W. Va. Code R. § 114-42-8

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 114-42-8 - Disciplinary Process

8.1. No later than sixty (60) days prior to the end of the reporting period, the Commissioner shall provide written notification to individual insurance producers and individual insurance adjusters subject to continuing insurance education requirements advising them as to the status of their continuing insurance education credits.

8.1.1. The Commissioner shall provide the notification to each individual insurance producer or individual insurance adjuster by electronic mail or by regular mail, if requested, addressed to the individual insurance producer at the last respective address appearing for the individual insurance producer in the records of the Commissioner.

8.1.2. Individual insurance producers who sell only preneed burial insurance contracts shall file with the Commissioner an affidavit, on a form to be provided by the Commissioner, verifying that the individual insurance producer is not engaged in the sale of any other type of insurance product.

8.1.3. Individual insurance producers engaged solely in telemarketing insurance products by a scripted presentation which has been filed with and approved by the Commissioner shall file an affidavit, on a form to be provided by the Commissioner, verifying that the individual insurance producer is not engaged in the sale of any other type of insurance product.

8.2. Any individual insurance producer or individual insurance adjuster who does not anticipate pursuing the required continuing insurance education requirements may elect to cancel his or her license prior to the end of the reporting period by submitting a written request to the Commissioner. Cancellation of a license revokes any privilege the individual insurance producer or individual insurance adjuster may have had to reinstate his or her license without completion of a pre-licensing insurance education course and/or examination.

8.2.1. Each request for cancellation of a license shall include the individual insurance producer's or individual insurance adjuster's name, address, license number, telephone number and reason for cancellation.

8.2.2. Cancellation of a license prohibits an individual insurance producer from further transacting insurance in West Virginia without successful completion of pre-licensing education and examination, and prohibits an individual insurance adjuster from further adjusting insurance claims in West Virginia without successful completion of examination.

8.3. Any individual insurance producer or individual insurance adjuster who has not met the continuing insurance education requirements for any reporting period may agree to a voluntary suspension of his or her license until such time as the continuing insurance education requirements have been met.

8.3.1. Each request for a voluntary suspension of a license shall include the individual insurance producer's or individual insurance adjuster's name, address, license number and telephone number.

8.3.2. An individual insurance producer may not transact insurance in West Virginia during the suspension period, and an individual insurance adjuster may not adjust insurance claims in West Virginia during the suspension period.

8.3.3. Any individual insurance producer who does not satisfy the mandatory continuing education requirements as of the last day of the reporting period following his or her voluntary suspension shall have his or her license automatically cancelled pursuant to the provisions of W. Va. Code § 33-12-8(h). Any individual insurance adjuster who does not satisfy the mandatory continuing education requirements as of the last day of the reporting period following his or her suspension shall have his or her license automatically terminated pursuant to the provisions of W. Va. Code § 33-12B-13(i).

8.4. The Commissioner will issue a notice automatically suspending the license of any individual insurance producer or individual insurance adjuster failing to meet continuing insurance education requirements who has not been granted an extension of time within which to comply, or who has submitted to the Commissioner a false or fraudulent certificate of compliance. The license shall remain suspended until such time as the individual insurance producer or individual insurance adjuster has demonstrated to the satisfaction of the Commissioner that he or she has complied with all requirements of this rule and all other applicable laws.

8.4.1. The individual insurance producer or individual insurance adjuster will have an opportunity to request a hearing on a notice of suspension resulting from his or her failure to meet continuing insurance education requirements. The effect of the notice of suspension will be stayed pending the individual insurance producer's or individual insurance adjuster's request for a hearing within the time designated in section 8.5 of this rule or pending completion of the hearing if a hearing is timely requested.

8.4.2. The burden of proving successful completion of continuing insurance education courses is at all times upon the individual subject to the continuing insurance education requirements.

8.4.3. Any individual insurance producer who does not satisfy the mandatory continuing education requirements as of the last day of the reporting period following his or her suspension shall have his or her license automatically cancelled pursuant to the provisions of W. Va. Code § 33-12-8(j). Any individual insurance adjuster who does not satisfy the mandatory continuing education requirements as of the last day of the reporting period following his or her suspension shall have his or her license automatically cancelled pursuant to the provisions of W. Va. Code § 33-12B-13(k).

8.5. Hearings - A hearing may be requested by an individual insurance producer, individual insurance adjuster or a provider in accordance with W. Va. Code § 33-2-13, 114CSR13, and the following:

8.5.1. Any individual insurance producer or individual insurance adjuster whose license is being suspended due to his or her failure to successfully complete and submit the required hours of continuing insurance education courses and wants to request a reconsideration hearing as permitted by W. Va. Code §§ 33-12-8(i) and/or 33-12B-13(j) must submit a request for hearing in writing to the Commissioner's office address in Charleston, West Virginia, either in person or by certified mail, return receipt requested. Such hearing shall be held within forty-five (45) days of the receipt of request for hearing and notice of the time, place, and matters to be considered at the hearing shall be provided by the Commissioner to all parties directly involved not less than fifteen (15) days prior to the date of hearing. Any request for a reconsideration hearing must be in compliance with W. Va. Code § 33-2-13, and must be made within thirty (30) days after the individual insurance producer's or individual insurance adjuster's receipt of the order entered by the Commissioner pursuant to section 8.4 of this rule for reconsideration of the matter. The Commissioner shall mail a copy of the order to the individual insurance producer or individual insurance adjuster by certified mail, return receipt requested. In cases where proof of receipt of the order is not received by the Commissioner, service of the order will be presumed complete upon the expiration of four (4) days following deposit by the Commissioner in the United States Mail. If the individual insurance producer or individual insurance adjuster makes a timely request for a hearing, the scope of the hearing will be whether the producer or adjuster has successfully completed and submitted the required hours of continuing insurance education courses. The hearing shall be conducted as provided in W. Va. Code § 33-2-13.

8.5.2. Any provider that has received a notice of assessed fee or whose course(s) or program(s) of instruction has been disapproved must submit a request for hearing in the same manner and within the same time as that set forth in subdivision a of this subsection. The Commissioner shall mail a copy of the notice of fee or notification of disapproval of courses or programs to the provider by certified mail, return receipt requested. In cases where proof of receipt of the notice of fee or notification of disapproval is not received by the Commissioner, service will be presumed complete upon the expiration of four (4) days following deposit by the Commissioner in the United States Mail. If the provider makes a timely request for a hearing, the scope of the hearing will be whether the fee was properly assessed, whether the provider has failed to pay the fee or whether the provider has established a pattern or practice of failure to comply with this rule. The hearing shall be conducted as provided in W. Va. Code § 33-2-13.

8.5.3. All requests for hearing must identify the order or notification upon which the hearing is requested and must set forth the grounds upon which it is asserted that the order or notification should be vacated or modified.

8.5.4. Untimely hearing requests will not be granted. A request is untimely if it is made by or on behalf of the individual insurance producer or individual insurance adjuster or provider after the time specified in subdivision a of this subsection or prior to the issuance of the order or notification.

8.6. Failure to appear at a hearing requested pursuant to section 8.5 of this rule will result in the following:

8.6.1. If the individual insurance producer or individual insurance adjuster fails to appear either in person or by counsel at the hearing without obtaining a continuance pursuant to 114CSR13, the order suspending his or her license will become final, and the individual insurance producer or individual insurance adjuster shall be assessed the costs set forth in section 8.7 of this rule.

8.6.2. If the provider fails to appear either in person or by counsel at the hearing without obtaining a continuance pursuant to 114CSR13, the provider's course(s) or program(s) will continue to be disapproved and the provider shall be assessed the costs set forth in section 8.7 of this rule.

8.7. Assessment of Costs.

8.7.1. A docket fee of seventy-five dollars ($75.00) may be assessed against an individual insurance producer, individual insurance adjuster or provider following a hearing if the Commissioner's prior action is not rescinded pursuant to W. Va. Code § 33-2-13.

8.7.2. The Commissioner may assess the costs of the hearing as provided for in W. Va. Code § 33-2-13 to any individual insurance producer, individual insurance adjuster or provider who fails to have the Commissioner's prior action rescinded.

8.7.3. The individual insurance producer or individual insurance adjuster or provider shall pay all applicable assessed fees before the Commissioner may complete reinstatement of the individual insurance producer's license or individual insurance adjuster's license or the approval of a provider's course(s) or program(s) of instruction.

8.7.4. All fees collected under this section shall be deposited, transferred, and paid out in accordance with W. Va. Code § 33-3-13.

8.8. Notification of Suspension.

8.8.1. Upon suspension of an individual insurance producer's license for failure to comply with the mandatory continuing insurance education requirements for the reporting period, the Commissioner shall:

8.8.1.a. Give notice of the suspension to the insurer(s) or employing agent with whom the individual insurance producer has a contractual relationship; and

8.8.1.b. Cancel all appointments of the individual insurance producer subject to disciplinary action.

8.8.2. Upon suspension of an individual insurance adjuster's license for failure to comply with the mandatory continuing insurance education requirements for the reporting period, the Commissioner shall give notice of the suspension to the insurer, third-party administrator, or employer of the individual insurance adjuster.

8.9. An insurer employing an individual insurance producer shall not renew or issue new appointments subject to continuing insurance education requirements to an individual insurance producer whose license has been suspended for failure to comply with mandatory continuing insurance education requirements until such time as the individual insurance producer's license has been reinstated and an application and appropriate fee have been submitted to and approved by the Commissioner. Further, an insurer, third-party administrator or independent adjusting company employing an individual insurance adjuster shall not continue to allow an individual insurance adjuster whose license has been suspended for failure to comply with mandatory continuing insurance education requirements to adjust claims for the employer until such time as the individual insurance adjuster's license has been reinstated and an application and appropriate fee have been submitted to and approved by the Commissioner.

8.10. Neither cancellation of a license nor any disciplinary action levied as a result of non-compliance with continuing insurance education requirements shall prohibit an individual insurance producer from receiving commissions which were vested and earned while that individual insurance producer maintained an approved license nor prohibit an individual insurance adjuster from receiving a salary or other work-related payment which were vested and earned while that individual insurance adjuster maintained an approved license.

W. Va. Code R. § 114-42-8