Top 5 Market Conduct Criticisms for P&C, Life/Health Insurers

The following are the top 5 criticisms for life/health insurers:

5. (life/health) Failure to issue correct EOBs

5. (life/health) Failure to issue correct EOBs :

4. (life/health) Failure to provide required claims and underwriting disclosures including those concerning coverage issues, policy replacements and fraud warnings

4. (life/health) Failure to provide required claims and underwriting disclosures including those concerning coverage issues, policy replacements and fraud warnings:

3. (life/health) Failure to use licensed and/or appointed producers and to provide proper notification of producer appointments or terminations, including maintenance of producer registers

3. (life/health) Failure to use licensed and/or appointed producers and to provide proper notification of producer appointments or terminations, including maintenance of producer registers:

2. (life/health) Failure to properly acknowledge, pay, investigate, or deny claims within specified time frames

2. (life/health) Failure to properly acknowledge, pay, investigate, or deny claims within specified time frames:

1. (life/health) Failure to use compliant policy forms and/or maintain compliant plans

1. (life/health) Failure to use compliant policy forms and/or maintain compliant plans: The following are the top 5 criticisms for P&C insurers:

5. (property/casualty) Failure to maintain claims documentation

5. (property/casualty) Failure to maintain claims documentation:

4. (property/casualty) Improper documentation of underwriting files

4. (property/casualty) Improper documentation of underwriting files:

3. (property/casualty) Failure to provide required compliant disclosures in claims processing

3. (property/casualty) Failure to provide required compliant disclosures in claims processing:

2. (property/casualty) Using unapproved/unfiled forms and rates

2. (property/casualty) Using unapproved/unfiled forms and rates :

1. (property/casualty) Failure to acknowledge, pay or deny claims within specified time frames

1. (property/casualty) Failure to acknowledge, pay or deny claims within specified time frames:

Wolters Kluwer’s annual list of compliance issues for both P&C and life/health insurers highlight the difficulty of keeping up with regulatory changes for claims, underwriting and distribution processes.

For a news story with more top market conduct criticisms and findings, click here.

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