August 22, 2014 RIRS Subgroup meeting€¦ · 1023 Statistical Filing Drop Use new code: Other Filing 1025 Legal Keep 1030 Market Conduct Exam Keep 1035 Financial Exam Keep 1040 Workers

August 22, 2014

Colorado’s comments on the proposed RIRS updates based on the attachment from the 06/25/2014 RIRS Subgroup meeting:

Colorado would like to request that the following Reason Codes be kept (see pg 11 of 14):

• 2028 TPA Violation – The comment section indicates that the new code "Violation related to TPA, MGA, or other third party" should be used instead. However, this new code is not included within the 06/25/2014 attachment. We want to ensure that either the new code is included or the old TPA code is kept.

• 2063 Employed Unlicensed Individuals – The feedback that was received from the section that regulates producer activity indicated that this would not necessarily be redundant with code 2062, allowed business from agent not appointed/licensed, and therefore should be kept.

• 2064 Paid Commissions to Unappointed Agents - The feedback that was received from the section that regulates producer activity indicated that this would not necessarily be redundant with code 2062, allowed business from agent not appointed/licensed, and therefore should be kept.

• 2074 Other States Action - The feedback that was received from the section that regulates producer activity indicated that they have taken actions against producers solely based on the action of another state. Therefore they do utilize this code and requested that it be kept.

• 2101 Certification Violation • 2102 Unauthorized Insurance Business

Colorado would like to request that the following Disposition Codes be kept (see pg 13 of 14):

• 3004 License, Cancelled • 3009 License, Probation • 3010 License, Conditional • 3012 License, Reinstatement • 3013 License, Granted • 3015 License, Voluntarily Surrendered • 3046 Stipulated Agreement/Order • 3051 Final Agency Order • 3052 Ordered to Comply with Specific Statue or Regulation • 3070 Re-Exam

Other: • RIRS code 2040 – Failure to Timely File does not appear to be consistently included with the

attached. Colorado would like to ensure that this code is kept. • Will a new “Notice of Regulatory Activity Form” be created to accommodate the updated

coding? (see last page)

DRAFT Attachment One

Regulatory Information Retrieval System (D) Subgroup

6/25/2014

RIRS

CodeCode Description

Code

StatusComments

TBA Market Add

TBA Financial Add

TBA Producer Add

TBA Company Licensing Add

Type of Action

To allow for filtering out some actions not weighted as much for market analysis, such as in MAPT.

© 2014 National Association of Insurance CommissionersAs of 6/20/2014

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6/25/2014

Description Status Comments

Bail Bond Add Will match ETS Lines of Business

Commercial Auto Add Will match ETS Lines of Business

Commercial Liability Add Will match ETS Lines of Business

Commercial Property Add Will match ETS Lines of Business

Credit Add Will match ETS Lines of Business

Fidelity and Surety Add Will match ETS Lines of Business

Group Accident and Health Add Will match ETS Lines of Business

Group Annuity Add Will match ETS Lines of Business

Group Life Add Will match ETS Lines of Business

Homeowner Add Will match ETS Lines of Business

Individual Accident and Health Add Will match ETS Lines of Business

Individual Life Add Will match ETS Lines of Business

Long Term Care Add Will match ETS Lines of Business

Medical Malpractice Add Will match ETS Lines of Business

Medicare Supplement Add Will match ETS Lines of Business

Other Add Will match ETS Lines of Business

Private Passenger Add Will match ETS Lines of Business

Title Add Will match ETS Lines of Business

Workers Comp Add Will match ETS Lines of Business

Line of Business


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6/25/2014

RIRS

CodeDescription

Code

StatusIndividual

Count

2011 - Current

Risk Bearing/

Business Entities

Count

2011 - Current

On Current

RIRS Form

On Current

CDS FormComments

ADJ Adjuster/Appraiser Keep x 1,991 x 451 x x

AIR Alien Insurer/Reinsurer Keep x 7 x x

BBA Bail Bond Agency Keep x 46 x

BNK Bank Keep x 1

BOG Bogus Firm Keep 17 x 2 x

BOG Bogus Representative Keep x

CAI Captive Insurer Keep x 7 x x

CAC Cert. Appl. Counselor Keep x x x Added for ACA

CEO Chief Executive Officer Keep x 1 x x

COO Chief Operation Officer Keep x x x

COP CO-OP Insurer Keep x x

DIT Director/Trustee Keep x 1 x x x

EMP Employee Keep x 9 x x

HCP Health Care Provider Keep x 1 x 1 x x

HMO Health Maintenance Org Keep x 2 x x

IPA In-Person Assister Keep x x Added for ACA

INC Insurance Consultant Keep x 3 x x x

JUA Joint Underwriting Assn Keep x x x

KEE Key Employee Keep x 2 x x

MGA Managing General Agent Keep x 3 x 8 x x

MET MET/MEWA Keep x 15 x x

NAV Navigator Keep x 1 x x Added for ACA

OFF Officer Keep x 4 x x

OTH Other Keep x 2,377 x 876 x x

PPO Preferred Provider Org Keep x x

PFC Premium Finance Co Keep x 11 x x

PRE President Keep x 9 x x

PRI Principal/Owner Keep x 99 x 31 x x

PRO Producer Keep x 24,038 x 3,013 x x

PAJ Public Adjustor Keep x 23 x

REI Reinsurance Intermediary Keep x x x x

RPG Risk Purchasing Group Keep x x x

RRG Risk Retention Group Keep x 7 x x

SEC Secretary Keep x x x

SCY Security Keep x x

SEI Self-Insured Keep x 3 x x

STF State Fund Keep x 1 x x

TPA Third Party Administrator Keep x 3 x 376 x x

TAG Title Agency Keep x 168 x

TRE Treasurer Keep x x

UDI U.S. Domiciled Insurer Keep x 10,618 x x

Entity Function/Role Codes


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6/25/2014

RIRS

CodeDescription

Code

StatusIndividual

Count

2011 - Current

Risk Bearing/

Business Entities

Count

2011 - Current

On Current

RIRS Form

On Current

CDS FormComments

Entity Function/Role Codes

UNK Unknown Keep x 1,639 x 614 x x

URO Utilization Review Org Keep x x 39 x x

VIP Vice President Keep x x

WBK Web Broker Keep x x Added for ACA

Total 30,221 16,297


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6/25/2014

RIRS


Code

StatusComments

1003 Market Analysis Keep

1005 Complaint Investigation Keep

1007 Field Investigation Keep

1008 Public Inquiry Drop Use new code: Other Inquiry, Investigation, or Audit

1010 Routine Dept Action Keep

1013 Financial Drop Use new code: Financial Analysis

1015 Other States Action Keep

1016 Annual Statement Drop Use new code: Financial Analysis

1018 Information/Referral From Another State Agency Keep

1020 Insurer Report Keep

1023 Statistical Filing Drop Use new code: Other Filing

1025 Legal Keep

1030 Market Conduct Exam Keep

1035 Financial Exam Keep

1040 Workers Comp Exam Drop Use Market Conduct Exam, Financial Exam, or new code: Other Inquiry, Investigation, or Audit

1045 Combined Exam Drop Use Market Conduct Exam or Financial Exam

1050 Bankruptcy Notices Keep

1055 Third Party Information Keep

1060 Licensing Administration Keep

1063 Background Check Keep

1065 Other Keep Change wording to 'State Specific'

TBA Market Conduct Investigation Add

TBA Other Inquiry, Investigation, or Audit Add

TBA Financial Analysis Add

TBA Rate/Form Filing Add

TBA Other Filing Add

TBA Multi State Regulatory Action Add

Origin of Action


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6/25/2014

RIRS

Code

Code

StatusCode Description in RIRS ETS Equivalent Category Comments

Add No RIRS Equivalent Internal/External audit Operations and Management

Add No RIRS Equivalent Safeguards for security of data and

information

Operations and Management

Add No RIRS Equivalent Monitoring contracts with MGAs, TPAs,

or other third party


2039 Keep FAILURE TO MAINTAIN BOOKS &

RECORDS

Maintenance of adequate books and

records


Add No RIRS Equivalent Privacy issues Operations and Management

Add No close match; could be similar to

(2102) Unauthorized insurance business

Appropriate licensure/certifications for

lines of business


Add No RIRS Equivalent Other Operations and Management issue Operations and Management

Add No RIRS Equivalent Maintenance of complaint log Complaint Handling

Add No RIRS Equivalent Failure to timely respond/manage

complaints

Complaint Handling

Add No RIRS Equivalent Failure to provide an adequate

response/resolution to complaints

Complaint Handling

Add No RIRS Equivalent Other Complaint Handling issue Complaint Handling

Add No RIRS Equivalent Timeliness of premium/billing notices Policyholder Service

Add No RIRS Equivalent Premium/billing notices not provided Policyholder Service

Add No RIRS Equivalent Other required notification/

correspondence not sent or not timely

Policyholder Service

Add No RIRS Equivalent Reasonable attempts to locate

policyholders

Policyholder Service

Add No RIRS Equivalent Nonforfeiture Policyholder Service

Add No RIRS Equivalent Free-look handling Policyholder Service

Add No RIRS Equivalent Reinstatements Policyholder Service

Add No RIRS Equivalent HIPAA compliance Policyholder Service

Add No RIRS Equivalent COBRA compliance Policyholder Service

Add No RIRS Equivalent Other Policyholder Service issue Policyholder Service

Add No RIRS Equivalent Rates filed and approved as necessary Rating

Add No RIRS Equivalent Rates not unfairly discriminatory Rating

Add No RIRS Equivalent Use of prohibited rating factors Rating

Add No RIRS Equivalent Incorrect application of rate Rating

Add No RIRS Equivalent Excessive rate Rating

Add No RIRS Equivalent Inadequate rate Rating

Add No RIRS Equivalent IPRM procedures/scheduled rating Rating

Add No RIRS Equivalent Other Rating issue Rating

Reason Codes Related to ETS Categories of Market Findings


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6/25/2014


Add No RIRS Equivalent Underwriting unfairly discriminatory Underwriting

Add No RIRS Equivalent Provision of disclosures/notifications Underwriting

2045 Keep REBATING Rebating Underwriting

Add No RIRS Equivalent Cancellation/nonrenewal notices not

timely

Underwriting

2003 Keep FAILURE TO SEND REQUIRED

CANCELLATION/NONRENEWAL

NOTICE

Cancellation/nonrenewal notices not

issued

Underwriting

Add No RIRS Equivalent Other cancellation/nonrenewal/rescission

issue

Underwriting

Add No RIRS Equivalent Declination notice - inadequate Underwriting

Add No RIRS Equivalent Declination notice - untimely or not

issued

Underwriting

Add No RIRS Equivalent Other declination problems Underwriting

Add No RIRS Equivalent Improper question on application Underwriting

Add No RIRS Equivalent Other Underwriting issue Underwriting

2053 Keep USE OF UNAPPROVED FORMS Forms filed and approved as necessary Forms

Add No RIRS Equivalent Mandated Coverages/Offerings Forms

Add No RIRS Equivalent Other Forms issue Forms

2014 Keep MISREPRESENTATION OF

INSURANCE PRODUCT/POLICY

Misrepresentation of insurance

products/policy

Marketing and Sales

Add No RIRS Equivalent Producer training, education, compliance Marketing and Sales

Add No RIRS Equivalent Illustrations Marketing and Sales

2012 Keep LIFE INSURANCE REPLACEMENT

VIOLATION

Replacement requirements Marketing and Sales

Add No RIRS Equivalent Disclosure/outline of coverage Marketing and Sales

Add No RIRS Equivalent Other Marketing and Sales issues Marketing and Sales

Add No RIRS Equivalent Initial contact Claims

Add No RIRS Equivalent Provision of appropriate claims materials

or other reasonable assistance

Claims

Add No RIRS Equivalent Adequate/timely investigation Claims

Add No RIRS Equivalent Timely resolution/prompt pay Claims

Add No RIRS Equivalent Files adequately documented Claims

Add No RIRS Equivalent Adequate explanations of claims

denied/closed without payment

Claims

Add No RIRS Equivalent Loss valuation Claims

Add No RIRS Equivalent Appropriate representation of coverage Claims


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"2040 Failure to timely file" not included anywhere, and should be kept.



6/25/2014


Add No RIRS Equivalent Not improperly compelling claimant to

litigate

Claims

Add No RIRS Equivalent Claim denials due to improper rescission Claims

Add No RIRS Equivalent Appropriate subrogation practices Claims

Add No RIRS Equivalent Payment of mandated coverages Claims

Add No RIRS Equivalent Other improper denial of claim Claims

Add No RIRS Equivalent Other improper claim settlement practice Claims

Add No RIRS Equivalent Other Claims Handling issue Claims

2062 Keep ALLOWED BUSINESS FROM AGENT

NOT APPOINTED/LICENSED

Producer/adjuster properly licensed Producer/Adjuster Licensing

2062 Keep ALLOWED BUSINESS FROM AGENT

NOT APPOINTED/LICENSED

Producer/adjuster properly appointed Producer/Adjuster Licensing

Add No RIRS Equivalent Producer/adjuster properly terminated Producer/Adjuster Licensing

Add No RIRS Equivalent Other Producer/Adjuster Licensing issue Producer/Adjustor Licensing

Add No RIRS Equivalent Network adequacy Improper Practices Related to Health

Insurance

Add No RIRS Equivalent Utilization review practices/procedures Improper Practices Related to Health

Insurance

Add No RIRS Equivalent Quality assurance practices Improper Practices Related to Health

Insurance

Add No RIRS Equivalent Grievance practices Improper Practices Related to Health

Insurance

Add No RIRS Equivalent Appeals practices/ procedures Improper Practices Related to Health

Insurance

Add No RIRS Equivalent External/independent review practices/

procedures

Improper Practices Related to Health

Insurance

Add No RIRS Equivalent Provider credentialing/monitoring Improper Practices Related to Health

Insurance

Add No RIRS Equivalent Other Improper Practices Related to

Health Insurance issue

Improper Practices Related to Health

Insurance

Add No RIRS Equivalent Cooperation with

examination/investigation

Inquiries/Investigations

2038 Keep FAILURE TO COMPLY WITH

PREVIOUS ORDER

Failure to comply with previous order Inquiries/Investigations

2035 Keep FAILURE TO RESPOND No ETS Equivalent Inquiries/Investigations

2036 Keep LATE OR INCOMPLETE RESPONSE No ETS equivalent Inquiries/Investigations

Add No RIRS Equivalent Other Inquiries/Investigations issue Inquiries/Investigations

Add No RIRS Equivalent Funds submitted for collection/ deposited

in qualified institution

Escrow/Settlement, Closing or Security

Deposit Funds


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6/25/2014


Add No RIRS Equivalent Appropriate interest paid Escrow/Settlement, Closing or Security

Deposit Funds

Add No RIRS Equivalent Appropriate disbursement

procedures/practices


Deposit Funds

Add No RIRS Equivalent Other Escrow/Settlement, Closing or

Security Deposit Funds issue


Deposit Funds


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6/25/2014

RIRS

Code

Code

StatusRIRS ETS Equivalent Category Comments

2072 Keep CURE OF FINANCIAL IMPAIRMENT No ETS Equivalent Impairment

2080 Keep DISSOLUTION No ETS Equivalent Impairment

2070 Keep FINANCIAL IMPAIRMENT No ETS Equivalent Impairment

2065 Keep NOTICE OF FINANCIAL IMPAIRMENT FROM OTHER

STATE

No ETS Equivalent Impairment

2097 Keep BAIL BOND FORFEITURE JUDGMENT No ETS equivalent Producer Related

2032 Keep CONTINUING EDUCATION REQUIREMENTS MET No ETS equivalent Producer Related

2108 Keep CRIMINAL PROCEEDINGS No ETS equivalent Producer Related

2107 Keep CRIMINAL RECORD/HISTORY No ETS equivalent Producer Related

2059 Keep FAILURE TO MAKE REQUIRED DISCLOSURE ON

LICENSE APP

No ETS equivalent Producer Related

2030 Keep FAILURE TO MEET CONTINUING EDUCATION

REQUIREMENTS


2037 Keep FAILURE TO NOTIFY DEPARTMENT OF ADDRESS

CHANGE


2042 Keep FAILURE TO PAY CHILD SUPPORT No ETS equivalent Producer Related

2104 Keep FAILURE TO REMIT PREMIUMS TO INSURER No ETS equivalent Producer Related

2075 Keep FAILURE TO REPORT OTHER STATE ACTION No ETS equivalent Producer Related

2103 Keep FIDUCIARY VIOLATION No ETS equivalent Producer Related

2106 Keep FORGERY No ETS equivalent Producer Related

2105 Keep MISAPPROPRIATION OF PREMIUM No ETS equivalent Producer Related

2058 Keep MISSTATEMENT ON APPLICATION No ETS equivalent Producer Related

2055 Keep NO LICENSE No ETS equivalent Producer Related

2060 Keep NOT APPOINTED No ETS equivalent Producer Related

2061 Keep SELLING FOR UNLICENSED INSURER No ETS equivalent Producer Related

RIRS

Code

Code


2056 Keep DEMONSTRATED LACK OF FITNESS OR

TRUSTWORTHINESS

No ETS equivalent Need a category

2085 Keep FAILURE TO PAY TAX No ETS equivalent Need a category

2087 Keep FAILURE TO PAY FEES No ETS equivalent Need a category

2090 Keep FAILURE TO PAY FINE No ETS equivalent Need a category

2095 Keep FAILURE TO PAY ASSESSMENT No ETS equivalent Need a category

2100 Keep NO CERTIFICATE OF AUTHORITY No ETS equivalent Need a category

2115 Keep OTHER No ETS Equivalent Need a category; change wording to

'State Specific'

Reason Codes Related to Non-ETS Categories of Market Findings

Reason Codes With No Categories


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6/25/2014

RIRS

Code

Code


2005 Drop UNDERWRITING New detailed underwriting codes are

added

2007 Drop MARKET CONDUCT EXAMINATION Does not describe a vioaltion

2010 Drop MARKETING & SALES New detailed marketing & sales codes

are added

2015 Drop CLAIM HANDLING New detailed claim violation codes are

added

2020 Drop POLICYHOLDER SERVICE New detailed policyholder violation

codes are added

2025 Drop ADVERTISING New detailed marketing & sales codes

are added

2026 Drop PREMIUM FINANCE ACT VIOLATION Codes added to described specific

violations. Citing an act can imply

numerous violations

2027 Drop SURPLUS LINES VIOLATION Does not describe a specific violation.

Suplus lines status can be determined

from the entity

2028 Drop TPA VIOLATION Replaced with new code "Violation

related to TPA, MGA, or other third

party"

2029 Drop UNFAIR INSURANCE PRACTICES ACT VIOLATION Codes added to described specific

violations. Citing an act can imply

numerous violations

2050 Drop RATE VIOLATION New detailed rating violating codes

added

2063 Drop EMPLOYED UNLICENSED INDIVIDUALS Redundent with respect to 2062 -

Allowed business from agent not

appointed/licensed

2064 Drop PAID COMMISSIONS TO UNAPPOINTED AGENTS Redundent with respect to 2062 -

Allowed business from agent not

appointed/licensed

2074 Drop OTHER STATES ACTION Does not describe a violation

2110 Drop RECONSIDERATION Does not describe a violation

2111 Drop INAPPROPRIATE SALES OR SOLICITATION TO A

MILITARY SERVICE MEMBER

Not used in prior three years. Replace

2111 and 2112 with new "military sales"

code

2112 Drop INAPPROPRIATE SALES OR SOLICITATION ON A

MILITARY INSTALLATION

Not used in prior three years. Replace

2111 and 2112 with new "military sales"

code

Reason Codes To Drop


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6/25/2014

RIRS

Code

Code


2101 ? CERTIFICATION VIOLATION

2102 ? UNAUTHORIZED INSURANCE BUSINESS

Reason Codes To Address


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6/25/2014

RIRS


Code

StatusComments

3001 License, Denied Keep

3003 License, Suspended Keep

3004 License, Cancelled Keep

3006 License, Revoked Keep

3009 License, Probation Keep

3010 License, Conditional Keep

3011 License, Supervision Keep

3012 License, Reinstatement Drop Does not describe an action pursuant to a violation

3013 License, Granted Drop Does not describe an action pursuant to a violation

3014 License, Surrendered Keep

3015 License, Voluntarily Surrendered Drop Collapse into the broader 3014, License, Surrendered

3016 License, Other Keep Change wording to License, State Specific Disposition

3021 Certificate of Authority, Denied Keep

3023 Certificate of Authority, Suspended Keep

3025 Certificate of Authority, Suspension Extended Drop Should not generate new RIRS record

3026 Certificate of Authority, Revoked Keep

3028 Certificate of Authority, Expired Drop Does not describe an action pursuant to a violation

3029 Certificate of Authority, Probation Keep

3031 Certificate of Authority, Reinstated Drop Does not describe an action pursuant to a violation; Should not generate a new RIRS record

3034 Certificate of Authority, Surrendered Keep

3036 Certificate of Authority, Other Keep Change wording to Certificate of Authority, State Specific Disposition

3042 Cease and Desist from Violations Keep

3043 Cease and Desist from all Insurance Activity Keep

3044 Remedial Measures Ordered Keep

3045 Consent Order Keep

3046 Stipulated Agreement/Order Keep

3047 Previous Order Vacated Keep

3048 Ordered to provide requested information Keep

3049 Stayed Order Keep

3050 Temporary Restraining Order Keep

3051 Final Agency Order Drop Not sure what this is, too generic. Use other existing code

3052 Ordered to Comply with Specific Statute or Regulation Drop Seems redundant with respect to 3042

3055 Reprimand Keep

3060 Hearing Waiver Keep

3065 Show Cause Keep

3070 Re-exam Drop Does not describe an action pursuant to a violation

3075 Rescission of Drop Does not describe an action pursuant to a violation

3076 Involuntary Forfeiture Keep

3078 Restitution Keep

Disposition of Action


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6/25/2014

RIRS


Code

StatusComments

Disposition of Action

3079 Suspended from Writing New Business; Renewals ok Keep

3080 Supervision Keep

3085 Rehabilitation Keep

3090 Liquidation Keep

3095 Conservatorship Keep

3097 Hearing Drop Not final disposition.

3100 Receivership Keep

3101 Ancillary Receivership Keep

3102 Monetary Penalty Keep

3103 Aggregate Monetary Penalty Drop New "Aggregate Multistate Monetary Penalty"

3103 Aggregate Monetary Penalty Keep Some monetary penalties are aggregates and not allocated per company

3104 Settlement Keep

3105 Other Keep Change wording to 'State Specific'

TBA Order or fine stayed Add

TBA Premium refund Add

TBA Return of excess profits Add

TBA Aggregate Multistate Monetary penalty Add


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Documents

August 22, 2014 RIRS Subgroup meeting€¦ · 1023 Statistical Filing Drop Use new code: Other Filing 1025 Legal Keep 1030 Market Conduct Exam Keep 1035 Financial Exam Keep 1040 Workers