§ 58-3-100. Insurance company licensing provisions. - North Carolina Statutes - USA Laws Searching

Statutes > North Carolina Statutes > Chapter 58 - Insurance. > § 58-3-100. Insurance company licensing provisions.

§ 58-3-100. Insurance company licensing provisions.

§ 58‑3‑100. Insurance company licensing provisions.

(a)        The Commissionermay, after notice and opportunity for a hearing, revoke, suspend, or restrictthe license of any insurer if:

(1)        The insurer fails orrefuses to comply with any law, order or rule applicable to the insurer.

(2)        After consideringthe standards under G.S. 58‑30‑60(b), the Commissioner determinesthat the continued operation of the insurer is hazardous to its policyholders,to its creditors, or to the general public.

(3)        The insurer has publishedor made to the Department or to the public any false statement or report.

(4)        The insurer or anyof the insurer's officers, directors, employees, or other representativesrefuse to submit to any examination authorized by law or refuse to perform anylegal obligation in relation to an examination.

(5)        The insurer is foundto make a practice of unduly engaging in litigation or of delaying theinvestigation of claims or the adjustment or payment of valid claims.

(b)        Any suspension,revocation or refusal to renew an insurer's license under this section may alsobe made applicable to the license or registration of any individual regulatedunder this Chapter who is a party to any of the causes for licensing sanctionslisted in subsection (a) of this section.

(c)        The Commissionermay impose a civil penalty under G.S. 58‑2‑70 if an HMO, servicecorporation, MEWA, or insurer fails to acknowledge a claim within 30 days afterreceiving written or electronic notice of the claim, but only if the noticecontains sufficient information for the insurer to identify the specificcoverage involved. Acknowledgement of the claim shall be one of the following:

(1)        A statement made tothe claimant or to the claimant's legal representative advising that the claimis being investigated.

(2)        Payment of theclaim.

(3)        A bona fide writtenoffer of settlement.

(4)        A written denial ofthe claim.

A claimant includes an insured, abeneficiary of a life or annuity contract, a health care provider, or a healthcare facility that is responsible for directly making the claim with aninsurer, HMO, service corporation, or MEWA. With respect to a claim under anaccident, health, or disability policy, if the acknowledgement sent to theclaimant indicates that the claim remains under investigation, within 45 daysafter receipt by the insurer of the initial claim, the insurer shall send aclaim status report to the insured and every 45 days thereafter until the claimis paid or denied. The report shall give details sufficient for the insured tounderstand why processing of the claim has not been completed and whether theinsurer needs additional information to process the claim. If the claimacknowledgement includes information about why processing of the claim has notbeen completed and indicates whether additional information is needed, it maysatisfy the requirement for the initial claim status report. This subsectiondoes not apply to HMOs, service corporations, MEWAs or insurers subject to G.S.58‑3‑225.

(d)        If a foreigninsurance company's license is suspended or revoked, the Commissioner shallcause written notification of the suspension or revocation to be given to allof the company's agents in this State. Until the Commissioner restores thecompany's license, the company shall not write any new business in this State.

(e)        The Commissionermay, after considering the standards under G.S. 58‑30‑60(b),restrict an insurer's license by prohibiting or limiting the kind or amount ofinsurance written by that insurer. For a foreign insurer, this restrictionrelates to the insurer's business conducted in this State. The Commissionershall remove any restriction under this subsection once the Commissionerdetermines that the operations of the insurer are no longer hazardous to thepublic or the insurer's policyholders or creditors. As used in this subsection,"insurer" includes an HMO, service corporation, and MEWA. (1899, c. 54, ss. 66, 75,112; 1901, c. 391, s. 5; Rev., ss. 4703, 4705; C.S., s. 6297; 1947, c. 721;1963, c. 1234; 1993, c. 409, s. 1; 1995, c. 193, s. 10; 1999‑294, s. 9;2000‑162, s. 4(b); 2001‑223, s. 2.2; 2001‑334, s. 15; 2003‑212,s. 26(a); 2005‑215, s. 2; 2005‑223, s. 7.)