Zoning In - Spring 2025

Northeast Zone

Massachusetts

Advisory Ruling 2025-1, dated March 31, 2025, notifies all licensed appraisers concerning the time frames specified in 212 CMR 2.00 et seq. regarding completion of completed appraisals and supplements. Specific requirements and procedures are set forth in this Ruling for Original Appraisals, Supplemental Appraisals, and Expedited Supplemental Appraisals. This Advisory Ruling shall be effective upon posting on the Auto Damage Appraiser Licensing Board public website. The Ruling further states that failure to comply with this ruling could result in fines and penalties as provided for by law.

New Hampshire

Bulletin INS 25-031-AB of April 14, 2025 addresses the virtual adjustment of vehicle claims and clarifies the insurers' obligations under the Unfair Claims Settlement Practices (“UCSP”) provisions of the Unfair Insurance Trade Practices law. The Department further indicates that “[w]hile virtual claims adjustment systems may help settle claims more quickly and reduce costs for the insurer, photographs and videos do not always reveal the true extent of the damage a vehicle has sustained. Consequently, to comply with the UCSP, insurers must provide an in-person inspection of a damaged vehicle within a reasonable period of time if requested by the consumer. Insurers may not deny a consumer's request for an in-person inspection on the grounds that the consumer initially elected to use a virtual adjustment system. Further, unreasonable delays in making in-person inspections may also be considered a violation of the UCSP if it rises to the level of an RSA 417:4, XV(a)(3) (duty to promptly and reasonably investigate) violation.”

Southeast Zone

Arkansas

HB 1079 establishes a new Subchapter 29 – Coverage for Genetic Testing for Inherited Gene Mutation and Evidence-Based Cancer Imaging under Title 23, Chapter 79. Newly enacted § 23-79-2902 specifies that, starting from January 1, 2026, health benefit plans offered, issued, or renewed in Arkansas shall provide coverage for:

• “Genetic testing for an inherited gene mutation in a clinical setting for an individual with a personal or family history of cancer if the genetic testing for an inherited gene mutation: (A) Provides clinical utility; and (B) Is ordered or recommended by a healthcare provider and is supported by medical and scientific evidence, including without limitation: (i) the National Comprehensive Cancer Network clinical practice recommendations that are level 2a or higher; (ii) Centers for Medicare & Medicaid Services national coverage determinations or Medicare administrative contractor local coverage determinations; or nationally recognized clinical practice guidelines;” and

• “Evidence-based cancer imaging for an individual at an increased risk of developing cancer if the evidence-based cancer imaging: (A) Provides clinical utility; and (B) Is ordered or recommended by a healthcare provider according to: (i) the National Comprehensive Cancer Network clinical practice recommendations that are level 2a or higher; or nationally recognized clinical practice guidelines.”

Additionally, the coverage for these services is not subject to annual deductibles, copayments, or coinsurance limits that apply to other covered benefits under a health benefit plan, with specific exceptions for plans providing health benefits to state and public school employees and self-funded governmental plans.

Florida

FAC Rule 69O-171.013, effective March 9, 2025, is a new rule specifying that “each insurer subject to paying premium tax, pursuant to section 624.509, F.S., and the State Fire Marshal regulatory assessment, pursuant to section 624.515, F.S., must provide discounts for policies that provide coverage for a 12-month period with an effective date between October 1, 2024, and September 30, 2025, consistent with the provisions of section 624.5108, F.S.” Regarding disclosure to policyholders, the “deductions required by section 624.5108(1), F.S., must:

(a) be separately stated on the policy declarations page;

(b) be provided as part of the renewal notice of the policy or the quote provided on new business subject to the time period set forth in paragraph (1); and

(c) be applied to the entirety of the premium due at the effectuation of the policy term.”

This Rule also provides for certain line of business exceptions, premium tax percentage cap on the policy premium, and reporting requirements.

Georgia

A new Rule under “Surprise Billing” requirements is adopted as Rule 120-2-106-.13 and is titled “Consumer Access to Contracted Healthcare (CATCH) Act Requirements”. Effective March 25, 2025, the stated primary purposes of this Rule are “to ensure compliance with the ‘Consumer Access to Contracted Health Act’ or ‘CATCH Act’ by assessing and ensuring adequacy and breadth of an insurer's provider network, ensuring insurers do not illegally deny pre-authorization of healthcare services, ensuring insurers comply with the CATCH Act requirements regarding telehealth services, and to allow for a variance or exception, if appropriate.” This Rule notes that the term “Insurer” does not include a “health maintenance organization,” as defined in Chapter 21 of Title 33 of the Official Code of Georgia, possessing a valid certificate of authorization obtained in accordance with O.C.G.A. § 33-21-2.

Reporting requirements under this new Rule specify that on March 1, 2025 and each following March 1, each insurer subject to the CATCH Act shall provide a report to the Commissioner such quantitative data as necessary to demonstrate compliance with O.C.G.A. § 33-20E-24 (the “CATCH Report”). As stated in this Rule, the CATCH Report must demonstrate the following:

• Insurer maintains a network of participating providers in sufficient number and appropriate type, including primary care and specialty care, pharmacies, clinical laboratories, and facilities, throughout such plan's service area to ensure covered persons have access to the full scope of benefits and services covered under such plan in accordance with the standards established by the Centers for Medicaid & Medicaid Services.

• Insurer maintains a network that is sufficient in number and types of providers, including providers that specialize in mental health and substance use disorder services, to ensure that all services will be accessible without unreasonable delay in accordance with the standards established by the Centers for Medicaid & Medicaid Services.

• Insurer has available participating providers within a reasonable time and distance to covered persons and accepting patients.

• Insurer maintains a network of participating providers that satisfy the meeting appointment wait time standards in accordance with the standards established by the Centers for Medicaid & Medicaid Services.

• Insurer did not engage in the prohibited actions set forth in O.C.G.A. § 33-20E-24 or O.C.G.A. § 33-20E-24 (e) and provides an attestation of the same.

Rule 120-2-106-.13 also addresses ongoing compliance monitoring by the Commissioner of Insurance, enforcement, and exceptions.

Kentucky

Bulletin 2025-01, dated April 22, 2025, provides the current position of the Department of Insurance regarding the Local Government Premium Tax (“LGPT”). This includes information regarding changes to procedures for adjudicating LGPT updates and amendments to various LGPT forms and documents regarding rates imposed by local governments on collected premium; as well as the Tax Schedule, Tax Code Descriptions, and Listing of Payees and Addresses documents, in accordance with KRS 91A.080.

West Virginia

Bulletin No. 2025-02, issued April 16, 2025, addresses the use of aerial imagery by homeowners insurers. The Office of the Insurance Commissioner (“OIC”) notes that “while aerial imagery can provide benefits when used appropriately, its misuse can result in inaccurate decisions and consumer confusion. For example, aerial imagery can be misused if an insurer relies upon aerial images that are vague, not recent, show the wrong structure or property, or do not clearly show damage or disrepair. Accordingly, insurers are reminded that they should use due diligence when utilizing aerial imagery and ensure that any action taken is based on accurate information.” The Bulletin provides specific guidance on the use of aerial imagery for nonrenewals, cancellations, underwriting, claims handling, and similar activities on the following topics:

• Aerial imagery, if used, should be used as only one tool;

• Consumer access to imagery; and

• Insurers should consider the age and clarity of aerial imagery

Midwest Zone

Illinois

Consumer complaint notification requirements in in 50 Ill. Adm. Code 931.40 are revised effective July 1, 2025 as follows:

In the required notice:

(a) Companies shall use the contact information for the Department of Insurance explicitly stating, “You may file a consumer complaint online at the Illinois Department of Insurance's website or by mail. The Department maintains a Consumer Division in Chicago at [insert current address here] and in Springfield at [insert current address here].”

(b) The address to be used for the company shall be an office that can service all types of complaints. If one office cannot service all types of complaints, then the additional addresses of each appropriate service office must be given.

(c) In addition to providing the required addresses, the notification should set forth the minimum amount of information included in the following suggested wording: “This notice is to advise you that should any complaints arise regarding this insurance, you may contact the following.”

Additionally, the requirement of providing such “written notice” shall be satisfied by the following revised requirements in 50 Ill. Adm. Code 931.30:

• Any printed notice delivered with a policy or certificate;

• Any adhering label attached to a policy or certificate;

• Any computerized notice issued concurrently with a computer issued policy or certificate; or

• Any other form of individual written notice substantially similar to the above.

Missouri

Bulletin 25-02, dated March 28, 2025, requests insurers issuing policies covering real or personal property to make sure the Catastrophe/Disaster Coordination Contact Information on file with the Department is current. The process for submission of updated Catastrophe/Disaster Coordination Contact information is provided in the Bulletin.

The Bulletin further addresses the scope of the Catastrophe/Disaster Coordination Contact role, indicating that the contact “should be available to communicate directly with the Director and senior Department leadership following a disaster within the state. This may include high-level communications about the Department's response efforts, the company's response efforts, logistic issues, and other urgent or non-urgent regulatory matters following a disaster.” Additionally, the contact should also be able to discuss or make resources available to the Department to discuss media-related inquiries, coordinate joint communication and consumer outreach efforts, and participate in industry conference calls and meetings regarding disaster response matters.

Western Zone

Montana

HB 136, effective October 1, 2025, addresses risk preventative measures for homeowners. Specifically, an insurer may provide a benefit or a premium reduction to a homeowner's insurance policyholder for preventative measures taken by the policyholder. As outlined in HB 136, preventative measures include but are not limited to actions that reduce the risk of damage to property from fire, wind, or hail.

Fire preventative measures include, but are not limited to, any of the following:

• using ignition-resistant, fire-resistive, or noncombustible building materials in construction, including noncombustible roofing or coating, exterior glazing for fire protection, and interior building materials designed to stop flame spread and prevent building collapse upon occupants and emergency service personnel;

• maintaining an adequate outside water source; providing annual confirmation, if requested by the insurer, that the insured has employed defensible space landscaping around the insured's structures;

• programs; keeping a border of at least 5 feet of nonflammable landscaping around the insured property;

• complying with any local, state, or federal fire prevention or community preparedness

• installing fire alarm or emergency alarm systems;

• complying with the requirements of the International Wildland-Urban Interface Code if a building is located in a wildland-urban interface area; and

• providing sufficient access to the property for firefighting equipment and authorized emergency vehicles as defined in 61-8-102.

Wind and hail preventative measures include but are not limited to the following:

• using an industry-approved resistant roof shingle; anchoring outdoor furniture;

• pruning tree branches or otherwise providing landscaping that reduces potential damage to the insured property; and

• installing protective coverings to avoid additional damage to the insured property.

Policyholder disclosure provisions require that an insurer who provides such a benefit or premium reduction must include the benefit or premium reduction in writing to the policyholder. Additionally, HB 136 provides that a benefit or premium reduction provided by an insurer under the above measures does not constitute an illegal rebate under 33-18-210 and that applicable rates may be filed.

Utah

Effective January 1, 2026, HB 48 enacts new Insurance Code Section 31A-22-1310, which addresses efforts to oversee wildfire risks associated with wildland urban interface property. Specific provisions are included in this new statutory citation for a wildland urban interface property and casualty insurer using additional fire hazard data in rating and underwriting. Also Section 31A-21-303 states that in addition to complying with its relevant requirements, “if due to risks of wildfire a wildland urban interface property and casualty insurer:

(a) cancels or nonrenews property and casualty insurance covering wildland urban interface property, the wildland urban interface property and casualty insurer shall include in the notice of cancellation or nonrenewal the facts on which the wildland urban interface property and casualty insurer's decision is based with reasonable precision; and

(b) increases the premium by more than 20% of the previous term's premium for property and casualty insurance covering wildland urban interface property, after receipt of a request for the information by the insured the wildland urban interface property and casualty insurer shall provide the insured the facts on which the wildland urban interface property and casualty insurer's decision is based with reasonable precision.”

New Mexico

SB 221 amends New Mexico’s § 59A-16-20 unfair claims settlement practices provisions, which sets forth certain practices as prohibited and defines those as unfair and deceptive practices, now includes a new subsection detailing an additional prohibited practice: “…treating an insured's inquiry relating to damage or loss as a claim when the facts of the inquiry are not covered in the policy, the insurer makes no payment to or on behalf of the insured and the claim does not involve deceptive practices on the part of the insured.”

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Kathy Donovan is Senior Compliance Counsel, insurance with Wolters Kluwer Financial Services. Kathy has more than two decades of experience in insurance compliance. Her expert commentary on legal and regulatory issues affecting the insurance industry is widely published and she is a regular presenter at various industry events.