reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › THE UNFAIR CLAIMS SETTLEMENT PRACTICES REGULATION › Section 284-30-355 - Certificates of insurance

Current through Register Vol. 24-14, July 15, 2024
(1) The
				following definitions apply to this section.
(a) "Certificate" or "certificate of
				insurance" means any document, without regard to title or description, that is
				issued by an insurer, insurance producer, or surplus line broker as evidence of
				property or casualty insurance coverage. Certificate or certificate of
				insurance as used in this section does not include an insurance policy,
				insurance binder, an automobile insurance identification or information card,
				or a certificate issued to a person or entity that has purchased coverage under
				a group master policy.
(b)
				"Certificate holder" means any person, other than a policyholder, that
				requests, obtains, or possesses a certificate.
(c) "Property" means the insurance coverages
				described in
				RCW
				 48.11.040.
(d) "Casualty" means the insurance coverages
				described in
				RCW
				 48.11.070.
(e) "Insurance binder" means a temporary
				document that serves as evidence of insurance until the insurance policy is
				issued.
(f) "Insurance policy"
				means the executed insurance policy issued to the named insured as part of an
				insurance transaction as defined in
				RCW
				 48.01.060.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › THE UNFAIR CLAIMS SETTLEMENT PRACTICES REGULATION › Section 284-30-360 - Standards for the insurer to acknowledge pertinent communications

Current through Register Vol. 24-14, July 15, 2024
(1) Within ten
				working days after receiving notification of a claim under an individual
				insurance policy, or within fifteen working days with respect to claims arising
				under group insurance contracts, the insurer must acknowledge its receipt of
				the notice of claim.
(a) If payment is made
				within that period of time, acknowledgment by payment constitutes a
				satisfactory response.
(b) If an
				acknowledgment is made by means other than writing, an appropriate notation of
				the acknowledgment must be made in the claim file of the insurer describing
				how, when, and to whom the notice was made.
(c) Notification given to an agent of the
				insurer is notification to the insurer.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › THE UNFAIR CLAIMS SETTLEMENT PRACTICES REGULATION › Section 284-30-370 - Standards for prompt investigation of a claim

Current through Register Vol. 24-14, July 15, 2024
Every insurer must complete its investigation of a claim
				  within thirty days after notification of claim, unless the investigation cannot
				  reasonably be completed within that time. All persons involved in the
				  investigation of a claim must provide reasonable assistance to the insurer in
				  order to facilitate compliance with this provision.
Statutory Authority:
					 RCW
					 48.02.060 and
					 48.30.010. 09-11-129 (Matter No. R
					 2007-08), §
											284-30-370, filed 5/20/09,
					 effective 8/21/09; 78-08-082 (Order R 78-3), §
											284-30-370, filed 7/27/78,
					 effective 9/1/78.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › THE UNFAIR CLAIMS SETTLEMENT PRACTICES REGULATION › Section 284-30-390 - Acts or practices considered unfair in the settlement of motor vehicle claims

Current through Register Vol. 24-14, July 15, 2024
In addition to the unfair claims settlement practices
				  specified in this regulation, the following acts or practices of the insurer
				  are hereby defined as unfair methods of competition and unfair or deceptive
				  acts or practices in the business of insurance, specifically applicable to the
				  settlement of motor vehicle claims:
(1) Failing to make a good faith effort to
				communicate with the repair facility chosen by the claimant.
(2) Arbitrarily denying a claimant's estimate
				for repairs.
(a) A denial of the claimant's
				estimate for repairs to be completed at the chosen repair facility based solely
				on the repair facility's hourly rate is considered arbitrary if the rate does
				not result in a higher overall cost of repairs.
(b) If the insurer pays less than the amount
				of the estimate from the claimant's chosen repair facility, the insurer must
				fully disclose the reason or reasons it paid less than the claimant's estimate,
				and must thoroughly document the circumstances in its claim file.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › THE UNFAIR CLAIMS SETTLEMENT PRACTICES REGULATION › Section 284-30-392 - Information that must be included in the insurer's total loss vehicle valuation report

Current through Register Vol. 24-14, July 15, 2024
The insurer's total loss vehicle valuation report must
				  include:
(1) All information collected
				during the initial inspection assessing the condition, equipment, and mileage
				of the loss vehicle;
(2) All
				information the insurer used to determine the actual cash value of the loss
				vehicle;
(3) A list of the
				comparable motor vehicles used by the insurer to arrive at the actual cash
				value. This list must include:
(a) The source
				of the information used;
(b) The
				date of the information;
(c) The
				contact information for the seller, the comparable motor vehicle's vehicle
				identification number, or both;
(d)
				The seller's asking price;
(e) The
				sold price, if available; and
(f)
				The location or contact information for each comparable motor vehicle at the
				time of the valuation.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › THE UNFAIR CLAIMS SETTLEMENT PRACTICES REGULATION › Section 284-30-393 - Insurer must include an insured's deductible in its subrogation demands

Current through Register Vol. 24-14, July 15, 2024
The insurer must include the insured's deductible, if any, in
				  its subrogation demands. Any recoveries must be allocated first to the insured
				  for any deductible(s) incurred in the loss, less applicable comparable fault.
				  Deductions for expenses must not be made from the deductible recovery unless an
				  outside attorney is retained to collect the recovery. The deduction may then be
				  made only as a pro rata share of the allocated loss adjustment expense. The
				  insurer must keep its insured regularly informed of its efforts related to the
				  progress of subrogation claims. "Regularly informed" means that the insurer
				  must contact its insured within sixty days after the start of the subrogation
				  process, and no less frequently than every one hundred eighty days until the
				  insured's interest is resolved.
Statutory Authority:
					 RCW
					 48.02.060. 11-13-029 (Matter No. R 2010-15),
					 §
											284-30-393, filed 6/7/11,
					 effective 7/8/11. Statutory Authority:
					 RCW
					  48.02.060 and
					 48.30.010. 09-11-129 (Matter No. R
					 2007-08), §
											284-30-393, filed 5/20/09,
					 effective 8/21/09.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › THE UNFAIR CLAIMS SETTLEMENT PRACTICES REGULATION › Section 284-30-394 - Denial of storage and towing costs

Current through Register Vol. 24-14, July 15, 2024
Prior to denying storage and towing costs, the insurer must
				  do all of the following:
(1) Advise
				the first party claimant by phone or in writing before it stops payment for
				storage of the loss vehicle. This communication must be documented in the claim
				file. If it is a phone call, the documentation must include the date, time,
				name of the person contacted and a summary of the conversation;
(2) Provide reasonable time for the claimant
				to move the loss vehicle before stopping payment for storage. Five calendar
				days is considered reasonable time unless the claimant agrees to a shorter time
				period;
(3) Pay any and all
				reasonable towing charges unless otherwise provided in the applicable insurance
				policy.
Statutory Authority:
					 RCW
					 48.02.060 and
					 48.30.010. 09-11-129 (Matter No. R
					 2007-08), §
											284-30-394, filed 5/20/09,
					 effective 8/21/09.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › THE UNFAIR CLAIMS SETTLEMENT PRACTICES REGULATION › Section 284-30-395 - Standards for prompt, fair and equitable settlements applicable to automobile personal injury protection insurance

Current through Register Vol. 24-14, July 15, 2024
The commissioner finds that some insurers limit, terminate,
				  or deny coverage for personal injury protection insurance without adequate
				  disclosure to insureds of their bases for such actions. To eliminate unfair
				  acts or practices in accord with
				  RCW
				   48.30.010, the following are hereby defined
				  as unfair methods of competition and unfair or deceptive acts or practices in
				  the business of insurance specifically applicable to automobile personal injury
				  protection insurance. The following standards apply to an insurer's
				  consultation with health care professionals when reviewing the reasonableness
				  or necessity of treatment of the insured claiming benefits under his or her
				  automobile personal injury protection benefits in an automobile insurance
				  policy, as those terms are defined in
				  RCW
				   48.22.005(1), (7), and (8),
				  and as prescribed at
				  RCW
				   48.22.085 through
				  48.22.100. This section applies
				  only where the insurer relies on the medical opinion of health care
				  professionals to deny, limit, or terminate medical and hospital benefit claims.
				  When used in this section, the term "medical or health care professional" does
				  not include an insurer's claim representatives, adjusters, or managers or any
				  health care professional in the direct employ of the insurer.
(1) Within a reasonable time after receipt of
				actual notice of an insured's intent to file a personal injury protection
				medical and hospital benefits claim, and in every case prior to denying,
				limiting, or terminating an insured's medical and hospital benefits, an insurer
				shall provide an insured with a written explanation of the coverage provided by
				the policy, including a notice that the insurer may deny, limit, or terminate
				benefits if the insurer determines that the medical and hospital services:
(a) Are not reasonable;
(b) Are not necessary;
(c) Are not related to the accident;
				or
(d) Are not incurred within
				three years of the automobile accident.
These are the only grounds for denial, limitation, or
				  termination of medical and hospital services permitted pursuant to
				  RCW
				   48.22.005(7),
				  48.22.095, or
				  48.22.100.
The written explanation responsive to an insured's intent to
				  file a personal injury protection medical and hospital benefits claim must also
				  include contact information for the office of the Washington state insurance
				  commissioner's consumer protection services, including the consumer protection
				  division's hotline phone number and the agency's web site address, and a
				  statement that the consumer may contact the office of the insurance
				  commissioner for assistance with questions or complaints.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › THE UNFAIR CLAIMS SETTLEMENT PRACTICES REGULATION › Section 284-30-400 - Enforcement

Current through Register Vol. 24-14, July 15, 2024
Violations of the standards for unfair claims settlement
				  practices in this regulation are subject to the enforcement provisions set
				  forth in RCW  48.30.010 and also constitute
				  a failure to comply with a regulation pursuant to
				  RCW
				   48.05.140(1).
Statutory Authority:
					 RCW
					 48.02.060 and
					 48.30.010. 09-11-129 (Matter No. R
					 2007-08), §
											284-30-400, filed 5/20/09,
					 effective 8/21/09; 78-08-082 (Order R 78-3), §
											284-30-400, filed 7/27/78,
					 effective 9/1/78.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › THE UNFAIR CLAIMS SETTLEMENT PRACTICES REGULATION › Section 284-30-450 - Insurance policies and contracts - Coverage for drugs

Current through Register Vol. 24-14, July 15, 2024
(1) Authority and purpose.
(a) Some insurers deny payment for drugs that
				have been approved by the Federal Food and Drug Administration (FDA) when the
				drugs are used for indications other than those stated in the labelling
				approved by the FDA (off-label use) while other insurers with similar coverage
				terms pay for off-label use. Denial of payment for off-label use can interrupt
				or effectively deny access to necessary and appropriate treatment for a person
				being treated for a life-threatening illness.
(b) Equity among insured residents of this
				state and fair claims settlement practices and fair competition among companies
				providing coverage to residents of this state require comparable reimbursement
				for prescribed drugs among insurers, health care service contractors, and
				health maintenance organizations.
(c) Use of off-label indications often
				provides efficacious drugs at a lower cost.
(d) To prevent unfair methods of claims
				settlements, unfair competition, and unfair or deceptive acts or practices of
				insurers and prohibited acts or practices of health care service contractors or
				health maintenance organizations, this rule is adopted.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › TRADE PRACTICES › Section 284-30-500 - Unfair practices with respect to vehicle insurance

Current through Register Vol. 24-14, July 15, 2024
(1) The following practices by any insurer
				with respect to every vehicle liability insurance policy applicable to private
				passenger automobiles registered or principally garaged in this state are
				unfair and prohibited:
(a) Failing to provide,
				to any insured under such policy, liability limits at least as great as those
				required by
				RCW
				 46.29.090, as measured at the effective date
				of the applicable policy or its renewal;
(b) Denying or limiting liability coverage in
				such policy to less than the insured's policy limits solely because the injured
				person qualifies as an insured as defined in
				RCW
				 48.22.005(5)(a);
(c) Denying or limiting liability coverage in
				such policy, with respect to injuries sustained by motorcycle passengers, to an
				amount below the bodily injury liability limits required by
				RCW
				 46.29.090, if the policy provides liability
				coverage for an insured's ownership, operation, or use of a
				motorcycle.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › TRADE PRACTICES › Section 284-30-550 - Receipts to be given

Current through Register Vol. 24-14, July 15, 2024
(1) To
				effectuate
				RCW
				 48.17.470 and
				48.17.480 and to eliminate unfair
				practices in accord with
				RCW
				 48.30.010, any insurance producer or other
				representative of an insurer who receives a contract payment or premium from or
				on behalf of an insured or applicant for homeowners', dwelling fire, private
				passenger automobile, motorcycle, individual life, or individual disability
				insurance shall deliver or mail a signed receipt therefor as promptly as
				possible, which should generally be no later than the next business day. Such
				receipt must be dated, identify the insurance producer and the insurance
				producer's address, identify the person by or for whom payment is made, state
				the amount received, identify the applicable insurer by its full legal name (or
				the premium finance company or Washington automobile insurance plan if payment
				is intended therefor), and identify the contract or policy including a brief
				description of the coverage for which payment is received.
(2) The receipt need not be an independent
				document but may be incorporated in an application or binder, if
				appropriate.
(3) For purposes of
				this section "life insurance" includes annuities.
(4) For purposes of this section "insurer"
				includes a health care service contractor and a health maintenance
				organization, and "disability insurance" includes their contracts and
				agreements.
(5) This section shall
				not apply to the receipt of checks or other instruments payable on their face
				to the insurer, premium finance company or the Washington Automobile Insurance
				Plan. It also shall not apply to payments (other than by cash) received by an
				insurance producer after delivery of the policy for which payment is made, when
				the payment is pursuant to a premium financing arrangement with the insurance
				producer or in response to a billing by the insurance producer.
(6) A failure to comply with this section
				shall be an unfair practice pursuant to
				RCW
				 48.30.010, and a violation of a regulation
				pursuant to
				RCW
				 48.17.530.
(7) Each insurer shall inform its insurance
				producers and appropriate representatives of the requirements of this
				section.
Statutory Authority:
					 RCW
					 48.02.060(3)(a) and
					 48.17.010(5).
					 11-01-159 (Matter No. R 2010-09), §
											284-30-550, filed 12/22/10,
					 effective 1/22/11. Statutory Authority:
					 RCW
					 48.02.060(3)(a). 85-02-019
					 (Order R 84-8), §
											284-30-550, filed
					 12/27/84.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › TRADE PRACTICES › Section 284-30-560 - Applications and binders

Current through Register Vol. 24-14, July 15, 2024
(1)
				Every application form used in connection with homeowners', dwelling fire and
				vehicle insurance, shall contain a clear and conspicuous statement setting
				forth whether or not coverage has commenced.
(a) If coverage has commenced, the effective
				date shall be stated.
(b) If
				coverage has not commenced, there shall be an explanation as to the
				circumstances which will cause coverage to commence and the time when coverage
				will become effective.
(c) The
				statement concerning commencement of coverage shall not be minimized, rendered
				obscure, or presented in an ambiguous fashion or intermingled with the other
				contents of the application so as to be confusing, misleading or not readily
				evident.
(d) A copy of such
				application shall be delivered or mailed to the applicant promptly following
				its execution.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › TRADE PRACTICES › Section 284-30-570 - Actual reason for canceling, denying or refusing to renew insurance to be disclosed

Current through Register Vol. 24-14, July 15, 2024
Whenever an insurer is required by law to give the reason for
				  its canceling, denying, or refusing to renew insurance, as, for example,
				  pursuant to
				  RCW
				   48.18.291,
				  48.18.292, or
				  48.30.320, it shall give the true
				  and actual reason for its action in clear and simple language, so that the
				  insured or applicant will not need to resort to additional research to
				  understand the real reason for the action. It is not sufficient, for example,
				  to state that an insured "does not meet the company's underwriting standards."
				  The reason why the individual does not meet such underwriting standards is what
				  must be given. If the actual reason relates to medical information, the insurer
				  may make a broad reference thereto and limit specific disclosure of details to
				  the applicant's or insured's physician.
Statutory Authority:
					 RCW
					 48.02.060(3)(a). 85-02-019
					 (Order R 84-8), §
											284-30-570, filed
					 12/27/84.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › TRADE PRACTICES › Section 284-30-572 - Discrimination prohibited

Current through Register Vol. 24-14, July 15, 2024
(1) It
				shall be an unfair practice for any insurer to decline, cancel, or refuse to
				renew any homeowners, dwelling fire or vehicle insurance policy, or to vary its
				terms, rates, conditions or benefits, because of an insured's or applicant's
				race, creed, color, national origin, religion, or ability to read, write, or
				speak the English language.
(2) It
				is an unfair practice for any insurer, and a prohibited practice for any health
				care service contractor or health maintenance organization, to discourage a
				claimant or an insured from contacting the insurance commissioner, or to
				unfairly discriminate against such person because of such contact.
Statutory Authority:
					 RCW
					 48.02.060,
					 48.44.050 and
					 48.46.200. 87-09-071 (Order R
					 87-5), §
											284-30-572, filed
					 4/21/87.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › TRADE PRACTICES › Section 284-30-574 - Insurer must make independent evaluation

Current through Register Vol. 24-14, July 15, 2024
It shall be an unfair practice for any insurer to rely solely
				  on another insurer's denial, cancellation, or nonrenewal of insurance to
				  support a denial or termination of coverage. In every case, an insurer must go
				  behind another insurer's action and make its own independent decision on the
				  merits. This section does not prohibit an insurer from denying a binder pending
				  its evaluation of another insurer's action, and does not apply to an
				  insurer-reinsurer relationship.
Statutory Authority:
					 RCW
					 48.02.060,
					 48.44.050 and
					 48.46.200. 87-09-071 (Order R
					 87-5), §
											284-30-574, filed
					 4/21/87.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › TRADE PRACTICES › Section 284-30-580 - Policies to be delivered, not held by insurance producers or title insurance agents

Current through Register Vol. 24-14, July 15, 2024
(1)RCW
				 48.18.260 requires that policies be delivered
				within a reasonable period of time after issuance. If an insurer relies upon
				its appointed insurance producers or title insurance agents to make deliveries
				of its policies, the insurer, as well as the appointed insurance producer or
				title insurance agent, is responsible for any delay resulting from the failure
				of the appointed insurance producer or title insurance agent to act
				diligently.
(2) Insurance producers
				and title insurance agents delivering insurance policies to insureds must make
				an actual physical delivery. It is not acceptable for an insurance producer or
				title insurance agent to merely obtain a receipt indicating a delivery and then
				to retain the policy, for safekeeping or otherwise, in the insurance producer's
				or title insurance agent's possession.
(3) Insurance producers and title insurance
				agents may obtain policies from owners or insureds and hold such policies
				briefly for analysis or servicing, giving a receipt therefor in every instance,
				but shall promptly return any such policies to their owners or insureds.
				Insurance producers and title insurance agents shall not otherwise take custody
				of, or hold, insurance policies, whether for fee or at no charge, unless a
				family or legal relationship clearly justifies such conduct, as, for example,
				where a policy belonging to a minor child of the insurance producer and title
				insurance agent is held, or where the insurance producer or title insurance
				agent is acting as a legal guardian or a court appointed representative and
				holds a policy of a ward or of an estate.
(4) It shall be an unfair practice and unfair
				competition for an insurer or insurance producer or title insurance agent to
				engage in acts or practices which are contrary to or not in conformity with the
				requirements of this section, and a violation of this section is prohibited and
				shall subject an insurer, insurance producer and title insurance agent to the
				penalties or procedures set forth in
				RCW
				 48.05.140,
				48.17.530, or
				48.30.010.
(5) Each insurer shall inform its appointed
				insurance producers or title insurance agents and appropriate representatives
				of the requirements of this section.
Statutory Authority:
					 RCW
					 48.02.060(3)(a) and
					 48.17.010(5).
					 11-01-159 (Matter No. R 2010-09), §
											284-30-580, filed 12/22/10,
					 effective 1/22/11. Statutory Authority:
					 RCW
					 48.02.060(3)(a). 85-02-019
					 (Order R 84-8), §
											284-30-580, filed
					 12/27/84.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › TRADE PRACTICES › Section 284-30-595 - Unfair practices regarding documented expenses for implementation credits

Current through Register Vol. 24-14, July 15, 2024
Under
				  RCW
				   48.30.140 and
				  48.30.150, an
				  insurer or health carrier may issue payment to offset a documented expense that
				  is incurred by a group policyholder in changing coverages from one insurer or
				  health carrier to another provided that the insurer or health carrier maintains
				  evidence of the documented expense for three years from the date of the
				  expense. An insurer or health carrier will describe in the policy or in any
				  such filing with the commissioner that the payment made to the group
				  policyholder will not exceed the amount of the documented expenses.
(1) The failure to maintain and document an
				expense incurred by a group policyholder constitutes an unfair trade practice
				and is a violation of this chapter.
(2) Upon the commissioner's request, the
				insurer or health carrier must provide proof of a documented expense in the
				form of paper or electronic copy.
(3) The definitions in this subsection apply
				throughout this section unless the context clearly requires otherwise.
(a) "Health carrier" has the same meaning as
				in
				RCW
				 48.43.005.
(b) "Insurer" has the same meaning as in
				RCW
				 48.01.050.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › TRADE PRACTICES › Section 284-30-600 - Unfair practices with respect to out-of-state group life and disability insurance

Current through Register Vol. 24-14, July 15, 2024
(1) Under
				RCW
				 48.30.010, it is an unfair method of
				competition and an unfair practice for any insurer to engage in any insurance
				transaction, as defined in
				RCW
				 48.01.060, regarding life insurance,
				annuities, or disability insurance coverage on individuals in this state under
				a group policy delivered to a policyholder outside this state when:
(a) The policy or certificate providing
				coverage in the state of Washington, including, but not limited to,
				applications, riders, or endorsements, contains any inconsistent, ambiguous or
				misleading clauses, or exceptions and conditions which unreasonably or
				deceptively affect the risk purported to be assumed in the general coverage of
				the policy or certificate.
(b) The
				policy or certificate providing coverage in the state of Washington, including,
				but not limited to, applications, riders, or endorsements, has any title,
				heading, or other indication of its provisions which is misleading.
(c) The policy or certificate delivered to
				residents of the state of Washington does not include all terms and conditions
				of the coverage.
(d) The type of
				group being covered under the contract providing coverage in the state of
				Washington does not qualify for group life insurance or group disability
				insurance under the provisions of
				Title
				48 RCW.
(e) The coverage is being solicited by
				deceptive advertising.
(f) With
				respect to disability insurance, the policy or certificate providing coverage
				in the state of Washington does not:
(i)
				Provide that claims will be processed in compliance with
				RCW
				 48.21.130 through
				48.21.148;
(ii) Meet the requirements as to benefits and
				coverage mandated by
				chapter
				48.21 RCW and rules
				effectuating that chapter, specifically including those set forth in chapter
				284-51 WAC, and WAC
				284-30-610,
				284-30-620 and
				284-30-630;
(iii) With respect to long-term care
				insurance, also meet the requirements of
				chapter
				48.84 RCW and chapter
				284-54 WAC;
(iv) With respect to
				medicare supplemental insurance, also meet the requirements of chapter 48.66
				RCW and chapter 284-66 WAC; and
(v)
				Meet the loss ratio standards applicable to group insurance under
				RCW
				 48.66.100 and
				48.70.030 and chapter 284-60
				WAC.
(g) With respect to
				life insurance, the out-of-state group policy or certificate providing coverage
				in the state of Washington fails to comply with the provisions of:
(i)Chapter 48.24 RCW;
(ii) WAC
				284-23-550 and
				284-23-600 through
				284-23-730;
(iii) WAC
				284-30-620; and
(iv) WAC
				284-30-630.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › TRADE PRACTICES › Section 284-30-610 - Unfair practices with respect to the solicitation of coverage under out-of-state group policies

Current through Register Vol. 24-14, July 15, 2024
(1) It is an
				unfair method of competition and an unfair practice for an insurer to permit a
				licensed insurance producer, whether appointed by the insurer or not, to
				solicit an individual in the state of Washington to buy or apply for life
				insurance, annuities, or disability insurance coverage when the coverage is
				provided under the terms of a group policy delivered to an association or
				organization (or to a trustee designated by the association or organization),
				as policyholder, outside this state, unless the following steps are taken:
(a) An accurately completed disclosure
				statement, substantially in the form set forth in subsection (2) of this
				section, must be brought to the attention of the individual being solicited
				before the application for coverage is completed and signed. The disclosure
				form must be signed by both the soliciting licensee and the individual being
				solicited and it must be given to the individual.
(b) A copy of the completed disclosure
				statement must be submitted by the soliciting licensee, with the application
				for coverage, to the insurer providing the coverage.
(c) The insurer must confirm the accuracy of
				the form's contents, and retain the copy for not less than three years from the
				date the coverage commences or from the date received, whichever is
				later.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › TRADE PRACTICES › Section 284-30-620 - Permissible time limit for benefits payable because of accidental injury or death

Current through Register Vol. 24-14, July 15, 2024
Beginning January 1, 1988, it shall be an unfair practice for
				  any insurer to deliver a policy of insurance in this state which provides for
				  benefits in case of accidental death or accidental injury, if it limits the
				  benefits payable thereunder to losses occurring within a stated period of time
				  after the accident, unless such period of time extends for at least one year
				  from the time of the accident. In other words, benefits for accidental death or
				  for covered expenses incurred because of an accidental injury shall be paid if
				  the covered death occurs, or the covered services are incurred, within one year
				  of the accident.
Statutory Authority:
					 RCW
					 48.02.060,
					 48.44.050 and
					 48.46.200. 87-09-071 (Order R
					 87-5), §
											284-30-620, filed
					 4/21/87.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › TRADE PRACTICES › Section 284-30-630 - Health questions in applications to be clear and precise

Current through Register Vol. 24-14, July 15, 2024
If an insurer, including a health care service contractor or
				  a health maintenance organization, intends to rely on an applicant's or
				  enrollee's answers to health questions in an application to determine
				  eligibility for coverage or the existence of a preexisting condition, such
				  questions must be clear and precise. Simply asking whether the applicant has
				  been under the care of a physician during the preceding year, for example, is
				  not sufficient to require a "yes" answer where the applicant has been using
				  medications that were prescribed prior to the start of the preceding year and
				  the applicant has not seen a physician for more than a year.
Statutory Authority:
					 RCW
					 48.02.060,
					 48.44.050 and
					 48.46.200. 87-09-071 (Order R
					 87-5), §
											284-30-630, filed
					 4/21/87.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › TRADE PRACTICES › Section 284-30-650 - Prompt responses required

Current through Register Vol. 24-14, July 15, 2024
It is an unfair practice for an insurer, and a prohibited
				  practice for a health care service contractor or a health maintenance
				  organization, to fail to respond promptly to any inquiry from the insurance
				  commissioner relative to the business of insurance. A lack of response within
				  fifteen business days from receipt of an inquiry will be considered untimely. A
				  response must be in writing, unless otherwise indicated in the inquiry. If the
				  inquiry originates from the commissioner's electronic company complaint system,
				  the response must be in writing and submitted using that same system. This rule
				  also applies to any other entity or person subject to the requirements of
				  chapter 48.30 RCW.
Statutory Authority:
					 RCW
					  48.02.060,
					 48.44.050,
					 48.46.200, and
					 48.30.010. 13-12-079 (Matter No. R
					 2013-05), §
											284-30-650, filed 6/5/13,
					 effective 1/1/14. Statutory Authority:
					 RCW
					  48.02.060,
					 48.44.050 and
					 48.46.200. 87-09-071 (Order R
					 87-5), §
											284-30-650, filed
					 4/21/87.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › TRADE PRACTICES › Section 284-30-660 - Deceptive use of quotations or evaluations prohibited

Current through Register Vol. 24-14, July 15, 2024
(1) It is an unfair or deceptive practice and
				an unfair method of competition pursuant to
				RCW
				 48.30.010 for any insurance company,
				insurance producer, surplus line broker, or title insurance agent in connection
				with the business of insurance, to utilize quotations or evaluations from
				rating or advisory services or other independent sources, in a manner likely to
				deceive the persons to whom the information is directed.
(2) Acts which are prohibited by this section
				include the following examples:
(a) If an
				insurer represents in its advertising that it has received an "A+" rating from
				an advisory service, such representation is deceptive unless it includes a
				clear explanation that such advisory service's practice is to rate insurance
				companies on the basis of "AAA," "AA," and declining to "A," if such is the
				case. The absence of such explanation would reasonably cause the ordinary
				person to believe falsely that the insurer had received the highest rating
				available from the service.
(b)
				Similarly, quoting figures or comments from a report, such as those
				representing claims paid or the capital or reserves or the quality of an
				insurer, in a manner to suggest that such figures or comments are impressive or
				that the report demonstrates the company to be particularly strong financially
				or of high quality relative to other companies, when such is not the case,
				creates a false impression and is deceptive.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › TRADE PRACTICES › Section 284-30-670 - Insurers must transact business in their legal name

Current through Register Vol. 24-14, July 15, 2024
(1) Purpose and Scope. The purpose of this
				regulation is to adopt a long standing bulletin and a technical assistance
				advisory regarding the use of trade names, group names, logos or trademarks.
				The purpose of this regulation is also to set forth requirements to help ensure
				that a consumer knows the legal name of the insurer they are doing business
				with.
(2) Pursuant to
				RCW
				 48.30.010, the commissioner has found and
				hereby defines it to be an unfair practice for an insurer to conduct its
				business in any name other than its own legal name as required by
				RCW
				 48.05.190. Unless consumers are aware of the
				insurer's legal name, a consumer's policy rights and legal rights may be
				compromised. In addition, when consumers seek the commissioner's assistance and
				are not aware of the insurer's legal name, the commissioner's staff must
				research it, which unnecessarily wastes the commissioner's resources and delays
				the inquiry and resolution, posing a risk of harm to the consumer.
(3) When used in this regulation, "legal
				name" of the insurer means the name displayed on the Washington state
				certificate of authority issued by the commissioner.
(4) Each insurer must have standards and
				procedures to ensure that each consumer with whom they conduct an insurance
				transaction is informed of and can consistently identify the legal name of the
				insurer. Each insurer must provide the insurance commissioner with its
				standards and procedures and proof of its compliance upon request. The insurer
				must be able to show the legal name was provided when issuing policy documents,
				billing statements, and other written communications regarding policy services,
				underwriting, and claims and at the point during policy sales transactions when
				the company is determined.
(5) To
				assist the commissioner in identifying the legal name of the insurer, insurers'
				written communications to the commissioner in response to any investigation,
				inquiry, enforcement matter or examination must include the insurer's NAIC
				code.
(6) This regulation does not
				bar the use of trade names, logos, trademarks or group names that identify
				companies collectively, for brand identification or for general purposes, but
				an insurer must also provide its legal name in the following situations:
(a) When the specific insurer is known, in
				negotiations preliminary to the execution of an insurance contract;
(b) In the execution of an insurance
				contract;
(c) In the transaction of
				matters subsequent to the execution of an insurance contract and arising out of
				it.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › TRADE PRACTICES › Section 284-30-700 - Restrictions as to denial and termination of homeowners insurance affected by day-care operations

Current through Register Vol. 24-14, July 15, 2024
(1)
				Beginning August 1, 1985, pursuant to
				RCW
				 48.30.010, it shall be an unfair practice for
				any insurer transacting homeowners insurance to deny homeowners insurance to an
				applicant therefor, or to terminate any homeowners insurance policy covering a
				dwelling located in this state, whether by cancellation or nonrenewal, for the
				principal reason that an insured under such policy is engaged in the operation
				of a day care facility, pursuant to
				chapter
				74.15 RCW, at the insured
				location.
(2) This rule does not
				prevent an insurer from excluding or limiting coverage with respect to
				liability or property losses arising out of business pursuits of an insured,
				specifically including those related to the operation of day care
				facilities.
Statutory Authority:
					 RCW
					 48.02.060. 85-17-018 (Order R 85-3), §
											284-30-700, filed
					 8/12/85.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › TRADE PRACTICES › Section 284-30-750 - Insurance producers' and surplus line brokers' fees to be disclosed

Current through Register Vol. 24-14, July 15, 2024
It shall be an unfair practice for any insurance producer or
				  surplus line broker providing services in connection with the procurement of
				  insurance to charge a fee in excess of the usual commission which would be paid
				  to an insurance producer or surplus line broker without having advised the
				  insured or prospective insured, in writing, in advance of the rendering of
				  services, that there will be a charge and its amount or the basis on which such
				  charge will be determined.
Statutory Authority:
					 RCW
					 48.02.060(3)(a) and
					 48.17.010(5).
					 11-01-159 (Matter No. R 2010-09), §
											284-30-750, filed 12/22/10,
					 effective 1/22/11. Statutory Authority:
					 RCW
					  48.02.060,
					 48.44.050 and
					 48.46.200. 87-09-071 (Order R
					 87-5), §
											284-30-750, filed
					 4/21/87.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › TRADE PRACTICES › Section 284-30-770 - Adverse notification requirements

Current through Register Vol. 24-14, July 15, 2024
(1) This section applies to all insurers,
				fraternal benefit societies, health carriers including disability, health
				maintenance organizations (HMOs), health care service contractors (HCSCs), and
				limited licensed carriers, and to all insurance policies, health plans, and
				insurance contracts.
(2) For the
				purpose of this section only the term "Adverse notification" means a notice,
				statement, or document from an insurer, fraternal benefit societies, health
				carriers including disability, HMOs, HCSCs, and limited licensed carriers to
				their insured, or enrollee, or both, describing one or more of the following:
(a) A claim denial;
(b) A final claim payment for less than the
				amount of the claim submitted. This does not include a claim that is paid less
				than the original amount to reflect the contracted health care provider's
				rate;
(c) An adverse benefit
				determination as defined in
				RCW
				 48.43.005(2); and
(d) Rescission, cancellation, termination or
				nonrenewal of a policy unless initiated by an insured. This does not apply to
				the end of a scheduled policy term or cancellation due to nonpayment of
				premium.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › MILITARY SALES PRACTICES › Section 284-30-850 - Authority, purpose, and effective date

Current through Register Vol. 24-14, July 15, 2024
In order to prevent unfair methods of insurance sales to
				  active duty service members of the United States armed forces, unfair
				  competition, and unfair or deceptive acts or practices by insurers, fraternal
				  benefit societies, or insurance producers, WAC
				  284-30-850 through
				  284-30-872 are adopted. These
				  rules may be called the "military sales practices" rules.
(1) The Military Personnel Financial Services
				Protection Act (P.L.
				109-290) was enacted by the 109th Congress to
				protect members of the United States armed forces from unscrupulous practices
				regarding the sale of insurance, financial, and investment products on and off
				military installations. The act requires this state to adopt rules that meet
				sales practice standards adopted by the National Association of Insurance
				Commissioners to protect members of the United States armed forces from
				dishonest and predatory insurance sales practices both on and off of a military
				installation.
(2) Based on the
				commissioner's authority under
				RCW
				 48.30.010 to define by rule methods of
				competition and other acts and practices in the conduct of the business of
				insurance found by the commissioner to be unfair or deceptive, after evaluation
				of the acts and practices of insurers, fraternal benefit societies, or
				insurance producers that informed the need for
				P.L.
				109-290, and because the commissioner is required
				by that act to adopt rules that meet the sales practice standards adopted by
				the National Association of Insurance Commissioners and federal law, the
				commissioner finds the acts or practices set forth in WAC
				284-30-850 through
				284-30-872 to be unfair or
				deceptive methods of competition or unfair or deceptive acts or practices in
				the business of insurance.
(3)
				These military sales practices rules are effective for all benefit contracts,
				insurance policies and certificates solicited, issued, or delivered in this
				state on and after (the effective date of these rules).
Statutory Authority:
					 RCW
					 48.02.060(3)(a) and
					 48.17.010(5).
					 11-01-159 (Matter No. R 2010-09), §
											284-30-850, filed 12/22/10,
					 effective 1/22/11. Statutory Authority:
					 RCW
					  48.02.060 and
					 48.30.010. 07-17-120 (Matter No. R
					 2007-01), §
											284-30-850, filed 8/20/07,
					 effective 9/20/07.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › MILITARY SALES PRACTICES › Section 284-30-855 - Scope

Current through Register Vol. 24-14, July 15, 2024
WAC
				  284-30-850 through
				  284-30-872 affect all life
				  insurance policies and certificates solicited or sold to an active duty service
				  member of the United States armed forces or his or her
				  dependent.
Statutory Authority:
					 RCW
					 48.02.060 and
					 48.30.010. 07-17-120 (Matter No. R
					 2007-01), §
											284-30-855, filed 8/20/07,
					 effective 9/20/07.