Agency: 160 - Office of Insurance Commissioner

The Office of the Insurance Commissioner (OIC) is responsible for regulating the insurance industry in Washington State and protecting consumers through education and timely communications. The activities of the OIC are primarily funded by fees from insurance organizations. Agency management develops policies, regulations, and codes to ensure that the citizens of Washington are able to access affordable insurance; it also provides the administrative support necessary for other divisions within the agency to carry out their functions.

This activity ensures compliance with all requirements applicable to insurance producers, surplus line brokers, adjusters, life settlement brokers, and other licensees including determination of eligibility for license issuance and renewal; performance of financial examinations of licensees; and compliance with the requirements applicable to their post-licensure activities including those relating to continuing education.

The agency responds to oral, written and face-to-face complaints and inquiries from consumers regarding insurance companies. Staff advocate, provide dispute resolution services, and educate consumers to ensure they can make informed choices about their insurance needs and rights. Assistance is rendered to enforce the various provisions of the insurance code with the primary function of ensuring that consumer rights have not been violated.

This activity provides a statewide network of trained volunteers and paid staff to educate, assist, and advocate for consumers regarding public and private health insurance and health care access issues.

This activity includes monitoring the solvency of insurance carriers, health care service contractors, health maintenance organizations, certified health plans, and self-funded Multiple Employer Welfare Arrangements authorized to conduct business in Washington State. Solvency issues, or conduct that may lead to issues with solvency, may be identified through market conduct oversight activities, financial examinations, or financial analysis of statements filed by insurers.

Staff handle enforcement actions against insurance companies, health carriers, insurance producers, health care benefit managers, and others; identify and investigate consumer and health care benefit manager/pharmacist complaints, violations of the insurance code and criminal insurance fraud; provide information and counsel to other agency divisions and allied law enforcement agencies; and support the public policy activities of the agency.

Staff review and take final disposition on insurance product filings to ensure compliance with state and federal law and rules when they are sold in Washington State. Rate filings, which include complex actuarial formulas, assumptions, and experience data, are reviewed to ensure that rates are neither excessive, inadequate, nor unfairly discriminatory. Policy forms (the insurance contract) and provider contracts (between health carriers and healthcare providers) are reviewed to ensure that the terms and conditions comply with state and federal laws.