Current through August 26, 2024
(1)
PURPOSE. This section interprets and implements s.
631.28,
Stats., by specifying the contents of a notice insurers must provide to
insureds about their right to file a complaint with the office of the
commissioner of insurance. This section also describes when and the manner in
which such notice must be provided.
(2) SCOPE. This section applies to all
policies or certificates in force, issued or renewed in Wisconsin on or after
the effective date of this section.
(3) DEFINITIONS. For purposes of this
section, "insured" means the policyholder for individual policies and both the
group policyholder and certificate holder for group policies.
(4) NOTICE FORMAT. Every insurer shall
disclose the insured's right to contact the office of the commissioner of
insurance regarding an insurance problem by providing a notice which shall:
(a) Be in the form as prescribed in Appendix
I or for policies subject to sub. (5) (d) in form as prescribed in Appendix
2;
(b) Include the issuer's
address, toll free phone number, if available, and phone number in no less than
12-point type and bold print.
Note: The language in sub. (4) (b) applies to
notices sent on or after March 1, 1995.
(c) Be in no less than 10-point type;
and
(d) Have the phrase "KEEP THIS
NOTICE WITH YOUR INSURANCE PAPERS," "PROBLEMS WITH YOUR INSURANCE?" in Appendix
I and the "OFFICE OF THE COMMISSIONER OF INSURANCE" in Appendices I and 2
capitalized and in bold lettering.
(5) NOTICE DELIVERY.
(a) For policies issued prior to the
effective date of this section, except for policies included under pars. (c)
and (d):
1. The notice shall be provided on
or before the insured's first renewal date after the effective date of this
section or within one year after the effective date of this section, whichever
is earlier, with a separate notice to the insured; or
2. For single premium policies, a separate
notice shall be provided on or before the insured's next anniversary date or
within one year after the effective date of this section, whichever is
earlier.
(b) For
policies or certificates issued on or after the effective date of this section,
except for policies included under pars. (c) and (d), a separate notice shall
be provided at the time the policy or certificate is issued.
(c) For surety and title insurance policies
the notice must be given as a separate notice to each claimant at the time a
claim is denied.
(d) For policies
subject to s.
632.83,
Stats., the insurer shall either give notice in the form as prescribed in
Appendix 2 and as specified in pars. (a) and (b) or may include the language in
Appendix 2 as part of the grievance procedure language in the policy and
certificates issued after the effective date and, for policies issued prior to
the effective date, provide a policy or certificate amendment on or before the
first renewal date after the effective date or within one year after the
effective date of this section, whichever is earlier.
