(215 ILCS 5/130.6) Sec. 130.6. Confidentiality. (a) Documents, materials, or other information, including the corporate governance annual disclosure, in the possession or control of the Department that are obtained by, created by, or disclosed to the Director or any other person under this Article are recognized by this State as being proprietary and to contain trade secrets. All such documents, materials, or other information shall be confidential by law and privileged, shall not be subject to the Freedom of Information Act, shall not be subject to subpoena, and shall not be subject to discovery or admissible in evidence in any private civil action. However, the Director is authorized to use the documents, materials, or other information in furtherance of any regulatory or legal action brought as a part of the Director's official duties. The Director shall not otherwise make the documents, materials, or other information public without the prior written consent of the insurer. (b) Neither the Director nor any person who received documents, materials, or other corporate governance annual disclosure-related information through examination or otherwise, while acting under the authority of the Director or with whom such documents, materials, or other information are shared pursuant to this Article, shall be permitted or required to testify in any private civil action concerning any confidential documents, materials, or information subject to subsection (a). (c) In order to assist in the performance of the Director's regulatory duties, the Director may: (1) upon request, share documents, materials, or |
| other corporate governance annual disclosure-related information, including the confidential and privileged documents, materials, and information subject to subsection (a), including proprietary and trade-secret documents and materials with other state, federal, and international financial regulatory agencies, including members of any supervisory college as defined in subsection (c) of Section 131.20, with the National Association of Insurance Commissioners, and with third-party consultants, if the recipient agrees in writing to maintain the confidentiality and privileged status of the corporate governance annual disclosure-related documents, materials, or other information and has verified in writing the legal authority to maintain confidentiality; and
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(2) receive documents, materials, or other
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| corporate governance annual disclosure-related information, including otherwise confidential and privileged documents, materials, and information, including proprietary and trade-secret information and documents from regulatory officials of other state, federal, and international financial regulatory agencies, including members of any supervisory college as defined in subsection (c) of Section 131.20, and from the National Association of Insurance Commissioners, and shall maintain as confidential or privileged any documents, materials, or information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material, or information.
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(d) A written agreement with the National Association of Insurance Commissioners or a third-party consultant governing sharing and use of information provided pursuant to this Article shall:
(1) include specific procedures and protocols for
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| maintaining the confidentiality and security of corporate governance annual disclosure-related information shared with the National Association of Insurance Commissioners or a third-party consultant pursuant to this Article, including procedures and protocols for sharing by the National Association of Insurance Commissioners only with other state regulators from states in which the insurance group has domiciled insurers; the agreement shall provide that the recipient agrees in writing to maintain the confidentiality and privileged status of the corporate governance annual disclosure-related documents, materials, or other information and has verified in writing the legal authority to maintain confidentiality;
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(2) specify that ownership of the corporate
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| governance annual disclosure-related information shared with the National Association of Insurance Commissioners or a third-party consultant remains with the Director and that the National Association of Insurance Commissioners' or third-party consultant's use of the information is subject to the direction of the Director;
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(3) prohibit the National Association of Insurance
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| Commissioners or a third-party consultant from storing the information shared pursuant to this Article in a permanent database after the underlying analysis is completed;
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(4) require the National Association of Insurance
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| Commissioners or a third-party consultant to provide prompt notice to the Director and to the insurer or insurance group regarding any subpoena, request for disclosure, or request for production of the insurer's or insurance group's corporate governance annual disclosure-related information;
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(5) require the National Association of Insurance
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| Commissioners or a third-party consultant to consent to intervention by an insurer in any judicial or administrative action in which the National Association of Insurance Commissioners or a third-party consultant may be required to disclose confidential information about the insurer shared with the National Association of Insurance Commissioners or a third-party consultant pursuant to this Article; and
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(6) require the National Association of Insurance
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| Commissioners or a third-party consultant to obtain written consent of the insurer before making any of the insurer's corporate governance annual disclosure-related information public.
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(e) The sharing of information and documents by the Director pursuant to this Article shall not constitute a delegation of regulatory authority or rulemaking, and the Director is solely responsible for the administration, execution, and enforcement of this Article.
(f) No waiver of any applicable privilege or claim of confidentiality in the documents, proprietary and trade-secret materials, or other corporate governance annual disclosure-related information shall occur as a result of disclosure of such information or documents to the Director under this Section or as a result of sharing as authorized in this Article.
(g) Documents, materials, or other information in the possession or control of the National Association of Insurance Commissioners or any third-party consultants pursuant to this Article shall be confidential by law and privileged, shall not be subject to the Freedom of Information Act, shall not be subject to subpoena, and shall not be subject to discovery or admissible in evidence in any private civil action.
(Source: P.A. 101-600, eff. 12-6-19.)
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(215 ILCS 5/131.1)
Sec. 131.1. Definitions. As used in this Article, the following terms have the respective
meanings set forth in this Section unless the context requires otherwise:
(a) An "affiliate" of, or person "affiliated" with, a specific person,
is a person that directly, or indirectly through one or more
intermediaries, controls, or is controlled by, or is under common control
with, the person specified.
(a-5) "Acquiring party" means such person by whom or on whose behalf the merger or other acquisition of control referred to in Section 131.4 is to be affected and any person that controls such person or persons. (a-10) "Associated person" means, with respect to an acquiring party, (1) any beneficial owner of shares of the company to be acquired, owned, directly or indirectly, of record or beneficially by the acquiring party, (2) any affiliate of the acquiring party or beneficial owner, and (3) any other person acting in concert, directly or indirectly, pursuant to any agreement, arrangement, or understanding, whether written or oral, with the acquiring party or beneficial owner, or any of their respective affiliates, in connection with the merger, consolidation, or other acquisition of control referred to in Section 131.4 of this Code. (a-15) "Company" has the same meaning as "company" as defined in Section 2 of this Code, except that it does not include agencies, authorities, or instrumentalities of the United States, its possessions and territories, the Commonwealth of Puerto Rico, the District of Columbia, or a state or political subdivision of a state. (b) "Control" (including the terms "controlling", "controlled by" and
"under common control with") means the possession, direct or indirect, of
the power to direct or cause the direction of the management and policies
of a person, whether through the ownership of voting securities, the holding
of shareholders' or policyholders' proxies by
contract other than a commercial contract for goods or non-management
services, or otherwise, unless the power is solely the result of an
official position with or corporate office held by the person. Control is presumed
to exist if any person, directly or indirectly, owns, controls, holds with
the power to vote, or holds shareholders' proxies representing 10% or
more of the voting securities of any other person, or holds or controls
sufficient policyholders' proxies to elect the majority of the board of
directors of the domestic company. This presumption may be rebutted by a
showing made in the manner as the Director may provide by rule. The Director
may determine, after
furnishing all persons in interest notice and opportunity to be heard and
making specific findings of fact to support such determination, that
control exists in fact, notwithstanding the absence of a presumption to
that effect.
(b-5) "Enterprise risk" means any activity, circumstance, event, or series of events involving one or more affiliates of a company that, if not remedied promptly, is likely to have a material adverse effect upon the financial condition or liquidity of the company or its insurance holding company system as a whole, including, but not limited to, anything that would cause the company's risk-based capital to fall into company action level as set forth in Article IIA of this Code or would cause the company to be in
hazardous financial condition as set forth in Article XII 1/2 of this Code. (b-10) "Exchange Act" means the Securities Exchange Act of 1934, as amended, together with the rules and regulations promulgated thereunder. (b-12) "Group capital calculation instructions" means the group capital calculation instructions as adopted by the NAIC and as amended by the NAIC from time to time in accordance with the procedures adopted by the NAIC. (b-15) "Group-wide supervisor" means the regulatory official authorized to engage in conducting and coordinating group-wide supervision activities who is determined or acknowledged by the Director under Section 131.20d of this Code to have sufficient contacts with an internationally active insurance group. (c) "Insurance holding company system" means two or more affiliated
persons, one or more of which is an insurance company as defined in
paragraph (e) of Section 2 of this Code.
(c-5) "Internationally active insurance group" means an insurance holding company system that: (1) includes an insurer registered under Section 4 of |
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(2) meets the following criteria:
(A) premiums written in at least 3 countries;
(B) the percentage of gross premiums written
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| outside the United States is at least 10% of the insurance holding company system's total gross written premiums; and
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(C) based on a 3-year rolling average, the total
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| assets of the insurance holding company system are at least $50,000,000,000 or the total gross written premiums of the insurance holding company system are at least $10,000,000,000.
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(d) (Blank).
(d-1) "NAIC" means the National Association of Insurance Commissioners.
(d-2) "NAIC Liquidity Stress Test Framework" is a separate NAIC publication which includes a history of the NAIC's development of regulatory liquidity stress testing, the scope criteria applicable for a specific data year, and the liquidity stress test instructions, and reporting templates for a specific data year, such scope criteria, instructions, and reporting template being as adopted by the NAIC and as amended by the NAIC from time to time in accordance with the procedures adopted by the NAIC.
(d-5) "Non-operating holding company" is a general business corporation functioning solely for the purpose of forming, owning, acquiring, and managing subsidiary business entities and having no other business operations not related thereto.
(d-10) "Own", "owned," or "owning" means shares (1) with respect to which a person
has title or to which a person's nominee, custodian, or other agent has title and which such
nominee, custodian, or other agent is holding on behalf of the person or (2) with respect to
which a person (A) has purchased or has entered into an unconditional contract, binding on both
parties, to purchase the shares, but has not yet received the shares, (B) owns a security
convertible into or exchangeable for the shares and has tendered the security for conversion or
exchange, (C) has an option to purchase or acquire, or rights or warrants to subscribe to, the shares and has exercised such option, rights, or warrants, or (D) holds a securities futures contract
to purchase the shares and has received notice that the position will be physically settled and is
irrevocably bound to receive the underlying shares. To the extent that any
affiliates of the stockholder or beneficial owner are acting in concert with the stockholder or
beneficial owner, the determination of shares owned may include the effect of aggregating the
shares owned by the affiliate or affiliates. Whether shares constitute shares owned shall
be decided by the Director in his or her reasonable determination.
(e) "Person" means an individual, a corporation, a limited liability company, a partnership, an
association, a joint stock company, a trust, an unincorporated
organization, any similar entity or any combination of the foregoing acting
in concert, but does not include any securities broker performing no more
than the usual and customary broker's function or joint venture
partnership exclusively engaged in owning, managing, leasing or developing
real or tangible personal property other than capital stock.
(e-5) "Policyholders' proxies" are proxies that give the holder the right to vote for the election of the directors and other corporate actions not in the day to day operations of the company.
(f) (Blank).
(f-3) "Scope criteria", as detailed in the NAIC Liquidity Stress Test Framework, are the designated exposure bases along with minimum magnitudes thereof for the specified data year, used to establish a preliminary list of insurers considered scoped into the NAIC Liquidity Stress Test Framework for that data year.
(f-5) "Securityholder" of a specified person is one who owns any security of such person, including common stock, preferred stock, debt obligations, and any other security convertible into or evidencing the right to acquire any of the foregoing.
(g) "Subsidiary" of a specified person is an affiliate controlled by
such person directly, or indirectly through one or more intermediaries.
(h) "Voting Security" is a security which gives to the holder thereof
the right to vote for the election of directors and includes any security
convertible into or evidencing a right to acquire a voting security.
(Source: P.A. 102-394, eff. 8-16-21; 102-578, eff. 7-1-22 (See Section 5 of P.A. 102-672 for effective date of P.A. 102-578); 102-813, eff. 5-13-22.)
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(215 ILCS 5/131.5) (from Ch. 73, par. 743.5)
Sec. 131.5. Statement; contents. In order to seek the approval of the
Director pursuant to Section 131.8, the applicant must file a statement
with the Director under oath or affirmation which contains as a minimum the
following information:
(1) The name and address of each acquiring party, and
(a) if such person is an individual, his |
| principal occupation and all offices and positions held during the past 5 years, and any conviction of crimes, other than minor traffic violations, during the past 10 years;
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(b) if such person is not an individual, a report
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| of the nature of its business operations during the past 5 years or for such lesser period as the person and any predecessors thereof has been in existence; an informative description of the business intended to be conducted by the person and the person's subsidiaries; and a list of all individuals who are or who have been selected to become directors or executive officers of the person, or who perform or will perform functions appropriate to such positions. The list must include for each individual the information required by subsection (1)(a).
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(2) The source, nature and amount of the
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| consideration used or to be used in effecting the merger, consolidation or other acquisition of control, a description of any transaction wherein funds were or are to be obtained for any such purpose, including any pledge of the company's own securities or the securities of any of its subsidiaries or affiliates, and the identity of persons furnishing such consideration. However, where a source of such consideration is a loan made in the lender's ordinary course of business, the identity of the lender must remain confidential, if the person filing the statement so requests.
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(3) Financial information as to the earnings and
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| financial condition of each acquiring party for the preceding 5 fiscal years of each acquiring party (or for such lesser period as the acquiring party and any predecessors thereof have been in existence) audited by an independent certified public accountant in accordance with generally accepted auditing standards and similar unaudited information as of a date not earlier than 90 days prior to the filing of the statement.
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(4) Any plans or proposals which each acquiring party
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| may have to liquidate such company, to sell its assets or merge or consolidate it with any person, or to make any other material change in its business or corporate structure or management.
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(5) The number of shares of any security referred to
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| in Section 131.4 which each acquiring party proposes to acquire, the terms of the offer, request, invitation, agreement, or acquisition referred to in Section 131.4, and a statement as to the method by which the fairness of the proposal was arrived.
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(6) The amount of each class of any security referred
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| to in Section 131.4 which is beneficially owned or concerning which there is a right to acquire beneficial ownership by each acquiring party.
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(7) A full description of any existing contracts,
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| arrangements or understandings with respect to any security referred to in Section 131.4 in which any acquiring party is involved, including but not limited to transfer of any of the securities, joint ventures, loan or option arrangements, puts or calls, guarantees of loans, guarantees against loss or guarantees of profits, division of losses or profits, or the giving or withholding of proxies. The description must identify the persons with whom such contracts, arrangements or understandings have been entered into.
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(8) A description of the acquisition of any security
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| or policyholders' proxy referred to in Section 131.4 during the 12 calendar months preceding the filing of the statement, by any acquiring party, including the dates of acquisition, names of the acquiring parties, and consideration paid or agreed to be paid therefor.
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(9) A description of any recommendations to acquire
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| any security referred to in Section 131.4 made during the 12 calendar months preceding the filing of the statement, by any acquiring party, or by anyone based upon interviews or at the suggestion of such acquiring party.
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(10) Copies of all tender offers for, requests or
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| invitations for tenders of, exchange offers for, and agreements to acquire or exchange any securities referred to in Section 131.4, and (if distributed) of additional soliciting material relating thereto.
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(11) The terms of any agreement, contract or
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| understanding made with, or proposed to be made with, any broker-dealer as to solicitation of securities referred to in Section 131.4 for tender, and the amount of any fees, commissions or other compensation to be paid to broker-dealers with regard thereto.
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(12) Beginning July 1, 2014, an agreement by the
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| person required to file the statement referred to in this Section 131.5 that the person will provide the annual report specified in subsection (a) of Section 131.14b for so long as control exists.
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(13) Beginning July 1, 2014, an acknowledgement by
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| the person required to file the statement referred to in this Section 131.5 that the person and all subsidiaries within its control in the insurance holding company system shall provide information to the Director upon request as necessary to evaluate enterprise risk to the company.
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(14) Any additional information as the Director may
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| by rule or regulation prescribe as necessary or appropriate for the protection of policyholders or in the public interest.
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(15) With respect to each acquiring party, the
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(A) the name and address of all associated
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| persons and a detailed description of every agreement, arrangement, and understanding between the acquiring party and all associated persons in connection with the merger, consolidation, or other acquisition of control;
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(B) the class or series and number of shares of
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| securities of the company that are directly or indirectly owned beneficially and of record by the acquiring party or the associated persons or both; and
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(C) a detailed description of each proxy,
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| contract, arrangement, understanding, or relationship pursuant to which the acquiring party or the associated persons, or both, have a right to vote, or cause or direct the vote of, any securities of the company.
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(Source: P.A. 102-578, eff. 7-1-22 (See Section 5 of P.A. 102-672 for effective date of P.A. 102-578) .)
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(215 ILCS 5/131.8) (from Ch. 73, par. 743.8)
Sec. 131.8.
(1) After the statement required by Section 131.5 has been
filed, the Director shall approve
any merger, consolidation or other acquisition of control referred to in
Section 131.4 unless
the Director finds that:
(a) after the change of control, the domestic company |
| referred to in Section 131.4 would not be able to satisfy the requirements for the issuance of a license to write the line or lines of insurance for which it is presently licensed;
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(b) the effect of the merger, consolidation or other
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| acquisition of control would be substantially to lessen competition in insurance in this State or tend to create a monopoly therein. In applying the competitive standard in this paragraph:
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(i) the informational requirements of subsection
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| (3)(a) and the standards of subsection (4)(b) of Section 131.12a shall apply,
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(ii) the merger or other acquisition shall not be
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| found substantially to lessen competition in insurance in this State or tend to create a monopoly therein if the Director finds that any of the situations meeting the criteria provided by subsection (4)(c) of Section 131.12a exist, and
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(iii) the Director may condition the approval of
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| the merger or other acquisition on the removal of the basis of disapproval within a specified period of time;
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(c) the financial condition of any acquiring party is
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| such as might jeopardize the financial stability of the domestic company or jeopardize the interests of its policyholders;
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(d) the plans or proposals which the acquiring party
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| has to liquidate the domestic company, sell its assets or consolidate or merge it with any person, or to make any other material change in its business or corporate structure or management, are unfair and unreasonable to policyholders of such company and not in the public interest; or
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(e) the competence, experience and integrity of those
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| persons who would control the operation of the domestic company are such that it would not be in the best interests of policyholders of such company and of the insurance buying public to permit the merger, consolidation or other acquisition of control.
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(2) The Director may hold a public hearing on any merger,
consolidation or other acquisition of control referred to in Section 131.4 if
the Director determines that the statement filed as required by
Section 131.5 does
not demonstrate compliance with the standards referred to in subsection (1), of
this Section, or if he determines that such acquisition of control is likely to be hazardous or prejudicial to the insurance buying public.
(3) The public hearing referred to in subsection
(2) must be held within 60 days after the statement
required by Section 131.5 is filed, and at least 20 days'
notice thereof must be
given by the Director to the person filing the statement and to the domestic
company. Not less than 7 days' notice of such hearing must be given by the person
filing the statement to such other persons as may be designated by the
Director and by the company to its shareholders. The Director must make
a determination within 60 days after the conclusion of the hearing. At the
hearing, the person filing the statement, the domestic company, any person to
whom notice of the hearing was sent, and any other person whose interests
may be affected thereby has the right to present evidence, examine and
cross-examine witnesses, and offer oral and written arguments and in connection
therewith is entitled to conduct discovery proceedings in the same manner as is
presently allowed in the Circuit Courts of this State. All discovery proceedings
must be concluded not later than 3 days prior to the commencement of the public hearing.
(4) If the proposed acquisition of control will require the approval of more than one state insurance commissioner, the public hearing referred to in subsection (2) of this Section may be held on a consolidated basis upon request of the person filing the statement referred to in Section 131.5 of this Code. Such person shall file the statement referred to in Section 131.5 of this Code with the National Association of Insurance Commissioners (NAIC) within 5 days after making the request for a public hearing. A commissioner may opt out of a consolidated hearing and shall provide notice to the applicant of the opt out within 10 days after the receipt of the statement referred to in Section 131.5 of this Code. A hearing conducted on a consolidated basis shall be public and shall be held within the United States before the commissioners of the states in which the companies are domiciled. Such commissioners shall hear and receive evidence. A commissioner may attend such hearing in person or by telecommunication.
(5) In connection with a change of control of a domestic company, any determination by the Director that the person acquiring control of the company shall be required to maintain or restore the capital of the company to the level required by the laws and regulations of this State shall be made not later than 60 days after the filing of the statement required by Section 131.5 of this Code.
(Source: P.A. 102-394, eff. 8-16-21.)
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(215 ILCS 5/131.12a) (from Ch. 73, par. 743.12a)
Sec. 131.12a. Acquisitions involving companies not otherwise covered.
(1) Definitions. The following definitions shall apply for the purposes
of this Section only:
(a) "Acquisition" means any agreement, arrangement or activity the
consummation
of which results in a person acquiring directly or indirectly the control
of another person or control of the insurance in force of another person,
and includes but is not limited to the acquisition of voting securities,
the acquisition of assets, the transaction of bulk reinsurance and the act
of merging or consolidating.
(b) An "involved company" includes a company which either acquires or
is acquired, is affiliated with an acquirer or acquired or is the result of a
merger.
(2) Scope.
(a) Except as exempted in paragraph (b) of this subsection (2), this Section
applies to any acquisition in which there is a change in control of a company
authorized to do business in this State.
(b) This Section shall not apply to the following:
(i) an acquisition subject to approval or disapproval |
| by the Director pursuant to Section 131.8;
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(ii) a purchase of securities solely for investment
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| purposes so long as such securities are not used by voting or otherwise to cause or attempt to cause the substantial lessening of competition in any insurance market in this State. If a purchase of securities results in a presumption of control under subsection (b) of Section 131.1, it is not solely for investment purposes unless the commissioner of the company's state of domicile accepts a disclaimer of control or affirmatively finds that control does not exist and such disclaimer action or affirmative finding is communicated by the domiciliary commissioner to the Director of this State;
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(iii) the acquisition of a person by another person
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| when both persons are neither directly nor through affiliates primarily engaged in the business of insurance, if pre-acquisition notification is filed with the Director in accordance with subsection (3)(a) of this Section, 30 days prior to the proposed effective date of the acquisition. However, such pre-acquisition notification is not required for exclusion from this Section if the acquisition would otherwise be excluded from this Section by any other subparagraph of subsection (2)(b);
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(iv) the acquisition of already affiliated persons;
(v) an acquisition if, as an immediate result of the
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(A) in no market would the combined market share
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| of the involved companies exceed 5% of the total market,
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(B) there would be no increase in any market
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(C) in no market would the combined market share
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| of the involved companies exceed 12% of the total market, and the market share increase by more than 2% of the total market.
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For the purpose of this subparagraph (b)(v), "market"
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| means direct written insurance premium in this State for a line of business as contained in the annual statement required to be filed by companies licensed to do business in this State;
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(vi) an acquisition for which a pre-acquisition
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| notification would be required pursuant to this Section due solely to the resulting effect on the ocean marine insurance line of business;
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(vii) an acquisition of a company whose domiciliary
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| commissioner affirmatively finds that such company is in failing condition; there is a lack of feasible alternative to improving such condition; the public benefits of improving such company's condition through the acquisition exceed the public benefits that would arise from not lessening competition; and such findings are communicated by the domiciliary commissioner to the Director of this State.
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(3) Pre-acquisition Notification; Waiting Period. An acquisition
covered by subsection (2) may be subject to an order pursuant to subsection
(5) unless the acquiring person files a pre-acquisition notification and the
waiting period has expired. The acquired person may file a pre-acquisition
notification. The Director shall give confidential treatment to information
submitted under this subsection in the same manner as provided in Section
131.22 of this Article.
(a) The pre-acquisition notification shall be in such form and contain
such information as prescribed by the Director, which shall conform
substantially to the form of notification adopted by the National Association
of Insurance Commissioners relating to those markets which, under subsection
(b)(v) of Section (2), cause the acquisition not to be exempted from the
provisions of this Section. The Director may require such additional material
and information as he deems necessary to determine whether the proposed
acquisition, if consummated, would violate the competitive standard of
subsection (4). The required information may include an opinion of an
economist as to the competitive impact of the acquisition in this State
accompanied by a summary of the education and experience of such person
indicating his or her ability to render an informed opinion.
(b) The waiting period required shall begin on the date of the receipt
by the Director of a pre-acquisition notification and shall end on the earlier
of the 30th day after the date of such receipt, or termination of the waiting
period by the Director. Prior to the end of the waiting period, the Director
on a one time basis may require the submission of additional needed information
relevant to the proposed acquisition, in which event the waiting period shall
end on the earlier of the 30th day after the receipt of such additional
information by the Director or termination of the waiting period by the
Director.
(4) Competitive Standard.
(a) The Director may enter an order under subsection (5)(a) with respect
to an acquisition if there is substantial evidence that the effect of the
acquisition may be substantially to lessen competition in any line of insurance
in this State or tend to create a monopoly therein or if the company fails
to file adequate information in compliance with subsection (3).
(b) In determining whether a proposed acquisition would violate the
competitive standard of paragraph (a) of this subsection the
Director shall consider the following:
(i) any acquisition covered under subsection (2)
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| involving 2 or more companies competing in the same market is prima facie evidence of violation of the competitive standards:
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(A) if the market is highly concentrated and the
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| involved companies possess the following shares of the market:
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Company A Company B
4% 4% or more
10% 2% or more
15% 1% or more
(B) if the market is not highly concentrated and
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| the involved companies possess the following shares of the market:
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Company A Company B
5% 5% or more
10% 4% or more
15% 3% or more
19% 1% or more
A highly concentrated market is one in which the
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| share of the 4 largest companies is 75% or more of the market. Percentages not shown in the tables are to be interpolated proportionately to the percentages that are shown. If more than 2 companies are involved, exceeding the total of the 2 columns in the table is prima facie evidence of violation of the competitive standard in paragraph (a) of this subsection. For the purpose of this subparagraph, the company with the largest share of the market shall be deemed to be Company A.
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(ii) There is a significant trend toward increased
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| concentration when the aggregate market share of any grouping of the largest companies in the market from the 2 largest to the 8 largest has increased by 7% or more of the market over a period of time extending from any base year 5-10 years prior to the acquisition up to the time of the acquisition. Any acquisition covered under subsection (2) involving 2 or more companies competing in the same market is prima facie evidence of violation of the competitive standard in paragraph (a) of this subsection if:
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(A) there is a significant trend toward increased
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| concentration in the market,
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(B) one of the companies involved is one of the
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| companies in a grouping of such large companies showing the requisite increase in the market share, and
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(C) another involved company's market is 2% or
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(iii) For the purpose of subsection (4)(b):
(A) The term "company" includes any company or
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| group of companies under common management, ownership or control.
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(B) The term "market" means the relevant product
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| and geographic markets. In determining the relevant product and geographical markets, the Director shall give due consideration to, among other things, the definitions or guidelines, if any, promulgated by the National Association of Insurance Commissioners and to information, if any, submitted by parties to the acquisition. In the absence of sufficient information to the contrary, the relevant product market is assumed to be the direct written insurance premium for a line of business with such line being that used in the annual statement required to be filed by companies doing business in this State and the relevant geographical market is assumed to be this State.
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|
(C) The burden of showing prima facie evidence of
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| violation of the competitive standard rests upon the Director.
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|
(iv) Even though an acquisition is not prima facie
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| violative of the competitive standard under subparagraph (b)(i) and (b)(ii) of this subsection the Director may establish the requisite anticompetitive effect based upon other substantial evidence. Even though an acquisition is prima facie violative of the competitive standard under subparagraphs (b)(i) and (b)(ii) of this subsection (4), a party may establish the absence of the requisite anticompetitive effect based upon other substantial evidence. Relevant factors in making a determination under this paragraph include, but are not limited to, the following: market shares, volatility of ranking of market leaders, number of competitors, concentration, trend of concentration in the industry, and ease of entry and exit into the market.
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|
(c) An order may not be entered under subsection (5)(a) if:
(i) the acquisition will yield substantial economies
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| of scale or economies in resource utilization that cannot be feasibly achieved in any other way, and the public benefits which would arise from such economies exceed the public benefits which would arise from not lessening competition; or
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|
(ii) the acquisition will substantially increase the
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| availability of insurance, and the public benefits of such increase exceed the public benefits which would arise from not lessening competition.
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|
(5) Orders and Penalties:
(a)(i) If an acquisition violates the standard of
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| this Section, the Director may enter an order
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|
(A) requiring an involved company to cease and
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| desist from doing business in this State with respect to the line or lines of insurance involved in the violation, or
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|
(B) denying the application of an acquired or
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| acquiring company for a license to do business in this State.
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|
(ii) Such an order shall not be entered unless there
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| is a hearing, notice of such hearing is issued prior to the end of the waiting period and not less than 15 days prior to the hearing, and the hearing is concluded and the order is issued no later than 60 days after the end of the waiting period. Every order shall be accompanied by a written decision of the Director setting forth his findings of fact and conclusions of law.
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|
(iii) (Blank).
(iv) An order pursuant to this paragraph shall not
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| apply if the acquisition is not consummated.
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|
(b) Any person who violates a cease and desist order of the Director under
paragraph (a) and while such order is in effect may after notice and hearing
and upon order of the Director be subject at the discretion of the Director to
any one or more of the following:
(i) a monetary penalty of not more than $10,000 for
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| every day of violation or
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|
(ii) suspension or revocation of such person's
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|
(c) Any company or other person who fails to make any filing required
by this Section and who also fails to demonstrate a good faith effort to
comply with any such filing requirement shall be subject to a civil penalty of
not more than $50,000.
(6) Inapplicable Provisions. Subsections (2) and (3) of Section 131.23 and
Section 131.25 do not apply to acquisitions covered under subsection (2).
(Source: P.A. 98-609, eff. 1-1-14.)
|
(215 ILCS 5/131.14) (from Ch. 73, par. 743.14)
Sec. 131.14.
Every company subject to registration must file a registration statement on a
form and in a format prescribed by the Director, which shall contain the following current information:
(1) the capital structure, general financial |
| condition, ownership and management of the company and any person controlling the company;
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|
(2) the identity and relationship of every member of
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| the insurance holding company system;
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|
(3) the following agreements in force, relationships
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| subsisting, and transactions currently outstanding or that have occurred during the last calendar year between such company and its affiliates:
|
|
(a) loans, other investments, or purchases, sales
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| or exchanges of securities of the affiliates by the company or of the company by its affiliates;
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|
(b) purchases, sales, or exchanges of assets;
(c) transactions not in the ordinary course of
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|
(d) guarantees or undertakings for the benefit of
|
| an affiliate which result in an actual contingent exposure of the company's assets to liability, other than insurance contracts entered into in the ordinary course of the company's business;
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|
(e) all management agreements, service contracts,
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| and cost-sharing arrangements;
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|
(f) reinsurance agreements;
(f-5) dividends and other distributions to
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|
(g) any pledge of the company's own securities,
|
| securities of any subsidiary or controlling affiliate, to secure a loan made to any member of the insurance holding company system; and
|
|
(h) consolidated tax allocation agreements;
(4) (blank);
(5) financial statements of or within an insurance
|
| holding company system, including all affiliates, if requested by the Director; financial statements may include, but are not limited to, annual audited financial statements filed with the U.S. Securities and Exchange Commission (SEC) pursuant to the Securities Act of 1933, as amended, or the Securities Exchange Act of 1934, as amended; a company required to file financial statements pursuant to this paragraph (5) may satisfy the request by providing the Director with the most recently filed parent corporation financial statements that have been filed with the SEC;
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|
(6) statements that the company's or its parent
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| company's board of directors or a committee thereof oversees corporate governance and internal controls and that the company's officers or senior management have approved and implemented and continue to maintain and monitor corporate governance and internal controls; and
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|
(7) other matters concerning transactions between
|
| registered companies and any affiliates as may be included from time to time in any registration forms adopted or approved by the Director.
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|
(Source: P.A. 98-609, eff. 1-1-14.)
|
(215 ILCS 5/131.14b) Sec. 131.14b. Enterprise risk filings. (a) Annual enterprise risk report. The ultimate controlling person of every company subject to registration shall also file an annual enterprise risk report. The report shall, to the best of the ultimate controlling person's knowledge and belief, identify the material risks within the insurance holding company system that could pose enterprise risk to the company. The report shall be filed with the lead state commissioner of the insurance holding company system as determined by the procedures within the Financial Analysis Handbook adopted by the National Association of Insurance Commissioners.
(b) Group capital calculation. Except as provided in this subsection, the ultimate controlling person of every insurer subject to registration shall concurrently file with the registration an annual group capital calculation as directed by the lead state commissioner. The report shall be completed in accordance with the NAIC Group Capital Calculation Instructions, which may permit the lead state commissioner to allow a controlling person who is not the ultimate controlling person to file the group capital calculation. The report shall be filed with the lead state commissioner of the insurance holding company system as determined by the commissioner in accordance with the procedures within the Financial Analysis Handbook adopted by the NAIC. Insurance holding company systems described in the following are exempt from filing the group capital calculation: (1) an insurance holding company system that has |
| only one insurer within its holding company structure, that only writes business and is only licensed in Illinois, and that assumes no business from any other insurer;
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|
(2) an insurance holding company system that is
|
| required to perform a group capital calculation specified by the United States Federal Reserve Board; the lead state commissioner shall request the calculation from the Federal Reserve Board under the terms of information sharing agreements in effect; if the Federal Reserve Board cannot share the calculation with the lead state commissioner, the insurance holding company system is not exempt from the group capital calculation filing;
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|
(3) an insurance holding company system whose
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| non-U.S. group-wide supervisor is located within a reciprocal jurisdiction as described in paragraph (C-10) of subsection (1) of Section 173.1 that recognizes the U.S. state regulatory approach to group supervision and group capital; and
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|
(4) an insurance holding company system:
(i) that provides information to the lead state
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| that meets the requirements for accreditation under the NAIC financial standards and accreditation program, either directly or indirectly through the group-wide supervisor, who has determined such information is satisfactory to allow the lead state to comply with the NAIC group supervision approach, as detailed in the NAIC Financial Analysis Handbook; and
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|
(ii) whose non-U.S. group-wide supervisor that
|
| is not in a reciprocal jurisdiction recognizes and accepts, as specified by the commissioner in regulation, the group capital calculation as the world-wide group capital assessment for U.S. insurance groups who operate in that jurisdiction.
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|
Notwithstanding the provisions of paragraphs (3) and (4) of this subsection, a lead state commissioner shall require the group capital calculation for U.S. operations of any non-U.S. based insurance holding company system where, after any necessary consultation with other supervisors or officials, it is deemed appropriate by the lead state commissioner for prudential oversight and solvency monitoring purposes or for ensuring the competitiveness of the insurance marketplace.
Notwithstanding the exemptions from filing the group capital calculation stated in paragraphs (1) through (4) of this subsection, the lead state commissioner has the discretion to exempt the ultimate controlling person from filing the annual group capital calculation or to accept a limited group capital filing or report in accordance with criteria as specified by the Director in regulation.
(c) Liquidity stress test. The ultimate controlling person of every insurer subject to registration and also scoped into the NAIC Liquidity Stress Test Framework shall file the results of a specific year's liquidity stress test. The filing shall be made to the lead state insurance commissioner of the insurance holding company system as determined by the procedures within the Financial Analysis Handbook adopted by the National Association of Insurance Commissioners:
(1) The NAIC Liquidity Stress Test Framework
|
| includes scope criteria applicable to a specific data year. These scope criteria are reviewed at least annually by the NAIC Financial Stability Task Force or its successor. Any change to the NAIC Liquidity Stress Test Framework or to the data year for which the scope criteria are to be measured shall be effective on January 1 of the year following the calendar year when such changes are adopted. Insurers meeting at least one threshold of the scope criteria are considered scoped into the NAIC Liquidity Stress Test Framework for the specified data year unless the lead state insurance commissioner, in consultation with the NAIC Financial Stability Task Force or its successor, determines the insurer should not be scoped into the Framework for that data year. Similarly, insurers that do not trigger at least one threshold of the scope criteria are considered scoped out of the NAIC Liquidity Stress Test Framework for the specified data year, unless the lead state insurance commissioner, in consultation with the NAIC Financial Stability Task Force or its successor, determines the insurer should be scoped into the Framework for that data year.
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|
The lead state insurance commissioner, in
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| consultation with the Financial Stability Task Force or its successor, shall assess the regulator's wish to avoid having insurers scoped in and out of the NAIC Liquidity Stress Test Framework on a frequent basis as part of the determination for an insurer.
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|
(2) The performance of, and filing of the results
|
| from, a specific year's liquidity stress test shall comply with the NAIC Liquidity Stress Test Framework's instructions and reporting templates for that year and any lead state insurance commissioner determinations, in conjunction with the NAIC Financial Stability Task Force or its successor, provided within the Framework.
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|
(Source: P.A. 102-578, eff. 7-1-22 (See Section 5 of P.A. 102-672 for effective date of P.A. 102-578); 102-813, eff. 5-13-22.)
|
(215 ILCS 5/131.20) (from Ch. 73, par. 743.20)
Sec. 131.20. Standards for transactions with affiliates; adequacy of
surplus. (1) Transactions with their affiliates by
companies subject to registration
are subject to the following standards:
(a) the terms are fair and reasonable;
(a-5) agreements for cost sharing services and |
| management shall include such provisions as may be required by rules and regulations issued by the Director;
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|
(b) charges or fees for services performed are
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|
(c) expenses incurred and payment received must be
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| allocated to the company in conformity with customary insurance accounting practices consistently applied;
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|
(d) the books, accounts, and records of each party
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| must be so maintained as to clearly and accurately disclose the precise nature and details of the transactions, including accounting information necessary to support the reasonableness of the charges or fees to the respective parties; and
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|
(e) the company's surplus as regards policyholders
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| following any transactions with affiliates or dividends or distributions to securityholders or affiliates must be reasonable in relation to the company's outstanding liabilities and adequate to meet its financial needs.
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|
(2) For purposes of this Article, in determining whether a company's
surplus as regards policyholders is reasonable in relation to the company's
outstanding liabilities and adequate to meet its needs, the following factors,
among others, may be considered:
(a) the size of the company as measured by its
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| assets, capital and surplus, reserves, premium writings, insurance in force and other appropriate criteria;
|
|
(b) the extent to which the company's business is
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| diversified among several lines of insurance;
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|
(c) the number and size of risks insured in each line
|
|
(d) the extent of the geographical dispersion of the
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|
(e) the nature and extent of the company's
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|
(f) the quality, diversification, and liquidity of
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| the company's investment portfolio;
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|
(g) the recent past and projected future trend in the
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| size of the company's investment portfolio;
|
|
(h) the surplus as regards policyholders maintained
|
| by companies comparable to the registrant in respect of the factors enumerated in this paragraph;
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|
(i) the adequacy of the company's reserves;
(j) the quality of the company's earnings and the
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| extent to which the reported earnings include extraordinary items; and
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|
(k) the quality and liquidity of investments in
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| affiliates. The Director may discount any such investment or treat any such investment as a non-admitted asset for purposes of determining the adequacy of surplus as regards policyholders whenever the investment so warrants.
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|
(Source: P.A. 98-609, eff. 1-1-14.)
|
(215 ILCS 5/131.20a) (from Ch. 73, par. 743.20a)
Sec. 131.20a. Prior notification of transactions; dividends and
distributions. (1) (a) The following transactions listed in items (i) through (vii) involving a domestic
company and any person in its insurance holding company system, including amendments or modifications (other than termination) of affiliate agreements previously filed pursuant to this Section, which are subject to any materiality standards contained in this Section, may not be entered
into unless the company has notified the Director in writing of its
intention to enter into such transaction at least 30 days prior thereto, or
such period as the Director may permit, and the Director has not
disapproved it within such period. The notice for amendments or modifications (other than termination) shall include the reasons for the change and the financial impact on the domestic company. Informal notice shall be reported, within 30 days after a termination of a previously filed agreement, to the Director for determination of the type of filing required, if any.
(i) Sales, purchases, exchanges of assets, loans or |
| extensions of credit, guarantees, investments, or any other transaction, except dividends, that involves the transfer of assets from or liabilities to a company (A) equal to or exceeding the lesser of 3% of the company's admitted assets or 25% of its surplus as regards policyholders as of the 31st day of December next preceding or (B) that is proposed when the domestic company is not eligible to declare and pay a dividend or other distribution pursuant to the provisions of Section 27.
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|
(ii) Loans or extensions of credit to any person that
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| is not an affiliate (A) that involve the lesser of 3% of the company's admitted assets or 25% of the company's surplus, each as of the 31st day of December next preceding, made with the agreement or understanding that the proceeds of such transactions, in whole or in substantial part, are to be used to make loans or extensions of credit to, to purchase assets of, or to make investments in, any affiliate of the company making such loans or extensions of credit or (B) that are proposed when the domestic company is not eligible to declare and pay a dividend or other distribution pursuant to the provisions of Section 27.
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|
(iii) Reinsurance agreements or modifications
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| thereto, including all reinsurance pooling agreements, reinsurance agreements in which the reinsurance premium or a change in the company's liabilities, or the projected reinsurance premium or a change in the company's liabilities in any of the next 3 years, equals or exceeds 5% of the company's surplus as regards policyholders, as of the 31st day of December next preceding, including those agreements that may require as consideration the transfer of assets from a company to a nonaffiliate, if an agreement or understanding exists between the company and nonaffiliate that any portion of those assets will be transferred to one or more affiliates of the company.
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|
(iv) All management agreements; service contracts,
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| other than agency contracts; tax allocation agreements; all reinsurance allocation agreements related to reinsurance agreements required to be filed under this Section; and all cost-sharing arrangements.
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|
(v) Direct or indirect acquisitions or investments in
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| a person that controls the company, or in an affiliate of the company, in an amount which, together with its present holdings in such investments, exceeds 2.5% of the company's surplus as regards policyholders. Direct or indirect acquisitions or investments in subsidiaries acquired pursuant to Section 131.2 of this Article (or authorized under any other Section of this Code), or in non-subsidiary insurance affiliates that are subject to the provisions of this Article, are exempt from this requirement.
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|
(vi) Any series of the previously described
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| transactions that are substantially similar to each other, that take place within any 180 day period, and that in total are equal to or exceed the lesser of 3% of the domestic company's admitted assets or 25% of its policyholders surplus, as of the 31st day of the December next preceding.
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|
(vii) Any other material transaction that the
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| Director by rule determines might render the company's surplus as regards policyholders unreasonable in relation to the company's outstanding liabilities and inadequate to its financial needs or may otherwise adversely affect the interests of the company's policyholders or shareholders.
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|
Nothing herein contained shall be deemed to authorize or permit any
transactions that, in the case of a company not a member of the same holding
company system, would be otherwise contrary to law.
(b) Any transaction or contract otherwise described in paragraph (a) of this
subsection that is between a domestic company and any person that is not its
affiliate and that precedes or follows within 180 days or is concurrent with a
similar transaction between that nonaffiliate and an affiliate of the domestic
company and that involves amounts that are equal to or exceed the lesser of 3%
of the domestic company's admitted assets or 25% of its surplus as regards
policyholders at the end of the prior year may not be entered into unless the
company has notified the Director in writing of its intention to enter into the
transaction at least 30 days prior thereto or such shorter period as the
Director may permit, and the Director has not disapproved it within such
period.
(c) A company may not enter into transactions which are part of
a plan
or series of like transactions with any person within the holding company
system if the purpose of those separate transactions is to avoid the
statutory threshold amount and thus avoid the review that would occur
otherwise. If the Director determines that such separate transactions were
entered into for such purpose, he may
exercise his authority under subsection (2) of Section 131.24.
(d) The Director, in reviewing transactions pursuant to paragraph (a),
shall consider whether the transactions comply with the standards set forth in
Section 131.20 and whether they may adversely affect the interests of
policyholders.
(e) The Director shall be notified within 30 days of any investment of the
domestic company in any one corporation if the total investment in that
corporation by the insurance holding company system exceeds 10% of that
corporation's voting securities.
(f) Except for those transactions subject to approval
under other
Sections
of this Code,
any such transaction or agreements which are not disapproved by the
Director may be effective as of the date set forth in the notice required
under this Section.
(g) If a domestic company enters into a transaction described in this
subsection without having given the required notification, the Director, using the notice and hearing procedure in subsection (2) of Section 403A of this Code, may
cause the company to pay a civil forfeiture of not more than $250,000. Each
transaction so entered shall be considered a separate offense.
(2) No domestic company subject to registration under Section 131.13 may
pay any extraordinary dividend or make any other extraordinary distribution
to its shareholders until: (a) 30 days after the Director has received
notice of the declaration thereof and has not within such period
disapproved the payment, or (b) the Director approves such payment within
the 30-day period. For purposes of this subsection, an extraordinary
dividend or distribution is any dividend or distribution of cash or other
property whose fair market value, together with that of other dividends or
distributions, made within the period of 12 consecutive months ending on the
date on which the proposed dividend is scheduled for payment or
distribution exceeds the greater of: (a) 10% of the company's
surplus as regards policyholders as of the 31st day of December next
preceding, or (b) the net income of the company for the 12-month period ending the 31st day
of December next preceding, but does not include pro rata distributions of
any class of the company's own securities.
Notwithstanding any other provision of law, the company may declare an
extraordinary dividend or distribution which is conditional upon the
Director's approval, and such a declaration confers no rights upon
security holders until: (a) the Director has approved the payment of the
dividend or distribution, or (b) the Director has not disapproved the
payment within the 30-day period referred to above.
(Source: P.A. 98-609, eff. 1-1-14; 98-910, eff. 7-1-15 .)
|
(215 ILCS 5/131.20d) Sec. 131.20d. Group-wide supervision of internationally active insurance groups. (a) The Director is authorized to act as the group-wide supervisor for any internationally active insurance group in accordance with the provisions of this Section. (b) The Director may otherwise acknowledge another regulatory official as the group-wide supervisor where the internationally active insurance group: (1) does not have substantial insurance operations |
|
(2) has substantial insurance operations in the
|
| United States, but not in this State; or
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|
(3) has substantial insurance operations in the
|
| United States and this State, but the Director has determined pursuant to the factors set forth in subsections (d) and (h) that the other regulatory official is the appropriate group-wide supervisor.
|
|
(c) An insurance holding company system that does not otherwise qualify as an internationally active insurance group may request that the Director make a determination or acknowledgment as to a group-wide supervisor pursuant to this Section.
(d) In cooperation with other state, federal, and international regulatory agencies, the Director will identify a single group-wide supervisor for an internationally active insurance group. The Director may determine that the Director is the appropriate group-wide supervisor for an internationally active insurance group that conducts substantial insurance operations concentrated in this State. However, the Director may acknowledge that a regulatory official from another jurisdiction is the appropriate group-wide supervisor for the internationally active insurance group. A regulatory official identified under this Section as the group-wide supervisor may determine that it is appropriate to acknowledge another supervisor to serve as the group-wide supervisor. The acknowledgment of the group-wide supervisor shall be made after consideration of the factors listed in paragraphs (1) through (5) of this subsection, and shall be made in cooperation with and subject to the acknowledgment of other regulatory officials involved with supervision of members of the internationally active insurance group, and in consultation with the internationally active insurance group. The Director shall consider the following factors when making a determination or acknowledgment under this subsection:
(1) the place of domicile of the insurance
|
| companies within the internationally active insurance group that hold the largest share of the group's written premiums, assets, or liabilities;
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|
(2) the place of domicile of the top-tiered
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| insurance company or companies in the insurance holding company system of the internationally active insurance group;
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|
(3) the location of the executive offices or
|
| largest operational offices of the internationally active insurance group;
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|
(4) whether another regulatory official is acting
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| or is seeking to act as the group-wide supervisor under a regulatory system that the Director determines to be:
|
|
(A) substantially similar to the system of
|
| regulation provided under the laws of this State; or
|
|
(B) otherwise sufficient in terms of providing
|
| for group-wide supervision, enterprise risk analysis, and cooperation with other regulatory officials; and
|
|
(5) whether another regulatory official acting or
|
| seeking to act as the group-wide supervisor provides the Director with reasonably reciprocal recognition and cooperation.
|
|
(e) Notwithstanding any other provision of law, when another regulatory official is acting as the group-wide supervisor of an internationally active insurance group, the Director shall acknowledge that regulatory official as the group-wide supervisor. However, in the event of a material change in the internationally active insurance group that results in:
(1) the internationally active insurance group's
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| insurance companies domiciled in this State holding the largest share of the group's premiums, assets, or liabilities; or
|
|
(2) this State being the place of domicile of the
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| top-tiered insurance company or companies in the insurance holding company system of the internationally active insurance group, the Director shall make a determination or acknowledgment as to the appropriate group-wide supervisor for such an internationally active insurance group pursuant to subsection (d).
|
|
(f) The Director is authorized to collect from any company registered pursuant to Section 131.13 all information necessary to determine whether the Director may act as the group-wide supervisor of an internationally active insurance group or if the Director may acknowledge another regulatory official to act as the group-wide supervisor. Before issuing a determination that an internationally active insurance group is subject to group-wide supervision by the Director, the Director shall notify the company registered pursuant to Section 131.13 and the ultimate controlling person within the internationally active insurance group. The internationally active insurance group shall have not less than 30 days to provide the Director with additional information pertinent to the pending determination. The Department shall publish on its Internet website the identity of internationally active insurance groups that the Director has determined are subject to group-wide supervision by the Director.
(g) If the Director is the group-wide supervisor for an internationally active insurance group, the Director is authorized to engage in any of the following group-wide supervision activities:
(1) assess the enterprise risks within the
|
| internationally active insurance group to ensure that:
|
|
(A) the material financial condition and
|
| liquidity risks to the members of the internationally active insurance group that are engaged in the business of insurance are identified by management; and
|
|
(B) reasonable and effective mitigation
|
|
(2) request, from any member of an internationally
|
| active insurance group subject to the Director's supervision, information necessary and appropriate to assess enterprise risk, including, but not limited to, information about the members of the internationally active insurance group regarding:
|
|
(A) governance, risk assessment, and management;
(B) capital adequacy; and
(C) material intercompany transactions;
(3) coordinate and, through the authority of the
|
| regulatory officials of the jurisdictions where members of the internationally active insurance group are domiciled, compel development and implementation of reasonable measures designed to ensure that the internationally active insurance group is able to timely recognize and mitigate enterprise risks to members of such internationally active insurance group that are engaged in the business of insurance;
|
|
(4) communicate with other state, federal, and
|
| international regulatory agencies for members within the internationally active insurance group and share relevant information subject to the confidentiality provisions of Section 131.22, through supervisory colleges as set forth in Section 131.20c or otherwise;
|
|
(5) enter into agreements with or obtain
|
| documentation from any company registered under Section 131.13, any member of the internationally active insurance group, and any other state, federal, and international regulatory agencies for members of the internationally active insurance group, providing the basis for or otherwise clarifying the Director's role as group-wide supervisor, including provisions for resolving disputes with other regulatory officials. Such agreements or documentation shall not serve as evidence in any proceeding that any company or person within an insurance holding company system not domiciled or incorporated in this State is doing business in this State or is otherwise subject to jurisdiction in this State; and
|
|
(6) other group-wide supervision activities,
|
| consistent with the authorities and purposes enumerated above, as considered necessary by the Director.
|
|
(h) If the Director acknowledges that another regulatory official from a jurisdiction that is not accredited by the NAIC is the group-wide supervisor, the Director is authorized to reasonably cooperate, through supervisory colleges or otherwise, with group-wide supervision undertaken by the group-wide supervisor, provided that:
(1) the Director's cooperation is in compliance with
|
| the laws of this State; and
|
|
(2) the regulatory official acknowledged as the
|
| group-wide supervisor also recognizes and cooperates with the Director's activities as a group-wide supervisor for other internationally active insurance groups where applicable. Where such recognition and cooperation is not reasonably reciprocal, the Director is authorized to refuse recognition and cooperation.
|
|
(i) The Director is authorized to enter into agreements with or obtain documentation from any company registered under Section 131.13, any affiliate of the company, and other state, federal, and international regulatory agencies for members of the internationally active insurance group that provide the basis for or otherwise clarify a regulatory official's role as group-wide supervisor.
(j) The Department may adopt regulations necessary for the administration of this Section.
(k) A registered company subject to this Section shall be liable for and shall pay the reasonable expenses of the Director's participation in the administration of this Section, including the engagement of attorneys, actuaries, and any other professionals and all reasonable travel expenses.
(Source: P.A. 102-394, eff. 8-16-21.)
|
(215 ILCS 5/131.22)
Sec. 131.22. Confidential treatment. (a) Documents, materials, or other information in the possession or control of the Department that are obtained by or disclosed to the Director or any other person in the course of an examination or investigation made pursuant to this Article and all information reported or provided to the Department pursuant to paragraphs (12) and (13) of Section 131.5 and Sections 131.13 through 131.21 are recognized by this State as being proprietary and to contain trade secrets, and shall be confidential by law and privileged, shall not be subject to the Illinois Freedom of Information Act, shall not be subject to subpoena, and shall not be subject to discovery or admissible in evidence in any private civil action. However, the Director is authorized to use the documents, materials, or other information in the furtherance of any regulatory or legal action brought as a part of the Director's official duties. The Director shall not otherwise make the documents, materials, or other information public without the prior written consent of the company to which it pertains unless the Director, after giving the company and its affiliates who would be affected thereby prior written notice and an opportunity to be heard, determines that the interest of policyholders, shareholders, or the public shall be served by the publication thereof, in which event the Director may publish all or any part in such manner as may be deemed appropriate. (b) Neither the Director nor any person who received documents, materials, or other information while acting under the authority of the Director or with whom such documents, materials, or other information are shared pursuant to this Article shall be permitted or required to testify in any private civil action concerning any confidential documents, materials, or information subject to subsection (a) of this Section. (c) In order to assist in the performance of the Director's duties, the Director: (1) may share documents, materials, or other |
| information, including the confidential and privileged documents, materials, or information subject to subsection (a) of this Section, including proprietary and trade secret documents and materials, with other state, federal, and international regulatory agencies, with the NAIC and its affiliates and subsidiaries, with third-party consultants, and with state, federal, and international law enforcement authorities and regulatory agencies, including members of any supervisory college allowed by this Article, provided that the recipient agrees in writing to maintain the confidentiality and privileged status of the document, material, or other information, and has verified in writing the legal authority to maintain confidentiality;
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(1.5) notwithstanding paragraph (1) of this
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| subsection (c), may only share confidential and privileged documents, material, or information reported pursuant to subsection (a) of Section 131.14b with commissioners of states having statutes or regulations substantially similar to subsection (a) of this Section and who have agreed in writing not to disclose such information;
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(1.7) notwithstanding paragraph (1) of this
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| subsection (c), may only share confidential and privileged documents, material, or information reported pursuant to Section 131.14b with the Illinois Insurance Guaranty Fund regarding any member company defined in Section 534.5 if the member company has an authorized control level event as defined in Section 35A-25; the Director may disclose the information described in this subsection so long as the Fund agrees in writing to hold that information confidential, in a manner consistent with this Code, and uses that information to prepare for the possible liquidation of the member company; access to the information disclosed by the Director to the Fund shall be limited to the Fund's staff and its counsel; the board of directors of the Fund may have access to the information disclosed by the Director to the Fund once the member company is subject to a delinquency proceeding under Article XIII subject to any terms and conditions established by the Director; and
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(2) may receive documents, materials, or information,
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| including otherwise confidential and privileged documents, materials, or information, including proprietary and trade secret information, from the NAIC and its affiliates and subsidiaries and from regulatory and law enforcement officials of other foreign or domestic jurisdictions, and shall maintain as confidential or privileged any document, material, or information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material, or information; any such documents, materials, or information, while in the Director's possession, shall not be subject to the Illinois Freedom of Information Act and shall not be subject to subpoena.
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(c-5) Written agreements with the NAIC or third-party consultants governing sharing and use of information provided pursuant to this Article consistent with subsection (c) shall:
(1) specify procedures and protocols regarding the
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| confidentiality and security of information shared with the NAIC and its affiliates and subsidiaries or third-party consultants pursuant to this Article, including procedures and protocols for sharing by the NAIC with other state, federal, or international regulators; the agreement shall provide that the recipient agrees in writing to maintain the confidentiality and privileged status of the documents, materials, or other information and has verified in writing the legal authority to maintain such confidentiality;
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(2) specify that ownership of information shared with
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| the NAIC and its affiliates and subsidiaries or third-party consultants pursuant to this Article remains with the Director and the NAIC's or third-party consultant's use of the information is subject to the direction of the Director;
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(3) require prompt notice to be given to a company
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| whose confidential information in the possession of the NAIC or third-party consultant pursuant to this Article is subject to a request or subpoena for disclosure or production;
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(4) require the NAIC and its affiliates and
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| subsidiaries or third-party consultants to consent to intervention by a company in any judicial or administrative action in which the NAIC and its affiliates and subsidiaries or third-party consultants may be required to disclose confidential information about the company shared with the NAIC and its affiliates and subsidiaries or third-party consultants pursuant to this Article; and
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(5) excluding documents, material, or information
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| reported pursuant to subsection (c) of Section 131.14b, prohibit the NAIC or third-party consultant from storing the information shared pursuant to this Code in a permanent database after the underlying analysis is completed.
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(d) The sharing of documents, materials, or information by the Director pursuant to this Article shall not constitute a delegation of regulatory authority or rulemaking, and the Director is solely responsible for the administration, execution, and enforcement of the provisions of this Article.
(e) No waiver of any applicable privilege or claim of confidentiality in the documents, materials, or information shall occur as a result of disclosure to the Director under this Section or as a result of sharing as authorized in subsection (c) of this Section.
(f) Documents, materials, or other information in the possession or control of the NAIC or third-party consultant pursuant to this Article shall be confidential by law and privileged, shall not be subject to the Illinois Freedom of Information Act, shall not be subject to subpoena, and shall not be subject to discovery or admissible in evidence in any private civil action.
(Source: P.A. 102-394, eff. 8-16-21; 102-578, eff. 7-1-22 (See Section 5 of P.A. 102-672 for effective date of P.A. 102-578); 102-813, eff. 5-13-22; 102-929, eff. 5-27-22.)
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(215 ILCS 5/132) (from Ch. 73, par. 744)
Sec. 132.
Market conduct and non-financial examinations.
(1) The Director, for the purposes of ascertaining the
non-financial business practices, performance, and operations of any
company, may make
examinations of:
(a) any company transacting or being organized to |
| transact business in this State;
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(b) any person engaged in or proposing to be engaged
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| in the organization, promotion, or solicitation of shares or capital contributions to or aiding in the formation of a company;
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(c) any person having a contract, written or oral,
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| pertaining to the management or control of a company as general agent, managing agent, or attorney-in-fact;
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(d) any licensed or registered producer, firm, or
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| administrator, or any person, organization, or corporation making application for any licenses or registration;
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(e) any person engaged in the business of adjusting
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| losses or financing premiums; or
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(f) any person, organization, trust, or corporation
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| having custody or control of information reasonably related to the operation, performance, or conduct of a company or person subject to the jurisdiction of the Director.
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(2) Every company or person being examined and its officers, directors,
and agents must provide to the Director convenient and free access at
all reasonable hours at its office or location to all books, records,
documents, and any or all papers relating to the
business, performance, operations, and affairs of the company. The
officers, directors, and
agents of the company or person must facilitate the examination and aid
in the examination so far as it is in their power to do so.
The Director and any authorized examiner have the power to administer
oaths and examine under oath
any person relative to the business of the company being examined.
(3) The examiners designated by the Director under Section 402 must
make a full and true report of every examination made by them, which
contains only facts ascertained from the books, papers, records, or documents,
and other evidence obtained by investigation
and examined by them or ascertained from the testimony of officers or
agents or other persons examined under oath concerning the business,
affairs, conduct, and performance of the
company or person. The report of
examination must be verified by the oath of the examiner in charge
thereof, and when so verified is prima facie evidence in any action or
proceeding in the
name of the State against the company, its officers, or agents upon the
facts stated therein.
(4) The Director must notify the company or person made the subject of
any examination hereunder of the
contents of the verified examination report before filing it and making the
report public of any matters relating thereto, and must afford the
company or person an opportunity to demand a hearing with reference to
the facts and other evidence therein contained.
The company or person may request a hearing within 10 days after
receipt of the examination report by giving the Director written notice
of that request, together with a statement of its objections. The
Director must then conduct a hearing in accordance with Sections 402 and
403. He must issue a written order based upon the examination report and
upon the hearing within 90 days after the report is filed or within 90
days after the hearing.
If the examination reveals that the company is operating in violation
of any law, regulation, or prior order, the Director in the written
order may require the company or person to take any action he considers
necessary or appropriate in accordance with the report of examination
or any hearing thereon. The order is subject to judicial review under
the Administrative Review Law.
The Director may withhold any report from public
inspection for such time as he may deem proper and may, after filing the
same, publish any part or all of the report as he considers to be in the
interest of the public, in one or more newspapers in this State, without
expense to the company.
(5) Any company which or person who violates or aids and abets any
violation of a written order issued under this Section shall be guilty
of a business offense and may be fined not more than $5,000. The penalty
shall be paid into the General Revenue fund of the State of Illinois.
(Source: P.A. 87-108.)
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(215 ILCS 5/136) (from Ch. 73, par. 748)
Sec. 136. Annual statement.
(1) Every company authorized to do business in this State or accredited by
this State shall submit to the Director by March 1st in each year
its financial statement for the year ending December 31st immediately preceding in such manner and in such form as
prescribed by the Director, which shall conform substantially to the
form of statement adopted by the National Association of Insurance
Commissioners. Unless the Director provides otherwise, the annual statement is
to be prepared in accordance with the annual statement instructions and the
Accounting Practices and Procedures Manual adopted by the National Association
of Insurance Commissioners. The Director shall have power to make such
modifications and additions in this form as he may deem desirable
or necessary to ascertain the condition and affairs of the company. The
Director shall have authority to extend the time for filing any statement by
any company for reasons which he considers good and sufficient. In every
statement the admitted assets shall be shown at the actual values as of the
last day of the preceding year, in accordance with Section 126.7.
The statement
shall be verified by oaths of the president and secretary of the company or, in
their absence, by 2 other principal officers. In addition, any company may be
required by the Director, when he considers that action to be necessary and
appropriate for the protection of policyholders, creditors, shareholders, or
claimants, to file, within 60 days after mailing to the company a notice that
such is required, a supplemental summary statement as of the last day of any
calendar month occurring during the 100 days next preceding the mailing of such
notice designated by him on forms prescribed and furnished by the Director. The
Director may require supplemental summary statements to be certified by an
independent actuary deemed competent by the Director or by an independent
certified public accountant.
(2) The statement of an alien company shall embrace only its
condition and transactions in the United States and shall be verified by
the oaths of its resident manager or principal representative in the
United States, except that in the case of any life company organized
under the laws of Canada or any province thereof, the statement may be
verified by the oaths of any of its principal officers designated for
that purpose by its board of directors.
(3) For the information of the public generally the Director shall
cause an abstract of the information contained in the annual statement
to be made available to the public as soon as practicable after filing
with the Department, by printing those abstracts in pamphlet tabular form
for free general distribution by the Department, or by such other
publication in the city of Springfield or in the city of Chicago as may
be reasonably necessary more fully to inform the public of the financial
condition of companies transacting business in this State.
(4) Each domestic, foreign, and alien insurer authorized to
do business in this State or accredited by this State shall participate
in the National Association of Insurance Commissioners' Insurance Regulatory
Information System, including the payment of all fees and charges of the
system. Each company shall, on or before March 1 of each year, file with the
National Association of Insurance Commissioners a copy of its annual financial
statement along with any additional filings prescribed by the Director for the
preceding year. The statement filed with the National Association of Insurance
Commissioners shall be in the same format and scope as that required by this
Code and shall include a signed jurat page and actuarial certification. Any
amendments and addendums to the annual statement shall also be filed with the
National Association of Insurance Commissioners. Each company shall also file
with the National Association of Insurance Commissioners annual and quarterly
financial statement information in computer readable format as required by the
Insurance Regulatory Information System.
Failure of a company to file financial statement information in computer
readable format shall subject the company to the provisions of Section 139.
(5) All financial analysis ratios and examination synopsis concerning
insurance companies that are submitted to the Director by the National
Association of Insurance Commissioners' Insurance Regulatory Information
System are confidential and may not be disclosed by the Director.
(6) Every property and casualty insurance company doing business in this State, unless otherwise exempted by the Director, shall annually submit the opinion of an appointed actuary entitled "Statement of Actuarial Opinion". This opinion shall be filed in accordance with the appropriate National Association of Insurance Commissioners Property and Casualty Annual Statement Instructions. (a) Every property and casualty insurance company |
| domiciled in this State that is required to submit a Statement of Actuarial Opinion shall annually submit an Actuarial Opinion Summary, written by the company's appointed actuary. This Actuarial Opinion Summary shall be filed in accordance with the appropriate National Association of Insurance Commissioners Property and Casualty Annual Statement Instructions and shall be considered as a document supporting the Actuarial Opinion required in this subsection (6). Each foreign and alien property and casualty company authorized to do business in this State shall provide the Actuarial Opinion Summary upon request.
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(b) An Actuarial Report and underlying workpapers as
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| required by the appropriate National Association of Insurance Commissioners Property and Casualty Annual Statement Instructions shall be prepared to support each Actuarial Opinion. If the insurance company fails to provide a supporting Actuarial Report or workpapers at the request of the Director or the Director determines that the supporting Actuarial Report or workpapers provided by the insurance company is otherwise unacceptable to the Director, the Director may engage a qualified actuary at the expense of the company to review the opinion and the basis for the opinion and prepare the supporting Actuarial Report or workpapers.
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(c) The appointed actuary shall not be liable for
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| damages to any person (other than the insurance company and the Director) for any act, error, omission, decision, or conduct with respect to the actuary's opinion, except in cases of fraud or willful misconduct on the part of the appointed actuary.
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(d) The Statement of Actuarial Opinion shall be
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| provided with the Annual Statement in accordance with the appropriate National Association of Insurance Commissioners Property and Casualty Annual Statement Instructions and shall be treated as a public document. Documents, materials, or other information in the possession or control of the Director that are considered an Actuarial Report, workpapers, or Actuarial Opinion Summary provided in support of the opinion, and any other material provided by the company to the Director in connection with the Actuarial Report, workpapers or Actuarial Opinion Summary, must be given confidential treatment, are not subject to subpoena, and may not be made public by the Director or any other persons. This paragraph (d) shall not be construed to limit the Director's authority to release the documents to the Actuarial Board for Counseling and Discipline (ABCD), so long as the material is required for the purpose of professional disciplinary proceedings and that the ABCD establishes procedures satisfactory to the Director for preserving the confidentiality of the documents, nor shall this paragraph (d) be construed to limit the Director's authority to use the documents, materials or other information in furtherance of any regulatory or legal action brought as part of the Director's official duties. Neither the Director nor any person who received documents, materials, or other information while acting under the authority of the Director shall be permitted or required to testify in any private civil action concerning any confidential documents, materials, or information subject to this subsection (6). Except where another provision of this Code expressly prohibits a disclosure of confidential information to the specific officials or organizations described in this subsection, the Director may:
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(i) share documents, materials, or other
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| information, including the confidential and privileged documents, materials or information subject to this paragraph (d) with the insurance department of any other state or country or with law enforcement officials of this or any other state or agency of the federal government at any time, as long as the agency or office receiving the document, material, or other information agrees in writing to hold it confidential and in a manner consistent with this Code;
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(ii) receive documents, materials, or
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| information, including otherwise confidential and privileged documents, materials, or information, from the National Association of Insurance Commissioners and its affiliates and subsidiaries, and from regulatory and law enforcement officials of other foreign or domestic jurisdictions, and shall maintain as confidential or privileged any document, material, or information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material, or information; and
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(iii) enter into agreements governing sharing and
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| use of information consistent with paragraph (d).
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(e) No waiver of any applicable privilege or claim of
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| confidentiality in the documents, materials or information shall occur as a result of disclosure to the Director under this Section or as a result of sharing as authorized in subparagraphs (i), (ii), and (iii) of paragraph (d) of subsection (6) of this Section. All 2008 Annual Statements, which are filed in 2009, and all subsequent Annual Statement filings shall be done in accordance with subsection (6) of this Section.
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(Source: P.A. 96-145, eff. 8-7-09; 97-486, eff. 1-1-12.)
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(215 ILCS 5/141a) (from Ch. 73, par. 753a)
Sec. 141a.
Managing general agents and retrospective compensation
agreements.
(a) As used in this Section, the following terms have the following
meanings:
"Actuary" means a person who is a member in good standing of the American
Academy of Actuaries.
"Gross direct written premium" means direct premium including policy and
membership fees, net of returns and cancellations, and prior to any cessions.
"Insurer" means any person duly licensed in this State as an insurance
company pursuant to Articles II, III, III 1/2, IV, V, VI, and
XVII of this Code.
"Managing general agent" means any person, firm, association, or
corporation, either separately or together with affiliates, that:
(1) manages all or part of the insurance business of |
| an insurer (including the management of a separate division, department, or underwriting office), and
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(2) acts as an agent for the insurer whether known as
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| a managing general agent, manager, or other similar term, and
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(3) with or without the authority produces, directly
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| or indirectly, and underwrites:
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(A) within any one calendar quarter, an amount of
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| gross direct written premium equal to or more than 5% of the policyholders' surplus as reported in the insurer's last annual statement, or
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(B) within any one calendar year, an amount of
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| gross direct written premium equal to or more than 8% of the policyholders' surplus as reported in the insurer's last annual statement, and either
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(4) has the authority to bind the company in
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| settlement of individual claims in amounts in excess of $500, or
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(5) has the authority to negotiate reinsurance on
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Notwithstanding the provisions of items (1) through (5), the following
persons shall not be considered to be managing general agents for the
purposes of this Code:
(1) An employee of the insurer;
(2) A U.S. manager of the United States branch of an
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(3) An underwriting manager who, pursuant to a
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| contract meeting the standards of Section 141.1 manages all or part of the insurance operations of the insurer, is affiliated with the insurer, subject to Article VIII 1/2, and whose compensation is not based on the volume of premiums written;
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(4) The attorney or the attorney in fact authorized
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| and acting for or on behalf of the subscriber policyholders of a reciprocal or inter-insurance exchange, under the terms of the subscription agreement, power of attorney, or policy of insurance or the attorney in fact for any Lloyds organization licensed in this State.
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"Retrospective compensation
agreement" means any arrangement, agreement, or contract having as its
purpose the actual or constructive retention by the insurer of a fixed
proportion of the gross premiums, with the balance of the premiums,
retained actually or constructively by the agent or the producer of the
business, who assumes to pay therefrom all losses, all subordinate
commission, loss adjustment expenses, and his profit, if any, with other
provisions of the arrangement, agreement, or contract being auxiliary or
incidental to that purpose.
"Underwrite" means to accept or reject risk on behalf of the insurer.
(b) Licensure of managing general agents.
(1) No person, firm, association, or corporation
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| shall act in the capacity of a managing general agent with respect to risks located in this State for an insurer licensed in this State unless the person is a licensed producer or a registered firm in this State under Article XXXI of this Code or a licensed third party administrator in this State under Article XXXI 1/4 of this Code.
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(2) No person, firm, association, or corporation
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| shall act in the capacity of a managing general agent with respect to risks located outside this State for an insurer domiciled in this State unless the person is a licensed producer or a registered firm in this State under Article XXXI of this Code or a licensed third party administrator in this State under Article XXXI 1/4 of this Code.
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(3) The managing general agent must provide a surety
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| bond for the benefit of the insurer in an amount equal to the greater of $100,000 or 5% of the gross direct written premium underwritten by the managing general agent on behalf of the insurer. The bond shall provide for a discovery period and prior notification of cancellation in accordance with the rules of the Department unless otherwise approved in writing by the Director.
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(4) The managing general agent must maintain an
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| errors and omissions policy for the benefit of the insurer with coverage in an amount equal to the greater of $1,000,000 or 5% of the gross direct written premium underwritten by the managing general agent on behalf of the insurer.
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(5) Evidence of the existence of the bond and the
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| errors and omissions policy must be made available to the Director upon his request.
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(c) No person, firm, association, or corporation acting in the capacity
of a managing general agent shall place business with an insurer unless
there is in force a written contract between the parties that sets forth
the responsibilities of each party, that, if both parties share
responsibility for a particular function, specifies the division of
responsibility, and that contains the following minimum provisions:
(1) The insurer may terminate the contract for cause
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| upon written notice to the managing general agent. The insurer may suspend the underwriting authority of the managing general agent during the pendency of any dispute regarding the cause for termination.
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(2) The managing general agent shall render accounts
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| to the insurer detailing all transactions and remit all funds due under the contract to the insurer on not less than a monthly basis.
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(3) All funds collected for the account of an insurer
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| shall be held by the managing general agent in a fiduciary capacity in a bank that is a federally or State chartered bank and that is a member of the Federal Deposit Insurance Corporation. This account shall be used for all payments on behalf of the insurer; however, the managing general agent shall not have authority to draw on any other accounts of the insurer. The managing general agent may retain no more than 3 months estimated claims payments and allocated loss adjustment expenses.
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(4) Separate records of business written by the
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| managing general agent will be maintained. The insurer shall have access to and the right to copy all accounts and records related to its business in a form usable by the insurer, and the Director shall have access to all books, bank accounts, and records of the managing general agent in a form usable to the Director.
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(5) The contract may not be assigned in whole or part
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| by the managing general agent.
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(6) The managing general agent shall provide to the
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| company audited financial statements required under paragraph (1) of subsection (d).
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(7) That appropriate underwriting guidelines be
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| followed, which guidelines shall stipulate the following:
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(A) the maximum annual premium volume;
(B) the basis of the rates to be charged;
(C) the types of risks that may be written;
(D) maximum limits of liability;
(E) applicable exclusions;
(F) territorial limitations;
(G) policy cancellation provisions; and
(H) the maximum policy period.
(8) The insurer shall have the right to: (i) cancel
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| or nonrenew any policy of insurance subject to applicable laws and regulations concerning those actions; and (ii) require cancellation of any subproducer's contract after appropriate notice.
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(9) If the contract permits the managing general
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| agent to settle claims on behalf of the insurer:
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(A) all claims must be reported to the company in
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(B) a copy of the claim file must be sent to the
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| insurer at its request or as soon as it becomes known that the claim:
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(i) has the potential to exceed an amount
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| determined by the company;
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(ii) involves a coverage dispute;
(iii) may exceed the managing general agent's
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| claims settlement authority;
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(iv) is open for more than 6 months; or
(v) is closed by payment of an amount set by
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(C) all claim files will be the joint property of
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| the insurer and the managing general agent. However, upon an order of liquidation of the insurer, the files shall become the sole property of the insurer or its estate; the managing general agent shall have reasonable access to and the right to copy the files on a timely basis.
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(D) any settlement authority granted to the
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| managing general agent may be terminated for cause upon the insurer's written notice to the managing general agent or upon the termination of the contract. The insurer may suspend the settlement authority during the pendency of any dispute regarding the cause for termination.
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(10) Where electronic claims files are in existence,
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| the contract must address the timely transmission of the data.
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(11) If the contract provides for a sharing of
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| interim profits by the managing general agent and the managing general agent has the authority to determine the amount of the interim profits by establishing loss reserves, controlling claim payments, or by any other manner, interim profits will not be paid to the managing general agent until one year after they are earned for property insurance business and until 5 years after they are earned on casualty business and in either case, not until the profits have been verified.
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(12) The managing general agent shall not:
(A) Bind reinsurance or retrocessions on behalf
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| of the insurer, except that the managing general agent may bind facultative reinsurance contracts under obligatory facultative agreements if the contract with the insurer contains reinsurance underwriting guidelines including, for both reinsurance assumed and ceded, a list of reinsurers with which automatic agreements are in effect, the coverages and amounts or percentages that may be reinsured, and commission schedules.
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(B) Appoint any producer without assuring that
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| the producer is lawfully licensed to transact the type of insurance for which he is appointed.
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(C) Without prior approval of the insurer, pay or
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| commit the insurer to pay a claim over a specified amount, net of reinsurance, that shall not exceed 1% of the insurer's policyholders' surplus as of December 31 of the last completed calendar year.
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(D) Collect any payment from a reinsurer or
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| commit the insurer to any claim settlement with a reinsurer without prior approval of the insurer. If prior approval is given, a report must be promptly forwarded to the insurer.
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(E) Permit its subproducer to serve on its board
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(F) Employ an individual who is also employed by
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(13) The contract may not be written for a term of
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(d) Insurers shall have the following duties:
(1) The insurer shall have on file the managing
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| general agent's audited financial statements as of the end of the most recent fiscal year prepared in accordance with Generally Accepted Accounting Principles. The insurer shall notify the Director if the auditor's opinion on those statements is other than an unqualified opinion. That notice shall be given to the Director within 10 days of receiving the audited financial statements or becoming aware that such opinion has been given.
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(2) If a managing general agent establishes loss
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| reserves, the insurer shall annually obtain the opinion of an actuary attesting to the adequacy of loss reserves established for losses incurred and outstanding on business produced by the managing general agent, in addition to any other required loss reserve certification.
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(3) The insurer shall periodically (at least
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| semiannually) conduct an on-site review of the underwriting and claims processing operations of the managing general agent.
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(4) Binding authority for all reinsurance contracts
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| or participation in insurance or reinsurance syndicates shall rest with an officer of the insurer, who shall not be affiliated with the managing general agent.
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(5) Within 30 days of entering into or terminating a
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| contract with a managing general agent, the insurer shall provide written notification of the appointment or termination to the Director. Notices of appointment of a managing general agent shall include a statement of duties that the applicant is expected to perform on behalf of the insurer, the lines of insurance for which the applicant is to be authorized to act, and any other information the Director may request.
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(6) An insurer shall review its books and records
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| each quarter to determine if any producer has become a managing general agent. If the insurer determines that a producer has become a managing general agent, the insurer shall promptly notify the producer and the Director of that determination, and the insurer and producer must fully comply with the provisions of this Section within 30 days of the notification.
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(7) The insurer shall file any managing general agent
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| contract for the Director's approval within 45 days after the contract becomes subject to this Section. Failure of the Director to disapprove the contract within 45 days shall constitute approval thereof. Upon expiration of the contract, the insurer shall submit the replacement contract for approval. Contracts filed under this Section shall be exempt from filing under Sections 141, 141.1 and 131.20a.
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|
(8) An insurer shall not appoint to its board of
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| directors an officer, director, employee, or controlling shareholder of its managing general agents. This provision shall not apply to relationships governed by Article VIII 1/2 of this Code.
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|
(e) The acts of a managing general agent are considered to be the acts
of the insurer on whose behalf it is acting. A managing general agent may
be examined in the same manner as an insurer.
(f) Retrospective compensation agreements for business written under
Section 4 of this Code in Illinois and outside of Illinois by an insurer
domiciled in this State must be filed for approval.
The standards for approval shall be as set forth under Section 141
of this Code.
(g) Unless specifically required by the Director, the provisions of this
Section shall not apply to arrangements between a managing general agent not
underwriting any risks located in Illinois and a foreign insurer domiciled in
an NAIC accredited state that has adopted legislation substantially similar to
the NAIC Managing General Agents Model Act. "NAIC accredited state" means a
state or territory of the United States having an insurance regulatory agency
that maintains an accredited status granted by the National Association of
Insurance Commissioners.
(h) If the Director determines that a managing general agent
has not materially complied with this Section or any regulation or
order promulgated hereunder, after notice and opportunity to be heard, the
Director may order a penalty in an amount not exceeding $100,000 for each
separate violation and may order the revocation or suspension of the producer's
license. If it is found that because of the material noncompliance the
insurer
has suffered any loss or damage, the Director may maintain a civil action
brought by or on behalf of the insurer and its policyholders and creditors for
recovery of compensatory damages for the benefit of the insurer and its
policyholders
and creditors or other appropriate relief. This subsection (h) shall not be
construed to prevent any other person from taking civil action against a
managing general agent.
(i) If an Order of Rehabilitation or Liquidation is entered
under Article XIII and
the receiver appointed under that Order determines that the managing general
agent or any other person has not materially complied with this Section or any
regulation or Order promulgated hereunder and the insurer suffered any loss
or damage therefrom, the receiver may maintain a civil action for recovery of
damages or other appropriate sanctions for the benefit of the insurer.
Any decision, determination, or order of the Director under this
subsection shall be subject to judicial review under the Administrative
Review Law.
Nothing contained in this subsection shall affect the right of the
Director to impose any other penalties provided for in this Code.
Nothing contained in this subsection is intended to or shall in any
manner limit or restrict the rights of policyholders, claimants, and auditors.
(j) A domestic company shall not during any calendar year write,
through a managing general agent or managing general agents, premiums in an
amount equal to or greater than its capital and surplus as of the preceding
December 31st unless the domestic company requests in writing the Director's
permission to do so and the Director has either approved the request or has
not disapproved the request within 45 days after the Director received the
request.
No domestic company with less than $5,000,000 of capital and surplus may
write any business through a managing general agent unless the domestic company
requests in writing the Director's permission to do so and the Director has
either approved the request or has not disapproved the request within 45 days
after the Director received the request.
(Source: P.A. 93-32, eff. 7-1-03 .)
|
(215 ILCS 5/141.4)
Sec. 141.4.
Disclosure of material transactions.
(a) An insurer domiciled in this State shall file a report with the Director
disclosing material acquisitions and dispositions of assets or material
nonrenewals, cancellations, or revisions of ceded reinsurance agreements unless
the acquisitions and dispositions of assets or the material nonrenewals,
cancellations, or revisions of ceded reinsurance agreements have been otherwise
submitted to the Director for review, approval, or information purposes. The
report must be filed no later than 15 days after the end of the calendar month
in which a reportable transaction occurs. A copy of the report, including any
exhibits or other attachments filed as a part of the report, shall be filed
with the National Association of Insurance Commissioners. All reports
obtained by or disclosed to the Director under this Section shall be given
confidential treatment and shall not be subject to subpoena and shall not be
made public by the Director, the National Association of Insurance
Commissioners, or any other person, except to insurance departments of other
states, without the prior written consent of the insurer to which it pertains
unless the Director, after giving the insurer who would be affected notice and
an opportunity to be heard,
determines that the interests of policyholders, shareholders, or the public
will be served by publication, in which event the Director may publish all or
any part in the manner the Director may deem appropriate.
(b) Asset acquisitions or dispositions that are not material do not have to
be reported under this Section. For purposes of this Section, a material
acquisition (or the aggregate of any series of related acquisitions during any
30 day
period) or disposition (or the aggregate of any series
of related dispositions during any 30 day period) is one that is nonrecurring
and not in the ordinary course of business and involves
more than 5% of
the reporting insurer's total admitted assets as reported in its most recent
statutory financial statement filed with the Director. Asset acquisitions
subject to this Section include, but are not limited to,
every purchase, lease, exchange, merger,
consolidation, succession, or other acquisition other than the construction or
development of real property by or for the reporting insurer or the acquisition
of materials for that purpose. Asset dispositions subject to this Section
include, but are not limited to,
every sale, lease, exchange, merger, consolidation, mortgage,
hypothecation, assignment (whether for the benefit of creditors or otherwise),
abandonment, destruction, or other disposition. All of the following
information shall be disclosed in the report of a material acquisition or
disposition of assets:
(1) Date of the transaction.
(2) Manner of acquisition or disposition.
(3) Description of the assets involved.
(4) Nature and amount of the consideration received |
|
(5) Purpose of, or reason for, the transaction.
(6) Manner by which the amount of consideration was
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|
(7) Gain or loss recognized or realized as a result
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|
(8) Name of the person from whom the assets were
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| acquired or to whom they were disposed.
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|
Insurers shall report acquisitions and dispositions on a nonconsolidated
basis
unless the insurer is part of a consolidated group of insurers that utilizes a
pooling arrangement or a 100% reinsurance
agreement that affects the solvency and integrity of the insurer's reserves
and the insurer ceded substantially all of its direct and assumed business to
the
pool. An insurer is deemed to have
ceded substantially all of its direct and assumed business to a pool if the
insurer has less than $1,000,000 total direct plus assumed written premiums
during a calendar year that are not subject to a pooling
arrangement and the net income of the business not subject to the pooling
arrangement represents less than 5% of the insurer's capital and
surplus.
(c) Ceded reinsurance agreement nonrenewals, cancellations, or revisions
that are not material do not have to be reported under this Section. For
purposes of this Section, a material nonrenewal, cancellation, or revision is
one that affects:
(1) For property and casualty business, including
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| accident and health business written by a property and casualty insurer:
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|
(A) more than 50% of the insurer's total ceded
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|
(B) more than 50% of the insurer's total ceded
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| indemnity and loss adjustment reserves.
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|
(2) For life, annuity, and accident and health
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| business: more than 50% of the total reserve credit taken for business ceded, on an annual basis, as indicated in the insurer's most recent annual statement.
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|
(3) Property and casualty or life, annuity, and
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| accident and health business:
|
|
(A) an authorized reinsurer representing more
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| than 10% of total cession is replaced by one or more unauthorized reinsurers; or
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|
(B) previously established collateral
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| requirements have been reduced or waived as respects one or more unauthorized reinsurer representing collectively more than 10% of a total cession.
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|
With respect to property and casualty business, including accident and health
business written by a property and casualty insurer, no filing shall be
required if the insurer's total ceded written premium represents, on an
annualized basis, less than 10% of its total written premium for direct and
assumed business. With respect to life, annuity, and accident and health
business, no filing shall be required if the total reserve credit taken for
business ceded represents, on an annualized basis, less than 10% of the
statutory reserve requirement prior to any cession.
All of the following information shall be disclosed in the report of a
material nonrenewal, cancellation, or revision of ceded reinsurance agreements:
(1) Effective date of the nonrenewal, cancellation or
|
|
(2) The description of the transaction with an
|
| identification of the initiator thereof.
|
|
(3) Purpose of, or reason for, the transaction.
(4) The identity of the replacement insurers, if
|
|
Insurers shall report all material nonrenewals, cancellations, or revisions
of ceded reinsurance agreements on a nonconsolidated basis unless the insurer
is
part of a
consolidated group of insurers that utilizes a pooling arrangement or 100%
reinsurance agreement that affects the solvency and integrity of the
insurer's reserves and the insurer ceded substantially all of its direct and
assumed business to the pool. An insurer is deemed to have ceded substantially
all
of its direct and
assumed business to a pool if the insurer has less than $1,000,000 of total
direct plus assumed written premiums during a calendar year that are not
subject to the pooling arrangement and the net income of the
business not subject to the pooling arrangement represents less
than 5% of the insurer's capital and surplus.
(Source: P.A. 89-97, eff. 7-7-95.)
|
(215 ILCS 5/143) (from Ch. 73, par. 755)
Sec. 143. Policy forms.
(1) Life, accident and health. No company
transacting the kind or kinds of business enumerated in Classes 1 (a), 1
(b) and 2 (a) of Section 4 shall issue or deliver in this State a policy
or certificate of insurance or evidence of coverage, attach an
endorsement or rider thereto,
incorporate by reference bylaws or other matter therein or use an
application blank in this State until the form and content of such
policy, certificate, evidence of coverage, endorsement, rider, bylaw or
other matter
incorporated by reference or application blank has been filed electronically
with the Director, either through the System for Electronic Rate and Form Filing (SERFF) or as otherwise prescribed by the Director, and
approved by the Director. Any such endorsement or rider
that unilaterally reduces benefits and is to be attached to a
policy subsequent to the date the policy is
issued must be filed with, reviewed, and formally approved by the
Director prior to the date it is attached to a policy issued or
delivered in this State. It shall be the duty of the Director to disapprove or withdraw
any such policy, certificate, endorsement, rider,
bylaw or other matter incorporated by reference or application blank
filed if it contains deficiencies, provisions which encourage
misrepresentation or are unjust, unfair, inequitable, ambiguous,
misleading, inconsistent, deceptive, contrary to law or to the public
policy of this State, or contains exceptions and conditions that
unreasonably or deceptively affect the risk purported to be assumed in
the general coverage of the policy. In all cases the Director shall
approve, withdraw, or disapprove any such form within 60 days after submission
unless the Director extends by not more than an additional 30 days the
period within which the form shall be approved, withdrawn, or disapproved by
giving written notice to the insurer of such extension before expiration
of the initial 60 days period. The Director shall withdraw approval
of a policy, certificate, evidence of coverage, endorsement, rider,
bylaw, or other matter incorporated
by reference or application blank if it is subsequently determined that such
policy, certificate, evidence of coverage, endorsement, rider, bylaw,
other matter, or application
blank is misrepresentative, unjust, unfair, inequitable, ambiguous, misleading,
inconsistent, deceptive, contrary to law or public policy of this State,
or contains exceptions or conditions which unreasonably or deceptively affect
the risk purported to be assumed in the general coverage of the policy or
evidence of coverage.
If a previously approved policy, certificate, evidence of
coverage, endorsement, rider, bylaw
or other matter incorporated by reference or application blank is withdrawn
for use, the Director shall serve upon the company an order of withdrawal
of use, either personally or by mail, and if by mail, such service shall
be completed if such notice be deposited in the post office, postage prepaid,
addressed to the company's last known address specified in the records
of the Department of Insurance. The order of withdrawal of use shall take
effect 30 days from the date of mailing but shall be stayed if within the
30-day period a written request for hearing is filed with the Director.
Such hearing shall be held at such time and place as designated in the order
given by the Director. The hearing may be held either in the City of Springfield,
the City of Chicago or in the county where the principal business address
of the company is located.
The action of the Director in
disapproving or withdrawing such form shall be subject to judicial review under
the
Administrative Review Law.
This subsection shall not apply to riders or endorsements issued or
made at the request of the individual policyholder relating to the
manner of distribution of benefits or to the reservation of rights and
benefits under his life insurance policy.
(2) Casualty, fire, and marine. The Director shall require the
filing of all policy forms issued or delivered by any company transacting
the kind or
kinds of business enumerated in Classes 2 (except Class 2 (a)) and 3 of
Section 4 in an electronic format either through the System for Electronic Rate and Form Filing (SERFF) or as otherwise prescribed and approved by the Director. In addition, he may require the filing of any
generally used riders, endorsements, certificates, application blanks, and
other matter
incorporated by reference in any such policy or contract of insurance.
Companies that are members of an organization, bureau, or association may
have the same filed for them by the organization, bureau, or association. If
the Director shall find from an examination of any such policy form,
rider, endorsement, certificate, application blank, or other matter
incorporated by
reference in any such policy so filed that it (i) violates any provision of
this Code, (ii) contains inconsistent, ambiguous, or misleading clauses, or
(iii) contains exceptions and conditions that will unreasonably or deceptively
affect the risks that are purported to be assumed by the policy, he
shall order the company or companies issuing these forms to discontinue
their use. Nothing in this subsection shall require a company
transacting the kind or kinds of business enumerated in Classes 2
(except Class 2 (a)) and 3 of Section 4 to obtain approval of these forms
before they are issued nor in any way affect the legality of any
policy that has been issued and found to be in conflict with this
subsection, but such policies shall be subject to the provisions of
Section 442.
(3) This Section shall not apply (i) to surety contracts or fidelity
bonds, (ii) to policies issued to an industrial insured as defined in Section
121-2.08 except for workers' compensation policies, nor (iii) to riders
or
endorsements prepared to meet special, unusual,
peculiar, or extraordinary conditions applying to an individual risk.
(Source: P.A. 102-775, eff. 5-13-22.)
|
(215 ILCS 5/143.19) (from Ch. 73, par. 755.19) Sec. 143.19. Cancellation of automobile insurance policy; grounds. After a policy of automobile insurance as defined in Section 143.13(a) has been effective for 60 days, or if such policy is a renewal policy, the insurer shall not exercise its option to cancel such policy except for one or more of the following reasons: a. Nonpayment of premium; b. The policy was obtained through a material |
|
c. Any insured violated any of the terms and
|
| conditions of the policy;
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|
d. The named insured failed to disclose fully his
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| motor vehicle crashes and moving traffic violations for the preceding 36 months if called for in the application;
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|
e. Any insured made a false or fraudulent claim or
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| knowingly aided or abetted another in the presentation of such a claim;
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|
f. The named insured or any other operator who either
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| resides in the same household or customarily operates an automobile insured under such policy:
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|
1. has, within the 12 months prior to the notice
|
| of cancellation, had his driver's license under suspension or revocation;
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|
2. is or becomes subject to epilepsy or heart
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| attacks, and such individual does not produce a certificate from a physician testifying to his unqualified ability to operate a motor vehicle safely;
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|
3. has a crash record, conviction record
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| (criminal or traffic), physical, or mental condition which is such that his operation of an automobile might endanger the public safety;
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|
4. has, within the 36 months prior to the notice
|
| of cancellation, been addicted to the use of narcotics or other drugs; or
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|
5. has been convicted, or had pretrial release
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| revoked, during the 36 months immediately preceding the notice of cancellation, for any felony, criminal negligence resulting in death, homicide or assault arising out of the operation of a motor vehicle, operating a motor vehicle while in an intoxicated condition or while under the influence of drugs, being intoxicated while in, or about, an automobile or while having custody of an automobile, leaving the scene of a crash without stopping to report, theft or unlawful taking of a motor vehicle, making false statements in an application for an operator's or chauffeur's license or has been convicted or pretrial release has been revoked for 3 or more violations within the 12 months immediately preceding the notice of cancellation, of any law, ordinance, or regulation limiting the speed of motor vehicles or any of the provisions of the motor vehicle laws of any state, violation of which constitutes a misdemeanor, whether or not the violations were repetitions of the same offense or different offenses;
|
|
g. The insured automobile is:
1. so mechanically defective that its operation
|
| might endanger public safety;
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|
2. used in carrying passengers for hire or
|
| compensation (the use of an automobile for a car pool shall not be considered use of an automobile for hire or compensation);
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|
3. used in the business of transportation of
|
| flammables or explosives;
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|
4. an authorized emergency vehicle;
5. changed in shape or condition during the
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| policy period so as to increase the risk substantially; or
|
|
6. subject to an inspection law and has not been
|
| inspected or, if inspected, has failed to qualify.
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|
Nothing in this Section shall apply to nonrenewal.
(Source: P.A. 101-652, eff. 1-1-23; 102-982, eff. 7-1-23; 102-1104, eff. 1-1-23 .)
|
(215 ILCS 5/143.19.1) (from Ch. 73, par. 755.19.1)
Sec. 143.19.1. Limits on exercise of right of nonrenewal. After a
policy of automobile insurance, as defined in
Section 143.13, has been effective or renewed for 5 or more years, the
company shall not exercise its right of non-renewal unless:
a. The policy was obtained through a material |
|
b. Any insured violated any of the terms and
|
| conditions of the policy; or
|
|
c. The named insured failed to disclose fully his
|
| motor vehicle crashes and moving traffic violations for the preceding 36 months, if such information is called for in the application; or
|
|
d. Any insured made a false or fraudulent claim or
|
| knowingly aided or abetted another in the presentation of such a claim; or
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|
e. The named insured or any other operator who either
|
| resides in the same household or customarily operates an automobile insured under such a policy:
|
|
1. Has, within the 12 months prior to the notice
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| of non-renewal had his drivers license under suspension or revocation; or
|
|
2. Is or becomes subject to epilepsy or heart
|
| attacks, and such individual does not produce a certificate from a physician testifying to his unqualified ability to operate a motor vehicle safely; or
|
|
3. Has a crash record, conviction record
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| (criminal or traffic), or a physical or mental condition which is such that his operation of an automobile might endanger the public safety; or
|
|
4. Has, within the 36 months prior to the notice
|
| of non-renewal, been addicted to the use of narcotics or other drugs; or
|
|
5. Has been convicted or pretrial release has
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| been revoked, during the 36 months immediately preceding the notice of non-renewal, for any felony, criminal negligence resulting in death, homicide or assault arising out of the operation of a motor vehicle, operating a motor vehicle while in an intoxicated condition or while under the influence of drugs, being intoxicated while in or about an automobile or while having custody of an automobile, leaving the scene of a crash without stopping to report, theft or unlawful taking of a motor vehicle, making false statements in an application for an operators or chauffeurs license, or has been convicted or pretrial release has been revoked for 3 or more violations within the 12 months immediately preceding the notice of non-renewal, of any law, ordinance or regulation limiting the speed of motor vehicles or any of the provisions of the motor vehicle laws of any state, violation of which constitutes a misdemeanor, whether or not the violations were repetitions of the same offense or different offenses; or
|
|
f. The insured automobile is:
1. So mechanically defective that its operation
|
| might endanger public safety; or
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|
2. Used in carrying passengers for hire or
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| compensation (the use of an automobile for a car pool shall not be considered use of an automobile for hire or compensation); or
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|
3. Used in the business of transportation of
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| flammables or explosives; or
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|
4. An authorized emergency vehicle; or
5. Changed in shape or condition during the
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| policy period so as to increase the risk substantially; or
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|
6. Subject to an inspection law and it has not
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| been inspected or, if inspected, has failed to qualify; or
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|
g. The notice of the intention not to renew is mailed
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| to the insured at least 60 days before the date of nonrenewal as provided in Section 143.17.
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|
(Source: P.A. 101-652, eff. 1-1-23; 102-982, eff. 7-1-23 .)
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(215 ILCS 5/143.31)
(Text of Section before amendment by P.A. 103-656 )
Sec. 143.31.
Uniform medical claim and billing forms.
(a) The Director shall prescribe by rule, after consultation with providers
of health care or treatment, insurers, hospital, medical, and dental service
corporations, and other prepayment organizations, insurance claim and billing
forms that the Director determines will provide for uniformity and simplicity
in insurance claims handling. The claim forms shall include, but need not be
limited to, information regarding the medical diagnosis, treatment, and
prognosis of the patient, together with the details of charges incident to the
providing of care, treatment, or services, sufficient for the purpose of
meeting the proof requirements of an insurance policy or a hospital, medical,
or dental service contract.
(b) An insurer or a provider of health care treatment may not refuse to
accept a claim or bill submitted on duly promulgated uniform claim and billing
forms. An insurer, however, may accept claims and bills submitted on any other
form.
(c) Accident and health insurer explanation of benefits paid statements or
claims summary statements sent to an insured by the accident and health insurer
shall be in a format and written in a manner that promotes understanding by
the
insured by setting forth all of the following:
(1) The total dollar amount submitted to the insurer |
|
(2) Any reduction in the amount paid due to the
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| application of any co-payment or deductible, along with an explanation of the amount of the co-payment or deductible applied under the insured's policy.
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|
(3) Any reduction in the amount paid due to the
|
| application of any other policy limitation or exclusion set forth in the insured's policy, along with an explanation thereof.
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|
(4) The total dollar amount paid.
(5) The total dollar amount remaining unpaid.
(d) The Director may issue an order directing an accident and health insurer
to comply with subsection (c).
(e) An accident and health insurer does not violate subsection (c) by using
a document that the accident and health insurer is required to use by the
federal government or the State.
(f) The adoption of uniform claim forms and uniform billing forms by the
Director under this Section does not preclude an insurer, hospital, medical, or
dental service corporation, or other prepayment organization from obtaining any
necessary additional information regarding a claim from the claimant, provider
of health care or treatment, or certifier of coverage, as may be required.
(g) On and after January 1, 1996 when billing insurers or otherwise filing
insurance claims with insurers subject to this Section, providers of health
care or treatment, medical services, dental services, pharmaceutical services,
or medical equipment must use the uniform claim and billing forms adopted by
the Director under this Section.
(Source: P.A. 91-357, eff. 7-29-99.)
(Text of Section after amendment by P.A. 103-656 )
Sec. 143.31. Uniform medical claim and billing forms.
(a) The Director shall prescribe by rule, after consultation with providers of health care or treatment, insurers, hospital, medical, and dental service corporations, and other prepayment organizations, insurance claim and billing forms that the Director determines will provide for uniformity and simplicity in insurance claims handling. The claim forms shall include, but need not be limited to, information regarding the medical diagnosis, treatment, and prognosis of the patient, together with the details of charges incident to the providing of care, treatment, or services, sufficient for the purpose of meeting the proof requirements of an insurance policy or a hospital, medical, or dental service contract.
(b) An insurer or a provider of health care treatment may not refuse to accept a claim or bill submitted on duly promulgated uniform claim and billing forms. An insurer, however, may accept claims and bills submitted on any other form.
(c) After receipt and adjudication or readjudication of any claim or bill with all required documentation from an insured or provider, or a notification under 42 U.S.C. 300gg-136, an accident and health insurer shall send explanation of benefits paid statements or claims summary statements to an insured in a format and written in a manner that promotes understanding by the insured by setting forth all of the following:
(1) The total dollar amount submitted to the insurer
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|
(2) Any reduction in the amount paid due to the
|
| application of any co-payment, coinsurance, or deductible, along with an explanation of the amount of the co-payment, coinsurance, or deductible applied under the insured's policy.
|
|
(3) Any reduction in the amount paid due to the
|
| application of any other policy limitation, penalty, or exclusion set forth in the insured's policy, along with an explanation thereof.
|
|
(4) The total dollar amount paid.
(5) The total dollar amount remaining unpaid.
(6) If applicable under 42 U.S.C. 300gg-111 or 42
|
| U.S.C. 300gg-115, other information required for any explanation of benefits described in either of those Sections.
|
|
(d) The Director may issue an order directing an accident and health insurer to comply with subsection (c).
(e) An accident and health insurer does not violate subsection (c) by using a document that the accident and health insurer is required to use by the federal government or the State.
(f) The adoption of uniform claim forms and uniform billing forms by the Director under this Section does not preclude an insurer, hospital, medical, or dental service corporation, or other prepayment organization from obtaining any necessary additional information regarding a claim from the claimant, provider of health care or treatment, or certifier of coverage, as may be required.
(g) On and after January 1, 1996 when billing insurers or otherwise filing insurance claims with insurers subject to this Section, providers of health care or treatment, medical services, dental services, pharmaceutical services, or medical equipment must use the uniform claim and billing forms adopted by the Director under this Section.
(Source: P.A. 103-656, eff. 1-1-25.)
|
(215 ILCS 5/143.34) Sec. 143.34. Electronic notices and documents. (a) As used in this Section: "Delivered by electronic means" includes: (1) delivery to an electronic mail address at which a |
| party has consented to receive notices or documents; or
|
|
(2) posting on an electronic network or site
|
| accessible via the Internet, mobile application, computer, mobile device, tablet, or any other electronic device, together with separate notice of the posting, which shall be provided by electronic mail to the address at which the party has consented to receive notice or by any other delivery method that has been consented to by the party.
|
|
"Party" means any recipient of any notice or document required as part of an insurance transaction, including, but not limited to, an applicant, an insured, a policyholder, or an annuity contract holder.
(b) Subject to the requirements of this Section, any notice to a party or any other document required under applicable law in an insurance transaction or that is to serve as evidence of insurance coverage may be delivered, stored, and presented by electronic means so long as it meets the requirements of the Uniform Electronic Transactions Act.
(c) Delivery of a notice or document in accordance with this Section shall be considered equivalent to any delivery method required under applicable law, including delivery by first class mail; first class mail, postage prepaid; certified mail; certificate of mail; or certificate of mailing.
(d) A notice or document may be delivered by electronic means by an insurer to a party under this Section if:
(1) the party has affirmatively consented to that
|
| method of delivery and has not withdrawn the consent;
|
|
(2) the party, before giving consent, is provided
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| with a clear and conspicuous statement informing the party of:
|
|
(A) the right of the party to withdraw consent to
|
| have a notice or document delivered by electronic means, at any time, and any conditions or consequences imposed in the event consent is withdrawn;
|
|
(B) the types of notices and documents to which
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| the party's consent would apply;
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|
(C) the right of a party to have a notice or
|
| document delivered in paper form; and
|
|
(D) the procedures a party must follow to
|
| withdraw consent to have a notice or document delivered by electronic means and to update the party's electronic mail address;
|
|
(3) the party:
(A) before giving consent, is provided with a
|
| statement of the hardware and software requirements for access to, and retention of, a notice or document delivered by electronic means; and
|
|
(B) consents electronically, or confirms consent
|
| electronically, in a manner that reasonably demonstrates that the party can access information in the electronic form that will be used for notices or documents delivered by electronic means as to which the party has given consent; and
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|
(4) after consent of the party is given, the insurer,
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| in the event a change in the hardware or software requirements needed to access or retain a notice or document delivered by electronic means creates a material risk that the party will not be able to access or retain a subsequent notice or document to which the consent applies:
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(A) provides the party with a statement that
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(i) the revised hardware and software
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| requirements for access to and retention of a notice or document delivered by electronic means; and
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(ii) the right of the party to withdraw
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| consent without the imposition of any condition or consequence that was not disclosed at the time of initial consent; and
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(B) complies with paragraph (2) of this
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(e) Delivery of a notice or document in accordance with this Section does not affect requirements related to content or timing of any notice or document required under applicable law.
(f) If a provision of this Section or applicable law requiring a notice or document to be provided to a party expressly requires verification or acknowledgment of receipt of the notice or document, the notice or document may be delivered by electronic means only if the method used provides for verification or acknowledgment of receipt.
(g) The legal effectiveness, validity, or enforceability of any contract or policy of insurance executed by a party may not be denied solely because of the failure to obtain electronic consent or confirmation of consent of the party in accordance with subparagraph (B) of paragraph (3) of subsection (d) of this Section.
(h) A withdrawal of consent by a party does not affect the legal effectiveness, validity, or enforceability of a notice or document delivered by electronic means to the party before the withdrawal of consent is effective.
A withdrawal of consent by a party is effective within a reasonable period of time after receipt of the withdrawal by the insurer.
Failure by an insurer to comply with paragraph (4) of subsection (d) of this Section and subsection (j) of this Section may be treated, at the election of the party, as a withdrawal of consent for purposes of this Section.
(i) This Section does not apply to a notice or document delivered by an insurer in an electronic form before the effective date of this amendatory Act of the 99th General Assembly to a party who, before that date, has consented to receive notice or document in an electronic form otherwise allowed by law.
(j) If the consent of a party to receive certain notices or documents in an electronic form is on file with an insurer before the effective date of this amendatory Act of the 99th General Assembly and, pursuant to this Section, an insurer intends to deliver additional notices or documents to the party in an electronic form, then prior to delivering such additional notices or documents electronically, the insurer shall:
(1) provide the party with a statement that
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(A) the notices or documents that shall be
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| delivered by electronic means under this Section that were not previously delivered electronically; and
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(B) the party's right to withdraw consent to
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| have notices or documents delivered by electronic means without the imposition of any condition or consequence that was not disclosed at the time of initial consent; and
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(2) comply with paragraph (2) of subsection (d)
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(k) An insurer shall deliver a notice or document by any other delivery method permitted by law other than electronic means if:
(1) the insurer attempts to deliver the notice or
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| document by electronic means and has a reasonable basis for believing that the notice or document has not been received by the party; or
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(2) the insurer becomes aware that the electronic
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| mail address provided by the party is no longer valid.
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(l) A producer shall not be subject to civil liability for any harm or injury that occurs as a result of a party's election to receive any notice or document by electronic means or by an insurer's failure to deliver a notice or document by electronic means unless the harm or injury is caused by the willful and wanton misconduct of the producer.
(m) This Section shall not be construed to modify, limit, or supersede the provisions of the federal Electronic Signatures in Global and National Commerce Act, as amended.
(n) Nothing in this Section shall prevent an insurer from posting on the insurer's Internet site any standard policy and any endorsements to such a policy that does not contain personally identifiable information, in accordance with Section 143.33 of this Code, in lieu of delivery to a policyholder, insured, or applicant for insurance by any other method.
(Source: P.A. 102-38, eff. 6-25-21.)
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(215 ILCS 5/143a)
Sec. 143a. Uninsured and hit-and-run motor vehicle coverage.
(1) No policy insuring against
loss resulting from liability imposed by law for bodily injury or death
suffered by any person arising out of the ownership, maintenance or use
of a motor vehicle that is designed for use on public highways and that
is either required to be registered in this State or is principally garaged
in this State shall be renewed, delivered, or issued for delivery
in this State unless coverage is provided therein or
supplemental thereto, in limits for bodily injury or death set forth in
Section 7-203 of the Illinois Vehicle Code for the
protection of persons insured thereunder who are legally entitled to
recover damages from owners or operators of uninsured motor vehicles and
hit-and-run motor vehicles because of bodily injury, sickness or
disease, including death, resulting therefrom. Uninsured motor vehicle
coverage does not apply to bodily injury, sickness, disease, or death resulting
therefrom, of an insured while occupying a motor vehicle owned by, or furnished
or available for the regular use of the insured, a resident spouse or resident
relative, if that motor vehicle is not described in the policy under which a
claim is made or is not a newly acquired or replacement motor vehicle covered
under the terms of the policy. The limits for any coverage for any vehicle
under the policy may not be aggregated with the limits for any similar
coverage, whether provided by the same insurer or another insurer, applying to
other motor vehicles, for purposes of determining the total limit of insurance
coverage available for bodily injury or death suffered by a person in any one
crash. No
policy shall be renewed, delivered, or issued for delivery in this
State unless it is provided therein that any dispute
with respect to the coverage and the amount of damages shall be submitted
for arbitration to the
American Arbitration Association and be subject to its rules for the conduct
of arbitration hearings
as to all matters except medical opinions. As to medical opinions, if the
amount of damages being sought is equal to or less than the amount provided for
in Section 7-203 of the Illinois Vehicle Code, then the current American
Arbitration Association Rules shall apply. If the amount being sought in an
American Arbitration Association case exceeds that amount as set forth in
Section 7-203 of the Illinois Vehicle Code, then the Rules of Evidence that
apply in the circuit court for placing medical opinions into evidence shall
govern. Alternatively, disputes with respect to damages and the coverage shall
be
determined in the
following
manner: Upon the insured requesting arbitration, each party to the
dispute shall select an arbitrator and the 2 arbitrators so named
shall select a third arbitrator. If such arbitrators are not selected
within 45 days from such request, either party may request that the
arbitration be submitted to the American Arbitration Association.
Any decision made by the arbitrators shall be binding for the amount of
damages not exceeding $75,000 for bodily injury to or
death of any one person, $150,000 for bodily injury to or death of 2 or more
persons in any one motor vehicle crash,
or the corresponding policy limits for bodily injury or death, whichever is
less.
All 3-person arbitration cases proceeding in accordance with any uninsured
motorist
coverage conducted in this State in
which the claimant is only seeking monetary damages up to the limits
set forth in Section 7-203 of the Illinois Vehicle Code
shall be subject to the following rules:
(A) If at least 60 days' written notice of the |
| intention to offer the following documents in evidence is given to every other party, accompanied by a copy of the document, a party may offer in evidence, without foundation or other proof:
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(1) bills, records, and reports of hospitals,
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| doctors, dentists, registered nurses, licensed practical nurses, physical therapists, and other healthcare providers;
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(2) bills for drugs, medical appliances, and
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(3) property repair bills or estimates, when
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| identified and itemized setting forth the charges for labor and material used or proposed for use in the repair of the property;
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(4) a report of the rate of earnings and time
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| lost from work or lost compensation prepared by an employer;
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(5) the written opinion of an opinion witness,
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| the deposition of a witness, and the statement of a witness that the witness would be allowed to express if testifying in person, if the opinion or statement is made by affidavit or by certification as provided in Section 1-109 of the Code of Civil Procedure;
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(6) any other document not specifically covered
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| by any of the foregoing provisions that is otherwise admissible under the rules of evidence.
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Any party receiving a notice under this paragraph (A)
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| may apply to the arbitrator or panel of arbitrators, as the case may be, for the issuance of a subpoena directed to the author or maker or custodian of the document that is the subject of the notice, requiring the person subpoenaed to produce copies of any additional documents as may be related to the subject matter of the document that is the subject of the notice. Any such subpoena shall be issued in substantially similar form and served by notice as provided by Illinois Supreme Court Rule 204(a)(4). Any such subpoena shall be returnable not less than 5 days before the arbitration hearing.
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(B) Notwithstanding the provisions of Supreme Court
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| Rule 213(g), a party who proposes to use a written opinion of an expert or opinion witness or the testimony of an expert or opinion witness at the hearing may do so provided a written notice of that intention is given to every other party not less than 60 days prior to the date of hearing, accompanied by a statement containing the identity of the witness, his or her qualifications, the subject matter, the basis of the witness's conclusions, and his or her opinion.
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(C) Any other party may subpoena the author or maker
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| of a document admissible under this subsection, at that party's expense, and examine the author or maker as if under cross-examination. The provisions of Section 2-1101 of the Code of Civil Procedure shall be applicable to arbitration hearings, and it shall be the duty of a party requesting the subpoena to modify the form to show that the appearance is set before an arbitration panel and to give the time and place set for the hearing.
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(D) The provisions of Section 2-1102 of the Code of
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| Civil Procedure shall be applicable to arbitration hearings under this subsection.
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(2) No policy insuring
against loss resulting from liability imposed by law for property damage
arising out of the ownership, maintenance, or use of a motor vehicle shall
be renewed, delivered, or issued for delivery in this State with respect
to any private passenger or recreational motor vehicle that is
designed for use on public highways and that is either required to be
registered in this State or is principally garaged in this State, unless coverage is made available in the amount of the actual
cash value of the motor vehicle described in the policy or the corresponding policy limit for uninsured motor vehicle property damage coverage,
whichever is less, subject to a maximum $250 deductible, for the protection of
persons insured thereunder who are legally entitled to recover damages from
owners or operators of uninsured motor vehicles and hit-and-run motor
vehicles because of property damage to the motor vehicle described in the
policy.
There shall be no liability imposed under the uninsured motorist
property damage coverage required by this subsection if the owner or
operator of the at-fault uninsured motor vehicle or hit-and-run motor
vehicle cannot be identified. This subsection shall not apply to any
policy which does not provide primary motor vehicle liability insurance for
liabilities arising from the maintenance, operation, or use of a
specifically insured motor vehicle.
Each insurance company providing motor vehicle property damage liability
insurance shall advise applicants of the availability of uninsured motor
vehicle property damage coverage, the premium therefor, and provide a brief
description of the coverage. That information
need be given only once and shall not be required in any subsequent renewal,
reinstatement or reissuance, substitute, amended, replacement or
supplementary policy. No written rejection shall be required, and
the absence of a premium payment for uninsured motor vehicle property damage
shall constitute conclusive proof that the applicant or policyholder has
elected not to accept uninsured motorist property damage coverage.
An insurance company issuing uninsured motor vehicle
property damage coverage may provide that:
(i) Property damage losses recoverable thereunder
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| shall be limited to damages caused by the actual physical contact of an uninsured motor vehicle with the insured motor vehicle.
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(ii) There shall be no coverage for loss of use of
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| the insured motor vehicle and no coverage for loss or damage to personal property located in the insured motor vehicle.
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(iii) Any claim submitted shall include the name and
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| address of the owner of the at-fault uninsured motor vehicle, or a registration number and description of the vehicle, or any other available information to establish that there is no applicable motor vehicle property damage liability insurance.
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Any dispute with respect to the coverage and the amount of
damages shall be submitted for
arbitration to the American Arbitration Association and be subject to its
rules for the conduct of arbitration hearings or for determination in
the following manner: Upon the insured requesting arbitration, each party
to the dispute shall select an arbitrator and the 2 arbitrators so named
shall select a third arbitrator. If such arbitrators are not selected
within 45 days from such request, either party may request that the
arbitration be submitted to the American Arbitration Association.
Any arbitration proceeding under this subsection seeking recovery for
property damages shall be
subject to the following rules:
(A) If at least 60 days' written notice of the
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| intention to offer the following documents in evidence is given to every other party, accompanied by a copy of the document, a party may offer in evidence, without foundation or other proof:
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(1) property repair bills or estimates, when
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| identified and itemized setting forth the charges for labor and material used or proposed for use in the repair of the property;
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(2) the written opinion of an opinion witness,
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| the deposition of a witness, and the statement of a witness that the witness would be allowed to express if testifying in person, if the opinion or statement is made by affidavit or by certification as provided in Section 1-109 of the Code of Civil Procedure;
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(3) any other document not specifically covered
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| by any of the foregoing provisions that is otherwise admissible under the rules of evidence.
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Any party receiving a notice under this paragraph (A)
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| may apply to the arbitrator or panel of arbitrators, as the case may be, for the issuance of a subpoena directed to the author or maker or custodian of the document that is the subject of the notice, requiring the person subpoenaed to produce copies of any additional documents as may be related to the subject matter of the document that is the subject of the notice. Any such subpoena shall be issued in substantially similar form and served by notice as provided by Illinois Supreme Court Rule 204(a)(4). Any such subpoena shall be returnable not less than 5 days before the arbitration hearing.
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(B) Notwithstanding the provisions of Supreme Court
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| Rule 213(g), a party who proposes to use a written opinion of an expert or opinion witness or the testimony of an expert or opinion witness at the hearing may do so provided a written notice of that intention is given to every other party not less than 60 days prior to the date of hearing, accompanied by a statement containing the identity of the witness, his or her qualifications, the subject matter, the basis of the witness's conclusions, and his or her opinion.
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(C) Any other party may subpoena the author or maker
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| of a document admissible under this subsection, at that party's expense, and examine the author or maker as if under cross-examination. The provisions of Section 2-1101 of the Code of Civil Procedure shall be applicable to arbitration hearings, and it shall be the duty of a party requesting the subpoena to modify the form to show that the appearance is set before an arbitration panel and to give the time and place set for the hearing.
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(D) The provisions of Section 2-1102 of the Code of
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| Civil Procedure shall be applicable to arbitration hearings under this subsection.
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(3) For the purpose of the coverage, the term "uninsured motor
vehicle" includes, subject to the terms and conditions of the coverage,
a motor vehicle where on, before, or after the date of the crash the
liability insurer thereof is unable to make payment with respect to the
legal liability of its insured within the limits specified in the policy
because of the entry by a court of competent jurisdiction of an order of
rehabilitation or liquidation by reason of insolvency on or after the date of the crash. An insurer's extension of coverage, as provided in this
subsection, shall be applicable to all crashes occurring after July
1, 1967 during a policy period in which its insured's uninsured motor
vehicle coverage is in effect. Nothing in this Section may be construed
to prevent any insurer from extending coverage under terms and
conditions more favorable to its insureds than is required by this Section.
(4) In the event of payment to any person under the coverage
required by this Section and subject to the terms and conditions of the
coverage, the insurer making the payment shall, to the extent thereof,
be entitled to the proceeds of any settlement or judgment resulting from
the exercise of any rights of recovery of the person against any person
or organization legally responsible for the property damage, bodily
injury or death for which the payment is made, including the proceeds
recoverable from the assets of the insolvent insurer. With respect to
payments made by reason of the coverage described in subsection (3), the
insurer making such payment shall not be entitled to any right of recovery
against the tortfeasor in excess of the proceeds recovered from the assets
of the insolvent insurer of the tortfeasor.
(5) This amendatory Act of 1967 (Laws of Illinois 1967, page 875) shall not be construed to terminate
or reduce any insurance coverage or any right of any party under this
Code in effect before July 1, 1967. Public Act 86-1155 shall not
be construed to terminate or reduce any insurance coverage or any right of
any party under this Code in effect before its effective date.
(6) Failure of the motorist from whom the claimant is legally
entitled to recover damages to file the appropriate forms with the
Safety Responsibility Section of the Department of Transportation within
120 days of the date of the crash shall create a rebuttable presumption that
the motorist was uninsured at the time of the injurious occurrence.
(7) An insurance carrier may upon good cause require the
insured to commence a legal action against the owner or operator of an
uninsured motor vehicle before good faith negotiation with the carrier. If
the action is commenced at the request of the insurance carrier, the
carrier shall pay to the insured, before the action is commenced, all court
costs, jury fees and sheriff's fees arising from the action.
The changes made by Public Act 90-451 apply to all policies of
insurance amended, delivered, issued, or renewed on and after January 1, 1998 (the effective
date of Public Act 90-451).
(8) The changes made by Public Act 98-927 apply to all policies of
insurance amended, delivered, issued, or renewed on and after January 1, 2015 (the effective
date of Public Act 98-927).
(Source: P.A. 102-775, eff. 5-13-22; 102-982, eff. 7-1-23; 103-154, eff. 6-30-23.)
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