Iowa Unfair Trade Practices and Claims Practices

The Iowa Unfair Trade Practices Act (Iowa Code Chapter 507B)

Iowa’s central trade practices statute is Iowa Code Chapter 507B, which defines and prohibits specific unfair or deceptive insurance practices. It applies to insurers and producers alike. Violations can trigger administrative penalties under Iowa Code 505.7A and 507B.7, license suspension or revocation under Iowa Code 522B.11, cease-and-desist orders under Iowa Code 507B.6A, civil liability, and — in serious cases — criminal prosecution.

Misrepresentation (Iowa Code 507B.4(3)(a)(1)–(10))

Iowa’s misrepresentation prohibition is broad. Iowa Code 507B.4(3)(a) makes it an unfair practice to make or circulate any estimate, illustration, statement, sales presentation, omission or comparison that misrepresents in any of the ways it lists; the statute requires no proof that the person knew the statement was false or meant to deceive. Among them:

• Misrepresenting the benefits, advantages, conditions, or terms of any insurance policy.
• Misrepresenting the dividends or share of surplus to be received on a policy.
• Making false or misleading statements about dividends or share of surplus previously paid on policies.
• Misrepresenting the financial condition of an insurer or the legal reserve system.
• Using a name or title that misrepresents the true nature of a policy or class of policies.
• Misrepresenting the policy as a share of stock.
• Using untrue or misleading statements in connection with a policy’s sale, conversion, or replacement.
• Misrepresentation by omission — leaving out information the consumer would need to make an informed decision.
• Misrepresenting to induce a lapse, forfeiture, exchange, conversion, or surrender of a policy, or to effect a pledge, assignment of, or loan against a policy.
• A misrepresentation, including an intentional misquote of the premium rate, made to induce the purchase of a policy.

False Information and Advertising (Iowa Code 507B.4(3)(b)(1); Iowa Admin Rule 191-15.3)

Iowa prohibits any false, deceptive, or misleading information about an insurer or its policies, whether published or circulated. Iowa Admin Rule 191-15.3 provides detailed advertising standards:

• Identification. Advertising must clearly identify the insurer.
• Truthfulness. Statements about policy benefits must be accurate and not misleading.
• Limitations. Information about exceptions, limitations and reductions must not be minimized, obscured or presented ambiguously, and words describing exclusions, limitations, exceptions and reductions must clearly, prominently and accurately show their negative or limited nature (Iowa Admin Rule 191-15.3(1), (4)).
• Comparisons. Comparisons with other policies or insurers must be fair and complete.
• Testimonials and endorsements. Must be genuine, must not be paid for in a way that creates an undisclosed bias, and must include any required disclosures.

Twisting

Twisting is the act of inducing a policyholder to lapse, surrender, exchange, or replace an existing policy or annuity in order to buy another, when doing so would operate to the policyholder’s overall detriment (Iowa Admin Rule 191-15.2); Iowa Admin Rule 191-15.7 prohibits it. The replacement itself is not the violation; inducing a replacement that works against the policyholder’s interests is. A legitimate replacement, fully and honestly disclosed, is permitted.

Churning

Churning is an industry term for replacing a client’s policy with another policy issued by the same insurer, primarily to generate fresh first-year commission rather than to benefit the client. Iowa’s twisting rule reaches it, because the rule does not depend on which insurer issues the new policy.

Rebating (Iowa Code 507B.4(3)(i))

Rebating means giving — or offering to give — a prospective or current policyholder any rebate of premium, or any valuable consideration or inducement not specified in the contract, as an inducement to buy insurance (Iowa Code 507B.4(3)(i)). The classic example is a producer who offers to return part of the first-year commission. Less obvious examples count too:

• Splitting commission with a client by check, cash, or transfer.
• Giving a non-trivial gift (a high-value gift card, expensive meal, event tickets) as an inducement.
• Promising future services unrelated to the policy as a reason to buy.
• Offering a discount, refund, or premium rebate not contained in the contract itself.

Two things are not rebating, even though they sometimes look like it:

• Dividends on a participating (mutual) policy — a return of premium when the insurer’s results are better than expected.
• Discounts the contract itself specifies or, for lines other than life, annuities, and accident and health, that an applicable rate filing provides (group rates, multi-policy discounts, payroll deduction credits).

Defamation (Iowa Code 507B.4(3)(c))

Making or circulating a statement that is false, or maliciously critical of or derogatory to the financial condition of any person, and that is calculated to injure that person, is defamation under Iowa Code 507B.4(3)(c).

Boycott, Coercion, and Intimidation (Iowa Code 507B.4(3)(d))

Iowa prohibits entering into an agreement to commit, or acting in concert to commit, any act of boycott, coercion, or intimidation that results or tends to result in unreasonable restraint of, or monopoly in, the business of insurance. The classic fact pattern is a group of insurers or producers agreeing to withhold business from a broker unless the broker stops placing certain accounts.

Unfair Discrimination (Iowa Code 507B.4(3)(g)(2)–(3); Iowa Admin Rule 191-15.11)

Iowa Code 507B.4(3)(g) prohibits unfair discrimination. In property and casualty insurance it reaches two contexts:

• Insurance other than life. Unfair discrimination between insureds of the same class for essentially the same hazard, in the premium, fees or rates charged, the benefits payable, or the terms of the contract (507B.4(3)(g)(2)).
• Domestic or sexual abuse. Any discrimination in the sale of insurance solely on the basis of domestic abuse or sexual abuse (507B.4(3)(g)(3)).

Iowa Admin Rule 191-15.11 prohibits denying or restricting coverage based solely on sex or marital status; physical or mental impairment, including blindness, unless based on sound actuarial principles or actual or reasonably anticipated experience; or being a victim of domestic abuse.

Unfair Claims Settlement Practices (Iowa Code 507B.4(3)(j)(1)–(15))

Iowa Code 507B.4(3)(j) lists specific claims practices that are unfair when committed or performed with such frequency as to indicate a general business practice. Highlights:

• (1) Misrepresenting policy provisions in connection with a claim.
• (2) Failing to acknowledge and act reasonably promptly upon communications about claims.
• (3) Failing to adopt and implement reasonable standards for the prompt investigation of claims.
• (4) Refusing to pay claims without conducting a reasonable investigation.
• (5) Failing to affirm or deny coverage of claims within a reasonable time after proof of loss has been completed.
• (6) Not attempting in good faith to effectuate prompt, fair, and equitable settlements of claims in which liability has become reasonably clear.
• (7) Compelling insureds to institute litigation to recover amounts due under a policy by offering substantially less than the amounts ultimately recovered.
• (8) Attempting to settle a claim for less than the amount to which a reasonable person would have believed the insured was entitled, based on advertising materials accompanying or made part of an application.
• (9) Attempting to settle claims on the basis of an application that was altered without notice to or knowledge or consent of the insured.
• (10) Making claim payments not accompanied by a statement explaining the coverage under which payments are being made.
• (11) Making known a policy of appealing from arbitration awards in favor of insureds or claimants, to compel them to accept less than the amount awarded.
• (12) Delaying the investigation or payment of claims by requiring a preliminary claim report and then formal proof of loss forms that contain substantially the same information.
• (13) Failing to promptly settle claims, where liability has become reasonably clear, under one portion of policy coverage in order to influence settlements under other portions.
• (14) Failing to promptly provide a reasonable explanation of the basis in the policy, the facts or the law for denying a claim or offering a compromise settlement.
• (15) Failing to comply with the Commissioner’s procedures for auditing claims submitted by health care providers (this item does not apply to liability, workers’ compensation, auto or homeowners medical payments, disability income or long-term care insurance).