For P&C, the top 10 criticisms are:
- Failure to acknowledge, to pay, or deny claims within specified time frames
- Using unapproved forms, unfiled rates and/or misapplication of rating factors
- Failure to cancel policies or non-renew policies in accordance with requirements
- Failure to provide required compliant disclosures in underwriting processes
- Failure to process total loss claims properly
- Failure to provide required compliant disclosures in claims processing
- Improper documentation of underwriting files
- Failure to adhere to producer appointment, termination and/or licensing requirements and adjuster licensing requirements
- Failure to pay correct amount under policy
- Improper documentation of claim files
And, for life and health insurers:
- Failure to pay claims properly in accordance with policy provisions
- Failure to use compliant policy forms and/or compliant plans
- Failure to properly acknowledge, pay, investigate, or deny claims within specified time frames
- Improper documentation of underwriting files
- Failure to use licensed and appointed producers and to provide proper notification of producer appointments or terminations, including maintenance of producer registers
- Failure to provide required disclosures including coverage issues, fraud warnings, and free-look periods
- Failure to adhere to required claims appeal processes
- Using unapproved/unfiled rates or forms and rating errors
- Improper documentation of claim files
- Failure to adhere to replacement requirements