375.936. Unfair practices defined.
Unfair practices defined.
375.936. Any of the following practices, if committed inviolation of section 375.934, are hereby defined as unfair tradepractices in the business of insurance:
(1) "Boycott, coercion, intimidation", entering into anyagreement to commit, or by any concerted action committing anyact of boycott, coercion or intimidation resulting in or tendingto result in an unreasonable restraint of, or monopoly in, thebusiness of insurance;
(2) "Defamation", making, publishing, disseminating, orcirculating, directly or indirectly, or aiding, abetting orencouraging the making, publishing, disseminating or circulatingof any oral or written statement or any pamphlet, circular,article or literature which is false, or maliciously critical ofor derogatory to the financial condition of any insurer, andwhich is calculated to injure such insurer;
(3) "Failure to maintain complaint handling procedures",failure of any person to maintain a complete record of all thecomplaints which it has received for a period of not less thanthree years. This record shall indicate the total number ofcomplaints, their classification by line of insurance, the natureof each complaint, the disposition of these complaints, and thetime it took to process each complaint. For purposes of thissubdivision, "complaint" shall mean any written communicationprimarily expressing a grievance;
(4) "False information and advertising generally", making,publishing, disseminating, circulating or placing before thepublic, or causing, directly or indirectly, to be made,published, disseminated, circulated, or placed before the public,in a newspaper, magazine or other publication, or in the form ofa notice, circular, pamphlet, letter or poster or over any radioor television station, or in any other way, an advertisement,announcement or statement containing any assertion,representation or statement with respect to the business ofinsurance or with respect to any insurer in the conduct of hisinsurance business, which is untrue, deceptive or misleading;
(5) "False statements and entries:"
(a) Knowingly filing with any supervisory or other publicofficial, or knowingly making, publishing, disseminating,circulating or delivering to any person, or placing before thepublic, or knowingly causing, directly or indirectly, to be made,published, disseminated, circulated, delivered to any person, orplaced before the public, any false material statement of fact asto the financial condition or dealings of an insurer;
(b) Knowingly making any false entry of a material fact inany book, report or statement of any insurer or knowinglyomitting to make a true entry of any material fact pertaining tothe business of such insurer in any book, report or statement ofsuch insurer;
(6) "Misrepresentations and false advertising of insurancepolicies", making, issuing, circulating, or causing to be made,issued or circulated, any estimate, illustrations, circular orstatement, sales presentation, omission, or comparison which:
(a) Misrepresents the benefits, advantages, conditions, orterms of any policy;
(b) Misrepresents the dividends or share of the surplus tobe received on any policy;
(c) Makes any false or misleading statements as to thedividends or share of surplus previously paid on any policy;
(d) Is misleading or is a misrepresentation as to thefinancial condition of any insurer, or as to the legal reservesystem upon which any life insurer operates;
(e) Uses any name or title of any policy or class ofpolicies misrepresenting the true nature thereof;
(f) Is a misrepresentation for the purpose of inducing ortending to induce the purchase, lapse, forfeiture, exchange,conversion, or surrender of any policy, including any intentionalmisquote of a premium rate;
(g) Is a misrepresentation for the purpose of effecting apledge or assignment of or effecting a loan against any policy;or
(h) Misrepresents any policy as being shares of stock;
(7) "Misrepresentation in insurance applications", makingfalse or fraudulent statements or representations on or relativeto an application for a policy, for the purpose of obtaining afee, commission, money, or other benefit from any insurer, agent,agency, broker or other person;
(8) "Prohibited group enrollments", no insurer shall offermore than one group contract of insurance through any personunless such person is licensed pursuant to law; however, thisprohibition shall not apply to employer-employee relationships,nor to any such enrollments;
(9) "Rebates":
(a) Except as otherwise expressly provided by law,knowingly permitting or offering to make or making any contractof life insurance, life annuity, accident and health insurance orother insurance, or agreement as to such contract other than asplainly expressed in the insurance contract issued thereon, orpaying or allowing, or giving or offering to pay, allow, or give,directly or indirectly, as inducement to such insurance orannuity, any rebate of premiums payable on the contract, or anyspecial favor or advantage in the dividends or other benefitsthereon, or any valuable consideration or inducement whatever notspecified in the contract; or giving, or selling, or purchasingor offering or to give, sell, or purchase as inducement to suchinsurance contract or annuity or in connection therewith, anystocks, bonds or other securities of any insurance company orother corporation, association, or partnership, or any dividendsor profits accrued thereon, or anything of value whatsoever notspecified in the contract;
(b) Nothing in subdivision (11) or paragraph (a) of thissubdivision shall be construed as including within the definitionof discrimination or rebates any of the following practices:
a. In the case of any contract of life insurance or lifeannuity, paying bonuses to nonparticipating policyholders orotherwise abating their premiums in whole or in part out ofsurplus accumulated from nonparticipating insurance; providedthat any such bonuses or abatement of premiums shall be fair andequitable to policyholders and for the best interest of thecompany and its policyholders;
b. In the case of life insurance policies issued on theindustrial debit plan, making allowance to policyholders who havecontinuously for a specified period made premium paymentsdirectly to an office of the insurer in an amount which fairlyrepresents the saving in collection expenses;
c. Readjustment of the rate of premium for a groupinsurance policy based on the loss or expense experiencethereunder, at the end of the first or any subsequent policy yearof insurance thereunder, which may be made retroactive only forsuch policy year;
(10) "Stock operations and advisory board contracts",issuing or delivering or permitting agents, officers or employeesto issue or deliver, agency company stock or other capital stock,or benefit certificates or shares in any common law corporation,or securities or any special or advisory board contracts or othercontracts of any kind promising returns and profits as aninducement to insurance;
(11) "Unfair discrimination":
(a) Making or permitting any unfair discrimination betweenindividuals of the same class and equal expectation of life inthe rates charged for any contract of life insurance or of lifeannuity or in the dividends or other benefits payable thereon, orin any other of the terms and conditions of such contract;
(b) Making or permitting any unfair discrimination betweenindividuals of the same class and of essentially the same hazardin the amount of premium, policy fees, or rates charged for anypolicy or contract of accident or health insurance or in thebenefits payable thereunder, or in any of the terms or conditionsof such contract, or in any other manner whatever, including anyunfair discrimination by not permitting the insured full freedomof choice in the selection of any duly licensed physician,surgeon, optometrist, chiropractor, dentist, psychologist,pharmacist, pharmacy, or podiatrist; except that the terms ofthis paragraph shall not apply to health maintenanceorganizations licensed pursuant to chapter 354, RSMo;
(c) Making or permitting any unfair discrimination betweenindividuals or risks of the same class and of essentially thesame hazards by refusing to issue, refusing to renew, cancelingor limiting the amount of insurance coverage on a property orcasualty risk because of the geographic location of the risk;
(d) Making or permitting any unfair discrimination betweenindividuals or risks of the same class and of essentially thesame hazards by refusing to issue, refusing to renew, cancelingor limiting the amount of insurance coverage on a residentialproperty risk, or the personal property contained therein,because of the age of the residential property;
(e) Refusing to insure, refusing to continue to insure, orlimiting the amount of coverage available to an individualbecause of the gender or marital status of the individual;however, nothing in this paragraph shall prohibit an insurer fromtaking marital status into account for the purpose of definingpersons eligible for dependent benefits;
(f) Refusing to insure solely because another insurer hasrefused to issue a policy, or has canceled or has refused torenew an existing policy for which that person was the namedinsured, nor shall any insurance company or its agent orrepresentative require any applicant or policyholder to divulgein a written application or otherwise whether any insurer hascanceled or refused to renew or issue to the applicant orpolicyholder a policy of insurance, provided that an insurer mayrequire the name of the prior carrier in order to verify theapplicant's previous claims or medical history;
(g) Canceling or refusing to insure or refusing to continueto insure a policy solely because of race, gender, color, creed,national origin, or ancestry of anyone who is or seeks to becomeinsured;
(h) Terminating, or modifying coverage or refusing to issueor refusing to renew any property or casualty policy or contractof insurance solely because the applicant or insured or anyemployee of either is mentally or physically impaired; exceptthat this paragraph shall not apply to accident and healthinsurance sold by a casualty insurer and, in addition, thisparagraph shall not be interpreted to modify any other provisionof law relating to the termination, modification, issuance orrenewal of any insurance policy or contract;
(i) The provisions of paragraphs (c), (d), (e), (f), (g),and (h) of this subdivision shall not apply if:
a. The refusal, cancellation, limitation, termination ormodification is for a business purpose which is not a merepretext for unfair discrimination, or
b. The refusal, cancellation, limitation, termination ormodification is required by law or regulatory mandate;
(12) "Unfair financial planning practices", an insuranceproducer, agent, broker or consultant:
(a) Holding himself out, directly or indirectly, to thepublic as a financial planner, investment adviser, financialconsultant, financial counselor, or any other specialist engagedin the business of giving financial planning or advice relatingto investments, insurance, real estate, tax matters, or trust andestate matters when such person is in fact engaged only in thesale of policies; provided, however, an insurance producer,agent, broker or consultant who has passed a professional courseof study may use the symbol of the professional designation onhis or her business card or stationery;
(b) Engaging in the business of financial planning withoutdisclosing to the client prior to the execution of the agreementprovided for in paragraph (c) of this subdivision or solicitationof the sale of a product or service that:
a. He is also an insurance salesperson; and
b. That a commission for the sale of an insurance productwill be received in addition to a fee for financial planning, ifsuch is the case. The disclosure requirement under this paragraphmay be met by including it in any disclosure required by federalor state securities law;
(c) Charging fees, other than commissions, for financialplanning by insurance agents, brokers or consultants, unless suchfees are based upon a written agreement, which is signed by theparty to be charged in advance of the performance of the servicesunder the agreement. A copy of the agreement shall be providedto the party to be charged at the time the agreement is signed bythe party and:
a. The services for which the fee is to be charged must bespecifically stated in the agreement;
b. The amount of the fee to be charged or how it will bedetermined or calculated must be specifically stated in theagreement;
c. The agreement must state that the client is under noobligation to purchase any insurance product through theinsurance agent, broker or consultant.
The insurance agent, broker or consultant shall retain a copy ofthe agreement for not less than three years after completion ofservices, and a copy shall be available to the director uponrequest;
(13) Any violation of section 375.445.
(L. 1959 H.B. 251 § 4, A.L. 1967 p. 516, A.L. 1969 p. 512, A.L. 1971 H.B. 508, A.L. 1976 S.B. 666, A.L. 1978 H.B. 1447, A.L. 1983 H.B. 127, A.L. 1991 S.B. 53)