Section § 769.80

Explanation
This law is officially called the Managing General Agents Act.
This act shall be known and may be cited as the Managing General Agents Act.

Section § 769.81

Explanation

This section defines key terms related to the insurance industry in California. An 'Actuary' is a professional member of recognized actuarial societies who is qualified to assess insurance risks and reserves. An 'Insurer' refers to any licensed entity operating as an insurer in California. 'Managing General Agent' or MGA describes entities or individuals managing a significant portion of an insurer's business, negotiating reinsurance contracts, or handling claims above a certain amount. However, employees of insurers, certain managers, or agents with defined roles and conditions are not considered MGAs. 'Underwrite' means having the authority to accept or reject insurance risks for an insurer.

As used in this article:
(a)CA Insurance Code § 769.81(a) “Actuary” means a person who is a member in good standing of the American Academy of Actuaries, the Casualty Actuarial Society, or the Society of Actuaries, and is qualified to sign a statement of actuarial opinion on loss reserves.
(b)CA Insurance Code § 769.81(b) “Insurer” means any person, firm, association, or corporation duly licensed as an insurer and operating under a certificate of authority in this state.
(c)CA Insurance Code § 769.81(c) “Managing General Agent” (MGA) means any person, firm, association, partnership, or corporation who negotiates and binds ceding reinsurance contracts on behalf of an insurer or manages all or part of the insurance business of an insurer (including the management of a separate division, department or underwriting office) and acts as an agent for that insurer whether known as an MGA, manager, or other similar term, who, with or without the authority, either separately or together with affiliates, produces, directly or indirectly, and underwrites an amount of gross direct written premium equal to or more than 5 percent of the policyholder surplus as reported in the last annual statement of the insurer in any one quarter or year together with one or more of the following: (1) adjusts or pays claims in excess of an amount determined by the commissioner, or (2) negotiates reinsurance on behalf of the insurer.
Notwithstanding the above, the following persons shall not be considered as MGAs for the purposes of this act:
(1)CA Insurance Code § 769.81(1) An employee of the insurer.
(2)CA Insurance Code § 769.81(2) A United States manager of the United States branch of an alien insurer.
(3)CA Insurance Code § 769.81(3) An underwriting manager which, pursuant to contract, manages the insurance operations of the insurer, is under common control with the insurer, subject to the holding company regulatory act, and whose compensation is not based on the volume of premiums written.
(4)CA Insurance Code § 769.81(4) The attorney-in-fact authorized by and acting for the subscribers of a reciprocal insurer or interinsurance exchange under powers of attorney.
(d)CA Insurance Code § 769.81(d) “Underwrite” means the authority to accept or reject risk on behalf of the insurer.

Section § 769.82

Explanation

This law states that a producer, who wants to operate as a Managing General Agent (MGA) for risks in California, must be licensed as either a property broker-agent and casualty broker-agent, or a life agent. The same licensing requirement applies to producers representing insurers based in California for risks located outside the state.

The insurance commissioner has the authority to require a fidelity bond. This bond acts as a form of financial protection for the insurer. Additionally, the commissioner can demand that the MGA holds an errors and omissions insurance policy. If this type of insurance isn't available at a reasonable price, the requirement can be temporarily lifted by the commissioner.

(a)CA Insurance Code § 769.82(a) No producer shall act in the capacity of an MGA with respect to risks located in this state for an insurer that holds a certificate of authority unless that producer is licensed as a property broker-agent and casualty broker-agent, or as a life agent in this state.
(b)CA Insurance Code § 769.82(b) No producer shall act in the capacity of an MGA representing an insurer domiciled in this state with respect to risks located outside this state unless that producer is licensed as a property broker-agent and casualty broker-agent, or as a life agent in this state.
(c)CA Insurance Code § 769.82(c) The commissioner may require a fidelity bond in an amount acceptable to him or her for the protection of the insurer.
(d)CA Insurance Code § 769.82(d) The commissioner may require the MGA to maintain an errors and omissions policy. If a policy is not generally available at a reasonable cost, the commissioner may, by rule, suspend the requirement of this subdivision until that coverage becomes generally available at a reasonable cost.

Section § 769.83

Explanation

This law is about how insurance producers, in the role of a Managing General Agent (MGA), must work with insurers. They need a written contract that clearly outlines the responsibilities of each party. This contract can be terminated by the insurer for a valid cause. The MGA has to provide monthly transactions and funds reports to the insurer. Any funds collected must be kept secure in a bank, and the MGA can only keep a limited amount to cover estimated claims for three months.

The MGA must keep detailed records, which both the insurer and the insurance commissioner can access. The contract cannot be assigned by the MGA, and strict underwriting and claim settlement procedures must be followed. Policies can be canceled by insurers according to these rules.

If the MGA is allowed to handle claims, they must report these promptly to the insurer under certain conditions, and claim file ownership is shared unless the insurer is liquidated. Profits can't be shared prematurely if determined by the MGA's loss reserve decisions. MGAs cannot bind reinsurance, commit insurers to syndicates, appoint unauthorized agents, settle large claims without insurer approval, or make certain other binding decisions without approval.

No producer acting in the capacity of an MGA shall place business with an insurer unless there is in force a written contract between the parties which sets forth the responsibilities of each party and where both parties share responsibility for a particular function, specifies the division of such responsibilities, and which contains the following minimum provisions:
(a)CA Insurance Code § 769.83(a) The insurer may terminate the contract for cause upon written notice to the MGA. The insurer may suspend the underwriting authority of the MGA during the pendency of any dispute regarding the cause for termination.
(b)CA Insurance Code § 769.83(b) The MGA shall render accounts to the insurer detailing all transactions and remit all funds due under the contract to the insurer on not less than a monthly basis.
(c)CA Insurance Code § 769.83(c) All funds collected for the account of an insurer shall be held by the MGA in a fiduciary capacity in a bank or savings association the deposits of which are insured by the Bank Insurance Fund or the Savings Association Insurance Fund of the Federal Deposit Insurance Corporation. This account shall be used for all payments on behalf of the insurer. The MGA may retain no more than three months estimated claims payments and allocated loss adjustment expenses. The requirements of this subdivision shall be in addition to the requirements of Sections 1734 and 1735.
(d)CA Insurance Code § 769.83(d) Separate records of business written by the MGA shall be maintained. The insurer shall have access to and the right to copy all accounts and records related to its business in a form usable by the insurer and the commissioner shall have access to all books, bank accounts, and records of the MGA in a form usable to the commissioner. Those records shall be retained by the MGA, and shall be the joint property of the insurer and MGA.
(e)CA Insurance Code § 769.83(e) The contract may not be assigned in whole or part by the MGA.
(f)CA Insurance Code § 769.83(f) Appropriate underwriting guidelines including:
(1)CA Insurance Code § 769.83(f)(1) The maximum annual premium volume.
(2)CA Insurance Code § 769.83(f)(2) The basis of the rates to be charged.
(3)CA Insurance Code § 769.83(f)(3) The types of risks which may be written.
(4)CA Insurance Code § 769.83(f)(4) Maximum limits of liability.
(5)CA Insurance Code § 769.83(f)(5) Applicable exclusions.
(6)CA Insurance Code § 769.83(f)(6) Territorial limitations.
(7)CA Insurance Code § 769.83(f)(7) Policy cancellation provisions.
(8)CA Insurance Code § 769.83(f)(8) The maximum policy period.
The insurer shall have the right to cancel or nonrenew any policy of insurance, except as limited by any other provision of this code.
(g)CA Insurance Code § 769.83(g) If the contract permits the MGA to settle claims on behalf of the insurer:
(1)CA Insurance Code § 769.83(g)(1) All claims shall be reported to the insurer in a timely manner.
(2)CA Insurance Code § 769.83(g)(2) A copy of the claim file shall be sent to the insurer at its request or as soon as it becomes known that the claim is subject to any of the following:
(A)CA Insurance Code § 769.83(g)(2)(A) Has the potential to exceed an amount determined by the commissioner or exceeds the limit set by the company, whichever is less.
(B)CA Insurance Code § 769.83(g)(2)(B) Involves a coverage dispute.
(C)CA Insurance Code § 769.83(g)(2)(C) May exceed the MGA’s claims settlement authority.
(D)CA Insurance Code § 769.83(g)(2)(D) Is open for more than six months.
(E)CA Insurance Code § 769.83(g)(2)(E) Is closed by payment of an amount set by the commissioner or an amount set by the insurer, whichever is less.
(3)CA Insurance Code § 769.83(g)(3) All claim files shall be the joint property of the insurer and MGA. However, upon an order of liquidation of the insurer such files shall become the sole property of the insurer or its estate; the MGA shall have reasonable access to and the right to copy the files on a timely basis.
(4)CA Insurance Code § 769.83(g)(4) Any settlement authority granted to the MGA may be terminated for cause upon the insurer’s written notice to the MGA or upon the termination of the contract. The insurer may suspend the settlement authority during the pendency of any dispute regarding the cause for termination.
(h)CA Insurance Code § 769.83(h) Where electronic claims files are in existence, the contract shall address the timely transmission of the data.
(i)CA Insurance Code § 769.83(i) If the contract provides for a sharing of interim profits by the MGA, and the MGA has the authority to determine the amount of the interim profits by establishing loss reserves or controlling claim payments, or in any other manner, interim profits will not be paid to the MGA until one year after they are earned for property insurance business and five years after they are earned on casualty business and not until the profits have been verified pursuant to Section 769.84.
(j)CA Insurance Code § 769.83(j) The MGA shall not do any of the following:
(1)CA Insurance Code § 769.83(j)(1) Bind reinsurance or retrocessions on behalf of the insurer, except that the MGA may bind facultative reinsurance contracts pursuant to obligatory facultative agreements if the contract with the insurer contains reinsurance underwriting guidelines including, for both reinsurance assumed and ceded, a list of reinsurers with which such automatic agreements are in effect, the coverages and amounts or percentages that may be reinsured and commission schedules. This paragraph shall not operate to prohibit transactions which are subject to Chapter 6.5 (commencing with Section 1781.1) of Part 2 of Division 1, if the MGA has complied with all of the requirements of that chapter.
(2)CA Insurance Code § 769.83(j)(2) Commit the insurer to participate in insurance or reinsurance syndicates.
(3)CA Insurance Code § 769.83(j)(3) Appoint any agent without assuring that the agent is lawfully licensed to transact the type of insurance for which he or she is appointed.
(4)CA Insurance Code § 769.83(j)(4) Without prior approval of the insurer, pay or commit the insurer to pay a claim over a specified amount, net of reinsurance, which shall not exceed 1 percent of the insurer’s policyholder’s surplus as of December 31 of the last completed calendar year.
(5)CA Insurance Code § 769.83(j)(5) Collect any payment from a reinsurer or commit the insurer to any claim settlement with a reinsurer, without prior approval of the insurer. If prior approval is given, a report shall be promptly forwarded to the insurer.
(6)CA Insurance Code § 769.83(j)(6) Permit any agent appointed pursuant to paragraph (3) to serve on the insurer’s board of directors.
(7)CA Insurance Code § 769.83(j)(7) Jointly employ an individual who is employed with the insurer.
(8)CA Insurance Code § 769.83(j)(8) Appoint a sub-MGA.

Section § 769.84

Explanation

This law section outlines several requirements that insurers need to follow when working with Managing General Agents (MGAs). First, insurers must keep an independent financial examination of each MGA they do business with. Then, they have to obtain an actuary's opinion annually if an MGA sets up loss reserves, to ensure these reserves are adequate. Insurers must regularly, at least twice a year, conduct onsite reviews of the MGA’s underwriting and claims operations. Additionally, only an officer not affiliated with the MGA can have authority over reinsurance contracts. Insurers must notify the commissioner in writing within 30 days if they enter into or end a contract with an MGA, and provide details on the MGA's responsibilities. Insurers also need to check quarterly if any of their producers have become MGAs, and notify both the producer and commissioner if so. Lastly, insurers cannot appoint any officer or director of an MGA to their own board except under specific exceptions.

(a)CA Insurance Code § 769.84(a) The insurer shall have on file an independent financial examination, in a form acceptable to the commissioner, of each MGA with which it has done business.
(b)CA Insurance Code § 769.84(b) If an MGA establishes loss reserves, the insurer shall annually obtain the opinion of an actuary attesting to the adequacy of loss reserves established for losses incurred and outstanding on business produced by the MGA. This is in addition to any other required loss reserve certification.
(c)CA Insurance Code § 769.84(c) The insurer shall periodically (at least semiannually) conduct an onsite review of the underwriting and claims processing operations of the MGA.
(d)CA Insurance Code § 769.84(d) Binding authority for all reinsurance contracts or participation in insurance or reinsurance syndicates shall rest with an officer of the insurer, who shall not be affiliated with the MGA.
(e)CA Insurance Code § 769.84(e) Within 30 days of entering into or termination of a contract with an MGA, the insurer shall provide written notification of such appointment or termination to the commissioner. Notices of appointment of an MGA shall include a statement of duties which the applicant is expected to perform on behalf of the insurer, the lines of insurance for which the applicant is to be authorized to act, and any other information the commissioner may request.
(f)CA Insurance Code § 769.84(f) An insurer shall review its books and records each quarter to determine if any producer has become, by operation of Section 769.81, an MGA as defined in that section. If the insurer determines that a producer has become an MGA pursuant to the above, the insurer shall promptly notify the producer and the commissioner of that determination and the insurer and the producer shall fully comply with this article within 30 days.
(g)CA Insurance Code § 769.84(g) An insurer shall not appoint to its board of directors an officer, director, employee, any agent appointed pursuant to paragraph (3) of subdivision (j) of Section 769.83, or controlling shareholder of its MGAs. This subdivision shall not apply to relationships governed by Article 4.7 (commencing with Section 1215) of Chapter 2 of Part 2 of Division 1.

Section § 769.85

Explanation

This law says that whatever actions an MGA takes legally count as actions of the insurance company they represent. Additionally, MGAs can be inspected and reviewed as though they are the insurance company themselves.

The acts of the MGA are considered to be the acts of the insurer on whose behalf it is acting. An MGA may be examined as if it were the insurer.

Section § 769.86

Explanation

If someone breaks the rules of this insurance article, the commissioner can take action after a formal hearing. This can include fines up to $25,000 for each violation, or suspension/revocation of their license. Such hearings will follow established government procedures and involve selected administrative law judges. The commissioner's decisions can be reviewed in court. Additionally, this section doesn't limit other penalties the commissioner might enforce or affect policyholders' and others' rights.

(a)CA Insurance Code § 769.86(a) If the commissioner finds after hearing that any person has violated any provision of this article he or she may order any of the following:
(1)CA Insurance Code § 769.86(a)(1) For each separate violation, a penalty in an amount not to exceed twenty-five thousand dollars ($25,000).
(2)CA Insurance Code § 769.86(a)(2) Revocation or suspension of the producer’s license.
(b)CA Insurance Code § 769.86(b) Hearings held pursuant to subdivision (a) shall be conducted in accordance with Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code, except that the hearings shall be conducted by administrative law judges chosen under Section 11502 or appointed by the commissioner.
(c)CA Insurance Code § 769.86(c) The decision, determination, or order of the commissioner pursuant to subdivision (a) shall be subject to judicial review.
(d)CA Insurance Code § 769.86(d) Nothing contained in this section shall affect the right of the commissioner to impose any other penalties provided for in this code, nor limit any other authority required or authorized by this code to be exercised by the commissioner.
(e)CA Insurance Code § 769.86(e) Nothing contained in this article is intended to or shall in any manner limit or restrict the rights of policyholders, claimants, and auditors.

Section § 769.87

Explanation

The commissioner is allowed to create rules and regulations to help put this law into practice and manage it effectively.

The commissioner may adopt reasonable rules and regulations for the implementation and administration of this article.