A new study by Wolters Kluwer Financial Services' Insurance Compliance Solutions Group has identified the top 10 reasons insurers don't meet compliance regulations during market conduct exams. Industry research in the life and health market shows that the top 10 most common market conduct compliance criticisms are:
1. Failure to acknowledge, pay, or deny claims within specified time frames
2. Use of unapproved or unfiled forms
3. Failure to adhere to advertising requirements
4. Failure to adhere to replacement requirements
5. Failure to issue notification of producer appointments or terminations
6. Use of unapproved or unfiled rates
7. Failure to adhere to grievance and appeals requirements
8. Failure to provide required disclosures (such as explanation of benefits or guaranty fund notices)
9. Failure to provide documentation of claims policies
10. Failure to properly terminate a policy
The study reviewed and analyzed the content in market conduct examinations across the United States, assigning all of the criticisms to various categories. The categories with the most criticisms constitute the top 10 list.
