Ins 6.54(2)
(2) Scope. This rule applies to all contracts issued, renewed or amended in Wisconsin affording automobile insurance coverage and all contracts issued, renewed or amended in Wisconsin affording coverage for loss or damage to real property used for residential purposes for not more than 4 living units or affording coverage for loss or damage to personal property used for residential purposes.
Ins 6.54(3)(a)(a) No insurance company shall refuse, cancel or deny insurance coverage to a class of risks solely on the basis of any of the following factors (taken individually or in combination), nor shall it place a risk in a rating classification on the basis of any of the following factors without credible information supporting such a classification and demonstrating that it equitably reflects differences in past or expected losses and expenses and unless such information is filed in accordance with ss.
625.12,
625.13 and
625.21 (2), Stats.:
Ins 6.54(3)(b)
(b) Nothing in
par. (a) shall be construed as including within the definition of prohibited practices any of the following:
Ins 6.54(3)(b)1.
1. Denying, cancelling or non-renewing the automobile or property insurance of a person convicted of an offense if the offense which resulted in the conviction is directly related to the risk to be insured;
Ins 6.54(3)(b)2.
2. Establishing a classification system merely for the purpose of developing statistical data;
Ins 6.54(3)(b)3.
3. Underwriting only the class of risks which are specified in the insurer's articles of incorporation;
Ins 6.54(3)(b)4.
4. Establishing a rate based on the record of all drivers of an insured automobile;
Ins 6.54(3)(b)5.
5. Establishing a rate based on the number of people residing in a household.
Ins 6.54(3)(d)
(d) No insurer shall require an applicant or insured to undergo a physical examination to obtain or continue coverage unless the cost of such physical examination is borne by the insurer.
Ins 6.54(4)
(4) Penalty. Violation of this rule may subject the insurer to the penalties set forth in s.
601.64, Stats.
Ins 6.54 History
History: Cr.
Register, March, 1976, No. 243, eff. 4-1-76; emerg. am. (1) and (3) (c), eff. 6-22-76; am. (1) and (3) (c),
Register, September, 1976, No. 249, eff. 10-1-76; am. (3) (a) 2.,
Register, April, 1977, No. 256, eff. 5-1-77; am. (3) (a) 2., and cr. (3) (d),
Register, March, 1979, No. 279, eff. 4-1-79; corrections in (1) and (3) (c) made under s. 13.93 (2m) (b) 7., Stats.,
Register, February, 2000, No. 530; correction in (3) (c) made under s. 13.93 (2m) (b) 7., Stats.,
Register January 2002 No. 553.
Ins 6.55
Ins 6.55
Discrimination based on sex, unfair trade practice. Ins 6.55(1)(1)
Purpose. The purpose of this rule is to eliminate the act of denying benefits or refusing coverage on the basis of sex, to eliminate unfair discrimination in underwriting criteria based on sex, and to eliminate any differences in rates based on sex which cannot be justified by credible supporting information. This rule interprets and implements s.
601.01 (3), Stats., and
ch. 628, Stats.
Ins 6.55(2)(a)(a) Insurer has the meaning defined in s.
600.03 (27), Stats., and in addition includes nonprofit service plans or service insurance corporations.
Ins 6.55(2)(b)
(b) Contract means any insurance policy, plan, certificate, subscriber agreement, statement of coverage, binder, rider or endorsement offered by an insurer subject to Wisconsin insurance law.
Ins 6.55(3)(a)(a) This rule shall apply to all contracts delivered in Wisconsin, or issued for delivery in Wisconsin on or after the effective date of this rule and to all existing group contracts subject to Wisconsin insurance law which are amended or renewed on or after the effective date of this rule.
Ins 6.55(3)(b)
(b) This rule shall not affect the right of fraternal benefit societies to determine eligibility requirements for membership.
Ins 6.55(4)(a)1.
1. Refuse or cancel coverage or deny benefits on the basis of the sex of the applicant or insured;
Ins 6.55(4)(a)2.
2. Restrict, modify, or reduce the benefits, term, or coverage on the basis of the sex of the applicant or insured.
Ins 6.55(4)(b)
(b) Examples of unfair trade practices defined by
par. (a) and prohibited by this rule are:
Ins 6.55(4)(b)1.
1. Denying coverage to females gainfully employed at home, employed part-time, or employed by relatives when coverage is offered to males similarly employed;
Ins 6.55(4)(b)2.
2. Denying benefits offered by policy riders to females when the riders are available to males;
Ins 6.55(4)(b)3.
3. Denying, under group contracts, dependent coverage to husbands of female employees, when dependent coverage is available to wives of male employees;
Ins 6.55(4)(b)4.
4. Denying disability income coverage to employed women when coverage is offered to men similarly employed;
Ins 6.55(4)(b)5.
5. Treating complications of pregnancy differently from any other illness or sickness under a contract;
Ins 6.55(4)(b)6.
6. Restricting, reducing, modifying, or excluding benefits payable for treatment of the genital organs of only one sex;
Ins 6.55(4)(b)7.
7. Offering lower maximum monthly benefits to women than to men who are in the same underwriting, earnings or occupational classification under a disability income contract;
Ins 6.55(4)(b)8.
8. Offering more restrictive benefit periods and more restrictive definitions of disability to women than to men in the same underwriting, earnings or occupational classification under a disability income contract;
Ins 6.55(4)(b)9.
9. Establishing different conditions by sex under which the policyholder may exercise benefit options contained in the contract.
Ins 6.55(5)
(5) Rates. When rates are differentiated on the basis of sex, the insurer must:
Ins 6.55(5)(a)
(a) File a brief letter of explanation along with a rate filing.
Ins 6.55(5)(b)
(b) Maintain written substantiation of such rate differentials in its home office.
Ins 6.55(5)(c)
(c) Justify in writing to the satisfaction of the commissioner the rate differential upon request.
Ins 6.55(5)(d)
(d) Base all such rates on sound actuarial principles or a valid classification system and actual experience statistics.
Ins 6.55(6)
(6) Penalty. Violation of this rule shall subject the insurer to the penalties set forth in s.
601.64, Stats.
Ins 6.55 History
History: Cr.
Register, May, 1976, No. 245, eff. 6-1-76; emerg. am. (1), eff. 6-22-76; am. (1),
Register, September, 1976, No. 249, eff. 10-1-76.
Ins 6.57
Ins 6.57
Appointment of insurance agents by insurers. Ins 6.57(1)(1) Submission of an application for an intermediary-agent appointment shall initiate the appointment of an agent in accordance with s.
628.11, Stats. The application shall be submitted to the office of the commissioner of insurance and entered in the OCI licensing system in a format specified by the commissioner within 15 days after the earlier of the date the agent contract is executed or the first insurance application is submitted and shall show the lines of authority being requested for that agent. An appointment is valid only for the lines of insurance requested. The effective date of a valid appointment is the date on which the appointment is submitted electronically in the format specified by the commissioner. The agent validation report is a computer-generated report prepared by the office of the commissioner of insurance. Billing for initial appointment shall be done annually at the same time and at the same rate as renewal appointments.
Ins 6.57(2)
(2) Notice of termination of appointment of individual intermediary in accordance with s.
628.11, Stats., shall be filed prior to or within 30 calendar days of the termination date with the office of the commissioner of insurance. Prior to or within 15 days of filing this termination notice, the insurer shall provide the agent written notice that the agent is no longer to be appointed as a representative of the company and that he or she may not act as its representative. This notice shall also include a formal demand for the return of all indicia of agency. "Termination date" means the date on which the insurer effectively severs the agency relationship with its intermediary-agent and withdraws the agent's authority to represent the company in any capacity.
Ins 6.57(2)(a)
(a) If the reason for termination is one of the reasons listed as other criteria in
s. Ins 6.59 (5) (d) or the insurer has knowledge the producer was found by a court, government body, or self-regulatory organization authorized by law to have engaged in any of the activities listed in
s. Ins 6.59 (5) (d), the insurer must submit complete explanations and documentation in writing to OCI within 30 days of the termination.
Ins 6.57(2)(b)
(b) If the insurer has knowledge of complaints received or problems experienced by the company involving company indebtedness, forgery, altering policies, fraud, misappropriation, misrepresentation, failure to promptly submit applications or premiums, poor policyholder service involving the intermediary being terminated, the insurer must submit complete explanations and documentation in writing to OCI within 30 days of the termination. This documentation need not prove violations, but should include situation where possible violations exist. The Office of the Commissioner of Insurance will investigate these situations and take appropriate action based upon the investigation.
Ins 6.57(2)(c)
(c) The insurer or the authorized representative of the insurer shall promptly notify the insurance commissioner in writing if, upon further review or investigation, the insurer discovers additional information that would have been reportable to the insurance commissioner under
par. (a) or
(b) had the insurer then known of its existence.
Ins 6.57(3)
(3) In addition each insurer shall pay once each year, in accordance with an assigned billing schedule and in a payment type prescribed by the commissioner, the annual appointment fee defined in
sub. (4), within 30 days after the mailing of a payment notice to such insurer showing the amount due for all individuals serving as agent for such insurer, according to the commissioner's records as of the notice date. A billing schedule shall be adopted by the commissioner under which appointment notices shall be sent to insurers.
Ins 6.57(4)
(4) Fees applicable for listing of insurance agents under s.
628.11, Stats.,
Resident individual intermediary-agents$ 7.00
Nonresident individual intermediary-agents$24.00
Ins 6.57 Note
Note: 2009 Wis. Act 28, section
3135, changed the minimum appointment fees to $16 for residents and $50 for non-residents.
Ins 6.57(5)
(5) No insurer shall accept business directly from any intermediary or enter into an agency contract with an intermediary unless that intermediary is a licensed agent appointed with that insurer.
Ins 6.57(6)
(6) No intermediary shall submit an application for insurance directly to an insurer or solicit insurance on behalf of a particular insurer or enter into an agency contract unless the agent is appointed with that insurer.
Ins 6.57 Note
Note: A free copy of each form referenced in this section may be obtained from the Office of the Commissioner of Insurance, P.O. Box 7872, Madison, WI 53707-7872 or on the office of the commissioner of insurance website at
http://oci.wi.gov/.
Ins 6.57 History
History: Cr.
Register, December, 1976, No. 252, eff. 1-1-77; r. and recr.
Register, March, 1978, No. 267, eff. 4-1-78; cr., (5) and (6),
Register, March, 1979, No. 279, eff. 4-1-79; am. (1) and (3),
Register, September, 1981, No. 309, eff. 1-1-82; am. (5),
Register, December, 1984, No. 348, eff. 1-1-85; am. (1),
Register, April, 1986, No. 364, eff. 5-1-86; am. (1) and (2),
Register, January, 1992, No. 433, eff. 2-1-92; emerg. am. (4), eff. 10-9-95; am. (4),
Register, February, 1996, No. 482, eff. 3-1-96; am. (4),
Register, June, 2000, No. 534, eff. 7-1-00;
CR 01-074: am. (1), (2), (5) and (6), cr. (2) (a) to (c),
Register January 2002 No. 553, eff. 2-1-02;
CR 05-111: am. (1), (2) (intro.) and (3)
Register October 2006 No. 610, eff. 11-1-06;
CR 09-022: am. (3), (5) and (6)
Register August 2009 No. 644, eff. 9-1-09.
Ins 6.58
Ins 6.58
Licensing of insurance intermediary firms as insurance agents. Ins 6.58(1)
(1)
Purpose. The purpose of this rule is to establish procedures for licensure of insurance intermediary firms as insurance intermediaries, reinsurance intermediaries or managing general agents.
Ins 6.58(1m)
(1m) Definition. In this section "firm" means a corporation, association, partnership, limited liability company, limited liability partnership, or other legal entity.
Ins 6.58(2)
(2) License. Any firm may obtain an insurance intermediary firm license under this section.
Ins 6.58(3)(a)(a) Application for a permanent intermediary license, reinsurance intermediary license or managing general agent license for a corporation or partnership shall be made on application form 11-50 or, for residents of states that have signed a declaration of uniform treatment with Wisconsin, the NAIC Uniform Application for Business Entity Non-Resident License/Registration form and filed with the commissioner of insurance. The application shall be accompanied by:
Ins 6.58 Note
Note: Copies of forms referenced in ss.
Ins 6.58 and
6.59 can be obtained at the office of the commissioner of insurance.
Ins 6.58(3)(a)2.
2. Certification that the articles of incorporation or association include the intent, in good faith, to do business as an intermediary, reinsurance intermediary or managing general agent;
Ins 6.58(3)(a)3.
3. Certification that the insurance intermediary firm will transact business in such a way that all acts that may only be performed by a licensed intermediary are performed exclusively by natural persons who are licensed under s.
628.04, Stats., and functioning within the scope of the license, and a list of such persons;
Ins 6.58(3)(a)4.
4. If the insurance intermediary firm is domiciled outside of Wisconsin, an agreement to be subject to the jurisdiction of the commissioner and the courts of this state on any matter related to the insurance intermediary firm's insurance activities in this state, on the basis of service of process under ss.
601.72 and
601.73, Stats.; and
Ins 6.58(3)(a)5.
5. A list of all partners, directors or principal officers or persons in fact having comparable power.
Ins 6.58(3)(a)6.
6. In the case of a corporation the application must be signed by an officer. In the case of a partnership the application must be signed by a partner.
Ins 6.58(3)(b)
(b) Determination of the acceptance or rejection of a completed application shall be made within 84 days. A completed application consists of form OCI 11-50 or the NAIC Uniform Application for Business Entity Nonresident License/Registration form and other required material described in
par. (a).
Ins 6.58(4)
(4) Standards of competence and trustworthiness. Ins 6.58(4)(a)(a) For partners, directors or principal officers who are licensed at the time of application under
sub. (4) as insurance intermediaries, reinsurance intermediaries or managing general agents, those standards as set [forth] in
s. Ins 6.59 (5) shall apply in lieu of the standards set forth in this section.
Ins 6.58 Note
Note: A missing word is shown in brackets.
Ins 6.58(4)(b)
(b) For partners, directors or principal officers who are not licensed at the time of application under
sub. (4) as insurance intermediaries, reinsurance intermediaries or managing general agents, the following criteria may be used in assessing trustworthiness and competence:
Ins 6.58(4)(b)1.
1. `Criminal record.' The conviction for crimes which are substantially related to insurance.
Ins 6.58(4)(b)2.
2. `Accuracy of information.' Any material misrepresentation in the information submitted on form 11-50.
Ins 6.58(4)(b)3.
3. `Regulatory action.' Any regulatory action taken with regard to any license held, such as insurance licenses in other states, real estate licenses and security licenses.
Ins 6.58(4)(b)4.
4. Other criteria which the commissioner considers evidence of untrustworthiness or incompetence.
