What breaks up the mid-winter doldrums better than 13 new advisory legal opinions from the New York Insurance Department's Office of General Counsel? Okay, that was a rhetorical question; don't stuff the comments section with responses to that. Instead, devote your attention to the following opinions issued in November and December:
- An agent may not add terms or clauses to a certificate of liability insurance that alter, expand, or otherwise modify the terms of the actual policy unless authorized by the insurer that has filed an appropriate endorsement with the Insurance Department and obtained prior approval. An insurer is not required to provide notice of cancellation or nonrenewal to an additional insured, although it may provide notice if it chooses to.
- A homeowners’ insurer may not deviate from its filed and approved policy forms and rates without the Insurance Department’s approval even if the insured consents to the terms and rates.
- A life insurer may offer, in conjunction with an individual life insurance policy, and for no separately identifiable charge, a service that provides a second medical opinion based upon a review of an insured’s medical records when the insured is diagnosed with a certain serious or life-threatening condition, but only if it holds an accident and health insurance license and it specifies the service as a benefit in the policy.
- Where an insured here has a lien agreement with a union benefit fund that provided a disability benefit governed by ERISA, and the agreement requires re-payment of the disability benefit to the fund, a no-fault insurer may not deduct the amount of the disability benefit from the no-fault benefit.
- An insurance agent may not share commission on the sale of long term care insurance with an entity, such as a college, that is not licensed as an insurance agent or broker. An insurance agent may not pay a referral fee to a college that makes the referral by sending to its alumni and supporters correspondence that “explains the benefits” of long term care insurance.
- An appraiser who, in New York negotiates, on behalf of an insurer, with a body shop selected by an insured, to settle upon the cost of repair, must be licensed as an independent insurance adjuster.
- A captive insurer may be owned by an entity that is not licensed as an insurer if it has sufficient net worth.
- A life insurance policy owner who is not a New York resident may elect in writing to have the life settlement laws of the state in which the policy owner resides govern the life settlement contract when the policy owner signs the contract in New York. (Note: This opinion also answered five other questions.)
- Regulation 194, which requires insurance producers to disclose to their clients information about their compensation:
- Does not apply to renewals unless the purchaser makes a request for more information
- Applies if a producer procures insurance for identical coverage and limits with a different insurer
- Does not apply when an insurer re-tiers a property/casualty policy upon renewal unless the purchaser makes a request for more information
- Does not apply if an insurer issues or offers to issue a superseding policy previously issued by another insurer under common control unless the purchaser makes a request for more information
- Applies If an insurance producer licensed in both New York and another state receives a telephone call in New York from an insured who is purchasing an automobile in the other state and seeking an auto insurance policy.
Also, an insurer may delegate to a broker the insurer’s obligation to maintain records pertaining to the producers' compensation. If an insurer has delegated the obligation to one of its appointed agents, the agent may in turn delegate it to an authorized broker. A wholesale broker or managing general agent that has no direct sales or solicitation contact with a purchaser has no obligation to maintain producer disclosure records.
The other three opinions pertained to coverage for an "enteral formula" under a health plan, and the permissibility of selling discount dental programs and repatriation and funeral contracts without an insurance license. All opinions the department has issued since 2000 are available on its Web site.