Insurance is one of those things that most people need but hate to buy. Add the fact that insurance policies are often hard to understand and it makes sense that many members of the general public get frustrated dealing with insurance. You do a great job helping your clients and customers in Seattle, Spokane, Tacoma, and the rest of Washington State get the right insurance and find ways to best mitigate their risks. Despite these best efforts, mistakes and misunderstandings occasionally occur. In some cases, this can lead to your clients, customers, or members of the public filing a complaint.
If this happens, your livelihood could be at risk when the Office of the Insurance Commissioner of Washington State takes disciplinary action against you. Situations like these require assistance from the Professional License Defense Team from the Lento Law Firm. We have extensive experience defending insurance professionals like yourself in disciplinary proceedings. We also have a deep understanding of the numerous Washington State insurance statutes and regulations that govern your practice. The moment you face a complaint and investigation into your insurance profession, contact us by calling 888-535-3686 or using our online contact form.
The Office of the Insurance Commissioner of Washington State
The Office of the Insurance Commissioner (OIC) regulates the insurance industry within Washington State. The OIC does this in two primary ways. First, the OIC requires eligible individuals and companies to obtain a license when soliciting (advertising), selling, or negotiating insurance contracts and policies within the state.
Second, the OIC enforces applicable provisions of the insurance laws and insurance regulations. One way they do this is by receiving and investigating complaints that individuals can file if they believe an insurance professional, such as an agent or broker, engaged in unlawful conduct.
Reasons the WA OIC Might Investigate and Discipline an Insurance Professional
If the OIC decides to take disciplinary action against you, it will most likely be for one or more of the following:
- Being convicted of a felony.
- Mishandling or misappropriating money while you conduct insurance business.
- Lying or providing misleading information on your insurance license application.
- Cheating on an insurance license examination.
- Being found to have committed fraud or any other unfair trade practice within the insurance industry.
- Misrepresenting or misleading a consumer about the terms, conditions, or benefits of an insurance contract or policy.
- Refusing to comply with a subpoena or other lawful order from the insurance commissioner of Washington or any other state.
- Having your insurance license suspended, revoked, or denied by another state.
- Using fraud or misrepresentation to obtain a Washington insurance license.
- Demonstrating financial irresponsibility, untrustworthiness, dishonesty, or incompetence.
- Committing forgery on any insurance document.
- Knowingly engaging in insurance business with someone who lacks a required insurance license.
- Violating one or more Washington State insurance laws or regulations.
The WA Office of the Insurance Commissioner Complaint Process
The process begins when someone files a complaint against you. This can easily be done online, but the OIC will also accept complaints by mail.
After the OIC receives the complaint, they'll confirm they have jurisdiction to process it. This will largely revolve around two things. First, whether the insurance policy was issued in Washington State or involved an insurance transaction within this state. Second, whether the allegations relate to an unlawful act under the applicable insurance laws or regulations of Washington.
If the OIC doesn't have jurisdiction (such as in situations involving unemployment or industrial insurance claims), they will try to refer the complaint to the appropriate agency or organization. Assuming the OIC has jurisdiction, they will notify you of the complaint and offer you an opportunity to respond to the allegations.
You'll usually learn of this when you get a Notice of Investigation. If you receive this notice, you must act quickly, as you could have as few as 15 days to prepare and transmit your response to the OIC. You also shouldn't ignore this notice because you're legally required to promptly respond to any inquiry from the OIC.
After you respond to the complaint, the OIC will review it and decide if they need more information. If they do, they'll reach out to you or the person who filed the complaint.
The OIC may reach out to you to see if an amicable resolution to the complaint can be negotiated. If not, the OIC may decide to impose sanctions against you and your insurance license. You may ask for an administrative hearing if you disagree with the OIC's decision.
The Administrative Hearing Process
You'll submit your hearing request to the Washington OIC Administrative Hearings Unit. You can file your request online, by fax (360-339-7061), or by mail:
Administrative Hearings
Office of the Insurance Commissioner
P.O. Box 40255
Olympia, WA 98504-0255
You have 90 days of the order or action of the OIC to request an administrative hearing. When submitting your request, you must include your reasons for the request and the factual and legal basis for believing the OIC's actions against you were improper or incorrect. You'll also need to provide a valid email address to receive electronic service of process.
If you decide to request an administrative hearing, you should act as quickly as you can because requesting an administrative hearing comes with the benefit of staying an order or action by the OIC. This is true as long as you make your demand before the effective date of the OIC order or action, and such a stay won't harm the general public.
You may hire the Lento Law Firm to assist you during this administrative hearings process. This includes filing the hearing request on your behalf. However, if you hire the Lento Law Firm to represent you, your contact information is still required to be included in your submission.
After receiving and processing your request, the OIC will schedule a Prehearing Conference (PHC) and inform you of this date. This typically takes place over the phone or via ZOOM.
The purpose of the PHC is to go over the procedural aspects of the administrative hearing. This includes explaining how the hearing process works, listing deadlines for motions (such as a motion for summary judgment), and identifying deadlines for the identification of witnesses and documents to be used as evidence. Besides yourself (or your attorney), there will be a presiding officer at the PHC, as well as an attorney from the OIC's Legal Affairs Division. This attorney will represent the interests of the OIC at the PHC and administrative hearing.
At the end of the PHC, the OIC sends you a Notice of hearing that summarizes what was discussed at the PHC, the date and time of the administrative hearing, and applicable deadlines. If you disagree with the outcome of the PHC, you can file an appeal within 10 days.
The hearing itself is a lot like a courtroom trial but more informal. Instead of a judge and jury, there will be a presiding officer. The presiding officer will be a licensed attorney with insurance experience but no prior knowledge of the facts or circumstances surrounding your case. In some cases, an administrative law judge from the Office of Administrative Hearings will oversee your hearing and have similar powers and responsibilities as a presiding officer. However, it will be the presiding officer that issues the final decision.
Also, like a conventional trial, administrative hearings are open to the general public.
The first part of the hearing consists of each side making an opening statement. Next, each side calls its witnesses and submits evidence to support their positions. Witness testimony is given under oath and is subject to cross-examination.
Once each side has presented its evidence and been allowed to challenge the evidence from the other side, it's time for closing arguments, which make up the third and final part of the hearing.
After the hearing, the presiding officer makes a decision. If they need additional information, the presiding officer may ask each side to submit additional evidence or present additional arguments before rendering a decision.
The evidentiary standard for administrative hearings is a preponderance of the evidence. In other words, you must set out evidence and arguments that prevent the OIC from establishing that it was more likely than not that you violated one or more Washington insurance regulations or laws.
The rules of evidence for administrative hearings will largely mirror that of the rules of evidence at criminal and civil trials, but may be less strict. This means it may be easier to get in evidence at an administrative hearing (like hearsay) than at a trial.
The presiding officer must issue a decision within 90 days of the hearing or after all evidence has been presented. This decision consists of three parts: Findings of Fact, Conclusions of Law, and a Final Order. The decision will either affirm the original actions of the OIC, modify the original actions of the OIC, or set aside the actions of the OIC.
Even if the presiding judge finds in your favor, the OIC still keeps a record of the complaint made against you. The OIC will preserve this complaint to see if there's a potential trend or pattern in how you carry out your insurance business.
If you disagree with the presiding officer's decision, you have two options. The first option is filing a petition for review. You must file this petition within 30 days of the presiding officer sending you their decision and submit the petition to the Washington Superior Court (the basic trial-level court of general jurisdiction).
Your second option is to file a Petition for Reconsideration. You have 10 days from the date of the presiding officer's decision to submit this petition. In this petition, you're basically telling the presiding officer that you think they were wrong and that you want the presiding officer to reconsider their initial decision.
Possible Punishments and Sanctions from the OIC
Discipline from the Office of the Commissioner will potentially take two forms. The first form is an action against your insurance license. This includes placing your license on probation, suspending, or revoking it. If applicable, it may also include the refusal to renew your license.
The OIC also has the option of imposing a fine. In certain cases, the OIC may impose a fine and take action against your insurance license. Even if you can avoid these sanctions, having to go through the stress and inconvenience of a disciplinary proceeding and administrative hearing can create a significant burden on you. This is why it's so important to get help when first learning of the OIC's investigation.
This investigation is a critical time in the disciplinary process because it provides you with the opportunity to respond to the allegations and give your side of the story. If you say the wrong thing, your statements could potentially be used against you in a subsequent administrative hearing.
Even if you don't incriminate yourself at the investigation phase, saying the wrong thing could mean missing an opportunity to avoid having to go through with an administrative hearing. One of the last things you want is to present your case at the administrative hearing and have the lawyer from the Legal Affairs Division of the OIC concede that had this information been brought to the OIC's attention during its investigation, it would have never imposed any sanctions. This would be a relief in that you've won your case, but it would also be frustrating because you could have avoided all the stress and worry if you simply provided a better response to the OIC when it sent you the Notice of Investigation.
License Defense for Washington Insurance Professionals
It doesn't matter if you're in Bellevue, Vancouver, or any other part of Washington, the Lento Law Firm's Professional License Defense Team can help. Maybe you just received the Notice of Investigation. Or perhaps you want to request an administrative hearing to challenge the OIC's imposition of discipline. It doesn't matter where you are in the disciplinary process, call us at 888-535-3686 or use our online contact form to schedule a consultation. The sooner you contact us, the more effective our help can be.
