West Virginia Code
Article 6C. Guaranteed Loss Ratios as Applied to Individual Sickness and Accident Insurance Policies
§33-6C-7. Rejection of Guarantees; Notice; Hearing

(a) The Insurance Commissioner may reject any loss ratio guarantee filed by an insurer within sixty days from the date on which it was filed for any of the following reasons:
(1) The insurer has demonstrated an inability to adequately monitor its loss ratios;
(2) The insurer has failed to take timely rate increases in accordance with sound actuarial principles during the three-year period prior to filing the loss ratio guarantee;
(3) The insurer has not complied with the terms of a previously filed loss ratio guarantee;
(4) The insurer has submitted false, misleading or fraudulent material or information to the commissioner;
(5) The insurer is impaired, insolvent or such other similar financial condition as defined in article ten or any other article of this chapter; or
(6) Such other criteria as the commissioner, by legislative rule or regulation, may determine is appropriate.
(b) The Insurance Commissioner may reject or cancel any loss ratio guarantee filed by an insurer which had been previously approved if, upon review and investigation, the commissioner determines that the insurer has not complied with the provisions of the guarantee or this article.
(c) In the event a newly submitted loss ratio guarantee is rejected, the commissioner shall, within sixty days after the date the loss ratio guarantee was filed, mail notice of the rejection to the insurer. In the event an existing or previously approved loss ratio guarantee is cancelled, the commissioner shall mail notice of the rejection or cancellation to the insurer within fifteen days of the decision to cancel. In either situation, the insurer may, within ten days of being notified of its rejection or cancellation, request a hearing before the commissioner, which hearing shall be held within forty-five days from the date the request is made.

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