18 Del. Admin. Code § 901-3.0

Current through Register Vol. 28, No. 5, November 1, 2024

Section 901-3.0 - Exemption from Arbitration

3.1 Insurers requesting exemption from the duty to arbitrate under a homeowners' insurance policy shall submit to the Insurance Commissioner the following:

3.1.1 A request for exemption from arbitration;

3.1.2 Copies or description of policies or plans for which exemption is requested;

3.1.3 A detailed description of its internal review or appraisal procedures;

3.1.4 Copies of documents to be provided to the insured describing its internal procedures including a statement that the insurer will be bound by a decision favorable to the insured;

3.1.5 A certification by an officer of the insurer with binding authority that the procedures described will be followed in all cases, that the insurer will be bound by a decision favorable to the insured and that all documents submitted are true and accurate; and

3.1.6 Payment of a non-refundable fee of $75.00.

3.2 The Commissioner shall exempt a homeowner insurer from arbitration under this Regulation and continue such exemption as long as the internal appraisal or review procedures submitted under subsection 3.1 contain the following minimum requirements:

3.2.1 The internal appraisal or arbitration procedure is performed by a panel of at least three individuals with both insured and insurer to select an equal number. Those selected by the parties shall select another member who shall preside over the panel. However, neither the insurer's assigned adjuster nor his or her supervisor may participate on the panel nor anyone under that supervisor's control;

3.2.2 The insured or his attorney is permitted to submit evidence and examine the adverse evidence and to appear before the panel prior to the time the matter is to be decided;

3.2.3 The insured is permitted to be represented by counsel;

3.2.4 The insured is informed as to the right to appeal, if any, an adverse decision;

3.2.5 The insured will be provided with at least 10 business days notice of all steps in the procedure. The decision will be made by a majority of the panel and must be provided to the parties, in writing, signed by the majority with a brief explanation of the reasons for the decision; and

3.2.6 The insurer will maintain complete records of the above for a period of three years for inspection at any time during business hours by the Commissioner or the Insurance Department.

3.3 The Commissioner may suspend, revoke or refuse to continue any exemption after notice and a hearing establishing violation of the above. The exemption provided above is not effective until the application has been filed, reviewed and approved by the Commissioner. The Commissioner may request reports from insurers from time to time on the above reviews.

18 Del. Admin. Code § 901-3.0

5 DE Reg. 1746 (03/01/02)
21 DE Reg. 579 (1/1/2018) (Final)