26-12-303. Enforcement by commissioner; penalty for violation.
(a) If within thirty (30) days following the giving of the notice specified in W.S. 26-12-302 the insurer has not ceased dissemination of any false advertising, and if the commissioner believes that the insurer is soliciting, issuing or delivering contracts of insurance to residents of this state or collecting premiums on those contracts or performing any other transaction in connection with that insurance, and that a proceeding by him in respect to those matters would be in the public interest, he shall take action against the insurer under W.S. 26-13-117.
(b) If pursuant to the proceeding the commissioner finds that the dissemination of false advertising is continuing, he shall order the insurer to desist therefrom and shall mail a copy of the order by certified or registered mail to the insurer at its principal place of business last of record with the commissioner and to the insurance supervisory official of the insurer's domiciliary state or province. Each violation after mailing of the desist order subjects the insurer to a penalty of two thousand dollars ($2,000.00), to be recovered by a civil action the commissioner brings against the insurer. Service of process upon the insurer in the action may be made upon the commissioner pursuant to W.S. 26-12-202 and 26-12-203 or in any other lawful manner.
26-13-102. Unfair methods and deceptive acts prohibited.
No person shall engage in this state in any trade practice which is defined in this article as or is determined pursuant to this article to be an unfair method of competition or an unfair or deceptive act or practice in the business of insurance.
26-13-103. Misrepresentations and false advertising prohibited.
(a) No person shall:
(i) Make, issue, circulate, or cause to be made, issued or circulated, any estimate, circular or statement misrepresenting the terms of any policy issued or to be issued or the benefits or advantages promised thereby or the dividends or share of the surplus to be received thereon;
(ii) Make any false or misleading statement as to the dividends or share of surplus previously paid on similar policies;
(iii) Make any misleading representation or any misrepresentation as to the financial condition of any insurer or as to the legal reserve system upon which any life insurer operates; or
(iv) Use any name or title of any policy or class of policies misrepresenting the true nature thereof.
26-13-104. Home office false advertising prohibited.
No person shall make in any manner in any advertising or other communication medium any advertisement, announcement or statement containing any assertion, representation or statement with respect to the business of insurance or with respect to any person in the conduct of his insurance business, which is untrue, deceptive or misleading.
No person shall make or issue, nor cause to be made or issued, any written or oral statement misrepresenting or making incomplete comparisons as to the terms, conditions or benefits contained in any policy for the purpose of inducing or attempting to induce the policyholder to lapse, forfeit, surrender, retain, exchange or convert any insurance policy.
26-13-106. False or misleading financial statements prohibited.
(a) No person shall:
(i) File with any supervisory or other public official or in any manner place or cause to be placed before any other person, any false statement of financial condition of an insurer with intent to deceive;
(ii) Make any false entry in any book, report or statement of any insurer with intent to deceive:
(A) Any agent or examiner lawfully appointed to examine into its condition or into any of its affairs; or
(B) Any public official to whom the insurer is required by law to report, or who has authority by law to examine into its condition or into any of its affairs.
(iii) With intent to deceive, willfully omit a true entry of any material fact pertaining to the insurer's business in any book, report or statement of the insurer; or
(iv) Advertise the capital or assets of an insurer without in the same advertisement setting forth the amount of the insurer's liabilities in equal prominence to the statement of capital and assets.
No person shall make or aid, abet or encourage the making in any manner in any communication medium of any oral or written statement which is false or maliciously critical of or derogatory to an insurer's financial condition, or of an organization proposing to become an insurer, and which is made to injure any person engaged or proposing to engage in the insurance business.
26-13-108. Boycott, coercion and intimidation prohibited; exception.
No person shall enter into any agreement to commit, or by any concerted action commit, any act of boycott, coercion or intimidation resulting in unreasonable restraint of or any monopoly in any business of insurance, except that an insurer owned or controlled by an association or organization may refuse to renew a casualty or liability policy because of nonpayment of dues to the association or organization if payment of dues is a prerequisite to obtaining or continuing the insurance.
(a) No person shall make or permit any unfair discrimination between current or prospective insureds or insured risks:
(i) Repealed by Laws 2023, ch. 32, § 2.
(ii) Of the same class, having similar insuring or risk characteristics and of essentially the same hazard in:
(A) The amount of premium, policy fees or rates charged for any policy or contract of insurance;
(B) The dividends or benefits payable thereunder;
(C) Any of the terms or conditions of the contract; or
(D) Any other manner.
(b) Repealed by Laws 2023, ch. 32, § 2.
(a) Except as otherwise provided by law, no person shall:
(i) Authorize, offer to make or make any contract of insurance or agreement as to that contract other than as expressed in the contract issued thereon;
(ii) Pay, allow or give or offer to pay, allow, give, receive or accept in any manner as inducement to the purchase of insurance or renewal of insurance:
(A) Any rebate, discount, credit or reduction of premiums payable on the contract;
(B) Any special favor or advantage in the dividends or other benefits thereon;
(C) Any paid employment or contract for services of any kind; or
(D) Any valuable consideration or inducement not specified in the contract.
(iii) In any manner give, sell or purchase or offer or agree to give, sell, purchase or allow as inducement to the insurance or in connection therewith, and whether or not to be specified in the policy or contract, any agreement of any form or nature promising:
(A) Returns and profits;
(B) Any stocks, bonds or other securities, or interest present or contingent therein or as measured thereby, of any insurer or other corporation, association or partnership; or
(C) Any dividends or profits accrued or to accrue thereon.
(iv) Offer or provide insurance as an inducement to the purchase of another policy or use the words "free", "no cost" or similar wording in an advertisement;
(v) Unfairly discriminate against a customer when offering or declining to offer any of the items authorized by subsection (c) of this section.
(b) Nothing in W.S. 26-13-109 or subsection (a) of this section shall prohibit any of the following practices:
(i) Paying bonuses to customers or abating their premiums in whole or in part out of surplus accumulated from nonparticipating insurance, provided that any bonuses or abatement of premiums are fair and equitable to customers and are in the insurer and its customers' best interests;
(ii) Making allowances to customers who have continuously made premium payments directly to the office of an insurer in an amount which fairly represents the saving in collection expense;
(iii) Readjustment of the premium rate for a group insurance policy based on the loss or expense experienced by the insurer, which may be made retroactive only for that policy year;
(iv) Reduction of premium rates for policies of large amount, but not exceeding savings in issuance and administration expenses reasonably attributable to those policies as compared with policies of a similar plan issued in smaller amounts;
(v) Reduction in premium rates for life or disability insurance policies on annuity contracts on salary savings, payroll deduction, preauthorized check, bank draft or similar plans in amounts reasonably commensurate with the savings made by the use of those plans;
(vi) Allowing or returning to an insurer's participating customers, members or subscribers dividends, savings or unabsorbed premium deposits;
(vii) The payment of commissions or other compensation to licensed producers;
(viii) The selling or offering for sale, contemporaneously with life insurance, of mutual fund shares or face amount certificates of regulated investment companies under offerings with the securities and exchange commission if the shares or face amount certificates and the life insurance may be purchased independently, at the same price as and upon the same terms and conditions as if purchased contemporaneously;
(ix) The offer or provision by insurers, producers or their affiliates of a product or service at no cost or a reduced cost when the product or service is not specified in the policy of insurance and the product or service:
(A) Relates to the insurance coverage;
(B) Is primarily designed to satisfy one (1) or more of the following:
(I) Provide loss mitigation or loss control;
(II) Reduce claim costs or claim settlement costs;
(III) Provide education about liability risks or risk of loss to persons or property;
(IV) Monitor or assess risk, identify sources of risk or develop strategies for eliminating or reducing risk;
(V) Enhance health;
(VI) Enhance financial wellness through items such as education or financial planning services;
(VII) Provide post-loss services;
(VIII) Incentivize behavioral changes to improve the health or reduce the risk of death or disability of a customer; or
(IX) Assist in the administration of retirement benefit insurance coverage.
(C) The cost to the insurer or producer offering the product or service to any given customer is reasonable in comparison to that customer's premiums or insurance coverage for the policy class;
(D) The insurer or producer ensures that the customer is provided with contact information to assist the customer with questions regarding the product or service;
(E) The availability of offered products or services shall be based on documented objective criteria, which shall by maintained by the insurer or producer and produced upon request by the department. If the insurer or producer does not have sufficient evidence, but has a good-faith belief that the offered products or services meet the criteria, the insurer or producer may provide the products or services as part of a pilot or testing program for no more than one (1) year. The department shall be notified of any pilot or testing program prior to launching. The program may proceed unless the department objects within thirty (30) days of notice.
(c) Unless prohibited by paragraphs (a)(ii) and (iii) of this section, an insurer or producer may:
(i) Offer or give non-cash gifts, items or services to customers in connection with the marketing, sale, purchase or retention of contracts of insurance, provided that the cost of the gifts, items or services are not included in any amounts charged to another person or entity. The customer shall not be required to purchase, continue to purchase or renew a policy in exchange for the gift, item or service. The total value of the gift, item or service per customer per calendar year shall not exceed:
(A) One hundred dollars ($100.00) or five percent (5%), but not to exceed one thousand dollars ($1,000.00), of the written premium for current customers; or
(B) One hundred dollars ($100.00) or five percent (5%), but not to exceed one thousand dollars ($1,000.00), of the quoted premium for prospective customers.
(ii) Conduct raffles or drawings for prizes to the extent permitted by state law at no cost to entrants. The drawing or raffle shall not obligate participants to purchase insurance and shall be open to the public. The customer shall not be required to purchase or renew a policy in exchange for entrance into the raffle or drawing. The total value of each raffle or drawing shall not exceed one hundred dollars ($100.00).
(d) Any person who provides any gift, item, service or prize under subsection (c) of this section shall retain records which shall be considered records of transactions under W.S. 26-9-228 and which shall be provided for inspection upon request of the commissioner. These records shall include but are not limited to receipts of purchase, dates of transaction and names of customers.
(e) The commissioner may adopt rules and regulations when implementing the permitted practices set forth in this section to ensure consumer protection.
(f) As used in this section:
(i) "Insurance" means as defined by W.S. 26-1-102(a)(xv) and also includes suretyship;
(ii) "Policy" means as defined by W.S. 26-1-102(a)(xxi) and also includes bond;
(iii) "Customer" means a policyholder, potential policyholder, certificate holder, potential certificate holder, insured, potential insured or applicant.
26-13-113. Deductible amount of collision coverage; subrogation; right to deductible.
(a) If an insurer pays a loss claim to its insured and the insurer decides to subrogate to the insured's loss claim, the deductible amount shall be included in the subrogated loss claim and the insurance carrier shall pay the deductible amount to its insured, without any deduction for expenses of collection, out of any recovery on the subrogated claim, before any part of the recovery is applied to any other use. If the amount of the deductible exceeds the recovery, the insurer shall pay only the amount of the recovery to the insured.
(b) If in any arbitration of the subrogated claim two (2) or more insurers agree to offset the claims of their insureds, the right of any insured to the return of his full deductible amount shall not be abridged.
26-13-114. Securities operations and advisory board contracts as insurance inducement prohibited.
No insurer or other person shall offer, issue or deliver or permit its agents, officers or employees to offer, issue or deliver, in this or any other state, agency company stock or other capital stock, benefit certificates, shares in any common-law corporation or any advisory board contract promising returns and profits as an inducement to insurance.
26-13-115. Desist orders by commissioner; appeal; violation of order.
(a) If the commissioner finds that any person in this state, after a hearing in which the person is notified of the hearing and the charges against him, has engaged or is engaging in any act or practice defined in or prohibited under this chapter, the commissioner shall order the person to desist from the acts or practices.
(b) The desist order is final upon expiration of the time allowed for appeals from the commissioner's orders, if no appeal is taken, or, if there is an appeal, upon final decision of the court if the court affirms the commissioner's order or dismisses the appeal. An intervenor in the hearing may appeal as provided in W.S. 26-2-129.
(c) If there is an appeal, to the extent that the commissioner's order is affirmed, the court shall issue its own order commanding obedience to the terms of the commissioner's order.
(d) No order of the commissioner pursuant to this section or order of the court to enforce it in any way relieves or absolves any person affected by the order from any other liability, penalty or forfeiture under law.
(e) Violation of any desist order is punishable as a violation of this code.
(f) This section does not affect or prevent the imposition of any penalty provided by this code or by other law for violation of any other provision of this chapter, whether or not any hearing is called or held or any desist order issued.
26-13-116. Procedures for undefined deceptive practices.
(a) If the commissioner believes that any person in conducting an insurance business in this state is engaging in any method of competition or in any act or practice, not defined in this chapter, which is unfair or deceptive and that a proceeding by him in respect thereto would be in the public interest, after a hearing in which the person charged receives a notice of the hearing and of the charges against him, the commissioner shall make a written report of his findings of fact relative to the charges and serve a copy thereof upon the person and any intervenor at the hearing.
(b) If the commissioner's report charges a violation of this chapter and if the method of competition, act or practice is not discontinued, the commissioner, through the attorney general, at any time after service of the report, may cause an action to be instituted to enjoin and restrain the person from engaging in the method, act or practice. In the action the court may grant a restraining order or injunction upon any just terms, but the people of this state are not required to give security before the issuance of the order or injunction. If a stenographic record of the proceedings in the hearing before the commissioner is made, a certified transcript thereof including all evidence taken and the report and findings shall be received in evidence in the action.
(c) If the commissioner's report made under subsection (a) of this section or order on hearing made under W.S. 26-2-128 does not charge a violation of this chapter, then any intervenor in the proceedings may appeal within the time and in the manner provided in W.S. 26-2-129(b).
26-13-117. Service of process upon unauthorized insurers.
(a) Service of all process, statements of charges and notices under this chapter upon unauthorized insurers shall be made in accordance with W.S. 26-3-122.
(b) The commissioner shall forward all process, statements of charges and notices to the insurer in the manner provided in W.S. 26-3-122.
(c) No default shall be taken against any unauthorized insurer until expiration of thirty (30) days after the date of forwarding by the commissioner under subsection (b) of this section, or date of service of process if under W.S. 26-12-203(b).
(d) W.S. 26-12-203(d) applies to all process, statements of charges and notices under this section.
(a) No person shall require as a condition to loaning money upon the security of any real or personal property, or to the selling of that property under contract, that the owner of the property to whom the money is to be loaned or the vendee of the property being sold, shall place, continue or renew any policy of insurance covering the property, or covering any liability related to the property or the use thereof, through a particular insurance agent or broker or in a particular insurer. This does not prevent the lender or vendor, upon a reasonable basis, from approving or disapproving of the insurer and representative selected to underwrite the insurance, but the basis for approval or disapproval shall relate only to:
(i) The adequacy and terms of the coverage with respect to the interest of the vendor or lender to be insured thereunder;
(ii) The financial standards to be met by the insurer; and
(iii) The ability of the insurer or representative to service the policy.
(a) Any insurer may retain, invest in or acquire the whole or any part of the capital stock of any other insurer, or have a common management with any other insurer, unless the retention, investment, acquisition or common management is inconsistent with any other provision of this code, or unless by reason thereof the insurers' business with the public is conducted in a manner which substantially lessens competition generally in the insurance business or tends to create any monopoly therein.
(b) Any person otherwise qualified may be a director of two (2) or more insurers which are competitors, unless the effect thereof is to lessen substantially competition between insurers or tends materially to create a monopoly.
26-13-120. Political contributions prohibited; penalty.
(a) No insurer shall in any manner pay or use, or offer, consent or agree to pay or use, any money or property:
(i) For or in aid of any:
(A) Political party, committee or organization;
(B) Corporation or other body organized or maintained for political purposes;
(C) Candidate for political office;
(D) Nomination for office; or
(E) Other political purpose; or
(ii) For the reimbursement or indemnification of any person for money or property so used.
(b) Any officer, director, stockholder, attorney or agent of any insurer which violates this section, who participates in, aids, abets, advises or consents to any such violation, and any person who solicits or knowingly receives any money or property in violation of this section, is guilty of a misdemeanor and shall be punished by imprisonment for not more than one (1) year and a fine of not more than one thousand dollars ($1,000.00). Any officer or director abetting in any contribution made in violation of this section is liable to the insurer for the amount so contributed.
(c) This section does not prohibit an insurer from otherwise lawful expenditures for presentation of information to legislators relative to proposed legislation affecting the insurer.
26-13-121. Illegal dealing in premiums; excess charges for insurance.
(a) No person shall willfully collect any sum as premium or charge for insurance:
(i) If the insurance is not then provided or is not in due course to be provided, subject to the insurer's acceptance of the risk, by an insurance policy issued by the insurer as authorized by this code;
(ii) In excess of the premium or charge applicable to the insurance, and as specified in the policy, in accordance with the applicable classifications and rates as filed with and approved by the commissioner; or
(iii) In cases where classifications, premiums or rates are not required by this code to be filed and approved, in excess of those specified in the policy and as fixed by the insurer.
(b) Subsection (a) of this section does not prohibit the charging and collection by surplus lines brokers licensed under chapter 11 of this code of the amount of applicable state and federal taxes, examination fee and nominal service charge to cover communication expenses, in addition to the premium required by the insurer. Nor does it prohibit the charging and collection by a life insurer of amounts actually to be expended for medical examination of an applicant for life insurance or for reinstatement of a life insurance policy.
(c) Each violation of this section is punishable under W.S. 26-1-107.
(a) No authorized or unauthorized insurer shall make available, through any rating plan or form, property, casualty or surety insurance to any firm, corporation or association of individuals at any preferred rate or premium based upon any fictitious grouping of the firm, corporation or association.
(b) No form or plan of insurance covering any group or combination of persons or risks shall be written or delivered within or outside this state to cover persons or risks in this state at any preferred rate or on any form other than as offered to persons not in the group or combination and to the public generally, unless the form, plan of insurance and the rates or premiums to be charged therefor have been submitted to and approved by the commissioner as being not unfairly discriminatory, and as not otherwise being in conflict with subsection (a) of this section or with chapter 14 of this code to the extent that chapter 14 is applicable thereto.
(c) This section does not apply to life insurance, disability insurance or annuity contracts.
(a) A person is considered to be engaging in an unfair method of competition and unfair and deceptive act or practice in the business of insurance if that person commits or performs with such frequency as to indicate a general business practice any of the following unfair claims settlement practices:
(i) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue;
(ii) Failing to acknowledge and act reasonably promptly upon communications with respect to claims arising under insurance policies;
(iii) Failing to adopt and implement reasonable standards for the prompt investigation of claims arising under insurance policies;
(iv) Refusing to pay claims without conducting a reasonable investigation based upon all available information;
(v) Failing to affirm or deny coverage of claims within a reasonable time after proof of loss statements have been completed;
(vi) Not attempting in good faith to effectuate prompt, fair and equitable settlements of claims in which liability has become reasonably clear;
(vii) Compelling insureds to institute litigation to recover amounts due under an insurance policy by offering substantially less than the amounts ultimately recovered in actions brought by such insureds;
(viii) Attempting to settle a claim for less than the amount to which a reasonable person would have believed he was entitled by reference to written or printed advertising material accompanying or made part of an application;
(ix) Attempting to settle claims on the basis of an application which was altered without notice to, or knowledge or consent of, the insured;
(x) Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which the payments are being made;
(xi) Making known to insureds or claimants a policy of appealing from arbitration awards in favor of insureds or claimants for the purpose of compelling them to accept settlements or compromises less than the amount awarded in arbitration;
(xii) Delaying the investigation or payment of claims by requiring an insured, claimant or the physician of either to submit a preliminary claim report and then requiring the subsequent submission of formal proof of loss forms, both of which submissions contain substantially the same information;
(xiii) Failing to promptly settle claims, where liability has become reasonably clear, under one (1) portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage;
(xiv) Failing to promptly provide a reasonable explanation of the basis in the insurance policy in relation to the facts or applicable law for denial of a claim or for the offer of a compromise settlement;
(xv) Denying or failing to timely pay disability insurance claims for medically necessary services, procedures or supplies as required by W.S. 26-40-201;
(xvi) Failing to comply with the external review procedures required by W.S. 26-40-201; or
(xvii) Failing to pay a claim after an external review organization has declared such claim to be a benefit covered under the terms of the insurance policy.
(a) No person shall prepare, issue or knowingly request the issuance of a certificate of insurance unless the form has been filed and approved in accordance with W.S. 26-15-110. No person shall alter or modify a certificate of insurance form unless the alteration or modification has been filed and approved in accordance with chapter 15 of this code.
(b) The commissioner shall disapprove the use of, or prohibit the use of, a certificate of insurance form filed under this section if the certificate of insurance form:
(i) Is unfair, misleading or deceptive;
(ii) Violates public policy; or
(iii) Fails to comply with this section or any other law of this state.
(c) The forms used for a certificate of insurance for surplus lines policies issued pursuant to the nonadmitted insurance law, W.S. 26-11-101 et seq., are not subject to the approval requirements of W.S. 26-15-110. Certificates issued for surplus lines insurance policies shall use either:
(i) A form approved for the policy by the insurer's home state; or
(ii) A standard form used by the issuing insurer if there is no relevant form approved by the home state.
(d) Each certificate of insurance shall contain the following or similar statement: "This certificate of insurance is issued as a matter of information only and confers no rights upon the certificate holder. Subject to W.S. 26-13-125(e), this certificate does not alter, amend or extend the coverage, terms, exclusions and conditions afforded by the policies referenced herein."
(e) No person shall demand or request the issuance of a certificate of insurance or other document, record or correspondence that the person knows contains any false or misleading information or that purports to affirmatively or negatively alter, amend or extend the coverage provided by the policy of insurance to which the certificate makes reference.
(f) The provisions of this section shall apply to all certificate holders, third party certificate administrators, policy holders, insurers, insurance producers and certificate of insurance forms issued as evidence of property or casualty insurance coverages on property, operations or risks located in this state, regardless of where the certificate holder, policy holder, insurer or insurance producer is located.
(g) A certificate of insurance is not a policy of insurance and does not affirmatively or negatively alter, amend or extend the coverage afforded by the policy to which the certificate of insurance makes reference. A certificate of insurance shall not confer to a certificate holder any new or additional rights beyond what the referenced policy or insurance provides. Any coverage or policy limits listed on the certificate of insurance shall accurately reflect policy limits.
(h) No certificate of insurance shall contain references to contracts other than the underlying contracts of insurance, including construction or service contracts. Notwithstanding any requirement, term or condition of any contract or other document with respect to which a certificate of insurance may be issued or may pertain, the insurance afforded by the referenced policy of insurance is subject to all the terms, exclusions and conditions of the policy itself.
(j) A person is entitled to receive notice of cancellation, nonrenewal or any material change or any similar notice concerning a policy of insurance only if the person has notice rights under the terms of the policy or any endorsement to the policy. The terms and conditions of the notice, including the required timing of the notice, are governed by the policy of insurance or endorsement and may not be altered by a certificate of insurance.
(k) Any certificate of insurance or any other document, record or correspondence prepared, issued or requested in violation of this section shall be null and void and of no force and effect.
(m) As used in this section:
(i) "Certificate" or "certificate of insurance" means any document or instrument, no matter how titled or described, which is prepared or issued as evidence of property or casualty insurance coverage. "Certificate" or "certificate of insurance" shall not include a policy of insurance, a certificate issued to a policyholder under a group master policy, an insurance binder, a policy endorsement, and automobile insurance identification card, or a certificate prepared or issued pursuant to any federal law, rule or regulation or any other law, rule or regulation of this state, in which the specific content and form of the certificate is enumerated therein;
(ii) "Certificate holder" means any person, other than a policyholder, who requests, obtains or possesses a certificate of insurance;
(iii) "Group master policy" means an insurance policy that provides coverage to eligible persons on a group basis through a group insurance program;
(iv) "Policyholder" means a person who has contracted with a property or casualty insurer for insurance coverage.
26-13-201. False applications, claims and proofs of loss prohibited.
(a) No person shall knowingly or willfully:
(i) Make any false or fraudulent statement or representation in or with reference to any application for insurance or for the purpose of obtaining any money or benefit;
(ii) Present or cause to be presented a false or fraudulent claim or any proof in support of a claim for the payment of the loss upon a contract of insurance;
(iii) Prepare, make or subscribe a false or fraudulent certificate, or other document with intent that the certificate or other document may be presented or used in support of the claim.
Any person who violates this article is subject to the penalty provided in W.S. 26-1-107, or as provided by any other applicable law which provides a greater penalty.
The purpose of this act is to assure that health insurance benefits not subject to the federal Employee Retirement Income Security Act are contractually guaranteed, and to avoid the conflict of interest that occurs when the carrier responsible for providing benefits has discretionary authority to decide what benefits are due. This act is also intended to assure that health insurance benefits contracts subject to the federal Employee Retirement Income Security Act which contain a discretionary clause provide appropriate disclosure of the clause and additional provisions to assure a fair determination of contract benefits. Nothing in this act shall be construed as imposing any requirement or duty on any person other than a health carrier.
(a) As used in this act:
(i) "Commissioner" means as defined in W.S. 26-1-102(a)(viii);
(ii) "Health care services" means services for the diagnosis, prevention, treatment, cure or relief of a health condition, illness, injury or disease;
(iii) "Health carrier" means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services, including a sickness and accident insurance company, a health maintenance organization, a nonprofit hospital and health service corporation, or any other entity providing a plan of health insurance, health benefits or health services;
(iv) "Person" means as defined in W.S. 8-1-102(a)(vi);
(v) "This act" means W.S. 26-13-301 through 26-13-305.
(a) No policy, contract, certificate or agreement offered or issued in this state by a health carrier to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services may contain a provision purporting to reserve discretion to the health carrier to interpret the terms of the contract, or to provide standards of interpretation or review that are inconsistent with the laws of this state. This subsection shall not apply to a policy, contract, certificate or agreement subject to and meeting the requirements of subsections
(b) and (c) of this section.
(b) Any group policy, contract, certificate or agreement subject to the federal Employee Retirement Income Security Act and offered or issued in this state by a health carrier to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services and which contains a provision purporting to reserve discretion to the health carrier to interpret the terms of the contract or to provide standards of interpretation or review shall contain the following language highlighted in bold in not less than twelve (12) point type: This benefit plan contains a discretionary clause. Determinations made by (insurer name) pursuant to the discretionary clause do not prohibit or prevent a claimant from seeking judicial review in court of (insurer name's) decisions. By including this discretionary clause (insurer's name) agrees to allow a court to review its determinations anew when a claimant seeks judicial review of (insurer name's) determinations of eligibility of benefits, the payment of benefits or interpretations of the terms and conditions applicable to the benefit plan.
(c) Any group policy, contract, certificate or agreement containing a discretionary clause as authorized in subsection
(b) of this section shall contain a provision entitling any person denied benefits in whole or in part to have the determination reviewed de novo in any court with jurisdiction.
Any person who violates this act is subject to the penalty provided in W.S. 26-1-107, or as provided by any other applicable law which provides a greater penalty.
26-14-101. Purpose of chapter; liberal interpretation.
The purpose of this chapter is to protect the public and policyholders against the effects of excessive, inadequate or unfairly discriminatory rates by promoting price competition among insurers. The provisions in this chapter are intended to prohibit unlawful price fixing agreements by or among insurers and to authorize essential cooperative activities among insurers in the rate making process and to regulate these activities to prohibit practices that tend to substantially lessen competition or create monopolies. This chapter shall be liberally interpreted to carry into effect the provisions of this section.
26-14-102. Scope and applicability of chapter; liberal interpretation.
(a) This chapter applies to all kinds of insurance written on risks in this state by any insurer authorized to do business, except nothing in this chapter applies to:
(i) Life insurance;
(ii) Disability insurance;
(iii) Reinsurance;
(iv) Insurance against loss of or damage to aircraft, their hulls, accessories and equipment, or against liability arising out of the ownership, maintenance or use of aircraft;
(v) Insurance of vessels or craft, their cargoes, marine builders' risks, marine protection and indemnity, or other risks commonly insured under marine, as distinguished from inland marine, insurance policies;
(vi) Title insurance;
(vii) Annuities;
(viii) Worker's compensation insurance as provided under title 27, chapter 14 of the Wyoming statutes.
(b) No insurer shall be required to file any rates with the commissioner other than those for insurance not subject to this act or defined as noncompetitive in this act, after the passage of this act.
(c) This chapter shall be liberally interpreted to carry out the purpose specified in W.S. 26-14-101.
(a) As used in this chapter:
(i) "Advisory organization" means any person or organization which assists insurers as authorized by W.S. 26-14-110. It does not include joint underwriting organizations, actuarial or legal consultants, a single insurer, any employees of an insurer or insurers under common control or management of their employees or managers;
(ii) "Competitive market" means any market except those which are noncompetitive pursuant to this chapter;
(iii) "Excessive" means a rate that is likely to produce a long-term profit that is unreasonably high for the insurance provided. In a competitive market rates shall not be considered excessive;
(iv) "Inadequate" means a rate which is unreasonably low for the insurance provided and the continued use of which endangers the solvency of the insurer using it or will have the effect of substantially lessening competition or creating a monopoly in any market;
(v) "Joint underwriting" means an arrangement established to provide insurance coverage for a risk, pursuant to which two (2) or more insurers contract with the insured for a price and policy terms agreed upon between or among the insurers;
(vi) "Market" means the statewide interaction between buyers and sellers in the procurement of a line of insurance coverage pursuant to the provisions of this chapter;
(vii) "Noncompetitive market" means:
(A) Residual markets;
(B) Pools;
(C) Credit property insurance, including vendors' single interest physical damage insurance where the buyer pays a separate charge for insurance; or
(D) Any market in which:
(I) There are less than five (5) insurers actually issuing a particular line of insurance as determined by the commissioner;
(II) Three (3) insurers transact more than ninety percent (90%) of the business;
(III) Two (2) insurers transact more than eighty percent (80%) of the business; or
(IV) There is reasonable evidence, as determined by the commissioner, of collusion among insurers in setting prices.
(viii) "Pool" means an arrangement pursuant to which two (2) or more insurers participate in the sharing of risks on a predetermined basis. A pool may operate as an association, syndicate or in any other generally recognized manner;
(ix) "Residual market mechanism" means an arrangement, either voluntary or mandated by law, involving participation by insurers in the equitable apportionment of risks among insurers for insurance which may be afforded applicants who are unable to obtain insurance through ordinary methods;
(x) "Supplementary rate information" means any manual or plan of rates, classification, rating schedule, minimum premium, policy fee, rating rule and any other similar information needed to determine an applicable rate in effect or to be in effect;
(xi) "Supporting information" means the experience and judgment of the filer and the experience or data of other insurers or organizations relied upon by the filer, the interpretation of any statistical data relied upon by the filer, a description of methods used in making the rates and other similar information relied upon by the filer;
(xii) "Unfairly discriminatory" refers to rates that cannot be actuarially justified. It does not refer to rates that produce differences in premiums for policyholders with like loss exposures but different expenses, or like expenses but different loss exposures, so long as the rate reflects such differences with reasonable accuracy. A rate is not unfairly discriminatory if it averages broadly among persons insured under a group, franchise or blanket policy or a mass marketing plan. No rate in a competitive market shall be considered unfairly discriminatory unless it violates the provisions of W.S. 26-14-105(b) in that they classify in whole or in part on the basis of race, color, creed or national origin.
(a) Rates shall not be excessive, inadequate or unfairly discriminatory.
(b) Risks may be classified in any way except that no risk may be classified in whole or in part on the basis of race, color, creed or national origin. In determining whether rates in a noncompetitive market are excessive, inadequate or unfairly discriminatory, consideration may be given to the following elements:
(i) Basic Rate Factors.-Consideration may be given to past and prospective loss and expense experience within and outside of this state, to catastrophe hazards and contingencies, to events or trends within and outside of this state, to dividends or savings to policyholders, members or subscribers and to all other factors and judgments deemed relevant by the insurer;
(ii) Classification.-Rates may be modified for individual risks in accordance with rating plans or schedules which establish standards for measuring probable variations in hazards or expenses, or both;
(iii) Expenses.-The expense provisions shall reflect the operating methods of the insurer and, so far as credible, its own actual and anticipated expense experience; and
(iv) Contingencies and Profits.-The rates may contain a provision for contingencies and a provision for a reasonable underwriting profit, and shall reflect investment income directly attributable to unearned premium and loss reserves.
(c) Repealed by Laws 2021, ch. 138, § 1.
(a) Rates in a noncompetitive market, when regulated, shall be regulated in accordance with W.S. 26-14-105 through 26-14-108 applicable to noncompetitive markets.
(b) The commissioner may regulate rates in an unregulated market if he determines that:
(i) The unregulated market is a noncompetitive market; and
(ii) Regulation will likely reduce rates for consumers in a total amount greater than the cost of regulation without substantially curtailing the availability of insurance in that market.
(c) The commissioner may declare a noncompetitive market competitive if he determines the noncompetitive market no longer meets the conditions of a noncompetitive market as defined in W.S. 26-14-103(a)(vii).
(d) To carry out the purpose of subsections (b) and (c) of this section, the commissioner, upon his own motion, may conduct a rate or other investigation. The commissioner shall conduct a rate or other investigation upon request of:
(i) Not less than ten percent (10%) of the insureds in any market;
(ii) Any organization representing not less than ten percent (10%) of the insureds in any market; or
(iii) Insurers selling at least thirty percent (30%) of the insurance in any market.
(e) The commissioner shall not be compelled to conduct an investigation of any line of insurance pursuant to subsection
(d) of this section more than once in any three (3) year period for any line of insurance but may do so.
(f) As a part of any investigation under subsection (d) of this section the commissioner:
(i) May require any insurer to submit actuarial and expense data relating to any line of insurance;
(ii) May contract the services of an actuarial consultant and assess the cost thereof against the parties requesting the investigation or against the insurers affected if the investigation is conducted upon the commissioner's motion;
(iii) Shall conduct a hearing upon not less than twenty (20) days written notice to affected parties, provided this requirement may be waived upon written agreement of the affected parties;
(iv) Depending upon the availability of data and the existence of sufficient experience to allow for an actuarially sound determination, may base any regulation of rates for any line of insurance under this section on experience or loss data for that line of insurance in:
(A) Wyoming alone;
(B) Wyoming and selected other states with reasonably similar characteristics; or
(C) The United States as a whole excluding states whose experience is atypical.
(g) For rates regulated pursuant to subsections (a) and
(b) of this section, there shall be a public hearing if within any twelve (12) month period an insurer requests approval of a base premium rate which when added to any other base premium rates pending or approved within that twelve (12) month period is twenty percent (20%) or more above the rate approved for the previous rating period. For health care professional malpractice insurance, a rate increase of more than twenty-five percent (25%) in any specialty shall cause a consolidated hearing on the rate increase. The informational hearing shall be held within sixty (60) days of the request for approval unless the commissioner delays the hearing for good cause. If the hearing is delayed the commissioner shall notify the insurer and any other person requesting notification of the reasons for the delay.
(h) The following shall apply to any market found to be noncompetitive pursuant to subsections (a) and (b) of this section and to any professional liability insurance for any health care provider licensed under title 33 of the Wyoming statutes:
(i) The rate charged any individual insured shall not exceed the base rate approved by the commissioner for the insured's risk class by more than one hundred percent (100%), unless the commissioner has established for the applicable risk class a percentage limit of less than one hundred percent (100%);
(ii) The rate charged an insured for extended reporting coverage following expiration, termination or nonrenewal of the insured's claims-made policy shall be subject to the following:
(A) The rate shall be calculated according to a formula set forth in the insured's policy, which formula shall be subject to approval by the commissioner;
(B) The formula shall be expressed as a percentage of the base rate for the insured's risk class or that insured's underwritten rate;
(C) The percentage may be varied on a uniform basis for each risk class by the length of time during which the events covered by the extended reporting coverage may have arisen; and
(D) If an individual elects to purchase the extended reporting coverage before the renewal date of his policy, the rates charged for the extended reporting coverage shall be computed based on the relevant rates for that insured before the renewal, not the rates that would be in effect upon renewal.
information; supporting information; public inspection; consent to rates.
(a) In competitive markets, every insurer shall maintain all rates and supplementary rate information to be used in this state, in accordance with the provisions of W.S. 26-14-113(b), and such information shall be made available to the commissioner upon his request.
(b) In noncompetitive markets, every insurer shall file with the commissioner all rates, supplementary rate information and supporting information for noncompetitive markets at least thirty (30) days before the proposed effective date. The commissioner may give written notice, within thirty (30) days of the receipt of the filing, that he needs additional time, not to exceed thirty (30) days from the date of the notice, to consider the filing. Upon written application of the insurer, the commissioner may authorize rates to be effective before the expiration of the waiting period or an extension thereof. A filing shall be deemed to meet the requirements of this chapter and to become effective unless disapproved pursuant to W.S. 26-14-108 by the commissioner before the expiration of the waiting period or an extension thereof. Residual market mechanisms or advisory organizations may file residual market rates. The filing shall be deemed in compliance with the filing provisions of this section unless the commissioner informs the insurer within ten (10) days after receipt of the filing as to what supplementary rate information or supporting information is required to complete the filing.
(c) All information provided to the insurance commissioner under this chapter shall be open to public inspection. Copies may be obtained from the commissioner upon request and upon payment of a reasonable fee.
(d) Notwithstanding any other provisions of this section, upon written application of the insured, stating the reason therefor filed with the commissioner, a rate in excess of that otherwise applicable may be used on any specific risk.