Statutory and Regulatory Insurance Provisions

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Issue. In the course of insurance litigation, the interpretation of specific insurance statutory and regulatory provisions invariably comes into play and a clear understanding of the law is a condition precedent to effective expert witness testimony. A few examples (and there are thousands of others) include:

  1. Whether a particular insurer’s policy complies with the statutory and regulatory requirements for such policies;
  2. How to interpret and apply in a specific case, the rate filing materials of a specific insurer;
  3. Whether a state DOI’s regulations as promulgated fall within their related statutory authority;
  4. The relationship of a state’s Unfair Claims Practices Act to standards of care as applicable to a particular insurer and a particular set of facts;
  5. Whether a violation of a state’s Unfair Claims Practices Act creates a cause of action in the first party or third party insured;
  6. Whether a life insurer’s application form complies with regulatory requirements;
  7. Whether an insured materially misrepresented information on a life, annuity or property casualty application form, given the subject state’s definition of materially misrepresented; and
  8. Whether a variable annuity complies with both state and federal (securities) law.

Expertise. As Commissioner of Insurance, Mr. Hager has applied state statutory and regulatory provisions in approving and disapproving tens of thousands of all types of life, health, and property casualty applications and forms. As a regulator for eight years, he also applied the law and related regulations (including Model NAIC Acts) to a wide range of transactions including mergers, reinsurance arrangements, insurer reserving and accounting practices, annual statement filings, agents and agent licensing activities, compliance and non-compliance with the Unfair Claims Practices Act and the Unfair Trade Practices Act, and market conduct actions.

As an insurance lawyer, Mr. Hager has written four insurance law review articles and understands the interplay between statutes, regulations, case law, NAIC model acts, NASD and SEC requirements (to insurance products with security features), application of the various treatises including Couch on Insurance 3rd and the application of the myriad of other supporting materials, all available to interpret and apply the law to a specific factual situation.

As General Counsel to the American Academy of Actuaries and later as President and Chief Executive Officer of the National Council on Compensation Insurance (NCCI), Mr. Hager had daily executive responsibilities to assure compliance of these organizations and all of their products to all applicable insurance law.

Conclusion. As an expert witness testifying in complex insurance matters, it is inevitable that a clear understanding of the application of the law to the subject transaction is a condition precedent to an effective expert opinion as to standards of care/ duty of care/ custom and practice. Mr. Hager brings this competence to every insurance expert witness assignment.

Contact Bill Hager at 561-306-5072 or via email to discuss your case.