"Customer" means a natural person with whom the agent or affiliate is doing or has, within 3 years from the act or transaction regulated by this section, done an insurance business as that term is defined in s. 618.02 (2)
"Personal financial transaction" includes a transaction in which the agent or an affiliate of the agent borrows money, property or securities from a customer; loans money, property or securities to a customer; acts as custodian for money, property or securities of a customer; obtains power of attorney over money, property or securities of a customer; obtains a guarantee of any loan from a customer; shares directly or indirectly in profits or losses with a customer; or without furnishing equal consideration obtains title to or ownership of any property of a customer. In this section "personal financial transaction" does not include transactions conducted by an agent or affiliate in the normal course of doing an insurance business such as holding an insurance policy for analysis or servicing, or receiving an insurance premium from a customer provided the transaction is properly recorded on the records of the agent or affiliate as required by s. Ins 6.61
, including the name of the insurer for whom the premium was received, and the agent or affiliate immediately issues a written receipt to the customer for the policy or premium.
The following are deemed to be unfair trade practices by an agent or affiliate pursuant to s. 628.34 (12)
, Stats., without limiting those terms to the practices specified in this section:
Effecting or attempting to effect a personal financial transaction with a customer unless any of the following apply:
The customer is a person residing in the household of the agent or affiliate at the time of the transaction.
The transaction is a bona fide arm's length business transaction where the customer is either qualified to understand and assess the transaction or has been advised or represented in the transaction by a qualified individual who is not the agent or affiliate.
The agent or affiliate is acting lawfully pursuant to authority given under federal or state law governing the securities or investment advisory business.
Knowingly being listed as a beneficiary of any proceeds of a life insurance policy or annuity issued to a customer unless the agent or affiliate has an insurable interest in the life of the customer.
Engaging in transactions with a customer in violation of ch. 551, Stats.
, the Wisconsin uniform securities law, ch. 553, Stats.
, the Wisconsin franchise investment law, the U.S. securities act of 1933 (15 USCS 77a et seq), the U. S. securities exchange act of 1934 (15 USCS 78a-78kk), the U. S. investment company act of 1940 (15 USCS 80 a-1 – 80a-52), or any rules or regulations promulgated under any of such laws.
Making misleading statements to a customer regarding or otherwise misrepresenting one's qualifications or services. This includes using terms such as "financial", "investment" or "retirement" in conjunction with terms such as "planner", "planning" or "consulting" when, under the circumstances, the statements, representations or use of these terms do not accurately describe the nature of the services offered or the qualifications of the person offering the services.
Selling, soliciting the sale, or assisting the sale, of health coverage that is:
Provided by a person who is not licensed as an insurer in this state; and
Represented to be authorized under, or exempt from state insurance regulation under, the federal employee retirement income security act (29 USCS 1001 et seq).
For the purpose of s. 618.39 (1)
, Stats., an agent should know that placement of insurance is illegal if the agent:
Sells, solicits the sale, or assists in the sale, of health coverage offered by a person not licensed as an insurer in this state; and
Knows that the health coverage is represented to be authorized, or exempt from state insurance regulation, under the federal employee retirement income security act (29 USCS 1001 et seq).
An agent's lack of knowledge of any of the following is not a defense to a violation of s. 618.39 (1)
That the person providing the coverage is not licensed in this state.
That the represented authorization or exemption under the federal employee retirement income security act is false (29 USCS 1001 et seq).
The commissioner shall order, for any agent who violates s. 618.39
, Stats., not less than revocation of the agent's license and that the agent pay any claims not paid within 60 days by the unauthorized insurer. An agent may establish the basis for a lesser penalty for a violation of s. 618.39
, Stats., only if the agent shows all of the following:
The agent made, and solicited to make, only a few sales of the coverage.
The agent did not serve as a general agent, was not eligible for override commissions, and was not responsible for recruiting, and did not recruit, other agents to sell the coverage.
A violation of sub. (2)
is a cause for denial of an agent license application under s. 628.04 (1)
, Stats., and a cause for agent license suspension, revocation or limitation under s. 628.10 (2) (b)
Ins 6.60 History
History: CR 01-072
: cr. Register January 2002 No. 553
, eff. 2-1-02.
This section protects insurance policyholders by prescribing minimum standards and techniques of accounting and data handling of intermediaries to ensure that timely and reliable information will exist and be available to the commissioner. This section implements and interprets ss. 601.42
, Stats., by establishing minimum records to be maintained by intermediaries.
This section applies to all intermediaries transacting insurance business in this state and to Wisconsin insurance transactions of nonresident intermediaries unless the nonresident is required to maintain records in a similar specified manner by the intermediary's state of domicile.
"Business checking account" means any account utilized by an intermediary for insurance-related transactions.
"Cash disbursed record" means a record showing all monies paid out by the intermediary in connection with insurance.
"Cash receipts record" means a record showing all monies received by the intermediary in connection with insurance.
"Commission statements" means records or statements which show the commissions and fees allocated to the intermediary for insurance transactions.
"Formal administrative action" means consent decrees, cease and desist orders, stipulations, suspensions, revocations, license denials, fines, forfeitures, settlement agreements, license restrictions or actions limiting the intermediary's method of conducting an insurance business but does not include administrative actions based solely on failing to comply with continuing education requirements or solely on failing to pay a regulation fee for licensing.
"Intermediary" means an agent, broker or producer and any person, partnership or corporation requiring a license under the provisions of ch. 628, Stats.
"Personnel records" means those records pertaining to anyone who is directly retained or employed by an intermediary in connection with insurance including subagents, secretaries, phone solicitors, and independent contractors.
"Policyholder records" means all records, applications, request for changes, claims, and complaints associated with a policy generated by or through the intermediary.
(4) Cash disbursed record.
The cash disbursed record shall show the name of the party to whom the payment was made, date of payment, and reason for payment.
(5) Cash receipts record.
The cash receipts record shall show the name of the party who remitted the money, date of receipt, and reason for payment.
(6) Commission statements.
The commission statements shall show the insured name, policy number, premium, amount of commission, and date allocated or paid or both.
(7) Personnel records.
Personnel records shall include dates of employment, position, description of principal duties, name of employee, and last known address and phone number of employee.
(8) Recordkeeping requirements.
Beginning on January 1, 1988, each intermediary shall maintain, for a 3-year period, unless a specific period is provided elsewhere, the following records:
(9) Special requirements for newly issued contracts.
Each intermediary shall maintain records for a 3-year period giving the effective date of the coverage on all newly issued contracts.
(10) Special requirements for individually-issued life and accident and health contracts.
Each intermediary shall maintain records for a 3-year period indicating that the necessary suitability inquiry and replacement procedures required by ss. Ins 2.07
, 2.14 (5) (f)
, 2.15 (9) (f)
, 3.27 (7)
, and 3.29
were followed for each individually-issued life and accident and health contract written or replaced or both.
(11) Special requirements for title insurance.
Each intermediary who is employed by, or is, an affiliate of a producer of title insurance shall maintain records for 3 years for each application or order for title insurance accepted in this state. The records shall state whether the application or order was directly or indirectly referred as provided by s. Ins 3.32 (5)
by a producer of title insurance which is an affiliate as defined by s. Ins 3.32 (3) (a)
and the name of each producer of title insurance who is an affiliate and acts as broker, agent, lender, representative or attorney in the transaction which resulted in the application or order. Each intermediary who is an affiliate of a producer of title insurance shall maintain a record of gross revenue from operations in this state from title insurance by quarter calendar year which shall separately show gross revenue from operations in this state derived from applications or orders for title insurance directly or indirectly referred by the affiliate.
(12) Place of maintaining records.
The intermediary shall maintain records required by subs. (8)
at the business address of the intermediary or the insurer recorded with the commissioner of insurance, or at another location only if the intermediary provides written notice of the other location to the commissioner of insurance.
(13) Updating records.
The intermediary shall update all intermediary records at reasonable intervals or as necessary and shall maintain all financial intermediary records according to accepted accounting principles.
(14) Maintaining policyholder records.
The intermediary shall retain policyholder records for a period of at least 3 years after termination or lapse of the policy.
(15) Change of name or address.
Each intermediary shall, within 30 days, notify the commissioner of insurance in writing of any change in the intermediary's name, residence address, and mailing address.
(16) Notification of formal administrative actions, criminal proceedings and lawsuits.
Each intermediary shall notify the commissioner in writing of the following within 30 days:
Except for action taken by the Wisconsin office of the commissioner of insurance, any formal administrative action against the intermediary taken by any state's insurance regulatory agency, commission or board or other regulatory agency which licenses the person for any occupational activity. The notification shall include a description of the basis for the administrative action and any action taken as a result of the proceeding, a copy of the notice of hearing and other documents describing the problem, a copy of the order, consent to order, stipulation, final resolution and other relevant documents.
Any initial pretrial hearing date related to any criminal prosecution of the intermediary taken in any jurisdiction, other than a misdemeanor charge related to the use of a motor vehicle or the violation of a fish and game regulation. The notification shall include a copy of the initial criminal complaint filed, the order resulting from the hearing and any other relevant legal documents.
Any felony conviction or misdemeanor conviction in any jurisdiction, other than a misdemeanor conviction related to the use of a motor vehicle or the violation of a fish and game regulation. The notification shall include a copy of the initial criminal complaint or criminal charging document filed, the judgement of conviction, the sentencing document, the intermediary's explanation of what happened to cause criminal proceedings, the intermediary's reasons why no action should be taken regarding the intermediary's license and any other relevant legal documents.
Any lawsuit filed against the licensee or the licensee's business in which there are allegations of misrepresentation, fraud, theft or embezzlement involving the licensee or the licensee's business. The notification shall include a copy of the initial suit documents, the intermediary's explanation of what happened to cause the civil proceedings, the intermediary's reasons why no action should be taken regarding the intermediary's license and any other relevant legal documents.
(17) Records maintained by insurers.
An insurer shall inform its intermediaries in writing of the requirements of this section and may, by written agreement, assume the responsibility to maintain these records for an individual intermediary if the records can be made immediately available to the commissioner of insurance on demand.
Ins 6.61 History
Cr. Register, March, 1977, No. 255
, eff. 4-1-77; am., Register, March, 1979, No. 279
, eff. 4-1-79; cr. (5), Register, September, 1981, No. 309
, eff. 10-1-81; cr. (2m), Register, November, 1986, No. 371
, eff. 12-1-86; r. and recr. Register, December, 1987, No. 384
, eff. 1-1-88; am. (16), Register, August, 1988, No. 392
, eff. 9-1-88; am. (16), Register, April, 1992, No. 436
, eff. 5-1-92; am. (15), Register, January, 1999, No. 517
, eff. 2-1-99; CR 01-074
; am. (3) (e), r. and recr. (16), Register January 2002 No. 553
, eff. 2-1-02; CR 05-111
: am. (3) (f) Register October 2006 No. 610
, eff. 11-1-06; CR 09-022
: am. (15) Register August 2009 No. 644
, eff. 9-1-09.
Filing requirements for multiple employer trusts and associations. Ins 6.62(1)(b)1.1.
"Multiple employer trust or association," except as provided by subd. 2.
, means a trust, association or other person which provides or offers to provide health care benefits or coverage to employees of 2 or more employers and which is:
Located outside this state and is not organized and regulated as an insurer domiciled in the United States.
"Multiple employer trust or association" does not include a person which:
Provides benefits or coverage under or pursuant to a collective bargaining agreement;
Is, or which provides benefits or coverage which are fully insured by, an insurer licensed to do business in this state;
Provides health care benefits or coverage solely to employees of governmental units;
No intermediary may solicit, advertise, or market in this state or accept an application or place coverage for a person who resides in this state with a multiple employer trust or association unless prior to solicitation, advertising, marketing, acceptance of the application, or placing the coverage:
The multiple employer trust or association files with the office the information required under sub. (5)
No multiple employer trust or association may solicit, advertise, or market in this state or accept an application for coverage from a person who is a resident, or who has employees who are residents, of this state unless prior to soliciting, advertising, marketing, or accepting an application it files with the office the information required under sub. (5)
If subsequent to a filing under sub. (2)
changes occur so that the information contained in the filing is no longer accurate, the multiple employer trust or association or intermediary which made the filing shall within 15 days of the date the change is effective make a filing under sub. (5)
with the correct information.
A multiple employer trust or association or intermediary required to file information under sub. (2)
, or (4)
shall file a properly completed form prescribed by the commissioner and shall attach:
A copy of any insurance policy or contract covering benefits or coverage offered by the multiple employer trust or association;
A copy of the organizational documents of the multiple employer trust or association, including the articles of incorporation, bylaws or trust instrument; and
A statement that the benefits or coverage are fully insured or a description of the extent to which they are not fully insured.