colorado statutes, rules, and regulations common to all lines

Terms in this set (26)

the commissioner of insurance is the head of the division of insurance, appointed by the governer, subject to confirmation of the appointmen by the senate. it is the duty of the commissioner to do any of the following:
- file and keep all books and papers required by law;
- issue certificates of authority to transact business;
- issue other certificates as required by law;
- examine all requests and applications for producer licences to be issued;
- make investigations and examinations if the commissioner believes there is a violation of the insurance laws in colorado;
- supervise the business of insurance in this state to assure that it is conducted in accordance with the state laws of this state and in such a manner as to protect policyholders and the general public;
- transmit all monies collected by the division of insurance to the department of the treasury's general fund;
- encourage the dissemination to the public of general information concerning insurance so as to work toward informed choices of insurance needs and options;
- evaluate insurance policies for long term care to determine their complience and to provide insurance companies with a written statement indicating the results;
-oversee the operation of electronic data interchange projects for purposes of uniform billing and electronic data exchange for health benefit coverages;
- adopt roles that set forth standards specefic to licensed provider networks or licensed individual providers concerning solvency and operation capacity or the performance of services consistent with the extent of risk being accepted by the licenced provider network or licenced individual providers;
- establish or amend reasonable rules that are neccessary to enable the commissioner to carry out his or her duties under the laws of the state;
- examine and investigate into the affairs of every person engaged in the business of insurance in this state in order to determine whether such person has been or is engaged in any unfair method of competition or in any unfair or deceptive act or prohibited practice;
- generally perform with justice and impartially all the duties that are imposed on the commissioner by the laws in relation to the business of insurance in this state.
all reasonable expenses and charges associated with the examination must be paid directly by the examinee to the examiner. if the examinee contests the amount of fee or costs by filling an objection with the commissioner, the charges will not be due until the commissioner reviewed the objection and made a judgement. the costs of financial examination of foreign companies made outside colorado must be paid by the company examined and must include the expenses of the commissioner.
the commissioner and examiners have the power to issue subpeoenas, administer oaths, and examine under oath any person as to any matter pertinent to the examination. upon the failure or refusal of any person to obey a subpeona, the commissioner may petition a court of competent jurisdiction for an order, which can be enforcable through contempt proceedings, compelling the person to appear and testify or produce documentary evidence.
in conducting the examination, the examiners must observe those guidelines and proceedures set forth in the most recent available edition of the examiner's handbook adopted by the national association of insurance commissioners and the colorado insurance examiners handbook. the commissioner may also employ such other guidelines or procedures, as the commissioner may deem appropriate.
the refusal of any company or any of its officers, directors, employees, or producers to submit to examination or to comply with any reasonable written request of the examiners will be grounds for suspension, revocation, denial, or nonrenewal of any license held by the company and subject to the commissioners jurisdiction.
any person who knowingly or willingly testifies falsely in reference to any matter material to an investigation, examination, or inquiry is guilty of a misdeamenor and, upon conviction, can be punished by a fine of not more than $5,000, or imprisonment for not more than 3 months, or by both.
the purpose of this regulation is to clarify the responsibility of insurance producers and brokers to treat each insurance policy and premiums handled as a seperate account of their insureds unless specefic authorization has been obtained from insureds to commingle multiple obligations and funds.
no insurance premium or refund recieved by an insurance producer, broker or agency by reason of the application for, issuance or termination of any particular policy may be credited to any other obligation owner by the insured to such producer, agency or other insurer unless specefic written authorization has been obtained from the insured to handle all policies and obligations from one account.
upon reciept, the insurance producer must treat all premiums and returned premiums in a fiduciary capacity, including but not limited to the following:
- upon receipt the insurance producer must treat all premiums and return premiums as trust funds and segregate them from his own funds;
- the insurance producer must keep an accurate record of all fiduciary funds;
- the insurance producer must not treat insurance premiums or returned premiums as a business or personal asset;
- the insurance producers financial statement should not reflect fiduciary funds as an assett or as income to the insurance producer;
- an insurance producer may not use fiduciary funds as collateral for personal or business loan, but the insurance producer may recieve interest on such funds and use as a compensation balance with the financial institution and;
- any deposit of such premium and returned premium funds into a bank or savings account must be into a seperate insurance trust account until actually remitted to the insurer or person entitled.
unfair claims practices means committing or performing, either in willfull violation or with such frequency as to indicate a tendancy to engage in a general business practice, any of the following:
- misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue
- failing to acknowledge and act reeasonably promptly upon communications with respect to claims arising under insurance policies
- failing to adopt and implement reasonable standards for the prompt investigation of claims arising insurance policies
- refusing to pay claims without conducting a reasonable investigation based upon all available information
- failing to affirm or deny coverage claims within a reasonable time after proof of loss statements have been completed
- not attempting in good faith to effectuate prompt, fair, and equitable settlements of claims in which liability has been completely clear.
- compelling insureds to institute litigation to recover amounts due under an insurance policy by offering substantially less than the amounts ultimately recoverd in actions brought by such insureds
- attempting to settle a claim for less than the amount to which a reasonable man whould have believed he was entitled to by reference to written or printed advertising material accompanying or made part of the application
- attempting to settle claims on the basis of an application which was altered without notice to, or knowledge or consent of the insured
- making claims payments to insureds or beneficiaries not accompinied by statement setting forth the coverage under which the payments are being made
- making known to insureds or claimants a policy of appealing from arbitration awards in favor of insureds or claimants for the purpose of compelling them to accept settlements or compromises less than the amount awarded in arbitration