INSURANCE — RATE REGULATION
Construction and purposes.
Scope of application.
Filing of rates and consent to rate.
Filings open to inspection.
Delegation of rate making and rate filing obligation.
Loss ratios for certain disability policies.
Delaying effect of rates.
Disapproval of rates.
Special restrictions on individual insurers.
Operation and control of rate service organizations.
Binding agreements by insurers.
Recording and reporting of experience.
Ch. 625 Cross-reference
See definitions in ss. 600.03
Construction and purposes. 625.01(1)
This chapter shall be liberally construed to achieve the purposes stated in sub. (2)
, which shall constitute an aid and guide to interpretation but not an independent source of power.
The purposes of this chapter are:
To protect policyholders and the public against the adverse effects of excessive, inadequate or unfairly discriminatory rates;
To encourage, as the most effective way to produce rates that conform to the standards of par. (a)
, independent action by and reasonable price competition among insurers;
To provide formal regulatory controls for use if independent action and price competition fail;
To authorize cooperative action among insurers in the rate-making process, and to regulate such cooperation in order to prevent practices that tend to bring about monopoly or to lessen or destroy competition;
To encourage the most efficient and economic marketing practices; and
To regulate the business of insurance in a manner that will preclude application of federal antitrust laws.
In this chapter, unless contrary to context:
"Market segment" means any line or kind of insurance or, if it is described in general terms, any subdivision thereof or any class of risks or combination of classes.
"Rate service organization" means any person, other than an employee of an insurer, who assists insurers in rate making or filing by:
Collecting, compiling and furnishing loss or expense statistics;
Recommending, making or filing rates or supplementary rate information; or by
Advising about rate questions, except as an attorney giving legal advice.
"Supplementary rate information" includes any manual or plan of rates, statistical plan, classification, rating schedule, minimum premium, policy fee, rating rule, rate-related underwriting rule and any other information prescribed by rule of the commissioner.
History: 1983 a. 189
Scope of application. 625.03(1m)
This chapter applies to all kinds and lines of direct insurance written on risks or operations in this state by any insurer authorized to do business in this state, except:
Life insurance other than credit life insurance;
Group and blanket accident and sickness insurance other than credit accident and sickness insurance.
To the extent that ch. 424
is inconsistent with this chapter, ch. 424
Legislative Council Note to sub. (3), 1975: Fraternals should be subjected to rate regulation to the same extent as and no farther than other insurers. [Bill 643-S]
The commissioner may by rule exempt any person or class of persons or any market segment from any or all of the provisions of this chapter, if and to the extent that the commissioner finds their application unnecessary to achieve the purposes of this chapter.
History: 1979 c. 102
s. 236 (6)
Rates shall not be excessive, inadequate or unfairly discriminatory, nor shall an insurer charge any rate which if continued will have or tend to have the effect of destroying competition or creating a monopoly.
Rates are presumed not to be excessive if a reasonable degree of price competition exists at the consumer level with respect to the class of business to which they apply. In determining whether a reasonable degree of price competition exists, the commissioner shall consider all relevant tests including:
The number of insurers actively engaged in the class of business;
The existence of rate differentials in that class of business;
Whether long-run profitability for insurers generally of the class of business is unreasonably high in relation to its riskiness.
If such competition does not exist, rates are excessive if they are likely to produce a long run profit that is unreasonably high in relation to the riskiness of the class of business, or if expenses are unreasonably high in relation to the services rendered.
Rates are inadequate if they are clearly insufficient, together with the investment income attributable to them, to sustain projected losses and expenses in the class of business to which they apply.
(4) Unfair discrimination.
One rate is unfairly discriminatory in relation to another in the same class if it clearly fails to reflect equitably the differences in expected losses and expenses. Rates are not unfairly discriminatory because different premiums result for policyholders with like loss exposures but different expense factors, or like expense factors but different loss exposures, so long as the rates reflect the differences with reasonable accuracy. Rates are not unfairly discriminatory if they are averaged broadly among persons insured under a group, franchise or blanket policy.
See also s. Ins 6.54
, Wis. adm. code.
Read together, ss. 625.11 and 625.22 provide that the insurance commissioner shall disapprove any rate that destroys competition, thus providing a regulatory remedy for rates that constitute restraints of trade and barring private rate-related suits for damages. Prentice v. Minnesota Title Ins. Co. 176 Wis. 2d 714
, 500 N.W.2d 658
There is no active state supervision of the organization established by title insurance companies to set uniform rates for its members and thus no "state-action immunity" for otherwise prohibited price-fixing engaged in by the member title insurers. FTC v. Ticor Title Insurance Co. 504 U.S. 621
, 119 L. Ed. 2d 410
There is no private right of action to enforce sub. (1). NAACP v. American Family Mutual Insurance Co. 978 F.2d 287
In determining whether rates comply with the standards under s. 625.11
, the following criteria shall be applied:
(1) Basic factors in rates.
Due consideration shall be given to all of the following that apply:
Past and prospective loss and expense experience within and outside of this state.
Loadings for leveling premium rates over time or for dividends or savings to be allowed or returned by insurers to their policyholders, members or subscribers.
Subject to s. 632.365
, all other relevant factors, including the judgment of technical personnel.
Risks may be classified in any reasonable way for the establishment of rates and minimum premiums, except that no classifications may be based on race, color, creed or national origin, and classifications in automobile insurance may not be based on physical condition or developmental disability as defined in s. 51.01 (5)
. Subject to s. 632.365
, rates thus produced may be modified for individual risks in accordance with rating plans or schedules that establish reasonable standards for measuring probable variations in hazards, expenses, or both. Rates may also be modified for individual risks under s. 625.13 (2)
The expense provisions included in the rates to be used by an insurer may reflect the operating methods of the insurer and, so far as it is credible, its own expense experience.
The rates may contain an allowance permitting a profit that is not unreasonable in relation to the riskiness of the class of business.
See also s. Ins 6.54
, Wis. adm. code.
Filing of rates and consent to rate. 625.13(1)
Except as provided in sub. (2)
, every authorized insurer and every rate service organization licensed under s. 625.31
which has been designated by any insurer for the filing of rates under s. 625.15 (2)
shall file with the commissioner all rates and supplementary rate information and all changes and amendments thereof made by it for use in this state within 30 days after they become effective.
(2) Consent to rate.
Upon written application of the insured, stating the insured's reasons therefor, filed with and not disapproved by the commissioner within 10 days after filing, a rate in excess of that provided by a filing otherwise applicable may be applied to any specific risk. The rate may be disapproved without a hearing, subject to s. 601.62 (3)
. If disapproved, the rate otherwise applicable applies from the effective date of the policy, but the insurer may cancel the policy proportionally on 10 days' notice to the policyholder. If the insurer does not cancel the policy the insurer shall refund any excess premium from the effective date of the policy.
History: 1979 c. 93
; 1983 a. 36