Chapter Ins 42

Ins 42.03(8)(b)1. 1. Has equalled or exceeded or has the potential to equal or exceed an amount which is .5% of the insurer’s policyholder surplus as of December 31 of the immediately preceding calendar year or exceeds the limit set by the insurer, whichever is less;

Ins 42.03(8)(b)2. 2. Involves a coverage dispute;

Ins 42.03(8)(b)3. 3. May exceed the managing general agent claims settlement authority;

Ins 42.03(8)(b)4. 4. Is open for more than 6 months; or

Ins 42.03(8)(b)5. 5. Is closed by payment of an amount equal to or greater than .5% of the insurer’s policyholder surplus as of December 31 of the immediately preceding calendar year or an amount set by the insurer, whichever is less.

Ins 42.03(9) (9) All claim files will be the joint property of the insurer and managing general agent. However, upon an order of liquidation of the insurer the files shall become the sole property of the insurer or its estate. The contract may provide that the managing general agent may have reasonable access to and the right to copy the files on a timely basis.

Ins 42.03(10) (10) Any settlement authority granted to the managing general agent may be terminated for cause upon the insurer’s written notice to the managing general agent or upon the termination of the contract. The insurer may suspend the settlement authority during the pendency of any dispute regarding the cause for termination.

Ins 42.03(11) (11) The managing general agent will timely transmit to the insurer appropriate data from electronic claims files.

Ins 42.03(12) (12) If the contract provides for a sharing of interim profits by the managing general agent, and the managing general agent has the authority to determine the amount of the interim profits by establishing loss reserves or controlling claim payments, or in any other manner, interim profits will not be paid to the managing general agent until one year after they are earned for property insurance business and 5 years after they are earned on casualty business and not until the profits have been verified as required under s. Ins 42.05.

Ins 42.03(13) (13) The managing general agent may not:

Ins 42.03(13)(a) (a) Bind reinsurance or retrocessions on behalf of the insurer, except that the managing general agent may bind facultative reinsurance contracts pursuant to obligatory facultative agreements if the contract with the insurer contains reinsurance underwriting guidelines including, for both reinsurance assumed and ceded, a list of reinsurers with which the automatic agreements are in effect, the coverages and amounts or percentages that may be reinsured and commission schedules;

Ins 42.03(13)(b) (b) Commit the insurer to participate in insurance or reinsurance syndicates;

Ins 42.03(13)(c) (c) Appoint any subproducer without assuring that the subproducer is lawfully licensed to transact the type of insurance for which the subproducer is appointed;

Ins 42.03(13)(d) (d) Without prior approval of the insurer, pay or commit the insurer to pay a claim over a specified amount, net of reinsurance, which shall not exceed 1% of the insurer’s policyholder surplus as of December 31 of the last completed calendar year;

Ins 42.03(13)(e) (e) Collect any payment from a reinsurer, or commit the insurer to any claim settlement with a reinsurer, without prior approval of the insurer. If prior approval is given, a report must be promptly forwarded to the insurer;

Ins 42.03(13)(f) (f) Permit its subproducer to serve on the insurer’s board of directors;

Ins 42.03(13)(g) (g) Jointly employ an individual who is employed by the insurer; or

Ins 42.03(13)(h) (h) Appoint a submanaging general agent.

Ins 42.03 History History: Cr. Register, July, 1993, No. 451, eff. 8-1-93.

Ins 42.035 Ins 42.035 Applicability.

Ins 42.035(1) (1) A managing general agent functioning without a written contract on or after August 1, 1993 is deemed to be subject to terms consistent with s. Ins 42.03.

Ins 42.035(2) (2) A managing general agent which first enters into, amends or renews a contract on or after August 1, 1993 is subject to s. Ins 42.03.

Ins 42.035(3) (3) A managing general agent not otherwise subject to s. Ins 42.03 under sub. (1) or (2) is subject to s. Ins 42.03 after September 30, 1994.

Ins 42.035 History History: Cr. Register, July, 1993, No. 451, eff. 8-1-93.

Ins 42.04 Ins 42.04 Effect of noncompliance on contract terms. A contract between an insurer and a managing general agent that violates s. Ins 42.03 is enforceable against the managing general agent as if it conformed to s. Ins 42.03.

Ins 42.04 History History: Cr. Register, July, 1993, No. 451, eff. 8-1-93.

Ins 42.05 Ins 42.05 Duties of insurers.

Ins 42.05(1) (1) Each insurer shall have on file an independent financial examination of each managing general agent with which it has done business after August 1, 1993.

Ins 42.05(2) (2) If a managing general agent establishes loss reserves, the insurer shall annually obtain the opinion of an actuary attesting to the adequacy of loss reserves established for losses incurred and outstanding on business produced by the managing general agent. This is in addition to any required loss reserve certification required under s. Ins 50.30 (1).

Ins 42.05(3) (3) An insurer shall at least semiannually conduct an on-site review of the underwriting and claims processing operations of its managing general agents.

Ins 42.05(4) (4) An insurer shall require that binding authority for all reinsurance contracts or participation in insurance or reinsurance syndicates shall rest with an officer of the insurer who is not associated with the managing general agent except the commissioner may give a written waiver of this subsection if the managing general agent is a wholly owned subsidiary of the insurer.

Ins 42.05(5) (5) Within 30 days of entering into or termination of a contract with a managing general agent, an insurer shall provide written notification of the appointment or termination to the commissioner. Notices of appointment of a managing general agent shall include a statement of duties which the applicant is expected to perform on behalf of the insurer, the lines of insurance for which the applicant is to be authorized to act, a copy of the contract, and any other information the commissioner may request.

Ins 42.05(6) (6) An insurer shall review its books and records each quarter of the calendar year to determine if any producer has become a managing general agent. If the insurer determines that a producer has become a managing general agent, the insurer shall promptly notify the producer and the commissioner of the determination and the insurer and producer shall fully comply with this chapter within 30 days.

Ins 42.05(7) (7) An insurer shall not appoint to its board of directors an officer, director, employe, subproducer or controlling shareholder of its managing general agents except the commissioner may give a written waiver of this subsection if the managing general agent is a wholly owned subsidiary of the insurer.

Ins 42.05 History History: Cr. Register, July, 1993, No. 451, eff. 8-1-93; CR 05-066: am. (2) Register January 2006 No. 601, eff. 2-1-06.

Ins 42.06 Ins 42.06 Examination authority. The acts of a managing general agent are acts of the insurer on whose behalf it is acting. A managing general agent may be examined as if it were the insurer.

Ins 42.06 History History: Cr. Register, July, 1993, No. 451, eff. 8-1-93.

Ins 42.07 Ins 42.07 Additional restrictions. This chapter is in addition to ss. 611.67 and 618.22, Stats.

Ins 42.07 History History: Cr. Register, July, 1993, No. 451, eff. 8-1-93.