Chapter recap
The Insurance Marketplace
How insurance is sold: distribution, agency authority, field underwriting
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Direct response = no producer; captive = one insurer; independent = several insurers.
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Authority: express (written), implied (reasonably necessary), apparent (the public's reasonable belief).
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Field underwriting: submit as given, report what you see, the underwriter decides.
Who is who: A&H agent, life agent, broker, solicitor, analyst
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A&H license: sickness, bodily injury, accidental death, may include disability income; no life, annuity or P&C.
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Agent acts for the insurer (§31, §32); broker acts for the client (§33); no A&H solicitor license (§1624).
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Analyst fee: written agreement signed by the person charged, required disclosures, copy kept 3 years (§1848).
Transacting, unlicensed activity, and other acts producers must avoid
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Transact = solicit, negotiate, execute, and handle matters after execution (§35).
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No license: misdemeanor, up to $50,000 and/or 1 year (§1633). 1033: written consent needed; up to 5 years; civil up to $50,000.
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§703: $500 + $100 per month; §777.1: no free insurance (exception: up to $1 per purchaser per year). E&O covers negligence, not intent.
Keeping a license: names, renewal, records, denial, appointments
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Address change: immediately (§1729). License number on cards, quotes, ads and licensed-activity emails ($200/$500/$1,000).
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On-time renewal with CE done: keep working up to 60 days after expiration (§1720). Records: 5 years; deliver within 30 days.
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All appointments end → inactive, not cancelled (§1704(b)). Partnership change → file within 30 days (§1711).
Fiduciary duty, continuing education, LTC training, administrators
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§1733: premiums are fiduciary funds; diverting them is theft. §1734: remit to the insurer or keep in a trust account.
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A&H + P&C licenses: 24 CE hours in all (3 ethics, incl. 1 hour fraud), not doubled.
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LTC: 8 hours before soliciting; Partnership: + 8 live classroom hours; counts toward CE, not on top of it.
Ethics: ten standards, seniors, and altering a disability application
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Ten standards: customer's interest first, needs-based recommendations, truthful, plain language, confidentiality, obey the law, no unfair remarks about competitors.
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Legal is not the same as ethical. Age 65+: duty of honesty, good faith and fair dealing before purchase (§785).
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Disability application: only the applicant alters it, or with written consent; insurer's administrative insertion is the exception (§10382).
Insurers: admitted or not, domestic, foreign or alien, and how they are organized
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Organized where? Domestic (CA), foreign (other state), alien (outside the US). Admitted? Separate question.
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Nonadmitted: no CA solvency regulation, no guarantee fund. Outline §703: misdemeanor + $500 + $100 per month or fraction.
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Ceding company = primary insurer. Mutual: policyowners own it, divisible surplus → policy dividends. Fraternal: no stock, lodge system.
Who regulates: the Code, regulations, the Commissioner, unfair practices, privacy, notices
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Code = legislature; Title 10 regulations = Commissioner. Commissioner: elected, max two 4-year terms (§12900).
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Health coverage presumed under CDI (§740); DMHC: all HMO/POS. Unfair practices: $5,000 per act, $10,000 if willful; only the Commissioner enforces.
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CA privacy: explicit prior consent (not just opt-out). Shall = must, may = optional. E-delivery needs opt-in (§38.6).
Insolvency, guarantee association, fraud, group replacement, discrimination
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Insolvent: impaired paid-in capital or can't pay when due; must also hold assets equal to required paid-in capital (§985).
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Refusing to deliver records after seizure: misdemeanor, up to $1,000 and/or 1 year (§1013). CLHIGA excludes self-funded portions.
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Group replacement within 60 days: cover everyone validly covered and eligible, regardless of actively-at-work or pregnancy rules (§10128.3).
Fair claims settlement: definitions, files, and the 15/40/30-day clock
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Claimant includes an attorney; adjuster, public adjuster or family member needs a written designation.
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Files: current year + 4 prior years. Respond 15 days (DOI 21); acknowledge 15, decide 40, pay 30.
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Certain disability and disability income policies are excluded from the 40- and 30-day limits (§2695.7(b)(4), (h)(1)).