Missouri P&C Study Guide

The combined paper draws from both halves of the book, and the shared territory is where the harder items sit: what turns a claims mistake into a violation, which days are working days, and two different statutes that both go by the name “termination.”

A single bad file is not a violation

RSMo 375.1005 puts a threshold in front of the entire Unfair Claims Settlement Practices Act. Nothing in RSMo 375.1007’s list of fifteen acts becomes an improper claims practice unless:

“(1) It is committed in conscious disregard of sections 375.1000 to 375.1018 or any rules promulgated under sections 375.1000 to 375.1018; or (2) It has been committed with such frequency to indicate a general business practice to engage in that type of conduct.”

A question describing one late acknowledgment on one claim is describing something that is not, by itself, a violation.

Two scope limits ride alongside. The act “is not intended to cover claims involving workers’ compensation, fidelity, suretyship or boiler and machinery insurance,” and “nothing … shall be construed to create or imply a private cause of action” (RSMo 375.1000.2). Enforcement is the director’s.

Working days and calendar days, mixed on purpose

Neither RSMo 375.1002 nor 20 CSR 100-1.010 defines “days” — and that absence is itself the finding, because Missouri resolves the question clock by clock instead.

The rule writes “working days” on the acknowledgment and determination clocks, and plain “days” on the investigation and status-letter clocks:

| Duty | Period | Unit | | Acknowledge notification of a claim | 10 | working | | Reply to communications that reasonably suggest a response | 10 | working | | Advise acceptance or denial | 15 | working | | Complete the investigation | 30 | calendar | | Status letters, then every | 45 | calendar | | Provide claim forms on request (RSMo 375.1007(13)) | 15 | calendar |

Two conditions matter as much as the numbers. The 15 working days run “after the submission of all forms necessary to establish the nature and extent of any claim” — not from notice of loss. And the 30-day investigation duty applies “unless the investigation cannot reasonably be completed within this time.”

Then the detail with your name on it: “notification to any agent of the insurer, including a producer representing the insurer, constitutes notification to the insurer” (20 CSR 100-1.030(2)). The clock starts at the producer, not at the home office.

One citation to retire: 20 CSR 100-1.040, the old prompt-investigation rule, was rescinded on 30 July 2008. The thirty-day duty survives at 20 CSR 100-1.050(4).

Vexatious refusal: two sections, two jobs

RSMo 375.420 supplies the money. A court or jury “may, in addition to the amount thereof and interest, allow the plaintiff damages not to exceed twenty percent of the first fifteen hundred dollars of the loss, and ten percent of the amount of the loss in excess of fifteen hundred dollars” plus “a reasonable attorney’s fee.” So the first tranche caps at $300. These are maxima and the award is discretionary — may, not shall — and the penalty is additive, not a substitute for the loss and interest.

Note the exception at the end of its list of covered lines: “except automobile liability insurance.”

RSMo 375.296 supplies the gateway. The insurer must have failed or refused to pay “for a period of thirty days after due demand therefor prior to the institution of the action” — a suit filed on day twenty fails it — on a contract “issued or delivered in this state to a resident of this state,” or to a Missouri-incorporated or authorised corporation. And it adds a presumption: “failure of an insurer to appear and defend any action, suit or other proceeding shall be deemed prima facie evidence that its failure to make payment was vexatious without reasonable cause.”

Rates: file after use, then five carve-backs

RSMo 379.321 requires manuals, rating plans, policies and forms to be filed “within ten days after” they are effective. Not prior approval.

Commercial property and casualty go further. Rates are filed “for informational purposes only within ten days of use” and are “not to be reviewed or approved by the department”; commercial underwriting rules are exempt from filing altogether (RSMo 379.321.6(1)-(2)).

Then five categories are carved back into full regulation (RSMo 379.321.6(4)): workers’ compensation, medical malpractice liability, farm property and liability, any coverage issued by an assigned risk or residual market plan, and any policy required by the division of workers’ compensation. The last of those is why RSMo 303.200.4 imposes prior approval on every form and rate of the Missouri Automobile Insurance Plan — a prior-approval island inside an otherwise file-after-use state.

The rate standard is conjunctive: rates “shall not be excessive, inadequate or unfairly discriminatory,” but no rate is excessive unless unreasonably high and reasonable competition does not exist (RSMo 379.318(4)).

Two statutes called “termination”

RSMo 375.022 is the appointment registry. A producer may not act for an insurer unless “listed on the company register of appointed insurance producers” — a company register, not a filing-by-filing appointment with the department. The insurer enters the producer within 30 days of authorising them. On termination both clocks are 30 days, but the recipient differs: a for-cause termination on a RSMo 375.141 ground requires notice to the director within 30 days of the effective date; any other reason requires only that company records be updated.

RSMo 375.033 is something else entirely, and it is a provision with no counterpart in the appointment statutes. A contract with an independent producer “shall not be terminated or cancelled by the insurer except by mutual agreement or unless ninety days’ written notice in advance has been given to the independent insurance producer AND the director.”

Do not print the ninety days without its price. RSMo 375.033.2: “during the ninety days’ notice period the independent insurance producer shall not write or bind any new business on behalf of the insurer without specific written approval.”

Two scope conditions, both testable. RSMo 375.031(4) defines “insurer” here as any property and casualty insurance company — so the right does not reach life or health contracts. And RSMo 375.031(3) expressly excludes exclusive (captive) producers from the definition of “independent.”