23 CAR Part 16 — Complaint Registers

title-23-part-1623 CAR pt. 16Regulation

Open source

Chapter I

Subchapter A

Subpart 1

23 CAR § 16-101 Purpose {#sec-23-car-16-101 omnilex-key=us-ar-regs-official--title-23-part-16--23 CAR § 16-101}

23 CAR § 16-101. Purpose.

The purpose of this part is to establish minimum standards for complaint registers to be maintained by insurers, health maintenance organizations, and risk retention groups pursuant to provisions of the Trade Practices Act, Arkansas Code § 23-66-206(4).

23 CAR § 16-102 Applicability and scope {#sec-23-car-16-102 omnilex-key=us-ar-regs-official--title-23-part-16--23 CAR § 16-102}

23 CAR § 16-102. Applicability and scope.

This part applies to all:

(1) Persons;

(2) Insurance policies and insurance contracts; and

(3) Contracts, certificates, subscriber agreements, or other evidences of coverage issued by insurers, health maintenance organizations, and risk retention groups where applicable.

23 CAR § 16-103 Definitions {#sec-23-car-16-103 omnilex-key=us-ar-regs-official--title-23-part-16--23 CAR § 16-103}

23 CAR § 16-103. Definitions.

As used in this part:

(1) "Complaint" means a written communication primarily expressing a grievance;

(2) "Insurance Department Complaint" means a written communication regarding a complaint transmitted by the State Insurance Department; and

(3) "Person" shall have the meaning as set forth in Arkansas Code § 23-66-203.

23 CAR § 16-104 Content of complaint registers {#sec-23-car-16-104 omnilex-key=us-ar-regs-official--title-23-part-16--23 CAR § 16-104}

23 CAR § 16-104. Content of complaint registers.

(a)(1) Exhibit A of this part sets forth the minimum information required to be maintained in a person's complaint register in order for it to comply with Arkansas law.

(2) Refinements and additions to the information specified therein may, of course, be maintained in such complaint register.

(b)(1) Exhibit B of this part contains an explanation of the various headings, codes, and other notations contained in Exhibit A.

(2) The codes are used in order to simplify both the:

(A) Identification of the action underlying the complaint; and

(B) Keeping of the records.

23 CAR § 16-105 Format of complaint registers {#sec-23-car-16-105 omnilex-key=us-ar-regs-official--title-23-part-16--23 CAR § 16-105}

23 CAR § 16-105. Format of complaint registers.

(a) Exhibit A is the suggested format for the complaint register required to be maintained by Arkansas law and this part.

(b) Refinements, deviations from, or additions to this suggested format are permitted so long as the minimum information contemplated by such format can be obtained for State Insurance Department review within a reasonable time following a request therefor by an authorized representative of the department.

23 CAR § 16-106 Maintenance of complaint registers {#sec-23-car-16-106 omnilex-key=us-ar-regs-official--title-23-part-16--23 CAR § 16-106}

23 CAR § 16-106. Maintenance of complaint registers.

(a) The complaint register shall be kept on a calendar year basis, and the number of complaints by line of insurance, function, reason, disposition, and states of origin shall be compiled not less frequently than annually.

(b) The complaint register required by this part shall be maintained commencing on and after sixty (60) days from the effective date of this part.

23 CAR § 16-107 Severability {#sec-23-car-16-107 omnilex-key=us-ar-regs-official--title-23-part-16--23 CAR § 16-107}

23 CAR § 16-107. Severability.

Any section or provision of this part held by a court to be invalid or unconstitutional will not affect the validity of any other section or provision of this part.

23 CAR pt. 16, Appendix A Complaint Register {#sec-23-car-pt.-16-appendix-a omnilex-key=us-ar-regs-official--title-23-part-16--23 CAR pt. 16, Appendix A}

EXHIBIT A COMPLAINT REGISTER

A COMPANY IDENTIFICATION NUMBER B NATURE OF COMPLAINT C LINE TYPE D COMPANY DISPOSITION AFTER COMPLAINT RECEIPT E DATE RECEIVED F DATE CLOSED G INSURANCE DEPARTMENT COMPLAINT H STATE OF ORIGIN FUNCTION CODE REASON CODE

23 CAR pt. 16, Appendix B Explanation {#sec-23-car-pt.-16-appendix-b omnilex-key=us-ar-regs-official--title-23-part-16--23 CAR pt. 16, Appendix B}

EXHIBIT B Explanation Column A. Company Identification Number. As noted, this refers to the identification number of the complaint and shall also include the license number or other means of identifying any license of the Insurance Department (such as agent, staff adjuster or independent adjuster) that may have been involved in the complaint. B. F unction Code. Complaints are to be classified by function(s) of the company involved. Separate classifications are to be maintained for underwriting, marketing and sales, claims, policyholder service and miscellaneous. C. R eason Code. Complaints are also to be classified by the nature of the complaint. The following is the classification required for each function specified above.

  1. Underwriting
    1. Company underwriting
    2. Individual's application
    , underwriting (this refers to any complaint where misrepresentations or declarations in an application for insurance resulted in company action involved in the complaint) c) Cancellation d) Rescission e) Nonrenewal f) Premiums and rating g) Delays h) Refusal to insure i) Miscellaneous (not covered by above)
  2. Marketing and Sales
    1. General advertising
    2. Ivass marketing advertising (advertising which is essentially directed to reach
    more people than in a one-to•one relationship) c) Agent handling d) Replacement e) Dividend illustration f) Delays g) Alleged misleading statement or misrepresentation h) Miscellaneous (not covered by above)
  3. Claims a) Claims procedure
  1. Delays
  2. Unsatisfactory settlements
  3. Natural disaster adjusting (hurricane or flood situations or other situations which

produce a large number of claims)

e) Unsatisfactory settlement offers

f) Denial of claim

g) Miscellaneous (not covered by above)

4) Policyholder service

a) Failure to respond

b) Delays

c) Miscellaneous (not covered by above)

5) Miscellaneous

C. Line Type. Complaints are to be c1Pcsified according to the line of insurance involved, as

follows:

  1. Automobile
  2. Fire
  3. Homeowners — Farmowners
  4. Crop
  5. Inland Marine
  6. Individual

Life 7) Group Life 8) Annuities 9) Individual Health — Accident & Sickness 10) Group

Health — Accident & Sickness 11) Workers' Compensation 12) Liability Insurance other than Automobile 13) Mobile Homeowners 14) Miscellaneous (not covered by above) D. Company Disposition After Receipt. The complaint register shall note the disposition of the complaint. The following examples illustrate the type of information called for, but are not intended to be required language or to exhaust the possibilities:

  1. Corrective action was taken;

  2. No action was deemed necessary:

  3. Satisfactory explanation was given to the complainant.

    Complaint register need not note the specific action taken with respect to the com-

    plaint, so long as the action was appropriate to the circumstances. If the company wishes

    it may use a code for entries in this column.

    1. Date Received. This refers to the date the complaint was received.
    2. Date Closed. This refers to the date on which the complaint was disposed of whether by

    one action or a series of actions as may be present in connection with some complaints.

    G. I

    nsurance Department Complaint. Complaints are to be classified so as to indicate if the

    origin of the complaint was from an Insurance Department.

    H. S

    tate of Origin. Complaint register should note the state from which the complaint

    originated. Ordinarily this will be the state of residence of the complainant.

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