Missouri Code of State Regulations
Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE
Division 100 - Insurer Conduct
Chapter 8 - Market Conduct Examination
Section 20 CSR 100-8.002 - Scope and Definitions

(A) "Company," any person as defined by section 374.202.2(1), RSMo;

(B) "Complaint," has the same meaning as in section 375.936(3), RSMo;

(C) "Confirmed Complaint," a complaint in which the state department of insurance determines:

(D) "Comprehensive market conduct examination," a full-scope examination that generally involves a review of the company's operations/management, complaint handling, marketing and sales, advertising materials, licensing, policyholder service, underwriting and rating, nonforfeitures, policy forms and filings, claim handling, and other state-specific requirements;

(E) "Department," the Department of Commerce and Insurance;

(F) "Desk examination," an examination that is conducted by an examiner at a location other than the company's premises. A desk examination is usually performed at the department's offices with the insurer providing requested documents by hard copy, microfiche, discs, or other electronic media, for review;

(G) "Director," the director of the Department of Commerce and Insurance;

(H) "Division," the Division of Insurance Market Regulation;

(I) "Examination warrant," a document issued by the director or the director's designee appointing one (1) or more examiners to perform a market conduct examination and instructing them as to the scope of the examination;

(J) "Examiner," any individual having been authorized by the director to conduct a market conduct examination under sections 374.202 to 374.207, RSMo;

(K) "Insurer," any person as defined by section 374.202.2(5), RSMo;

(L) "Market analysis," a process whereby market conduct surveillance personnel collect and analyze information from filed schedules, surveys, reports, and other sources in order to develop a baseline understanding of the marketplace and to identify patterns or practices of insurers or companies licensed to do business in this state that deviate significantly from the norm or that may pose a potential risk to insurance consumers;

(M) "Market conduct action," any of the full range of activities that the director may initiate to assess and address the market and practices of individual insurers or companies, beginning with market analysis and extending to examinations. The director's activities to resolve an individual consumer complaint or other reports of a specific instance of misconduct are not market conduct actions for the purposes of this chapter;

(N) "Market conduct examination," the examination of the insurance operations of an insurer or company licensed to do business in this state in order to evaluate compliance with the applicable laws and regulations of this state. A market conduct examination may be either a comprehensive examination or a targeted examination. A market conduct examination conducted under sections 374.202 to 374.207, RSMo, is separate and distinct from a financial examination of an insurer, but may be conducted at the same time;

(O) "Market conduct surveillance personnel," those individuals employed or contracted by the director to collect, analyze, review, examine, or act on information on the insurance marketplace, which identifies pattern or practices of insurers and other companies;

(P) "National Association of Insurance Commissioners" or "NAIC," the organization of insurance regulators from the fifty (50) states, the District of Columbia, and the four (4) United States territories;

(Q) "NAIC market conduct uniform examination procedures," the set of guidelines developed and adopted by the NAIC designed to be used by market conduct surveillance personnel in conducting an examination;

(R) "NAIC Market Regulation Handbook," a handbook, developed and adopted by the NAIC, or successor product, which-

(S) "NAIC standard data request," the set of field names and descriptions developed and adopted by the NAIC for use by market conduct surveillance personnel in an examination;

(T) "On-site examination," an examination conducted at the company's home office or the location where the records under review are stored;

(U) "Qualified contract examiner," a person under contract to the department, who is qualified by education, experience, and, where applicable, professional designations, to perform market conduct actions; and

(V) "Targeted examination," a focused exam, based on the results of market analysis indicating the need to review either a specific line of business or specific business practices, including, but not limited to, underwriting and rating, marketing and sales, complaint handling, operations or management, advertising materials, licensing, policyholder services, nonforfeitures, claims handling, policy forms and filings, or any other area of review in the NAIC Market Regulation Handbook. A targeted examination may be conducted by desk examination or by an on-site examination.