Key Takeaways
- The Michigan Insurance Code prohibits misrepresentation, false advertising, and unfair claims practices
- Rebating is prohibited in Michigan, with limited exceptions for nominal value items
- Twisting and churning are prohibited practices subject to license revocation and fines
- Insurers must handle claims in good faith within specified timeframes
- Unfair discrimination based on protected characteristics is prohibited in underwriting and rating
Unfair Trade Practices
The Michigan Insurance Code (MCL 500) prohibits various unfair or deceptive practices in the insurance industry.
Misrepresentation
Producers and insurers are prohibited from:
False Statements
- Making false statements about policy terms or benefits
- Misrepresenting the financial condition of an insurer
- Using misleading policy illustrations
- Making false statements about competitors
- Misrepresenting the nature of the insurance transaction
Examples of Misrepresentation
| Prohibited Statement | Why It's Misrepresentation |
|---|---|
| "This policy covers everything" | No policy covers all losses |
| "Your rates will never increase" | Rates can and do change |
| "This company is the largest" | If not true, it's false |
| "You must buy today" | False urgency |
| "This is just like a bank CD" | Misrepresenting insurance as banking product |
False Advertising
Michigan prohibits deceptive insurance advertising:
- Ads must be truthful and not misleading
- Must clearly identify as insurance advertisement
- Cannot use testimonials that are not genuine
- Cannot imply government endorsement
- Must include insurer's name
Digital and Social Media Rules
- Same standards apply to social media and websites
- Must be clear it's an advertisement
- Cannot make claims that cannot be substantiated
- Producer must be identified
- Records of advertisements must be maintained
Rebating
Rebating is offering inducements not specified in the policy to purchase insurance:
What Is Prohibited
- Returning part of premium to insured
- Offering gifts or prizes of significant value
- Paying for referrals to non-licensed individuals
- Sharing commission with non-licensed persons
- Special favors or services not available to all
Limited Exceptions
Michigan allows:
- Premium financing arrangements
- Dividends specified in policy
- Legitimate marketing items of nominal value (pens, calendars)
- Group premium discounts specified in contract
Exam Tip: Rebating is prohibited in Michigan. Items of nominal value for marketing purposes are permitted.
Twisting and Churning
Twisting
Making misrepresentations to induce replacement of existing insurance:
- Falsely claiming existing policy is worthless
- Misrepresenting surrender values
- Hiding costs of replacement
- Exaggerating benefits of new policy
Churning
Excessive replacement of policies to generate commissions:
- Multiple replacements for same client
- Pattern of replacements in book of business
- Ignoring client's best interests
- Creating new surrender charge periods
Penalties
| Violation | Potential Penalty |
|---|---|
| First offense | Warning, fine, or suspension |
| Repeat offense | License revocation |
| Per violation | Significant fines |
| Consumer harm | Restitution required |
Unfair Claims Practices
Michigan requires insurers to handle claims fairly and promptly:
Prohibited Practices
- Misrepresenting policy provisions to claimants
- Failing to acknowledge claims promptly
- Failing to communicate claim decisions
- Denying claims without reasonable investigation
- Offering substantially less than reasonable value
- Delaying payment to force settlement
- Requiring excessive documentation
- Failing to affirm or deny coverage in reasonable time
Claim Handling Standards
| Action | Requirement |
|---|---|
| Acknowledge claim | Promptly |
| Begin investigation | Promptly after notice |
| Accept or deny claim | Reasonable time after proof of loss |
| Pay claims | Promptly after settlement |
Bad Faith
If an insurer acts in bad faith, policyholders may recover:
- Policy benefits owed
- Consequential damages
- Penalty interest on delayed payments
- Attorney's fees in some cases
Unfair Discrimination
Michigan prohibits unfair discrimination in insurance:
Protected Characteristics
| Protected | Cannot Discriminate Based On |
|---|---|
| Race | Prohibited in all circumstances |
| Religion | Prohibited |
| National Origin | Prohibited |
| Disability | With actuarial limitations |
| Genetic Information | GINA protections apply |
| Marital Status | Limitations apply |
What IS Permitted
Risk-based underwriting using:
- Age
- Sex (for life insurance)
- Health history
- Claims history
- Occupation (with limitations)
- Tobacco use
- Lifestyle factors (hazardous activities)
Which of the following is generally PERMITTED in Michigan insurance sales?
Which practice involves making misrepresentations to induce a policyholder to replace existing coverage?