| Contact Person: | Illinois Department of Insurance | 320 West Washington Street |
| Mark Smith | Review Requirements Checklist | Springfield, IL 62767-0001 |
| 217-782-1791 | ||
| mark.a.smith@illinois.gov | Effective as of 9/1/03 |
| Line(s) of | Filing | Line(s) of | Filing |
| Business | Code(s) | Insurance | Code(s) |
| Workers' Compensation | 16.0000 | Alternative Worker's Compensation | 16.0001 |
| Employers Liability | 16.0002 | ||
| Standard Workers' Compensation | 16.0004 |
*This checklist does not apply to Excess Workers Compensation. See specific Excess Workers Compensation checklist.
| Illinois Insurance Code Link | Illinois Compiled Statutes Online | ||
| Illinois Administrative Code Link | Administrative Regulations Online | ||
| Product Coding Matrix | Product Coding Matrix | ||
| REVIEW REQUIREMENTS | REFERENCE | DESCRIPTION OF REVIEW STANDARDS REQUIREMENTS | LOCATION OF STANDARD IN FILING |
|---|---|---|---|
| NOTE: These brief summaries do not include all requirements of all laws, regulations, bulletins, or requirements, so review actual law, regulation, bulletin, or requirement for details to ensure that forms are fully compliant before filing with the Department of Insurance. | |||
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GENERAL REQUIREMENTS FOR ALL FILINGS |
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| LINE OF AUTHORITY | |||
| Must have proper Class and Clause authority to conduct this line of business in Illinois. | 215 ILCS 5/4 List of Classes/Clauses |
To write Workers' Compensation insurance in Illinois, companies
must be licensed to write:
To write Employers Liability insurance in Illinois, companies must be licensed to write:
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| NAIC UNIFORM TRANSMITTAL FORM | |||
| If insurers wish to use the NAIC Uniform Transmittal form, in lieu of cover letters and explanatory memorandums, the Department will accept such form. | NAIC Uniform Transmittal Form | If insurers wish to use the NAIC Uniform Transmittal form, in lieu of cover letters and explanatory memorandums, the Department will accept such form. | |
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NAIC SELF-CERTIFICATION PILOT PROGRAM |
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| Requirements for expediting filing review in accordance with NAIC Self-Certification Pilot Program. | Newsletter Article regarding Department's Participation | The Department began participating in the NAIC Self-Certification
Pilot Program effective September 1, 2003.
If an authorized company officer completes the Self-Certification form, and submits such form with the filing, the Department will expedite review of the filing ahead of all other filings received to date. The Department will track company compliance with the laws, regulations, bulletins, and this checklist and report such information to the NAIC. |
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| GENERAL REQUIREMENTS FOR FORM FILINGS | |||
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FILING SUBMISSION |
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| Requirements for company FEIN and filing numbers. | Company must include all Federal Employer Identification
Numbers (FEINs) for companies making the filing.
Companies must assign a filing number which may be alpha, numeric, or both, but may not exceed 15 characters. Each filing number must be unique within a company and may not be repeated on subsequent filings. Please refer to Company Bulletin 88-53 for specific information and guidance. |
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| Forms under one filing number must have common coverage relationship. | All forms under an assigned filing number must have some
common coverage relationship (e.g. all forms in an auto filing must pertain
only to auto, etc.).
Please refer to Company Bulletin 88-53 for specific information and guidance. |
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NO FILE OR FILING EXEMPTIONS |
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| Manuscript endorsements are not required to be filed. | 215 ILCS 5/143(3) | Insurers are not required to file riders or endorsements
prepared to meet special, unusual, peculiar, or extraordinary conditions
applying to an individual risk.
Because Section 143(3) exempts only riders or endorsements, policy forms applying to an individual risk must still be filed. In addition, because Section 143(3) exempts only endorsements applying to an individual risk, if a company uses the same endorsement on more than one risk, such form no longer qualifies for the filing exemption and must be filed. |
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THIRD PARTY FILERS AUTHORITY |
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| Licensed rating organizations must file policy forms and modifications to such forms no later than 30 days before such filings are to take effect. | 215 ILCS 5/457 | Licensed rating organizations must file with the Director all policy forms, and each modification of such forms, which it requires its members and subscribers to adhere to, no later than 30 days before such filings or modifications are to take effect. | |
| FORMS -- POLICY PROVISIONS | |||
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AMBIGUOUS & MISLEADING |
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| The Director may disapprove a form filing if it contains inconsistent, ambiguous, or misleading clauses. | 215 ILCS 5/143(2) | Director may disapprove any form that contains inconsistent, ambiguous, or misleading clauses. | |
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APPLICATIONS |
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| Applications must be filed. | 215 ILCS 5/143(2) | Applications must be filed. | |
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BANKRUPTCY PROVISIONS |
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| Policies that contain liability coverage must include a bankruptcy provision. | 215 ILCS 5/388 | All policies containing liability coverage must include a provision stating that insolvency or bankruptcy of the insured shall not release the company from its duties to pay under the policy. | |
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BLANK ENDORSEMENTS |
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| Blank endorsements are acceptable for filing, with exceptions. | 215 ILCS 5/143(2) | Blank endorsements may be filed, but may not be used to decrease coverage, increase rates or deductibles, or negatively alter any terms or conditions of coverage, unless such change is at the sole request of the insured. Any forms that contain provisions to the contrary are deemed to contain exceptions and conditions that unreasonably or deceptively affect the risks that are purported to be assumed by the policy, in violation of Section 143(2) and will be disapproved accordingly. | |
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CANCELLATION & NON-RENEWAL |
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| May not refuse to issue a policy on sole basis of previous refusal, cancellation or nonrenewal by any insurer. | 215 ILCS 5/143.10 | No company shall refuse to issue a policy on the sole basis that the insured or applicant for such policy was previously refused issuance or renewal of a policy by an insurer, or such insured's policy was cancelled on a prior date by any insurer. | |
| Loss information requested for underwriting. | 215 ILCS 5/143.10a | No prospective insurer shall request the insured to provide more detailed loss information than required by it to underwrite the same line or class of insurance. | |
| Loss information required to be provided.
Does not apply to insurance policies to which Section 19(o) of the Illinois Workers' Compensation Act applies (820 ILCS 305/19(o). |
215 ILCS 5/143.10a | Insurer shall provide the following loss information to the
first named insured within 30 days of the insured's request, and at the
same time as any notice of cancellation or nonrenewal, except where the
policy has been cancelled for nonpayment of premium, material misrepresentations
or fraud on the part of the insured:
a) on closed claims, date and description of occurrence, and total amounts of payments; b) on open claims, date and description of occurrence, total amount of payments and total reserves, if any; and c) for any occurrence not included in (a) or (b), the date and description of occurrence and total reserves, if any. Does not apply to insurance policies to which Section 19(o) of the Illinois Workers' Compensation Act applies (820 ILCS 305/19(o). Insurer shall also provide additional loss information, including specific loss reserves, to the first named insured as soon as possible, but in no event later than 20 days of receipt of named insured's mailed or delivered written request for such information at the request of a prospective insurer. Insurer shall automatically extend coverage under the existing policy, at the same terms and conditions by the same number of days it takes the insurer to provide the insured with this additional information. |
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| Policy must contain cancellation provision. | 215 ILCS 5/143.11 | Policy must include a cancellation provision setting out the manner in which the policy may be cancelled. | |
| May not refuse to issue certain policies solely due to hate crimes. | 215 ILCS 5/143.24c | Insurers may not refuse to issue a policy solely on the basis
that one or more claims have been made against any policy during the preceding
60 months, for a loss that is the result of a hate crime, if the insured
provides evidence to the insurer that the act causing the loss is identified
as a hate crime on a police report.
Applies to policies issued to an individual, a religious organization described in Section 170(b)(1)(A)(i) of Title 26 of the United States Code, or an educational organization described in Section 170(b)(1)(A)(ii) of Title 26 of the United States Code, or any other nonprofit organization described in Section 170(b)(1)(A)(vi) of Title 26 of the United States Code that is organized and operated for religious, charitable, or educational purposes. |
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| Rating or underwriting decisions based solely on domestic violence. | 215 ILCS 5/155.22b | No insurer that issues a property and casualty policy may use the fact that an applicant or insured incurred bodily injury as a result of a battery committed against him/her by a spouse or person in the same household as a sole reason for a rating or underwriting decision. | |
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Conditional Renewal |
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| Assignment or transfer of policies among or between insurers within an insurance holding company system or insurers under common management or control, or as a result of a merger, acquisition, or restructuring of an insurance company, is not a nonrenewal for purposes of the notification requirements. | 215 ILCS 5/143.11b | Assignment or transfer of policies among or between insurers
within an insurance holding company system or insurers under common management
or control, or as a result of a merger, acquisition, or restructuring of
an insurance company, is not a nonrenewal for purposes of the notification
requirements.
If the increase in the renewal premium is 30% or more, contains a change in deductibles or change in coverage that materially alters the policy, the company must adhere to provisions in Section 143.17a as described below. A company making an assignment or transfer of a policy among or between insurers as stated above, must deliver to the named insured notice of such assignment or transfer at least 60 days prior to the renewal date. An exact and unaltered copy of the notice shall be sent to the insured's producer, if known, and agent of record. |
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| Requirements for advance notice of renewal with changes in deductibles, changes in coverage that materially alters the policy, or increase of 30% or more. | 215 ILCS 5/143.17a | If an insurer offers to renew directly to the named insured with a renewal increase of 30% or more, or with a change in deductible or coverage that materially alters the policy, the insurer must mail or deliver to the named insured, written notice of such premium increase or change at least 60 days prior to the renewal or anniversary date. |
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Notice of Cancellation |
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| Cancellation notice mailing requirements and requirements for canceling premium financed insurance contracts. | 215 ILCS 5/143.14 | Insurer must mail cancellation notice to named insured and
to the mortgage or lien holder, and send copy of such notice to the insured's
broker, if known, or the agent of record, at the last mailing address known
by insurer. Insurer must maintain proof of mailing on a form acceptable
to U.S. Post Office or other commercial mail delivery service.
Section 143.14 also contains requirements for canceling premium financed insurance contracts and procedures for returning unearned premium. See law for specific details of requirements. |
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| Number of days notice required for cancellation of commercial policies and notice requirements. | 215 ILCS 5/143.16 | Insurer must mail cancellation notice to the named insured
at least: 10 days prior to effective date of cancellation for nonpayment
of premium; 30 days prior to effective date of cancellation during the first
60 days of coverage; 60 days prior to effective date of cancellation after
coverage has been effective for 61 days or more.
All notices shall include a specific explanation of the reason(s) for cancellation. |
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| Cancellation notice must advise insured of right to request a hearing. | 215 ILCS 5/143.23 | If an insurer cancels a commercial policy mid-term per Section 143.16a, for any reason except non-payment of premium, the cancellation notice must advise the named insured of the right to appeal and the procedure to follow for such appeal. | |
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Notice of Non-renewal |
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| Number of days notice required for nonrenewing a commercial policy and other notice requirements. | 215 ILCS 5/143.17a | Nonrenewal notice must be mailed to the named insured at
least 60 days in advance of the nonrenewal date.
Insurer must maintain proof of mailing of such notice on a recognized U.S. Post Office form or a form acceptable to the U.S. Post Office or other commercial mail delivery service. If the insurer fails to mail notice of nonrenewal to the named insured at least 60 days in advance of the nonrenewal date, the insurer must extend the policy for an additional year or until the effective date of any similar insurance procured by the insured, whichever is less, on the same terms and conditions as the policy sought to be terminated, unless the insurer has manifested its intention to renew at a different premium that represents an increase not exceeding 30%. An exact and unaltered copy shall be sent to the insured's broker if known, or the agent of record, and to the mortgage or lien holder at the last mailing address known by the company. Nonrenewal notice must provide a specific explanation of the reason(s) for nonrenewal. |
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Permissible Reasons for Cancellation |
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| May not cancel because agent's contract with insurer was terminated. | 215 ILCS 5/141.01 | Insurers may not cancel any policy on the ground that the company's contract with the agent through whom the policy was obtained has been terminated. | |
| May not cancel a policy on sole basis of previous refusal, cancellation or nonrenewal by any insurer. | 215 ILCS 5/143.10 | Insurers may not cancel a policy on the sole basis that the insured or applicant for such policy was previously refused issuance or renewal of a policy by an insurer, or such insured's policy was cancelled on a prior date by any insurer. | |
| Reasons for canceling a commercial policy that has been in effect for 60 days or more. | 215 ILCS 5/143.16a | After a policy has been in effect for 60 days, insurer may
only cancel for the following 6 reasons: (a) non-payment of premium; (b)
the policy was obtained through a material misrepresentation; (c) any insured
violated any terms and conditions of the policy; (d) the risk originally
accepted has measurably increased; (e) the insurer certifies to the Director
of the loss of reinsurance for all or a substantial part of the underlying
risk; or (f) the Director determines that continuation of the policy could
place the insurer in violation of Illinois insurance laws.
Rule 940 outlines requirements for certification of loss of reinsurance. |
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| May not cancel certain policies solely due to hate crimes. | 215 ILCS 5/143.24c | Insurers may not cancel a policy solely on the basis that
one or more claims have been made against any policy during the preceding
60 months, for a loss that is the result of a hate crime, if the insured
provides evidence to the insurer that the act causing the loss is identified
as a hate crime on a police report.
Applies to policies issued to an individual, a religious organization described in Section 170(b)(1)(A)(i) of Title 26 of the United States Code, or an educational organization described in Section 170(b)(1)(A)(ii) of Title 26 of the United States Code, or any other nonprofit organization described in Section 170(b)(1)(A)(vi) of Title 26 of the United States Code that is organized and operated for religious, charitable, or educational purposes. |
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| Rating or underwriting decisions based solely on domestic violence. | 215 ILCS 5/155.22b | No insurer that issues a property and casualty policy may use the fact that an applicant or insured incurred bodily injury as a result of a battery committed against him/her by a spouse or person in the same household as a sole reason for a rating or underwriting decision. | |
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Permissible Reasons for Non-renewal |
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| May not refuse to renew because agent's contract with insurer was terminated. | 215 ILCS 5/141.01 | Insurers may not refuse to renew any policy on the ground that the company's contract with the agent through whom the policy was obtained has been terminated. | |
| May not refuse to renew a policy on sole basis of previous refusal, cancellation or nonrenewal by any insurer. | 215 ILCS 5/143.10 | Insurers may not refuse to renew a policy on the sole basis that the insured or applicant for such policy was previously refused issuance or renewal of a policy by an insurer, or such insured's policy was cancelled on a prior date by any insurer. | |
| Insurers may nonrenew for almost any reason(s) except those
specifically prohibited in other Illinois insurance laws or regulations.
However, insurers must give a specific explanation of the reason(s) for nonrenewal. |
215 ILCS 5/143.17a | Insurers may nonrenew for almost any reason(s) except those
specifically prohibited in other Illinois insurance laws or regulations.
However, insurers must give a specific explanation of the reason(s) for nonrenewal. |
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| May not refuse to renew certain policies solely due to hate crimes. | 215 ILCS 5/143.24c | Insurers may not refuse to renew a policy solely on the basis
that one or more claims have been made against any policy during the preceding
60 months, for a loss that is the result of a hate crime, if the insured
provides evidence to the insurer that the act causing the loss is identified
as a hate crime on a police report.
Applies to policies issued to an individual, a religious organization described in Section 170(b)(1)(A)(i) of Title 26 of the United States Code, or an educational organization described in Section 170(b)(1)(A)(ii) of Title 26 of the United States Code, or any other nonprofit organization described in Section 170(b)(1)(A)(vi) of Title 26 of the United States Code that is organized and operated for religious, charitable, or educational purposes. |
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| Rating or underwriting decisions based solely on domestic violence. | 215 ILCS 5/155.22b | No insurer that issues a property and casualty policy may use the fact that an applicant or insured incurred bodily injury as a result of a battery committed against him/her by a spouse or person in the same household as a sole reason for a rating or underwriting decision. | |
| Return Premium | |||
| Computation of premiums -- refunds. | 215 ILCS 5/462b | If the insurer applies incorrect classifications, payrolls or any other incorrect factors of a rating system that results in the insured paying excess premiums, the insurer shall refund the excessive premiums paid for the period during which the incorrect classifications, payrolls or other rating factors were applied. | |
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CONSUMER INFORMATION |
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| Cancellation notice must advise insured of right to request a hearing. | 215 ILCS 5/143.23 | If an insurer cancels a policy mid-term per Section 143.16a, for any reason except non-payment of premium, the cancellation notice must advise the named insured of the right to request a hearing to appeal such decision, and the procedure to follow for such appeal. | |
| Written notice of company's complaint Department and Department of Insurance Public Service Department. | 215 ILCS 5/143c | No policy may be delivered unless the policyholder or certificate
holder is provided written notice of the address of the complaint Department
of the insurance company, and the address of the Public Service Department
of the Department of Insurance or its successor.
Rule 931 provides more specific guidance that: a) such notice shall accompany any newly issued policy or binder; b) "written notice" shall be satisfied by: any printed notice delivered with a policy or certificate; any adhering label attached to a policy or certificate; any computerized notice issued concurrently with a computer issued policy or certificate; or any other form of individual written notice substantially similar to the above. The address to be used for the Department of Insurance should be: Illinois Department of Insurance, Consumer Department or Public Services Section, Springfield, IL 62767. The address to be used for the company shall be an office that can service all types of complaints. If one office cannot service all types of complaints, then the additional addresses of each appropriate service office must be given. In addition to providing the required addresses, the notification should set forth the minimum amount of information included in the following suggested wording: "This notice is to advise you that should any complaints arise regarding this insurance, you may contact the following." |
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CONTENT OF POLICIES |
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| Reasons for which the Director may disapprove a form filing. | 215 ILCS 5/143(2) | The Director may disapprove any form that (i) violates any provision of the Illinois Insurance Code, (ii) contains inconsistent, ambiguous, or misleading clauses, or (iii) contains exceptions and conditions that will unreasonably or deceptively affect the risks that are purported to be assumed by the policy. | |
| Requirements for form content and readability. | 50 IL Adm. Code 753 | There must be printed at the head of the policy the name
of the insurer or insurers issuing the policy, the location of the Home
Office thereof; a statement of whether the insurer is a stock, mutual, reciprocal,
Lloyds, alien insurer, or an insurer operating under a charter by Special
Act of the Legislature of any state. There may be added thereto such devices,
emblems or designs and dates as are appropriate for the insurer issuing
the policy.
All forms must be identified by a descriptive title, form number and edition identification. All forms must be printed in not less than eight-point type. |
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DEFENSE WITHIN LIMITS |
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| Defense costs may not be included in limits of liability. | 215 ILCS 5/143(2) | Defense costs must be paid as supplement to the limits of liability. Defense costs may not be included in the limits of liability. Any forms that contain provisions to the contrary are deemed to contain exceptions and conditions that unreasonably or deceptively affect the risks that are purported to be assumed by the policy, in violation of Section 143(2) and will be disapproved accordingly. | |
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DEFINITIONS |
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| Definition of "renewal" or "to renew." | 215 ILCS 5/143.13(d) | Definition of "renewal" or "to renew." | |
| Definition of "nonpayment of premium." | 215 ILCS 5/143.13(e) | Definition of "nonpayment of premium." | |
| Definition of "policy delivered or issued for delivery in this State." | 215 ILCS 5/143.13(f) | Definition of "policy delivered or issued for delivery in this State." | |
| Definition of "cancellation" or "cancelled." | 215 ILCS 5/143.13(g) | Definition of "cancellation" or "cancelled." | |
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DISCRIMINATION |
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| May not cancel certain policies, or refuse to issue or renew certain policies solely due to hate crimes. | 215 ILCS 5/143.24c | Insurers may not cancel a policy, or refuse to issue or renew
a policy solely on the basis that one or more claims have been made against
any policy during the preceding 60 months, for a loss that is the result
of a hate crime, if the insured provides evidence to the insurer that the
act causing the loss is identified as a hate crime on a police report.
Applies to policies issued to an individual, a religious organization described in Section 170(b)(1)(A)(i) of Title 26 of the United States Code, or an educational organization described in Section 170(b)(1)(A)(ii) of Title 26 of the United States Code, or any other nonprofit organization described in Section 170(b)(1)(A)(vi) of Title 26 of the United States Code that is organized and operated for religious, charitable, or educational purposes. |
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| Redlining -- When geographic location of risk may be grounds for refusing to insure. | 215 ILCS 5/155.22 | Insurer may not refuse to provide insurance solely on the basis of the specific geographic location of the risk unless such refusal is for a business purpose which is not a mere pretext for unfair discrimination. | |
| Rating, claims handling, and underwriting decisions based solely on domestic violence. | 215 ILCS 5/155.22b | No insurer that issues a property and casualty policy may use the fact that an applicant or insured incurred bodily injury as a result of a battery committed against him/her by a spouse or person in the same household as a sole reason for a rating, underwriting, or claims handling decision. | |
| Intentional acts exclusion -- exception for innocent co-insured. | 215 ILCS 5/155.22b | If a policy excludes property damage coverage for intentional acts, the insurers may not deny payment to an innocent co-insured who did not cooperate in or contribute to the creation of the loss if the loss arose out of a pattern of criminal domestic violence and the perpetrator of the loss is criminally prosecuted for the act causing the loss. | |
| Unfair methods of competition or unfair or deceptive acts or practices defined. | 215 ILCS 5/424(3) | It is an unfair method of competition or unfair and deceptive act or practice if a company makes or permits any unfair discrimination between individuals or risks of the same class or of essentially the same hazard and expense element because of the race, color, religion, or national origin of such insurance risks or applicants. | |
| Procedure as to unfair methods of competition or unfair or deceptive acts or practices not defined. | 215 ILCS 5/429 | Outlines the procedures the Director follows when he has reason to believe that a company is engaging in unfair methods of competition or unfair or deceptive acts or practices. | |
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Domestic Abuse |
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| Rating, claims handling, and underwriting decisions based solely on domestic violence. | 215 ILCS 5/155.22b | No insurer that issues a property and casualty policy may use the fact that an applicant or insured incurred bodily injury as a result of a battery committed against him/her by a spouse or person in the same household as a sole reason for a rating, underwriting, or claims handling decision. | |
| Intentional acts exclusion -- exception for innocent co-insured. | 215 ILCS 5/155.22b | If a policy excludes property damage coverage for intentional acts, the insurers may not deny payment to an innocent co-insured who did not cooperate in or contribute to the creation of the loss if the loss arose out of a pattern of criminal domestic violence and the perpetrator of the loss is criminally prosecuted for the act causing the loss. | |
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EXCLUSIONS & LIMITATIONS |
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| Blank endorsements are acceptable for filing, with exceptions. | 215 ILCS 5/143(2) | Blank endorsements may be filed, but may not be used to decrease coverage, increase rates or deductibles, or negatively alter any terms or conditions of coverage, unless such change is at the sole request of the insured. Any forms that contain provisions to the contrary are deemed to contain exceptions and conditions that unreasonably or deceptively affect the risks that are purported to be assumed by the policy, in violation of Section 143(2) and will be disapproved accordingly. | |
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Mold |
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| Filing procedures and requirements for exclusions and limitations related to mold. | Please refer to Company Bulletin 2002-07 for specific information and guidance. | ||
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Terrorism |
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Terrorism Risk Insurance Program Reauthorization Act of 2007 and Filing Procedures and Requirements for Terrorism-Related Forms, Rules and Rates |
Company Bulletin 2008-01
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Please refer to Company Bulletin 2008-01 for specific information and guidance. |
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GROUP POLICIES |
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| Group Workers' Compensation policies are not specifically allowed by statute. | 50 IL Adm. Code 906 | Per Regulation 906, there are no enabling statutes in IL
which authorize the writing of group fire, casualty, inland marine, or surety
insurance. The effect is to require that all fire, casualty, inland marine,
or surety insureds of the same class shall be treated alike. This regulation
is not applicable where the Illinois Insurance Code specifically authorizes
the grouping of risks.
Therefore, Workers' Compensation coverage may not be written on a group basis in Illinois. Per the referenced statutes and rules, the only lines of business that may be written on a group basis in Illinois are: a) group vehicle; b) group professional liability; c) group inland marine; d) group legal. |
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LOSS SETTLEMENTS |
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| Claims handling requirements. | 820 ILCS 305/1 | All claims must be handled in accordance with the Illinois Workers' Compensation Act. | |
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Action Against Company |
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| Periods of limitation tolled. | 215 ILCS 5/143.1 | If the form contains a provision limiting the period of time within which the insured may bring suit, the provision must state that the running of such period is tolled from the date proof of loss is filed until the date the claim is denied in whole or in part. | |
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Defense Costs |
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| Defense costs may not be included in limits of liability. | 215 ILCS 5/143(2) | Defense costs must be paid as supplement to the limits of liability. Defense costs may not be included in the limits of liability. Any forms that contain provisions to the contrary are deemed to contain exceptions and conditions that unreasonably or deceptively affect the risks that are purported to be assumed by the policy, in violation of Section 143(2) and will be disapproved accordingly. | |
| Deductible | |||
| Rating plan must contain offer of a deductible applicable to the medical benefit only. | 215 ILCS 5/456(1)(e) | Rating plan shall contain a mandatory offer of a deductible applicable only to the medical benefit under the Work Comp Act (820 ILCS 3-5/1 et seq.). Such deductible offer shall be in a minimum amount of at least $1000 per accident. | |
| MEDICAL PAYMENTS | |||
| Rating plan must contain offer of a deductible applicable to the medical benefit only. | 215 ILCS 5/456(1)(e) | Rating plan shall contain a mandatory offer of a deductible applicable only to the medical benefit under the Work Comp Act (820 ILCS 3-5/1 et seq.). Such deductible offer shall be in a minimum amount of at least $1000 per accident. | |
| NOTICE REQUIREMENTS | |||
| Cancellation notice must advise insured of right to request a hearing. | 215 ILCS 5/143.23 | If an insurer cancels a policy mid-term per Section 143.16a, for any reason except non-payment of premium, the cancellation notice must advise the named insured of the right to request a hearing to appeal such decision, and the procedure to follow for such appeal. | |
| Written notice of company's complaint Department and Department of Insurance Public Service Department. | 215 ILCS 5/143c | No policy may be delivered unless the policyholder or certificate
holder is provided written notice of the address of the complaint Department
of the insurance company, and the address of the Public Service Department
of the Department of Insurance or its successor.
Rule 931 provides more specific guidance that: a) such notice shall accompany any newly issued policy or binder; b) "written notice" shall be satisfied by: any printed notice delivered with a policy or certificate; any adhering label attached to a policy or certificate; any computerized notice issued concurrently with a computer issued policy or certificate; or any other form of individual written notice substantially similar to the above. The address to be used for the Department of Insurance should be: Illinois Department of Insurance, Consumer Department or Public Services Section, Springfield, IL 62767. The address to be used for the company shall be an office that can service all types of complaints. If one office cannot service all types of complaints, then the additional addresses of each appropriate service office must be given. In addition to providing the required addresses, the notification should set forth the minimum amount of information included in the following suggested wording: "This notice is to advise you that should any complaints arise regarding this insurance, you may contact the following." |
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OTHER INSURANCE |
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| Requirements for "Other Insurance" provisions. | 215 ILCS 5/143(2) | "Other Insurance" provisions must state that coverage under the policy will share proportionately with other similar coverages the insured may have. Any forms that contain provisions to the contrary are deemed to contain exceptions and conditions that unreasonably or deceptively affect the risks that are purported to be assumed by the policy, in violation of Section 143(2) and will be disapproved accordingly. | |
| READABILITY | |||
| Requirements for form content and readability. | 215 ILCS 5/143(2) | There must be printed at the head of the policy the name
of the insurer or insurers issuing the policy, the location of the Home
Office thereof; a statement of whether the insurer is a stock, mutual, reciprocal,
Lloyds, alien insurer, or an insurer operating under a charter by Special
Act of the Legislature of any state. There may be added thereto such devices,
emblems or designs and dates as are appropriate for the insurer issuing
the policy.
All forms must be identified by a descriptive title, form number and edition identification. All forms must be printed in not less than eight-point type. Any forms that contain provisions to the contrary are deemed to be misleading and ambiguous and to contain exceptions and conditions that unreasonably or deceptively affect the risks that are purported to be assumed by the policy, in violation of Section 143(2) and will be disapproved accordingly. |
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REBATES |
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| Payments or acceptance of rebates prohibited. | 215 ILCS 5/469 | No company or employee thereof, and no broker or agent shall
pay, allow or give, or offer to pay, allow or give, directly or indirectly,
as an inducement to insurance, or after insurance has been effected, any
rebates, discount, abatement, credit or reduction of the premium named in
a policy of insurance, or any special favor or advantage in the dividends
or other benefits to accrue thereon, or any valuable consideration or inducement
whatever, not specified in the policy of insurance, except to the extent
provided for in an applicable filing.
No insured named in a policy of insurance, nor any employee of such insured shall knowingly receive or accept, directly or indirectly, any such rebate, discount, abatement, credit, or reduction of premium, or any such special favor or advantage or valuable consideration or inducement. |
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VOIDANCE |
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| Requirements to rescind a policy for misrepresentation or false warranty. | 215 ILCS 5/154 | A policy may not be rescinded, defeated or avoided unless the misrepresentation is stated in the policy, endorsement or rider attached thereto, or in the written application therefore, and was made with the actual intent to deceive, or materially affected either the acceptance of the risk or the hazard assumed by the company. | |
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OTHER |
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| Endorsements that amend another endorsement are prohibited. | 215 ILCS 5/143(2) | An endorsement cannot be used to amend another endorsement. Such endorsements are deemed to result in inconsistent, ambiguous, or misleading clauses, in violation of Section 143(2) and will be disapproved accordingly. | |
| Requirements for termination of line of business. | 215 ILCS 5/143.11a | A company must notify the Director of the termination of a line of insurance, as well as the reasons for the action, 90 days before termination of any policy is effective. | |
| Negative response roll-ons are prohibited. | 215 ILCS 5/429 | Form changes that are optional may not be applied "automatically unless the insured rejects." Insureds must be offered the option and must respond affirmatively for the change to apply. To apply the option automatically unless rejected is to engage in an unfair or deceptive act or practice. | |
| RATE, RULE, RATING PLAN, CLASSIFICATION, AND TERRITORY FILING REQUIREMENTS | |||
| Workers compensation rates and rules, and employers' liability
insurance rates and rules incidental thereto and written in connection therewith,
are required to be filed in Illinois.
In addition, insurers must file a Form RF-3 for all rate level changes. |
215 ILCS 5/457 |
Every company must file with the Director every manual of classifications, rules and rates, and every rating plan and modification that it intends to use. Filings must be made no later than 30 days after they become effective.If a company adopts a pure premium filed by a rating organization, the company must file with the Director the modification factor it is using for expenses and profit so that the final rates in use by such company can be determined. In addition, all companies must file a Form RF-3 (Summary Sheet) for all rate level changes, within 30 days after the effective date of such rate change. Companies are prohibited from continuing to use the new rates and rate level if the rates and the Form RF-3 have not been submitted to the DOI within 30 days of the effective date. |
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| Required rate and rule filings for licensed advisory organizations. | 215 ILCS 5/457 | Each licensed rating organization must file with the Director
every manual of classification, every manual of rules and advisory rates,
pure premium which has been fully adjusted and fully developed, every rating
plan and modifications of any of the foregoing it intends to recommend for
use no later than 30 days after they take effect.
Further, licensed rating organizations must file with the Director the rate classification system, all rating rules, rating plans, policy forms, and underwriting rules or similar materials, and each modification of any of the foregoing which it requires its members and subscribers to adhere to no later than 30 days before such filings or modifications are to take effect. |
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| RATING PLAN REQUIREMENTS | |||
| Rating decisions based solely on domestic violence. | 215 ILCS 5/155.22b | No insurer may that issues a property and casualty policy may use the fact that an applicant or insured incurred bodily injury as a result of a battery committed against him/her by a spouse or person in the same household as a sole reason for a rating decision. | |
| Making of rates -- expenses provisions. | 215 ILCS 5/456(1)(b) | Expense provisions included in the rates for use by any company or group of companies may differ from those of other companies or groups to reflect the requirements of the operating methods of any such company or group with respect to any kind of insurance, or with respect to any subDepartment or combination thereof for which subDepartment or combination separate expense provisions are applicable. | |
| Making of rates -- factors that companies must consider. | 215 ILCS 5/456(1)(a) | When making rates, due consideration shall be given to past and prospective loss experience within and outside IL, to catastrophe hazards, to a reasonable margin for profit and contingencies, to dividends, savings, or unabsorbed premium deposits allowed/returned by companies to their policyholders, to past and prospective expenses both countrywide and specifically in IL, and to underwriting practice and judgment and to all other relevant factors within and outside IL. | |
| Making of rates -- classifications. | 215 ILCS 5/456(1)(c) | Risks may be grouped by classifications for establishing rates and minimum premiums. Classification rates may be modified to produce rates for individual risks in accordance with rating plans which measure variation in hazards or expense provisions or both. | |
| Rates shall not be excessive, inadequate or unfairly discriminatory. | 215 ILCS 5/456(1)(d) | Rates shall not be excessive, inadequate or unfairly discriminatory.
A rate in a competitive market is not excessive. A rate in a noncompetitive market is excessive if it is likely to produce a long run profit that is unreasonably high for the insurance provided or if expenses are unreasonably high in relation to the services rendered. A rate is not inadequate unless it is clearly insufficient to sustain projected losses and expenses in the class of business to which it applies and the use of such rates has or, if continued, will have the effect of substantially lessening competition or the tendency to create monopoly in any market. Unfair discrimination exists if, after allowing for practical limitations, price differentials fail to reflect equitably the differences in expected losses and expenses. A rate is not unfairly discriminatory because different premiums result for policyholders with like exposures but different expenses, or like expenses but different loss exposures, so long as the rate reflects the differences with reasonable accuracy. |
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| Competitive market is presumed to exist. | 215 ILCS 5/460 | A competitive market is presumed to exist unless the Director, after a hearing, determines that a reasonable degree of competition does not exist in the market and the Director issues a ruling to that effect. Market shall mean the statewide workers' compensation and employers' liability lines of business. | |
| Rating plan must contain offer of a deductible applicable to the medical benefit only. | 215 ILCS 5/456(1)(e) | Rating plan shall contain a mandatory offer of a deductible applicable only to the medical benefit under the Work Comp Act (820 ILCS 3-5/1 et seq.). Such deductible offer shall be in a minimum amount of at least $1000 per accident. | |
| Rating plan must include a rule permitting 2 or more employers with similar risk characteristics to pool premium and loss experience for determining rate or premium. | 215 ILCS 5/456(f) | Rating plan or program shall include a rule permitting 2 or more employers with similar risk characteristics, who participate in a loss prevention program or safety group, to pool their premium and loss experience in determining their rate or premium for such participation in the program. | |
| Disapproval of rate or rule filings. | 215 ILCS 5/458 | If, within 30 days of any filing, the Director finds that
such filing doesn't meet the requirements of Article XXIX, he shall send
to the company or rating organization a written notice of disapproval of
such filing, and stating when, within a reasonable period thereafter, such
filing shall be deemed no longer effective.
This Section also sets forth procedures for which the Director will disapprove a Workers' Compensation rate for rule filing. |
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| ADOPTIONS OF RATE SERVICE ORGANIZATIONS' (RSO) FILINGS | |||
| Loss Costs | |||
| Requirements for additional information if a company adopts a pure premium filed by a rating organization. | 215 ILCS 5/457 | If a company adopts a pure premium filed by a rating organization,
the company must file with the Director the modification factor it is using
for expenses and profit so that the final rates in use by such company can
be determined.
Filings must be made no later than 30 days after they become effective. |
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INDIVIDUAL RISK RATING |
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| Individual risks. | 50 IL Adm. Code 2902 | A company is not required to file rates or RF-3s for individual
Illinois risks which cannot be rated in the normal course of business rating
because of special or unusual characteristics, as provided in Section 456(1)(c),
and which must be rated on the basis of underwriting judgment.
Company must maintain documentary information regarding such individual risk rates for review by the Department's Property & Casualty Evaluation Section. |
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| LOSS COST MULTIPLIERS | |||
| Requirements for additional information if a company adopts a pure premium filed by a rating organization. | 215 ILCS 5/457 | If a company adopts a pure premium filed by a rating organization,
the company must file with the Director the modification factor it is using
for expenses and profit so that the final rates in use by such company can
be determined.
Filings must be made no later than 30 days after they become effective. |
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| PREMIUM REFUND | |||
| Computation of premiums -- refunds. | 215 ILCS 5/462b | If the insurer applies incorrect classifications, payrolls or any other incorrect factors of a rating system that results in the insured paying excess premiums, the insurer shall refund the excessive premiums paid for the period during which the incorrect classifications, payrolls or other rating factors were applied. | |
| OTHER | |||
| Rating decisions based solely on domestic violence. | 215 ILCS 5/155.22b | No insurer that issues a property and casualty policy may use the fact that an applicant or insured incurred bodily injury as a result of a battery committed against him/her by a spouse or person in the same household as a sole reason for a rating decision. | |
| Unfair methods of competition or unfair or deceptive acts or practices defined. | 215 ILCS 5/424(3) | It is an unfair method of competition or unfair and deceptive act or practice if a company makes or permits any unfair discrimination between individuals or risks of the same class or of essentially the same hazard and expense element because of the race, color, religion, or national origin of such insurance risks or applicants. | |
| Procedure as to unfair methods of competition or unfair or deceptive acts or practices not defined. | 215 ILCS 5/429 | Outlines the procedures the Director follows when he has reason to believe that a company is engaging in unfair methods of competition or unfair or deceptive acts or practices. |