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Ohio State Regulations & NAIC Insurance Law

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Licensing

To apply for an Ohio resident producer’s license, you must:

  • Be at least 18 years old.
  • Be an Ohio resident before you submit your application.

Required pre-licensing course and exam

Before you can sit for the Ohio pre-licensing exam, you must successfully complete a Department of Insurance-approved pre-licensing course.

Fingerprints/background check

As part of the application process, you must submit fingerprints to the Ohio Department of Insurance.

Timing matters:

  • Plan to get fingerprinted after you pass the state exam.
  • Get fingerprinted at least one day before you apply for the license.

Controlled business

Controlled business is insurance written primarily for the benefit of the producer or the producer’s family members.

  • Producers may not obtain an Ohio insurance license for the sole purpose of writing controlled business.
  • You may sell a policy to yourself or to family members, but you can’t get licensed only for that purpose.

Non-resident license

To obtain a nonresident license, a licensed producer must meet the following requirements:

  • The individual must have an Ohio resident producer license in good standing.
  • The individual must complete the appropriate application and submit the required fees to the insurance department/commission in each state they wish to become licensed in.
  • The individual’s home state must offer equal reciprocity for the state you are attempting to obtain a non-resident license in. Currently, Ohio has reciprocation agreements with all other states.

Temporary license

A temporary producer license is valid only if the temporary producer is sponsored and appointed by an insurance company.

Key limits:

  • It’s a once-in-a-lifetime license per line of authority.
  • It’s valid for a maximum of 6 months from the date the license is issued.

Inactive status

An Ohio resident producer who is ordered to active military duty may place their license on inactive status until they are discharged.

While the license is inactive:

  • The producer may continue to receive residual (“trailing”) commissions.
  • The producer may not solicit or transact any new business.

Renewal maintenance

Ohio insurance licenses are initially issued for 2 years.

Renewal rules:

  • A producer must renew every 2 years, by the last day of the licensee’s birth month.
  • There is a 30-day grace period after expiration.
    • Renewing during the grace period results in a $50 late fee.
  • If the license is not renewed during the grace period:
    • The license expires.
    • All company appointments are canceled.

Reinstatement rules:

  • A producer may have a license reissued within 12 months of expiration without retesting.
  • If the producer has been without a license for more than 12 months, they must complete the pre-licensing course, retest, and be fingerprinted before applying for a new license.

Continuing education

All states, including Ohio, require continuing education (CE) to renew major lines (life, health, property, liability) insurance licenses.

In Ohio:

  • Individuals must complete 24 hours of CE before renewing their license.

Notice of change of name or address

Any change of name or address (residential or business) must be reported by the licensee to the Ohio Department of Insurance within 30 days.

Failure to report changes may result in monetary fines and/or license suspension.

Company regulations

An insurance company must be authorized by the Ohio Department of Insurance to conduct business in Ohio.

To receive authorization, the company must provide:

  • Rate tables
  • Articles of incorporation (including the nature and purpose of the company’s business intentions)
  • Corporate bylaws
  • Appropriate fees

Place of business

Every resident insurance producer authorized to conduct business in Ohio must maintain a place of business (with public access) within the state.

Capital and surplus requirement

An insurer authorized to conduct insurance business in Ohio must maintain minimum corporate standards.

  • The certificate of authority allows the insurer to conduct business in Ohio only if it maintains the minimum capital or permanent surplus required.

Duties of the Director of Insurance

The Ohio Director of Insurance is a state executive position. The Director is the chief executive of the Ohio Department of Insurance, which regulates insurance companies operating in Ohio.

  • The Director is appointed by the Governor and serves at the pleasure of the Governor.

The Office of Insurance works to protect both consumers and businesses. The Director manages the department and ensures the state’s insurance laws are executed and enforced.

The Director’s duties are outlined in Chapter 3901, Section 04 of the Ohio State Code and include:

  • Investigate all claims and complaints of legal violations relating to insurance.
  • If the Director finds that laws have been violated, their findings and supporting documents will be forwarded to the state attorney general to pursue prosecution.
  • Monitor transactions of all companies including domestic, foreign, and alien insurance companies.
  • Audit the books and records of any resident producer as frequently as necessary.
  • Collect all fees associated with producers and insurers.
  • Determine and administer fines associated with violations for insurers and producers.
  • Issue reports pertaining to the suspension and revocation of licenses of producers and certificates of authority for insurers.
  • Approve documentation used by insurance companies such as forms and rates.
Sidenote
Know this...

The Director does not have the authority to arrest, issue injunctions, or sentence jail time. The Director can start the process, but it takes a law officer to arrest and a judge or court of law to issue injunctions or sentence jail time.

Suspend, revoke or non-renew

The Director has the authority to suspend, revoke, or refuse to renew a license for:

  • Providing false information on the application for an insurance license.
  • Omitting any relevant information on an application that would have disqualified the individual from being eligible to receive a license.
  • Being found guilty of a violation or the noncompliance of insurance regulations and laws…
  • Committing fraud while attempting to obtain an insurance license.
  • Commingling policy owners’, insurers’, and beneficiaries’ money with the producer’s own money.
  • Providing false information in reference to the terms and conditions of an insurance contract.
  • Having been found guilty of a felony (or misdemeanor involving activities related to the individual’s moral character.)
  • Having been convicted of violations in reference to unfair trade practices or fraud.
  • Having engaged in activities of a fraudulent nature which allowed the person to involve themselves in dishonest, coercive, untrustworthy, and financially irresponsible practices.
  • Having had a prior insurance license revoked or suspended in a state other than Ohio.
  • Using another person’s identity and forging their name on an insurance application.
  • Being found guilty of using unethical practices or cheating on an examination for an insurance license.

Cease and desist

If the Director believes that a producer has violated (or is about to violate) an Ohio insurance regulation, the Director may issue a cease and desist order.

  • A cease and desist order does not suspend or revoke the recipient’s registration.
  • It does require the recipient to stop or limit the activity addressed in the order.

Hearing

A cease and desist order must be followed immediately, but the Director’s actions are not “final and binding.” Any Ohio resident producer subject to disciplinary action has the right to request a hearing to discuss the merits of the situation.

The Director may also investigate any producer doing business in Ohio to determine whether a hearing is required.

  • If sufficient evidence is found, the Director will issue a notice with the date and time of the hearing.
  • The notice will be sent to interested parties at least 20 days before the hearing.

If a hearing finds a known violation of Ohio insurance law, the Director may (in addition to issuing a cease and desist order) impose a civil penalty of up to $15,000 per violation.

Unfair claims settlement practices

  • The intentional obstruction and delay of claims payment or the delay of a claims investigation is a violation of regulation.
  • Neglecting to provide a prompt response and written explanation of insurance policy terms, conditions, and laws related to the contract are examples of unfair claims settlement practices.
  • Failure to provide claims without launching a thorough investigation is a violation of regulation.
  • Making settlement claims based on information contained on an application that has been altered without the insured’s consent is a violation of regulation.
  • Denying a claim without conducting a thorough investigation.
  • Attempting to settle a claim for less than fair market value.

Policy forms

Ohio is a “file and use” state.

  • A file and use filing is submitted to the Department, and the insurer may begin using it as soon as it is filed.
  • The insurer does not have to wait for Department approval before using it.
  • File and use does not mean the insurer can submit anything; the filing must still comply with Ohio laws, regulations, and bulletins.

If the wording on a health insurance policy (or other form) conflicts with Ohio state law, the policy will be amended to minimum conformity with state statutes.

Record maintenance

Complete and accurate records must be kept at the producer’s place of business for a minimum of 3 years.

Records must show:

  • Every contract placed
  • The named insured
  • Changes or amendments
  • Premiums received with each transaction

Records may be inspected at any time by the Department of Insurance or a representative appointed on its behalf.

Fraudulent producer representation

A producer violates regulation if they represent to the public that they are licensed to conduct insurance business in Ohio but have not passed the appropriate licensing examination.

This includes public communications such as:

  • Advertisements
  • Letterheads
  • Circulars
  • Business cards
  • Other methods of representation

A producer found guilty of conducting business in Ohio in any line of insurance for which they are not properly licensed may have any other insurance license suspended or revoked.

Misrepresentation

  • Misrepresentation involving the creation or distribution of policies, quotes, and illustrations designed to provide inaccurate information about the terms and conditions of a policy is prohibited.
  • Providing inaccurate or incomplete information or comparisons regarding the benefits of a policy is an example of misrepresentation.
  • Providing inaccurate or incomplete information with the sole purpose of inducing lapse, exchange, conversion, forfeiture, or surrender is a violation as well (twisting).

False advertising

Communication involving the publication of newspapers, magazines, radio, or television that is intended to deliver false information in reference to insurance is a violation of NAIC regulation.

Defamation

  • The intentional and malicious circulation of written or oral information intended for the direct or indirect dissemination of derogatory statements is prohibited.
  • Publishing and circulating inaccurate information regarding the financial condition of an insurer, person, or competitor in the insurance industry is a violation of NAIC regulation.

Boycott, coercion and intimidation

Participation in any boycott or activity involving coercion and intimidation for the sole purpose of retaining business, or that results in a monopoly of insurance business, is prohibited.

False financial statements

Any licensed producer who makes false statements containing inaccurate material facts or false statements on an application for insurance is in violation of NAIC regulation.

Illegal inducements

In Ohio, it is prohibited to induce the purchase of insurance by offering anything with a monetary value in excess of $10.

It is also prohibited to accept anything with a monetary value in excess of $10 from a client.

A producer who participates in this activity may be subject to license suspension and a monetary fine.

Unfair discrimination

Discriminating on the basis of class, race, marital status, or sexual preference is a violation of regulation.

  • Any unfair discriminatory practices intended to directly or indirectly favor an applicant or insured are prohibited.
  • Denying insurance coverage based on blindness or partial blindness is considered discrimination and is a violation of NAIC regulation.

Errors & omissions

Errors & Omissions (E&O) insurance is a type of professional liability insurance that protects insurance agents if they are sued for negligent performance of their duties.

  • E&O covers honest mistakes that result in financial damage to customers or prospects.
  • E&O does not cover violations of insurance regulation.

Rebating

Ohio licensed producers are prohibited from directly or indirectly giving any refund, discount, favor, or credit to reduce premiums to induce the purchase of insurance.

Furthermore, producers in Ohio are also prohibited from receiving any payment for the sale, solicitation, or negotiation of insurance outside of commissions and/or salary.

Sidenote
Know this...

To “solicit” or “negotiate” insurance implies that the person is licensed.

Sharing commission

Splitting or sharing commissions with a licensed producer is allowed.

  • Both parties must be licensed in the line of business in which the commission is being split.

Twisting

Twisting is prohibited.

  • Providing false information or expressing derogatory ideas about the financial condition of a competitor company with the intent to cause an existing policy to lapse or be surrendered is a violation of law.
  • Any written or oral statements used to induce the lapse, termination, exchange, or surrender of an insurance contract based on inaccurate information are prohibited.

Unfair marketing practices

The Department of Insurance establishes minimum standards for full and fair disclosure of policy content. It also requires standardization and simplification of the terms used to describe insurance coverage.

Advertising may not involve:

  • Any implication that policies are approved or that the financial condition of a company is endorsed by any government agency or by any independent group, individual, organization, or society.
  • Any statements regarding advertising that are false or untrue in reference to the time frame in which claims are paid.

Gramm-Leach Bliley Act (GLBA)

This law repealed the Glass-Steagall Act of 1933, allowing consolidation of commercial banks, investment institutions, and insurance companies.

GLBA:

  • Established a framework of responsibilities for federal and state regulators across these financial industries.
  • Permits financial services companies to merge and engage in new business activities (including insurance), while attempting to address the regulatory issues raised by these combinations.

McCarran-Ferguson Act

Federal law signed in 1945 in which Congress declared that the insurance industry would be regulated at the state level.

  • Grants insurers a limited exemption from federal antitrust legislation.

National Association of Insurance Commissioners (NAIC)

The NAIC is the U.S. standard-setting and regulatory support organization created and governed by the chief insurance regulators from the 50 states, the District of Columbia, and five U.S. territories.

Through the NAIC, state insurance regulators:

  • Establish standards and best practices
  • Conduct peer review
  • Coordinate regulatory oversight

NAIC staff supports these efforts and represents the collective views of state regulators domestically and internationally. NAIC members, together with the central resources of the NAIC, form the national system of state-based insurance regulation in the U.S.

Fair Credit Reporting Act of 1971

If an applicant is denied insurance, employment, or credit due to information collected, this regulation grants access to the information and the reasons for the denial.

  • After receiving notice that an adverse underwriting decision has been made (which must be communicated within 3 days), an individual has 90 business days to request a copy of the report.

Privacy Act of 1974

This regulation provides a system for the collection, use, and dissemination of information gathered during the underwriting process.

When an applicant signs the insurance application (notice regarding insurance information practices), the applicant gives the insurer the right to check:

  • Driving records
  • MIB
  • Consumer investigative reports

A signed application authorizes the insurer to collect information for 30 months. If the insurer has not done so by then, a new authorization must be obtained.

Telemarketing

The DO NOT CALL registry is a list of telephone numbers, intended to prevent calls from telemarketers.

Unsolicited sales calls must follow these provisions:

  • No call may be placed outside of the hours of 8 am to 9 pm local time where the call is received.
  • The sales nature of the call must be disclosed and the nature of the product/service being offered must be disclosed.
  • The caller must identify themselves and the broker/dealer they represent.
  • If a prize is being offered, the prize cannot be contingent on purchase.

CAN-Spam

When an unsolicited e-mail is sent, the sender must:

  • Use the word advertisement or the letters ADV on the subject line.
  • Notate the physical location from where the email originated.
  • Give the recipient the opportunity to opt out of ever receiving another email from the sender.

Insurance guaranty association

The Ohio Insurance Guaranty Association is made up of authorized insurers and is controlled by a board.

  • Joining the association is part of the authorization process that allows insurance companies to conduct business in Ohio.
  • This is not unique to Ohio; insurers must be authorized in every state where they transact business.

Once authorized, any insurer doing business in Ohio must contribute to the Ohio Insurance Guarantee Fund, which is intended to indemnify policy owners of insurance companies that have become insolvent (up to $100,000 cash and $300,000 total benefits).

Licensing

  • Must be 18+ and Ohio resident to apply
  • Complete approved pre-licensing course before exam
  • Fingerprints required after passing exam, before application

Controlled business

  • License cannot be obtained solely for writing insurance for self/family
  • Selling to self/family allowed, but not as sole purpose

Non-resident license

  • Must have Ohio license in good standing
  • Apply and pay fees in other states; reciprocity required

Temporary license

  • Sponsored by insurer; valid once per line, max 6 months

Inactive status

  • Active military duty: license can go inactive
  • May receive trailing commissions, but cannot solicit new business

Renewal maintenance

  • License valid for 2 years; renew by birth month end
  • 30-day grace period with $50 late fee
  • Reinstatement within 12 months without retesting; after 12 months, must retake course, exam, fingerprints

Continuing education

  • 24 hours CE required for renewal of major lines

Notice of change of name or address

  • Must report changes within 30 days
  • Failure may result in fines or suspension

Company regulations

  • Must be authorized by Ohio Department of Insurance
  • Submit rate tables, articles, bylaws, fees

Place of business

  • Resident producers must maintain public-accessible business in Ohio

Capital and surplus requirement

  • Insurer must maintain minimum capital/surplus to keep certificate of authority

Duties of the Director of Insurance

  • Appointed by Governor; enforces insurance laws
  • Investigates violations, audits, collects fees, administers fines
  • Issues, suspends, or revokes licenses/certificates
  • Approves forms and rates
    • Cannot arrest, issue injunctions, or sentence jail time

Suspend, revoke or non-renew

  • Grounds: false info, fraud, felonies, unethical practices, prior revocations, misrepresentation, cheating, commingling funds

Cease and desist

  • Director may order halt to violations
  • Does not suspend/revoke license, but requires activity to stop

Hearing

  • Right to hearing on disciplinary actions
  • Notice sent at least 20 days before hearing
  • Civil penalty up to $15,000 per violation

Unfair claims settlement practices

  • Delaying claims, failing to investigate, or denying without investigation is prohibited
  • Must provide prompt, written explanations and fair settlements

Policy forms

  • Ohio is “file and use” state: use forms upon filing, must comply with law
  • Conflicting policy wording amended to state minimums

Record maintenance

  • Keep complete records for minimum 3 years
  • Must show contracts, insureds, amendments, premiums
  • Subject to inspection by Department

Fraudulent producer representation

  • Illegal to claim licensure without passing exam
  • Applies to ads, business cards, letterheads, etc.
  • Unlicensed activity may result in suspension/revocation

Misrepresentation

  • Prohibited to provide false/incomplete info about policies
  • Twisting: inducing lapse/exchange by misrepresentation is a violation

False advertising

  • False info in media about insurance is prohibited

Defamation

  • Malicious, false statements about insurers/competitors prohibited

Boycott, coercion and intimidation

  • Prohibited to use these for business retention or monopoly

False financial statements

  • Illegal to make false statements on insurance applications

Illegal inducements

  • Cannot offer/accept anything over $10 to induce insurance purchase
  • Violations may lead to suspension and fines

Unfair discrimination

  • Discrimination by class, race, marital status, sexual preference, blindness is prohibited

Errors & omissions

  • E&O insurance covers negligent mistakes, not regulatory violations

Rebating

  • Prohibited to give/receive premium reductions or extra payments outside commissions/salary

Sharing commission

  • Allowed only if both parties licensed in same line

Twisting

  • Prohibited to induce policy lapse/exchange with false info about competitors

Unfair marketing practices

  • Must provide full, fair disclosure; no false claims of government approval
  • No misleading statements about claim payment timeframes

Gramm-Leach Bliley Act (GLBA)

  • Repealed Glass-Steagall; allows banks, insurers, investment firms to merge
  • Sets regulatory framework for combined financial services

McCarran-Ferguson Act

  • Insurance regulated at state level
  • Limited exemption from federal antitrust laws

National Association of Insurance Commissioners (NAIC)

  • Sets standards, best practices, peer review, regulatory coordination among states

Fair Credit Reporting Act of 1971

  • Denial notice must be given within 3 days; 90 days to request report copy

Privacy Act of 1974

  • Applicant authorizes info collection for 30 months via signed application
  • Covers driving records, MIB, investigative reports

Telemarketing

  • No calls outside 8 am–9 pm local time
  • Must disclose sales nature, identity, product/service
  • Prizes cannot be contingent on purchase

CAN-Spam

  • Unsolicited emails must use “advertisement”/“ADV” in subject
  • Must show sender location, provide opt-out

Insurance guaranty association

  • All authorized insurers must join and contribute
  • Protects policyholders if insurer becomes insolvent (up to $100,000 cash, $300,000 total benefits)

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Ohio State Regulations & NAIC Insurance Law

Licensing

To apply for an Ohio resident producer’s license, you must:

  • Be at least 18 years old.
  • Be an Ohio resident before you submit your application.

Required pre-licensing course and exam

Before you can sit for the Ohio pre-licensing exam, you must successfully complete a Department of Insurance-approved pre-licensing course.

Fingerprints/background check

As part of the application process, you must submit fingerprints to the Ohio Department of Insurance.

Timing matters:

  • Plan to get fingerprinted after you pass the state exam.
  • Get fingerprinted at least one day before you apply for the license.

Controlled business

Controlled business is insurance written primarily for the benefit of the producer or the producer’s family members.

  • Producers may not obtain an Ohio insurance license for the sole purpose of writing controlled business.
  • You may sell a policy to yourself or to family members, but you can’t get licensed only for that purpose.

Non-resident license

To obtain a nonresident license, a licensed producer must meet the following requirements:

  • The individual must have an Ohio resident producer license in good standing.
  • The individual must complete the appropriate application and submit the required fees to the insurance department/commission in each state they wish to become licensed in.
  • The individual’s home state must offer equal reciprocity for the state you are attempting to obtain a non-resident license in. Currently, Ohio has reciprocation agreements with all other states.

Temporary license

A temporary producer license is valid only if the temporary producer is sponsored and appointed by an insurance company.

Key limits:

  • It’s a once-in-a-lifetime license per line of authority.
  • It’s valid for a maximum of 6 months from the date the license is issued.

Inactive status

An Ohio resident producer who is ordered to active military duty may place their license on inactive status until they are discharged.

While the license is inactive:

  • The producer may continue to receive residual (“trailing”) commissions.
  • The producer may not solicit or transact any new business.

Renewal maintenance

Ohio insurance licenses are initially issued for 2 years.

Renewal rules:

  • A producer must renew every 2 years, by the last day of the licensee’s birth month.
  • There is a 30-day grace period after expiration.
    • Renewing during the grace period results in a $50 late fee.
  • If the license is not renewed during the grace period:
    • The license expires.
    • All company appointments are canceled.

Reinstatement rules:

  • A producer may have a license reissued within 12 months of expiration without retesting.
  • If the producer has been without a license for more than 12 months, they must complete the pre-licensing course, retest, and be fingerprinted before applying for a new license.

Continuing education

All states, including Ohio, require continuing education (CE) to renew major lines (life, health, property, liability) insurance licenses.

In Ohio:

  • Individuals must complete 24 hours of CE before renewing their license.

Notice of change of name or address

Any change of name or address (residential or business) must be reported by the licensee to the Ohio Department of Insurance within 30 days.

Failure to report changes may result in monetary fines and/or license suspension.

Company regulations

An insurance company must be authorized by the Ohio Department of Insurance to conduct business in Ohio.

To receive authorization, the company must provide:

  • Rate tables
  • Articles of incorporation (including the nature and purpose of the company’s business intentions)
  • Corporate bylaws
  • Appropriate fees

Place of business

Every resident insurance producer authorized to conduct business in Ohio must maintain a place of business (with public access) within the state.

Capital and surplus requirement

An insurer authorized to conduct insurance business in Ohio must maintain minimum corporate standards.

  • The certificate of authority allows the insurer to conduct business in Ohio only if it maintains the minimum capital or permanent surplus required.

Duties of the Director of Insurance

The Ohio Director of Insurance is a state executive position. The Director is the chief executive of the Ohio Department of Insurance, which regulates insurance companies operating in Ohio.

  • The Director is appointed by the Governor and serves at the pleasure of the Governor.

The Office of Insurance works to protect both consumers and businesses. The Director manages the department and ensures the state’s insurance laws are executed and enforced.

The Director’s duties are outlined in Chapter 3901, Section 04 of the Ohio State Code and include:

  • Investigate all claims and complaints of legal violations relating to insurance.
  • If the Director finds that laws have been violated, their findings and supporting documents will be forwarded to the state attorney general to pursue prosecution.
  • Monitor transactions of all companies including domestic, foreign, and alien insurance companies.
  • Audit the books and records of any resident producer as frequently as necessary.
  • Collect all fees associated with producers and insurers.
  • Determine and administer fines associated with violations for insurers and producers.
  • Issue reports pertaining to the suspension and revocation of licenses of producers and certificates of authority for insurers.
  • Approve documentation used by insurance companies such as forms and rates.
Sidenote
Know this...

The Director does not have the authority to arrest, issue injunctions, or sentence jail time. The Director can start the process, but it takes a law officer to arrest and a judge or court of law to issue injunctions or sentence jail time.

Suspend, revoke or non-renew

The Director has the authority to suspend, revoke, or refuse to renew a license for:

  • Providing false information on the application for an insurance license.
  • Omitting any relevant information on an application that would have disqualified the individual from being eligible to receive a license.
  • Being found guilty of a violation or the noncompliance of insurance regulations and laws…
  • Committing fraud while attempting to obtain an insurance license.
  • Commingling policy owners’, insurers’, and beneficiaries’ money with the producer’s own money.
  • Providing false information in reference to the terms and conditions of an insurance contract.
  • Having been found guilty of a felony (or misdemeanor involving activities related to the individual’s moral character.)
  • Having been convicted of violations in reference to unfair trade practices or fraud.
  • Having engaged in activities of a fraudulent nature which allowed the person to involve themselves in dishonest, coercive, untrustworthy, and financially irresponsible practices.
  • Having had a prior insurance license revoked or suspended in a state other than Ohio.
  • Using another person’s identity and forging their name on an insurance application.
  • Being found guilty of using unethical practices or cheating on an examination for an insurance license.

Cease and desist

If the Director believes that a producer has violated (or is about to violate) an Ohio insurance regulation, the Director may issue a cease and desist order.

  • A cease and desist order does not suspend or revoke the recipient’s registration.
  • It does require the recipient to stop or limit the activity addressed in the order.

Hearing

A cease and desist order must be followed immediately, but the Director’s actions are not “final and binding.” Any Ohio resident producer subject to disciplinary action has the right to request a hearing to discuss the merits of the situation.

The Director may also investigate any producer doing business in Ohio to determine whether a hearing is required.

  • If sufficient evidence is found, the Director will issue a notice with the date and time of the hearing.
  • The notice will be sent to interested parties at least 20 days before the hearing.

If a hearing finds a known violation of Ohio insurance law, the Director may (in addition to issuing a cease and desist order) impose a civil penalty of up to $15,000 per violation.

Unfair claims settlement practices

  • The intentional obstruction and delay of claims payment or the delay of a claims investigation is a violation of regulation.
  • Neglecting to provide a prompt response and written explanation of insurance policy terms, conditions, and laws related to the contract are examples of unfair claims settlement practices.
  • Failure to provide claims without launching a thorough investigation is a violation of regulation.
  • Making settlement claims based on information contained on an application that has been altered without the insured’s consent is a violation of regulation.
  • Denying a claim without conducting a thorough investigation.
  • Attempting to settle a claim for less than fair market value.

Policy forms

Ohio is a “file and use” state.

  • A file and use filing is submitted to the Department, and the insurer may begin using it as soon as it is filed.
  • The insurer does not have to wait for Department approval before using it.
  • File and use does not mean the insurer can submit anything; the filing must still comply with Ohio laws, regulations, and bulletins.

If the wording on a health insurance policy (or other form) conflicts with Ohio state law, the policy will be amended to minimum conformity with state statutes.

Record maintenance

Complete and accurate records must be kept at the producer’s place of business for a minimum of 3 years.

Records must show:

  • Every contract placed
  • The named insured
  • Changes or amendments
  • Premiums received with each transaction

Records may be inspected at any time by the Department of Insurance or a representative appointed on its behalf.

Fraudulent producer representation

A producer violates regulation if they represent to the public that they are licensed to conduct insurance business in Ohio but have not passed the appropriate licensing examination.

This includes public communications such as:

  • Advertisements
  • Letterheads
  • Circulars
  • Business cards
  • Other methods of representation

A producer found guilty of conducting business in Ohio in any line of insurance for which they are not properly licensed may have any other insurance license suspended or revoked.

Misrepresentation

  • Misrepresentation involving the creation or distribution of policies, quotes, and illustrations designed to provide inaccurate information about the terms and conditions of a policy is prohibited.
  • Providing inaccurate or incomplete information or comparisons regarding the benefits of a policy is an example of misrepresentation.
  • Providing inaccurate or incomplete information with the sole purpose of inducing lapse, exchange, conversion, forfeiture, or surrender is a violation as well (twisting).

False advertising

Communication involving the publication of newspapers, magazines, radio, or television that is intended to deliver false information in reference to insurance is a violation of NAIC regulation.

Defamation

  • The intentional and malicious circulation of written or oral information intended for the direct or indirect dissemination of derogatory statements is prohibited.
  • Publishing and circulating inaccurate information regarding the financial condition of an insurer, person, or competitor in the insurance industry is a violation of NAIC regulation.

Boycott, coercion and intimidation

Participation in any boycott or activity involving coercion and intimidation for the sole purpose of retaining business, or that results in a monopoly of insurance business, is prohibited.

False financial statements

Any licensed producer who makes false statements containing inaccurate material facts or false statements on an application for insurance is in violation of NAIC regulation.

Illegal inducements

In Ohio, it is prohibited to induce the purchase of insurance by offering anything with a monetary value in excess of $10.

It is also prohibited to accept anything with a monetary value in excess of $10 from a client.

A producer who participates in this activity may be subject to license suspension and a monetary fine.

Unfair discrimination

Discriminating on the basis of class, race, marital status, or sexual preference is a violation of regulation.

  • Any unfair discriminatory practices intended to directly or indirectly favor an applicant or insured are prohibited.
  • Denying insurance coverage based on blindness or partial blindness is considered discrimination and is a violation of NAIC regulation.

Errors & omissions

Errors & Omissions (E&O) insurance is a type of professional liability insurance that protects insurance agents if they are sued for negligent performance of their duties.

  • E&O covers honest mistakes that result in financial damage to customers or prospects.
  • E&O does not cover violations of insurance regulation.

Rebating

Ohio licensed producers are prohibited from directly or indirectly giving any refund, discount, favor, or credit to reduce premiums to induce the purchase of insurance.

Furthermore, producers in Ohio are also prohibited from receiving any payment for the sale, solicitation, or negotiation of insurance outside of commissions and/or salary.

Sidenote
Know this...

To “solicit” or “negotiate” insurance implies that the person is licensed.

Sharing commission

Splitting or sharing commissions with a licensed producer is allowed.

  • Both parties must be licensed in the line of business in which the commission is being split.

Twisting

Twisting is prohibited.

  • Providing false information or expressing derogatory ideas about the financial condition of a competitor company with the intent to cause an existing policy to lapse or be surrendered is a violation of law.
  • Any written or oral statements used to induce the lapse, termination, exchange, or surrender of an insurance contract based on inaccurate information are prohibited.

Unfair marketing practices

The Department of Insurance establishes minimum standards for full and fair disclosure of policy content. It also requires standardization and simplification of the terms used to describe insurance coverage.

Advertising may not involve:

  • Any implication that policies are approved or that the financial condition of a company is endorsed by any government agency or by any independent group, individual, organization, or society.
  • Any statements regarding advertising that are false or untrue in reference to the time frame in which claims are paid.

Gramm-Leach Bliley Act (GLBA)

This law repealed the Glass-Steagall Act of 1933, allowing consolidation of commercial banks, investment institutions, and insurance companies.

GLBA:

  • Established a framework of responsibilities for federal and state regulators across these financial industries.
  • Permits financial services companies to merge and engage in new business activities (including insurance), while attempting to address the regulatory issues raised by these combinations.

McCarran-Ferguson Act

Federal law signed in 1945 in which Congress declared that the insurance industry would be regulated at the state level.

  • Grants insurers a limited exemption from federal antitrust legislation.

National Association of Insurance Commissioners (NAIC)

The NAIC is the U.S. standard-setting and regulatory support organization created and governed by the chief insurance regulators from the 50 states, the District of Columbia, and five U.S. territories.

Through the NAIC, state insurance regulators:

  • Establish standards and best practices
  • Conduct peer review
  • Coordinate regulatory oversight

NAIC staff supports these efforts and represents the collective views of state regulators domestically and internationally. NAIC members, together with the central resources of the NAIC, form the national system of state-based insurance regulation in the U.S.

Fair Credit Reporting Act of 1971

If an applicant is denied insurance, employment, or credit due to information collected, this regulation grants access to the information and the reasons for the denial.

  • After receiving notice that an adverse underwriting decision has been made (which must be communicated within 3 days), an individual has 90 business days to request a copy of the report.

Privacy Act of 1974

This regulation provides a system for the collection, use, and dissemination of information gathered during the underwriting process.

When an applicant signs the insurance application (notice regarding insurance information practices), the applicant gives the insurer the right to check:

  • Driving records
  • MIB
  • Consumer investigative reports

A signed application authorizes the insurer to collect information for 30 months. If the insurer has not done so by then, a new authorization must be obtained.

Telemarketing

The DO NOT CALL registry is a list of telephone numbers, intended to prevent calls from telemarketers.

Unsolicited sales calls must follow these provisions:

  • No call may be placed outside of the hours of 8 am to 9 pm local time where the call is received.
  • The sales nature of the call must be disclosed and the nature of the product/service being offered must be disclosed.
  • The caller must identify themselves and the broker/dealer they represent.
  • If a prize is being offered, the prize cannot be contingent on purchase.

CAN-Spam

When an unsolicited e-mail is sent, the sender must:

  • Use the word advertisement or the letters ADV on the subject line.
  • Notate the physical location from where the email originated.
  • Give the recipient the opportunity to opt out of ever receiving another email from the sender.

Insurance guaranty association

The Ohio Insurance Guaranty Association is made up of authorized insurers and is controlled by a board.

  • Joining the association is part of the authorization process that allows insurance companies to conduct business in Ohio.
  • This is not unique to Ohio; insurers must be authorized in every state where they transact business.

Once authorized, any insurer doing business in Ohio must contribute to the Ohio Insurance Guarantee Fund, which is intended to indemnify policy owners of insurance companies that have become insolvent (up to $100,000 cash and $300,000 total benefits).

Key points

Licensing

  • Must be 18+ and Ohio resident to apply
  • Complete approved pre-licensing course before exam
  • Fingerprints required after passing exam, before application

Controlled business

  • License cannot be obtained solely for writing insurance for self/family
  • Selling to self/family allowed, but not as sole purpose

Non-resident license

  • Must have Ohio license in good standing
  • Apply and pay fees in other states; reciprocity required

Temporary license

  • Sponsored by insurer; valid once per line, max 6 months

Inactive status

  • Active military duty: license can go inactive
  • May receive trailing commissions, but cannot solicit new business

Renewal maintenance

  • License valid for 2 years; renew by birth month end
  • 30-day grace period with $50 late fee
  • Reinstatement within 12 months without retesting; after 12 months, must retake course, exam, fingerprints

Continuing education

  • 24 hours CE required for renewal of major lines

Notice of change of name or address

  • Must report changes within 30 days
  • Failure may result in fines or suspension

Company regulations

  • Must be authorized by Ohio Department of Insurance
  • Submit rate tables, articles, bylaws, fees

Place of business

  • Resident producers must maintain public-accessible business in Ohio

Capital and surplus requirement

  • Insurer must maintain minimum capital/surplus to keep certificate of authority

Duties of the Director of Insurance

  • Appointed by Governor; enforces insurance laws
  • Investigates violations, audits, collects fees, administers fines
  • Issues, suspends, or revokes licenses/certificates
  • Approves forms and rates
    • Cannot arrest, issue injunctions, or sentence jail time

Suspend, revoke or non-renew

  • Grounds: false info, fraud, felonies, unethical practices, prior revocations, misrepresentation, cheating, commingling funds

Cease and desist

  • Director may order halt to violations
  • Does not suspend/revoke license, but requires activity to stop

Hearing

  • Right to hearing on disciplinary actions
  • Notice sent at least 20 days before hearing
  • Civil penalty up to $15,000 per violation

Unfair claims settlement practices

  • Delaying claims, failing to investigate, or denying without investigation is prohibited
  • Must provide prompt, written explanations and fair settlements

Policy forms

  • Ohio is “file and use” state: use forms upon filing, must comply with law
  • Conflicting policy wording amended to state minimums

Record maintenance

  • Keep complete records for minimum 3 years
  • Must show contracts, insureds, amendments, premiums
  • Subject to inspection by Department

Fraudulent producer representation

  • Illegal to claim licensure without passing exam
  • Applies to ads, business cards, letterheads, etc.
  • Unlicensed activity may result in suspension/revocation

Misrepresentation

  • Prohibited to provide false/incomplete info about policies
  • Twisting: inducing lapse/exchange by misrepresentation is a violation

False advertising

  • False info in media about insurance is prohibited

Defamation

  • Malicious, false statements about insurers/competitors prohibited

Boycott, coercion and intimidation

  • Prohibited to use these for business retention or monopoly

False financial statements

  • Illegal to make false statements on insurance applications

Illegal inducements

  • Cannot offer/accept anything over $10 to induce insurance purchase
  • Violations may lead to suspension and fines

Unfair discrimination

  • Discrimination by class, race, marital status, sexual preference, blindness is prohibited

Errors & omissions

  • E&O insurance covers negligent mistakes, not regulatory violations

Rebating

  • Prohibited to give/receive premium reductions or extra payments outside commissions/salary

Sharing commission

  • Allowed only if both parties licensed in same line

Twisting

  • Prohibited to induce policy lapse/exchange with false info about competitors

Unfair marketing practices

  • Must provide full, fair disclosure; no false claims of government approval
  • No misleading statements about claim payment timeframes

Gramm-Leach Bliley Act (GLBA)

  • Repealed Glass-Steagall; allows banks, insurers, investment firms to merge
  • Sets regulatory framework for combined financial services

McCarran-Ferguson Act

  • Insurance regulated at state level
  • Limited exemption from federal antitrust laws

National Association of Insurance Commissioners (NAIC)

  • Sets standards, best practices, peer review, regulatory coordination among states

Fair Credit Reporting Act of 1971

  • Denial notice must be given within 3 days; 90 days to request report copy

Privacy Act of 1974

  • Applicant authorizes info collection for 30 months via signed application
  • Covers driving records, MIB, investigative reports

Telemarketing

  • No calls outside 8 am–9 pm local time
  • Must disclose sales nature, identity, product/service
  • Prizes cannot be contingent on purchase

CAN-Spam

  • Unsolicited emails must use “advertisement”/“ADV” in subject
  • Must show sender location, provide opt-out

Insurance guaranty association

  • All authorized insurers must join and contribute
  • Protects policyholders if insurer becomes insolvent (up to $100,000 cash, $300,000 total benefits)