I.C · The Insurance Marketplace
Inside an insurer, and who may be one
Think of an insurer as a restaurant: someone brings in customers, someone decides which orders the kitchen can take, someone prices the menu, and someone handles complaints. Each job is a division.
The four major operating divisions:
Marketing/sales: distributes the products.
Underwriting: decides whether to accept an individual risk and how to classify it. Underwriters use the rates; they do not calculate them.
Actuarial: analyzes loss data and calculates the rates each class of risk must produce.
Claims: investigates and pays losses.
Market conduct regulations are the state laws that regulate how an insurer treats the public: its underwriting, sales, ratemaking and claims handling. They are different from solvency regulation, such as minimum capital requirements, which looks at the insurer's financial strength.
Who may be an insurer? Under §150, any person capable of making a contract may be an insurer, subject to the restrictions the Insurance Code imposes. Capacity to contract alone is not enough. Section 19 defines "person" broadly: any person, association, organization, partnership, business trust, limited liability company or corporation.
Penalty for working for a nonadmitted insurer (§§703, 1760.1): unless you are a surplus line broker, acting as agent for a nonadmitted insurer, or aiding it to transact business in California for a home state insured, is a misdemeanor. The violator also forfeits $500, plus $100 for each month or fraction of a month the violation continues. Example: 2.5 months counts as 3 months, so $500 + $300 = $800.
Remember
· Actuarial calculates rates; underwriting selects and classifies risks.
· Market conduct = how insurers treat the public (underwriting, sales, rates, claims).
· §703: misdemeanor plus $500 + $100 per month or fraction of a month.
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