PA Insurance Department Review Requirements Commercial General Liability

Transcription

1 Review Requirements Reference Comments SUBMISSION PACKAGE REQUIREMENTS TRANSMITTAL LETTER Ch. 133 of Title 31 POLICY Ch of Title 31 MATERIAL DIFFERENCES Ch of Title 31 AUTHORIZATION LETTER Ch of Title 31 ENDORSEMENTS Ch. 133 or Title 31 Duplicate copies of transmittal letter for hard copy filings. For electronic submissions, only the transmittal header is required. Duplicate copies of the general liability policy(s) if submitted in hard copy. For electronic submissions, only one copy of a policy(s) is required to be attached. An explanation of the material differences of any information appearing in the policy which is noted as variable. If the filing is being submitted on behalf of the insurer, a letter of authorization from the insurer preceding the filing or a letter of authorization from the insurer submitted by the party authorized to submit the filing. If the filing includes endorsements, an explanation of when the endorsements will be used. FILING FEE 40 P.S. 50 Any filing fee as required by 40 P.S. 50. TRANSMITTAL LETTER REQUIREMENTS REPRESENTATIVE IDENTITY Ch (a) of Title 31 Identify the representative of the insurer or other party authorized to make the filing. INSURER IDENTITY Ch (b) Identify the insurer whose name appears on each filed policy. TYPE OF INS AND COVERAGE Ch. 133 of Title 31 Identify the general type and coverage of each policy submitted: for example, professional liability. FORM NUMBER Ch 133.4(c) of Title 31 Identify the form number of each filed form. ENDORSEMENTS Ch 133.4(f) of Title 31 REPLACEMENT OF POLICY Ch of Title 31 PA Insurance Department Review Requirements Commercial General Liability This checklist applies to general liability insurance policies and endorsements which are not deregulated under the Department's Deregulation of commercial lines property and casualty forms. Forms proposed to be issued in this Commonwealth shall be submitted for filing or approval, unless specifically excepted under section 354 of The Insurance Company Law of 1921 (40 P. S. 477b). Forms shall be submitted separately for each line of insurance, that is, automobile, glass, general liability, homeowners, fire, package and the like, on behalf of each filing company. Submissions are to be directed to the Director, Bureau of Regulation of Rates and Policies, Commonwealth of Pennsylvania, Insurance Department, Harrisburg, Pennsylvania (Pennsylvania Bulletin Annex A, Notice No ; Act 86 of 1986; 40 P.S ) For an endorsement, identify the policy(s) with which the endorsement will be used. State if each policy is replacing a previously approved form. If replacement is involved, the document must identify: 1. The form number of the form to be replaced. 2. The date that the form was approved. 3. A description of the changes made to the form to be replaced. INNOVATIVE FEATURES Ch of Title 31 Briefly describe any innovative or unique features of each form. Page 1 of 5

2 GENERAL FORM REQUIREMENTS CANCELLATION AND NON- RENEWAL DECLARATIONS PAGE 40 P.S Ch 133.4(a & b) of Title 31 ENDORSEMENTS Ch. 133 of Title 31 MATERIAL DIFFERENCES Ch of Title 31 POLICY PAGE Ch (b) of Title 31 POLICY PAGE 40 P.S. 440 The insurer must provide a 15 business day minimum notice in cases of misrepresentation and non-payment, otherwise, a minimum of 60 business days is required. The notice shall state: Notice of Cancellation or Notice of Non-Renewal, state specific reasons for the cancellation or non-renewal, and at the insured s request, shall provide loss info for the last three years of the policy. Declarations pages are to be filed indicating the insuring company and home office address. Endorsements may be filed with a statement explaining when the endorsements will be used. Any information appearing in a form which is different, shall be bracketed or otherwise marked to denote difference. Variability shall be limited to: insurer address, insurer phone, and individual information. The full corporate name of the insurer shall appear prominently on the first page of a policy. A marketing name or logo may also be used on the first page of a policy provided that the marketing name or logo does not mislead as to the identity of the insurer providing the coverage. If the full corporate name of the insurer does not appear on a rider, the name shall be added to the first page of the rider by any legible means for filing and insurer identification purposes. A current insurer address consisting of at least a city and state shall appear on the first page of a policy. Two signatures of insurer officers shall appear on the first page of a policy. At least one signature of an insurer officer shall appear on an endorsement. An endorsement shall state that it is attached to and made part of the policy. A policy identification number shall appear at the bottom of the policy. The policy number shall be adequate to distinguish the policy from all others used by the insurer. The policy number may be the same as that of a policy to be replaced. However if the policy to be replaced was approved by the Department, it may not have been issued in this Commonwealth and shall be withdrawn from any issuance in this Commonwealth. Page 2 of 5 A policy shall contain a brief description that shall appear prominently on the cover page of the policy or shall be visible without opening the policy. The brief description shall contain at least the following information: a.) An indication that the form is a policy. b.) A caption of the type of general liability coverage provided, for example professional liability.

3 TERMINOLOGY Ch (a) of Title 31 TERMINOLOGY Ch 133.7(b) of Title 31 An endorsement shall contain a caption of the type of coverage provided; for example, professional liability; and an indication that the form is an endorsement. The use of misleading titles or descriptions which are intended to give the impression that there are no coverage exceptions, exclusions or limitations of benefits in a policy are prohibited. A policy may afford risk coverage subject to specifically recited exclusions or limitations, but may not be entitled or described as all risk. A policy or form bearing the caption or reference that the policy or form is a Pennsylvania or standard policy or form will not be accepted for filing, unless authorized by statute. POLICY PROVISONS ACCIDENTAL DEATH BENEFIT Ch of Title 31 ASSESSABLE POLICY Ch of Title 31 ENDORSEMENTS Ch of Title 31 EXCLUDED COVERAGE Ch of Title 31 EXTENDED REPORTING ENDORSEMENT 40 P.S FRAUD STATEMENT 18 Pa C.S. 4117(k)(1) A provision for accidental death benefit may not contain a requirement that death occurs within a specific time period. Each assessable policy shall have the words This is an assessable policy printed prominently on the backer of the policy panel, as well as on the face of the policy, in letters not less than 16-point in size. Open face, blank or computer endorsements are permitted and will be approved conditionally subject to the requirement that if the endorsements, when issued, affect the coverage they shall be resubmitted as complete forms identified by individual form numbers. Policies or other forms containing a coverage or reference to a coverage which may not be written in this Commonwealth by the insurer shall specifically exclude the coverage on the face of the form by imprinting or by rubber stamp. The insurer must provide for a 60 day period after cancellation or nonrenewal during which the insured may purchase an extended reporting period endorsement. All applications for insurance and all claim forms shall contain or have attached thereto the following notice: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. Page 3 of 5

4 Within 15 working days after receipt by the insurer of properly executed proof 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 LOSS PROVISION Ch (a)(1) of Title 31 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. NOTICE OF PREMIUM INCREASE 40 P.S PREJUDGMENT INTEREST PUNITIVE DAMAGES RETURN OF UNEARNED PREMIUM UNFAIR OR DECEPTIVE PRACTICES UNFAIR SEX OR MARITAL DISCRIMINATION RATE AND RULE CANCELATION, NON-RENEWAL, NOTICE OF PREMIUM INCREASE Supreme Court of PA, Rule of Civil Procedure P.S. 3404(a)(b) 40 P.S (a)(10) 40 P.S (a)(7) An insurer shall notify the insured of a premium increase not less than 30 days prior to renewal of the policy. Prejudgment interest may not be included with the limit of liability and must be provided for if the policy covers bodily injury or property damage. No law in PA prohibiting. When cancellation by insurer occurs, return of premium must be made in 10 business days or less after termination date. When cancellation by insured occurs, return of premium must be made in 30 business days or less after termination date. The form shall not contain any misrepresentations, inconsistencies, or misleading clauses. Insurers are prohibited to deny benefits or coverage to individuals based on any unfair sex or marital discrimination. Refer to appropriate Form section PRICING 40 P.S (a) This shall apply to property and casualty insurance, including fidelity, surety and guaranty bond and fire insurance, inland marine insurance and any combination thereof, on risk or operations located in Pennsylvania. 40 P.S and 4(b) This shall not apply to personal risks, workers' compensation insurance, title insurance, accident and health insurance, reinsurance other than statutorily authorized joint reinsurance mechanisms, (ocean) marine insurance, aircraft insurance, and insurance covering loss in excess of at least $10,000 from any one event issued to self-insurers. Refer to 40 P.S and for complete definitions of these terms. Refer to the workers' compensation insurance specific requirements' checklist. Requirements' checklists are still being developed for insurance covering personal risks and title insurance. Page 4 of 5

5 Requirements' checklists are still being developed for insurance covering accident and health risks. Refer to the Accident and Health Bureau. 40 P.S and 4(b) Filings are not required for reinsurance other than statutorily authorized joint reinsurance mechanisms, (ocean) marine insurance, aircraft insurance, and insurance covering loss in excess of at least $10,000 from any one event issued to self-insurers. Refer to 40 P.S and 40 P.S (b) for complete definitions of these terms. RATING STANDARDS 40 P.S (b) Rates shall not be excessive, inadequate, or unfairly discriminatory. PRICING (EXEMPT) LARGE COMMERCIAL RISKS (Individual Risk Submissions) PRICING (PRIOR APPROVAL) 40 P.S (d) 40 P.S (c)(2)(v) Insurers shall not be required to file forms or rates (or rules) for large commercial risks with the department. Refer to 40 P.S for the definition of large commercial risk. If rates developed for individual insureds do not deviate from the (currently approved) base rates by more than 25% (increase or decrease), individual filings shall not be required. ASSIGNED RISKS AND RESIDUAL MARKETS PRICING (FILE AND USE) 40 P.S (b) 40 P.S (e)(2) 40 P.S (c)(2)(i) 40 P.S (c)(2)(ii) Agreements and rates (and rules) for Assigned Risks (and Assigned Risk Plans) and Residual Markets shall be subject to filing, review and prior approval. This includes filings for the Fair Plan and the Joint Underwriting Association (JUA). The JUA shall file updated rates for all health care providers by May 1 of each year. Initial base rates (and rules) shall be subject to filing, review and prior approval. Also, if proposed changes to an approved base rate will increase or decrease the approved base rate by more than 10% annually in the aggregate, the changes shall be subject to filing, review and prior approval. Refer to 40 P.S for the definition of small commercial risk. PRICING (USE AND FILE) 40 P.S (c)(2)(iii) If proposed changes to an approved base rate will increase or decrease the approved base rate by 10% or less annually in the aggregate, the changes shall be filed with the department no later than 45 days prior to their effective date. If rates developed for individual insureds deviate from the base rate by more than 25% (increase or decrease), they may be used immediately 40 P.S (c)(2)(vi) and shall be filed with the department no later than 30 days after the effective date of the rate. Note that this provision includes Consent-to- Rate/Excess Rate filings. Page 5 of 5