurer, upon receiving
				  notification of a claim, shall, within 10 working days, acknowledge the receipt
				  of the notice unless payment is made within the period of time. If an
				  acknowledgment is made by means other than writing, an appropriate notation of
				  the acknowledgment shall be made in the claim file of the insurer and dated.
				  Notification given to an agent of an insurer shall be notification to the
				  insurer, dating from the time the insurer receives notice.
(b) Every insurer, upon receipt of an inquiry
				  from the Department respecting a claim shall, within 15 working days of receipt
				  of the inquiry, furnish the Department with an adequate response to the
				  inquiry.
(c) An appropriate reply
				  shall be made within 10 working days on other pertinent communications from a
				  claimant which reasonably suggest that a response is expected.
(d) Every insurer, upon receiving
				  notification of claim, shall provide within 10 working days necessary claim
				  forms, instructions and reasonable assistance so that first-party claimants can
				  comply with the policy conditions and reasonable requirements of the insurer.
				  Compliance with this subsection within 10 working days of notification of a
				  claim shall constitute compliance with subsection (a).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 146 - UNFAIR INSURANCE PRACTICES › Subchapter A - UNFAIR CLAIMS SETTLEMENT PRACTICES › Section 146.6 - Standards for prompt investigation of claims

Current through Register Vol. 54, No. 28, July 13, 2024
Every insurer shall complete investigation of a claim
					 within 30 days after notification of claim, unless the investigation cannot
					 reasonably be completed within the time. If the investigation cannot be
					 completed within 30 days, and every 45 days thereafter, the insurer shall
					 provide the claimant with a reasonable written explanation for the delay and
					 state when a decision on the claim may be expected.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 146 - UNFAIR INSURANCE PRACTICES › Subchapter A - UNFAIR CLAIMS SETTLEMENT PRACTICES › Section 146.7 - Standards for prompt, fair and equitable settlements applicable to insurers

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Acceptance or
				  denial of a claim shall comply with the following:
(1) Within 15 working days after receipt by
				  the insurer of properly executed proofs of loss, the first-party claimant shall
				  be advised of the acceptance or denial of the claim by the insurer. An insurer
				  may not deny a claim on the grounds of a specific policy provision, condition
				  or exclusion unless reference to the provision, condition or exclusion is
				  included in the denial. The denial shall be given to the claimant in writing
				  and the claim file of the insurer shall contain a copy of the denial.
(2) Where there is a reasonable basis
				  supported by specific information available for review by the insurance
				  regulatory authority that the first-party claimant has fraudulently caused or
				  contributed to the loss by arson or other illegal activity, the insurer is
				  relieved from the requirements of this subsection; provided, however, that the
				  claimant shall be advised of the acceptance or denial of the claim within a
				  reasonable time for full investigation after receipt by the insurer of a
				  properly executed proof of loss.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 146 - UNFAIR INSURANCE PRACTICES › Subchapter A - UNFAIR CLAIMS SETTLEMENT PRACTICES › Section 146.8 - Standards for prompt, fair and equitable settlements applicable to automobile insurance

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
				  Insurers may not recommend that third-party claimants make claim under their
				  own policies solely to avoid paying claims under the insurer's insurance policy
				  or insurance contract.
(b) Insurers
				  may not require a claimant to travel unreasonably either to inspect a
				  replacement automobile, to obtain a repair estimate or to have the automobile
				  repaired at specific repair shops.
(c) Insurers shall, upon the request of the
				  claimant, include the first-party claimant's deductible, if any, in subrogation
				  demands. Subrogation recoveries shall be shared on a proportionate basis with
				  the first-party claimant, unless the deductible amount has been otherwise
				  recovered. A deduction for expenses can not be made from the deductible
				  recovery unless an outside attorney is retained to collect the recovery. The
				  deduction may then be for only a pro rata share of the allocated loss
				  adjustment expense.
(d) If an
				  insurer prepares an appraisal of the cost of automobile repairs, the appraisal
				  shall be in an amount for which it may be reasonably expected the damage can be
				  satisfactorily repaired. The insurer shall give a copy of the appraisal to the
				  claimant and may furnish to the claimant, upon his unsolicited request, the
				  names of two or more conveniently located repair shops.
(e) When the amount claimed is reduced
				  because of betterment or depreciation information for the reduction shall be
				  contained in the claim file. The deductions shall be itemized and specified as
				  to dollar amount and shall be appropriate for the amount of
				  deductions.
(f) When the insurer
				  elects to repair in a first-party claim, the insurer shall cause the damaged
				  automobile to be restored to its condition prior to the loss at no additional
				  cost to the claimant other than as stated in the policy and within a reasonable
				  period of time.
(g) The insurer may
				  not use as a basis for cash settlement with a first-party claimant an amount
				  which is less than the amount which the insurer would pay if repairs were made,
				  other than in total loss situations, unless the amount is agreed to by the
				  insured or provided by the insurance policy or insurance contract.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 146 - UNFAIR INSURANCE PRACTICES › Subchapter A - UNFAIR CLAIMS SETTLEMENT PRACTICES › Section 146.9 - Comparative negligence

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Where
				  comparative negligence is applied to a claim settlement offer or denial,
				  insurers shall fully disclose to claimants the basis in fact or in applicable
				  law for the offer or denial and settlement standards relating to the
				  claims.
(b) Insurers may not use
				  comparative negligence claim settlement standards which are inequitable and
				  which result in compelling claimants to litigate by offering substantially less
				  than the amount due and ultimately recovered in actions brought by the persons.
				  Comparative negligence should not be applied to a claim settlement to reduce
				  amounts claimants would otherwise be entitled to but for their negligence
				  without reasonable evidence of the negligence and its relativity to the total
				  negligence involved. A record of the evidence and the evaluation of its effect
				  should be maintained in the claim file.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 146 - UNFAIR INSURANCE PRACTICES › Subchapter A - UNFAIR CLAIMS SETTLEMENT PRACTICES › Section 146.10 - Written notice to claimants of payment of claim in third-party settlements

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Upon payment of
				  $1,000 or more in settlement of a third-party liability claim, if the claimant
				  is a natural person, the insurer shall cause written notice to be mailed to the
				  claimant at the same time payment is made, by the insurer or its
				  representative, including the insurer's attorney, to the claimant's attorney or
				  other representative of the claimant by draft, check or otherwise.
(b) Nothing in this subsection will
				  constitute a violation of this chapter if an insurer makes a good faith effort
				  to comply with this section.
(c) A
				  violation of this section will be deemed to occur if an insurer fails to
				  provide the notice to claimants with a frequency that indicates that it is a
				  general business practice.
The provisions of this §
												146.10 issued under sections 206,
						506, 1501 and 1502 of The Administrative Code of 1929 (71 P. S.
						§§
													66,
						186,
						411 and
						412); and the Unfair
						Insurance Practices Act (40 P. S. §§
													1171.1-1171.15).
This section cited in 31 Pa. Code §
												146.2 (relating to
						definitions).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 146a - PRIVACY OF CONSUMER FINANCIAL INFORMATION › Subchapter A - GENERAL PROVISIONS › Section 146a.1 - Purpose

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Purpose
. This chapter governs the treatment of nonpublic
				  personal financial information about individuals by various licensees of the
				  Department. This chapter:
(1) Requires a
				  licensee to provide notice to individuals about its privacy policies and
				  practices.
(2) Describes the
				  conditions under which a licensee may disclose nonpublic personal financial
				  information about individuals to affiliates and nonaffiliated third
				  parties.
(3) Provides methods for
				  individuals to prevent a licensee from disclosing that
				  information.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 146a - PRIVACY OF CONSUMER FINANCIAL INFORMATION › Subchapter A - GENERAL PROVISIONS › Section 146a.2 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
The following words and terms, when used in this chapter,
					 have the following meanings, unless the context requires otherwise:
Act
-The Insurance Department Act of 1921
					 (40
					 P. S. §§
											1-321)
Affiliate
-A company that controls, is
					 controlled by or is under common control with another company.
Clear and conspicuous
-That a notice is
					 reasonably understandable and designed to call attention to the nature and
					 significance of the information in the notice. Examples include:
(i)
Reasonably
				  understandable
. A licensee makes its notice reasonably understandable
				  if it does all of the following:
(A) Presents
				  the information in the notice in clear, concise sentences, paragraphs and
				  sections.
(B) Uses short
				  explanatory sentences or bullet lists whenever possible.
(C) Uses definite, concrete, everyday words
				  and active voice whenever possible.
(D) Avoids multiple negatives.
(E) Avoids legal and highly technical
				  business terminology whenever possible.
(F) Avoids explanations that are imprecise
				  and readily subject to different interpretations.