The Market Conduct Unit

The Market Conduct Unit examines the records of domestic and foreign insurance companies to review the treatment of policyholders and claimants in Connecticut. Examinations are conducted on a routine basis or as needed. Examinations include the review of policy underwriting and rating, cancellations and non-renewals, and claim settlements. The division also performs routine examinations of the marketing and solicitation practices of insurance companies. The marketing and solicitation examinations include the review of original insurance applications, advertising materials, and agent recruiting, training and supervision procedures.

The Market Conduct Unit performs examinations of insurance companies, healthcare centers, fraternal benefit societies and medical utilization review companies doing business in Connecticut to analyze how the insurance market and the individual companies meet and service the needs of Connecticut consumers. The examinations are conducted to ensure equitable treatment of policyholders and claimants, and compliance with statutes and regulations.

Property-Casualty Unit and the Life-Health Unit

The Property-Casualty Unit and the Life-Health Unit conduct Comprehensive Examinations, Target Examinations and Survey Examinations on an ongoing basis. The examinations review the following areas:

• operations/management
• complaint handling
• marketing and sales
• producer licensing
• policyholder service
• underwriting and rating
• claims

Utilization Review Unit

The Utilization Review Unit conducts annual Survey Examinations of all licensed Connecticut Utilization Review Companies. Areas of consideration are:

• utilization review policies and procedures
• annual summary/statistical reports
• timeliness of determinations to certify/not certify care
• appeal handling
• enrollee and provider communications
• provider credentialing

Market Conduct Unit

The Market Conduct Unit, upon completion of an examination or investigation, imposes appropriate administrative actions as warranted. Matters not resolved through negotiated agreements are presented at Formal Hearings.

Types of Market Conduct Examinations:

• Comprehensive Examination – full scope examinations generally involving a review of all of a company’s business practices.
• Target Examinations – focused examinations reviewing either a specific line of business or a specific business practice.
• Survey Examinations – data requests and questionnaires are sent to selected companies requesting information pertinent to their insurance activities in Connecticut. Certified responses are reviewed for compliance.

The Market Conduct Unit utilizes and shares information with the National Association of Insurance Commissioners’ databases. Market Conduct participates with other states in NAIC collaborative efforts and multi-state cooperative examinations.