Slow claim handling, the use of unapproved rates and a failure to provide required compliant disclosures top the list of market conduct actions taken against U.S. property and casualty insurers in 2014, according to Wolters Kluwer Financial Services.

Wolters Kluwer Financial Services uses public data published in its annual lists of market conduct actions against insurers.

“Claims management has consistently been one of the top three compliance challenges for insurers over the last several years, and once again was the top compliance challenge in 2014 across all lines of business,” said Kathy Donovan, senior compliance counsel at Wolters Kluwer Financial Services. “Insurance claims professionals have to manage a variety of internal and external factors when processing claims, including claimant communications and mandatory disclosures, all within established time frames. The targeted end result is providing proper payment in accordance with policy provisions and state law.”

The full list of top 10 actions against P/C insurers using 2014 data is set forth below.

  1. Failure to acknowledge, pay, investigate or deny claims within specified timeframes
  2. Using unapproved/unfiled rates and rules or misapplying rating factors
  3. Failure to provide required compliant disclosures in claims processing
  4. Failure to cancel or non-renew policies in accordance with requirements
  5. Failure to process total loss claims properly
  6. Failure to adhere to producer appointment, termination, records and/or licensing requirements
  7. Improper/incomplete documentation of underwriting files
  8. Improper/incomplete documentation of claim files
  9. Failure to provide required compliant disclosures in underwriting processes
  10. Failure to process and pay claims in accordance with policies

Wolters Kluwer provides compliance, risk management and audit solutions to insurers and the financial services industry. The firm operates in 40 countries and is headquartered in the Netherlands.

Source: Wolters Kluwer Financial Services