Ins 4.10(10)(b)(b) The manner and scope of the inspection shall be prescribed by the Plan with the approval of the commissioner. Ins 4.10(10)(c)(c) An inspection report shall be made for each property inspected covering pertinent structural and occupancy features as well as the general condition of the building and surrounding structures. Representative photographs may be taken during the inspection to indicate the pertinent features of building, construction, maintenance, occupancy, and surrounding property. Ins 4.10(10)(e)(e) After the inspection, a copy of the completed inspection report and any relevant photographs shall be kept on file by the Plan. The report shall include a description of any deficient physical condition charges proposed by the inspector. A copy of the inspection report shall be made available to the applicant or agent upon request. Ins 4.10(11)(11) Procedure after inspection and receipt of application. Ins 4.10(11)(a)(a) After receipt of the application, the inspection report, and any additional underwriting information requested from the applicant, and the application, the Plan shall within 5 business days complete and send to the applicant an action report advising him or her of one of the following: Ins 4.10(11)(a)1.1. That the risk is acceptable. If the inspection reveals substandard conditions, appropriate charges may be imposed but the report shall specify the improvements necessary for removal of each such charge. Ins 4.10(11)(a)2.2. That the risk is declined unless reasonable improvements noted in the action report are made by the applicant and confirmed by reinspection. Ins 4.10(11)(a)3.3. That the risk is declined because it fails to meet reasonable underwriting standards as set forth in sub. (12) or (13). Reasonable underwriting standards as set forth in sub. (12) or (13) shall not include neighborhood or area location or any environment hazard beyond the control of the property owner. Ins 4.10(11)(b)(b) If the risk is accepted, the action report shall advise the applicant of: Ins 4.10(11)(b)2.2. The amount of coverage the Plan agrees to write, if specified improvements are made. Ins 4.10(11)(b)3.3. The amount of coverage the Plan agrees to write only if a large or special deductible is agreed to by the applicant. Ins 4.10(11)(c)(c) If the risk is accepted, the Plan, upon receipt of the premium, shall deliver the policy to the applicant or to the licensed agent designated by the applicant for delivery to the applicant. The Plan shall remit the commissions to the licensed agent designated by the applicant. If no licensed agent is so designated, the policy shall be delivered to the applicant and the commission shall be retained by the Plan. Ins 4.10(11)(d)(d) If the risk is conditionally declined under par. (a) 2. but can be improved to meet reasonable standards the Plan shall promptly advise the applicant what improvements noted in the action report should be made to the property. Upon completion of the improvements by the applicant or property owner, the Plan when so notified, shall have the property promptly reinspected under sub. (10) and shall send a new action report to the applicant. Ins 4.10(11)(e)(e) If a risk is declined under par. (a) 3., the Plan shall promptly send copies of the inspection and action reports to the applicant and shall advise the applicant of the right to a hearing set forth in sub. (16) (a). Ins 4.10(12)(12) Reasonable underwriting standards for property coverage. The following characteristics may be used in determining whether a risk is acceptable for property coverage. Where there is more than one cause for declination, all shall be listed and complied with before the property may be accepted for insurance purposes. Ins 4.10(12)(a)(a) Physical condition of property; however, the mere fact that a property does not satisfy all current building code specifications will not, of itself, suffice as a reason for declination. Ins 4.10(12)(b)(b) The property’s present use such as extended vacancy or extended unoccupancy of the property for 60 consecutive days. Properties that are vacant or unoccupied for more than 60 days may be insured while rehabilitation or reconstruction work is actively in process meaning that the insured or owner should make monthly progress in order to complete the rehabilitation or reconstruction within a one year time frame. Ins 4.10(12)(c)(c) Other specific characteristics of ownership, condition, occupancy or maintenance, that violate the law and that result in substantial increased exposure to a loss. Any circumstance considered under this paragraph must relate to the peril insured against. Ins 4.10(12)(d)(d) Characteristics of ownership or maintenance of building including any 2 of the following conditions: Ins 4.10(12)(d)1.1. Failure to pay real estate taxes on the property after the taxes have been delinquent for one year or more. Real estate taxes shall not be deemed to be delinquent for this purpose even if they are due and constitute a lien so long as a grace period remains under local law during which such taxes may be paid without penalty. Ins 4.10(12)(d)2.2. Failure, within the insured’s control, to furnish water for 30 consecutive days or more. Ins 4.10(12)(d)3.3. Failure, within the insured’s control, to furnish heat for 30 consecutive days or more during the heating season. Ins 4.10(12)(d)4.4. Failure, within the insured’s control, to furnish public lighting for 30 consecutive days or more. Ins 4.10(12)(e)(e) Physical condition of buildings which results in an outstanding order to vacate, an outstanding demolition order or in being declared unsafe in accordance with the applicable law. Ins 4.10(12)(f)(f) One or more of the conditions for nonrenewal as listed in sub. (14) currently exist. The Plan shall, upon notice that conditions at the buildings have changed, consider new application for coverage. Ins 4.10(12)(g)(g) Vandalism and malicious mischief coverage shall not be provided for a dwelling or commercial property where the property has been subject to 2 vandalism and malicious mischief losses, each loss amounting to at least $500.00 in the immediately preceding 12-month period or 3 or more such losses in the immediately preceding 24-month period. Ins 4.10(12)(h)(h) Previous loss history or matters of public record concerning the applicant or any person defined as an insured under the policy. Ins 4.10(12)(i)(i) Any other guidelines which have been approved by the commissioner. Ins 4.10(13)(13) Reasonable underwriting standards for liability coverage. The following characteristics may be used in determining whether a risk is acceptable for liability insurance on homeowner policies: Ins 4.10(13)(a)(a) Liability insurance shall only be provided as contained in the Wisconsin Insurance Plan homeowners policy. Ins 4.10(13)(c)(c) Liability insurance shall not be provided for risks with any of the following deficiencies, as disclosed by the application or inspection, until they have been corrected. Ins 4.10(13)(c)1.1. Broken, cracked, uneven or otherwise faulty steps, porches, decks, sidewalks, patios and similar areas. Ins 4.10(13)(c)2.2. Downspouts or drains which discharge onto sidewalks or driveways. Ins 4.10(13)(c)4.4. Animals known to be vicious or animals which have caused a liability claim. Ins 4.10(13)(c)5.5. Swimming pools or private ponds not fenced in accordance with local regulations. Ins 4.10(13)(c)7.7. Junk cars, empty refrigerators or other potentially dangerous objects in the yard which are an attraction to children. Ins 4.10(13)(d)(d) Previous loss history or matters of public record concerning the applicant or any person defined as an insured under the policy. Ins 4.10(13)(e)(e) Any other guidelines which have been approved by the commissioner. Ins 4.10(13)(f)(f) Liability insurance may not be provided where there is a business operating at the insured location, unless the applicant has in force a business liability policy with limits of at least $100,000 per occurrence providing premises liability coverage. Ins 4.10(13)(g)(g) Liability insurance shall not be provided where the applicant owns three or more horses or other riding animals, unless the applicant has in force a liability policy with limits of at least $100,000 per occurrence providing coverage for the ownership and use of these horses or these other riding animals. Ins 4.10(14)(14) Cancellation; nonrenewal and limitations; review of eligibility. Ins 4.10(14)(a)(a) The Plan shall not cancel or refuse to renew a policy issued by the Plan except for the following: Ins 4.10(14)(a)1.1. Facts as confirmed by inspection or investigation which would have been grounds for nonacceptance of the risk by the Plan had they been known to the Plan at the time of acceptance. Ins 4.10(14)(a)2.2. Changes in the physical condition of the property or other changed conditions as confirmed by inspection or investigation that make the risk uninsurable under sub. (12) or (13). Ins 4.10(14)(a)4.4. At least 65% of the rental units in the building are unoccupied, and the insured has not received prior approval from the Plan of a rehabilitation program which necessitates a high degree of unoccupancy. Ins 4.10(14)(a)5.5. Unrepaired damage exists and the insured has stated that repairs will not be made or such time has elapsed as clearly indicates that the damage will not be repaired. The elapsed time under this subdivision is a length of time over 60 days where the damage remains unrepaired, unless there are known to be extenuating circumstances. Ins 4.10(14)(a)6.6. After a loss, permanent repairs following payment of the claim have not been commenced within 60 days, unless there are known to be extenuating circumstances. The 60-day period starts upon acceptance of payment of the claim. Ins 4.10(14)(a)8.8. Utilities such as electric, gas or water services have been disconnected or the insured has failed to pay an account for such services within 120 days; Ins 4.10(14)(a)9.9. Real estate taxes have not been paid for a 2-year period after the taxes have become delinquent. Real estate taxes shall not be deemed to be delinquent for this purpose if they are due and constitute a lien, so long as a grace period remains under local law under which taxes may be paid without penalty. Ins 4.10(14)(a)10.10. There is good cause to believe based on reliable information that the building will be burned for the purpose of collecting the insurance on the property. The removal of damaged salvageable items, such as normally permanent fixtures, from the building shall be considered under this item when the insured can give no reasonable explanation of such removal. Ins 4.10(14)(a)11.11. A named insured or loss payee or other person having a financial interest in the property being convicted of the crime of arson or a crime involving a purpose to defraud an insurance company. The fact that an appeal has been entered shall not negate the use of this subdivision. Ins 4.10(14)(a)12.12. The property has been subject to more than 2 losses, each loss amounting to at least $500 or 1% of the insurance in force, whichever is greater, in the immediately preceding 12-month period, or more than 3 such losses in the immediately preceding 24-month period, provided that the cause of such losses is due to the conditions which are the responsibility of the owner named insured or due to the actions of any person defined as an insured under the policy. Ins 4.10(14)(a)13.13. Theft frequency in which there have been more than 2 thefts, each loss amounting to at least $500 in a 12-month period. Ins 4.10(14)(a)15.15. On homeowners policies, excessive theft or liability losses. If on a given property there have been 2 or more losses within a 2-year period or 3 or more losses within a 5-year period, with theft and liability evaluated separately, the Plan may convert the homeowners policy to a dwelling policy. Ins 4.10(14)(a)16.16. On homeowner policies, excessive vandalism and malicious mischief losses. In the event that a given property has been subject to 2 vandalism and malicious mischief losses, each loss amounting to at least $500.00, in the immediately preceding 12-month period or 3 or more such losses in the immediately preceding 24-month period, the Plan may convert the homeowners policy to a dwelling policy without vandalism and malicious mischief coverage. Ins 4.10(14)(e)(e) At the completion of 36 months of coverage and prior to 48 months, each risk shall be reviewed for its eligibility for coverage in the voluntary market. The risk shall be submitted by the Plan to the agent of record, if any, for a search of the voluntary market. If the agent resubmits the risk to the Plan, it must be resubmitted by a new application and accompanied by a current rejection notice. The Plan shall reinspect the risk before coverage is provided. Ins 4.10(15)(a)(a) Participation and assessments by and upon each insurer in the Plan for losses and expenses in connection with Plan business shall be levied and assessed by the governing committee of the Plan on the basis of participation factors determined annually, giving effect to the proportion which such insurer’s weighted premiums written bears to the aggregate weighted premiums written by all insurers in the Plan. Ins 4.10(15)(b)(b) If any member fails to pay an assessment within 30 days after it is due, the unpaid assessment may be collected from the remaining members. Ins 4.10(16)(a)(a) Each notice by the plan to an insured or applicant of cancellation, nonrenewal, reduction in coverage or declination shall include notice of the right to a hearing under ch. Ins 5, if the person files a petition for a hearing with the commissioner of insurance not later than 30 days after the notice is mailed. The notice shall describe the requirements of s. Ins 5.11 (1). Ins 4.10(16)(b)(b) The office of the commissioner of insurance shall hold a hearing within 30 days after receipt of a complete petition under par. (a), except under either of the following circumstances: Ins 4.10(16)(b)1.1. The issue is the plan’s intent to cancel, nonrenew or reduce the petitioner’s coverage, and the plan waives the right to a hearing within 30 days. Ins 4.10(16)(b)2.2. The issue is the plan’s declination of the petitioner’s application for coverage and the petitioner waives the right to a hearing within 30 days. Ins 4.10(16)(c)(c) At the hearing the petitioner has the burden of proving by a preponderance of the evidence that the plan’s decision is erroneous under this chapter or the policy terms. Ins 4.10(16)(d)(d) Filing a petition under par. (a) stays the action of the plan with respect to cancellation, nonrenewal or reduction in coverage. The petitioner’s coverage shall remain in effect during the pendency of the proceedings as long as the petitioner continues to pay the plan premium. Ins 4.10(16)(e)(e) The plan shall comply with the final decision and order in the contested case proceeding. A final decision and order affirming the plan’s decision to cancel, nonrenew or reduce the petitioner’s coverage shall take effect 30 days after the date of the final decision and order. Upon receipt of the final decision and order, the plan shall notify the petitioner of the action it intends to take to implement the order. Ins 4.10 NoteNote: A petition under sub. (16) shall be filed as provided in s. Ins 5.17. Ins 4.10(17)(a)(a) Commission to the licensed agent designated by the applicant shall be 10% of all policy premiums. The Plan shall not license agents. Ins 4.10(17)(b)(b) In the event of cancellation of a policy, or if an endorsement is issued which requires the premium to be returned to the insured, the agent shall refund ratably to the Plan commissions on the return premium at the same rate at which such commissions were originally paid. Ins 4.10(18)(18) Public education. In cooperation with the insurance commissioner, the Plan shall undertake a continuing education program with insurers, agents and consumers about the Plan’s insurance program and its availability. All insurers and agents shall cooperate fully in the continuing education program. Ins 4.10(19)(a)(a) Each insurer shall require its licensed agents to cooperate fully in the accomplishment of the intents and purposes of the plan. Ins 4.10(19)(b)(b) Licensed insurance agents may not act as agents for the Plan. Ins 4.10(19)(c)(c) Licensed insurance agents may not do any of the following: Ins 4.10(19)(c)4.4. Act on behalf of the Plan or commit the Plan to any course of action. Ins 4.10(19)(d)(d) Insurance agents shall assist applicants who need to apply for coverage under the plan and shall submit applications that meet the requirements of sub. (9). Agents shall follow the rules and procedures of the Plan. Ins 4.10(20)(20) Review by commissioner. The governing committee shall report to the commissioner the name of any insurer or agent which fails to comply with the provisions of the Plan or with any rules prescribed thereunder by the governing committee or to pay within 30 days any assessment levied.
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Office of the Commissioner of Insurance (Ins)
administrativecode/Ins 4.10(13)
administrativecode/Ins 4.10(13)
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