The manual rate, classification or form is inappropriate because it does not adequately reflect the exposure represented by the risk;
The risk is so different from other risks that no single manual rate or classification could be representative of all such risks;
The risk belongs to a classification that does not develop enough experience to warrant sufficient credibility for rate-making purposes; or
The risk involves a new product or coverage as to which there are no appropriate analogous exposures for rate-making purposes.
(4) Rate filing exemption.
The following rates shall not be filed with the commissioner by the insurer or rate service organization on behalf of the insurer provided the insurer complies with sub. (7)
The rate for an individual risk written under a rating rule class filed with the commissioner which must be accompanied by a certification by a qualified actuary that the rate under the rating rule class cannot be objectively rated for at least one of the following reasons:
The class generates insufficient loss experience to be reliably used in rating;
The class loss experience is so volatile as to make it unreliable;
Prospective losses for this class are likely to change rapidly and unpredictably; or
Risks within the class are so dissimilar that a single rate would not be representative of all risks in the class.
Rates for excess liability insurance provided in an amount not less than $1,000,000 in excess of a specified retained limit provided such retained limit is not less than:
$350,000 per occurrence as respects those exposures covered by underlying insurance; or
$10,000 per occurrence as respects those exposures not covered by underlying insurance.
Rates for risks developing annual products liability and completed operations insurance premiums of $5,000 or more at the basic limit.
Rates for risks developing annual increased limits written premium determined by customary rating procedures of $5,000 or more.
Rates for risks developing $100,000 or more annual manual basic limit premium individually or in any combination of general liability insurance, commercial automobile, crime or glass.
Rates for liability insurance increased limits if the risk is reinsured on a facultative basis.
Rates for an adjustment of the aggregate limit of general liability insurance at any time during the policy period.
Rates for coverage which is materially broader or more restrictive than the coverage upon which the manual rate is based.
(5) Utilization of rate filing exemption.
An insurer or a rate service organization wishing to utilize the rate filing exemption or modification granted by sub. (4)
shall have on file with the commissioner rating rules pertaining to the situations described in sub. (4)
(6) Disapproval of filed rules.
If the commissioner determines that a rating rule does not meet the rate standards set forth in s. 625.11
, Stats., the commissioner may exercise the authority granted by s. 625.22
, Stats., and disapprove the rate.
(7) Insurer records.
An insurer using a rate subject to the exemption granted by sub. (4)
shall maintain separate records and documentation for a period of 3 years after the rate is no longer used. This documentation shall include all details of the factors used in determining the rate or classification for a particular risk, including conditions used to qualify a rate for an exemption under sub. (4)
. The insurer shall provide these records to the commissioner upon request.
Ins 6.785 History
Emerg. cr. eff. 8-3-92; cr. Register, February, 1993, No. 446
, eff. 3-1-93.
Advisory councils and committees. Ins 6.79(1)(1)
The purpose of this section is to delineate the process by which the commissioner may create advisory councils and committees under s. 15.04 (1) (c)
, Stats., to assist in dealing with regulatory problems pursuant to s. 601.20
, Stats., and may include assistance with rule-making pursuant to s. 227.13
Each council or committee shall advise the commissioner on matters relating to specific issues or subjects presented to the members for study and review by the commissioner of insurance.
(3) Expense reimbursement.
Members of the councils and committees shall receive no salary or compensation for service on the councils or committees but shall be reimbursed for their actual and necessary expenses in attending meetings or while performing other duties as directed by the commissioner.
The councils or committees shall meet as needed or at such times as requested by the commissioner.
For each council or committee created by the commissioner, membership may not exceed 15 members and shall be representative of the various interested parties and include persons who possess expertise or interest on the issue or topic of the council or committee.
The commissioner shall appoint the chair, unless the commissioner authorizes a different process for selection. The commissioner shall appoint an employee of the office as a non-voting member to assist the council or committee with its duties. The commissioner or a designee shall keep a record of all proceedings, transactions, communications, and other official acts of the councils and committees. The commissioner or a designee appointed by the commissioner shall serve as a voting member when the council or committee is convened in accordance with s. 15.04 (1) (c)
, Stats. The files and records of the councils and committees shall be maintained at the office of the commissioner of insurance.
Members of the councils and committees serve at the pleasure of the commissioner.
Ins 6.79 History
Cr. Register, January, 1980, No. 289
, eff. 2-1-80; correction in (1) under s. 13.93 (2m) (b) 7., Stats., Register, September, 1984, No. 348
; r. (2) (c), Register, November, 1991, No. 431
, eff. 12-1-91; correction in (1) made under s. 13.93 (2m) (b) 7., Stats., Register, February, 2000, No. 530
; CR 08-064
: r. and recr. Register December 2008 No. 636
, eff. 1-1-09.
The purpose of this section is to establish standards for record retention by insurers and other persons subject to the regulation of the commissioner.
This section shall apply to all insurers licensed under chs. 611
, Stats., and including the Local Property Insurance Fund, the State Life Insurance Fund, and the State Indemnity Fund.
2. Sections Ins 2.07 (5) (a) 2. d. and (b) 2. b.
apply to life insurance.
Ins 6.80 Note
Note: Sections Ins 2.07 (5) (a) 2. d. and (b) 2. b. do not exist. Section Ins 2.07 was repealed and recreated eff. 3-1-82.
"Hard copy" means any information which is procured from an alternate storage facility such as microfilm, microfiche or electronic data processing and reproduced into proper form.
Corporate records such as minute books, articles and by-laws, and stock and membership records shall be retained as permanent records.
Rate books, agents' handbooks, underwriting manuals, specimen forms, and related actuarial material, as well as reinsurance contracts, shall be retained as long as the related insurance coverage remains in force.
Records of insurance company operations and other financial records reasonably related to insurance operations for the preceding 3 years shall be maintained and be available to the commissioner.
Records maintained under par. (b)
may be in written form or in any other form capable of being converted to written form within a reasonable period of time.
Original documents, such as claim files, invoices, cancelled checks, underwriting information and other similar materials may be maintained on microfilm or microfiche so long as the records thus maintained are readily available to the commissioner and can be reproduced in hard copy.
Accounting records, policy master files, reserve inventories, and other similar records normally produced in hard copy may be maintained on electromagnetic tape provided such tapes are preserved and that the company can and will reproduce the appropriate hard copy within a reasonable period of time at the request of the commissioner.
The statutes of limitations, escheat laws, and statutes regarding minors of the various jurisdictions in which the insurer does business shall control the retention of pertinent records, other than permanent records, beyond the period mentioned in par. (b)
. These records may include, but shall not be limited to, claims files, supplementary contract files, records of uncashed checks, and underwriting files.
Subject to this rule and applicable statutes and rules or regulations of this and other jurisdictions in which the insurer is licensed to do business, the insurer may set its retention of records to conform to its storage facilities.
Records with regard to insurance company operations in the state of Wisconsin for the preceding 3 years shall be maintained in the form specified under sub. (4)
and be available to the commissioner, or the insurance regulatory agency of the insurer's state of domicile.
The requirements of this rule pertaining to an insurer's operations in the state of Wisconsin may be met by compliance with the record retention law of its state of domicile. If no such law or regulation exists, an insurer may comply with this rule by presenting a statement attesting to the fact that its record retention system is acceptable to its state of domicile.
Violations of this rule by any person shall subject the person to the penalties set forth in s. 601.64
(8) Effective date.
As provided in s. 227.22 (2) (intro.)
, Stats., this rule shall take effect on the first day of the month following its publication.
Ins 6.80 History
Cr. Register, June, 1981, No. 306
, eff. 7-1-81; r. (6) under s. 13.93 (2m) (b) 16., Stats., Register, December, 1984, No. 348
; correction in (8) made under s. 13.93 (2m) (b) 7., Stats., Register, May, 1987, No. 377
; cr. (2) (b) 10., Register, November, 1993, No. 455
, eff. 2-1-94; corrections in (3) made under s. 13.93 (2m) (b) 7., Stats., Register, February, 2000, No. 530
; correction in (2) (b) 5. and 6. made under s. 13.93 (2m) (b) 7., Stats., Register January 2002 No. 553
Notification of a person's right to file a complaint with the commissioner. Ins 6.85(1)
This section interprets and implements s. 631.28
, Stats., by specifying the contents of a notice insurers must provide to insureds about their right to file a complaint with the office of the commissioner of insurance. This section also describes when and the manner in which such notice must be provided.
This section applies to all policies or certificates in force, issued or renewed in Wisconsin on or after the effective date of this section.
For purposes of this section, "insured" means the policyholder for individual policies and both the group policyholder and certificate holder for group policies.
(4) Notice format.
Every insurer shall disclose the insured's right to contact the office of the commissioner of insurance regarding an insurance problem by providing a notice which shall:
Be in the form as prescribed in Appendix I or for policies subject to sub. (5) (d)
in form as prescribed in Appendix 2;
Include the issuer's address, toll free phone number, if available, and phone number in no less than 12-point type and bold print.
Ins 6.85 Note
Note: The language in sub. (4) (b) applies to notices sent on or after March 1, 1995.
Have the phrase "KEEP THIS NOTICE WITH YOUR INSURANCE PAPERS," "PROBLEMS WITH YOUR INSURANCE?" in Appendix I and the "OFFICE OF THE COMMISSIONER OF INSURANCE" in Appendices I and 2 capitalized and in bold lettering.
For policies issued prior to the effective date of this section, except for policies included under pars. (c)
The notice shall be provided on or before the insured's first renewal date after the effective date of this section or within one year after the effective date of this section, whichever is earlier, with a separate notice to the insured; or
For single premium policies, a separate notice shall be provided on or before the insured's next anniversary date or within one year after the effective date of this section, whichever is earlier.
For policies or certificates issued on or after the effective date of this section, except for policies included under pars. (c)
, a separate notice shall be provided at the time the policy or certificate is issued.
For surety and title insurance policies the notice must be given as a separate notice to each claimant at the time a claim is denied.
For policies subject to s. 632.83
, Stats., the insurer shall either give notice in the form as prescribed in Appendix 2 and as specified in pars. (a)
or may include the language in Appendix 2 as part of the grievance procedure language in the policy and certificates issued after the effective date and, for policies issued prior to the effective date, provide a policy or certificate amendment on or before the first renewal date after the effective date or within one year after the effective date of this section, whichever is earlier.
Ins 6.85 History
Emerg. cr. eff. 2-1-93; cr. Register, February, 1993, No. 446
, eff. 3-1-93; correction in (5) (d), Register, April, 1993, No. 448
, eff. 5-1-93; am. (4) (b) and Appendix, Register, January, 1995, No. 469
, eff. 2-1-95; correction in (5) (d) made under s. 13.93 (2m) (b) 7., Stats., Register January 2002 No. 553
Prohibited uses of senior-specific designations. Ins 6.90(1)(1)
The purpose of this rule is to set forth standards to protect consumers from advertising and trade practices that are deceptive, misleading, or restrain competition unreasonably, with respect to the use of senior-specific certifications and professional designations in the advertising, solicitation, sale or purchase of, or advice made in connection with, life or health insurance, or an annuity product.