|
The Market Conduct Division
|
The Market Conduct Division |
Telephone: |
1-800-203-3447 |
| |
Fax: |
860-297-3872 |
| |
E-mail: |
cid.mc@ct.gov |
| |
Program Manager: |
Kurt Swan |
| |
Telephone: |
860-297-3972 |
|
|
|
| Life and Health/Utilization Review |
Principal Examiner: |
Steve DeAngelis |
| |
Telephone: |
860-297-3881 |
|
|
|
| Property and Casualty |
Principal Examiner: |
Mark Duffy |
| |
Telephone: |
860-297-3949 |
|
|
|
The Market Conduct Division performs examinations of insurance companies, healthcare centers, fraternal benefit societies and medical utilization review companies doing business in Connecticut to analyze how the insurance market and the individual companies meet and service the needs of Connecticut consumers. The examinations are conducted to ensure equitable treatment of policyholders and claimants, and compliance with statutes and regulations.
- Property-Casualty Unit and the Life-Health Unit
- The Property-Casualty Unit and the Life-Health Unit conduct Comprehensive Examinations, Target Examinations and Survey Examinations on an ongoing basis. The examinations review the following areas:
- - operations/management
- - complaint handling
- - marketing and sales
- - producer licensing
- - policyholder service
- - underwriting and rating
- - claims
- Utilization Review Unit
- The Utilization Review Unit conducts annual Survey Examinations of all licensed Connecticut Utilization Review Companies. Areas of consideration are:
- - utilization review policies and procedures
- - annual summary/statistical reports
- - timeliness of determinations to certify/not certify care
- - appeal handling
- - enrollee and provider communications
- - provider credentialing
-
- Market Conduct Division
- The Market Conduct Division, upon completion of an examination or investigation, imposes appropriate administrative actions as warranted. Matters not resolved through negotiated agreements are presented at Formal Hearings.
- Types of Market Conduct Examinations:
- Comprehensive Examination – full scope examinations generally involving a review of all of a company’s business practices.
- Target Examinations – focused examinations reviewing either a specific line of business or a specific business practice.
- Survey Examinations – data requests and questionnaires are sent to selected companies requesting information pertinent to their insurance activities in Connecticut. Certified responses are reviewed for compliance.
- The Market Conduct Division utilizes and shares information with the National Association of Insurance Commissioners’ databases. Market Conduct participates with other states in NAIC collaborative efforts and multi-state cooperative examinations.
Content Last Modified on 4/23/2009 12:26:54 PM
|
