Insurance Regulatory

Sedgwick’s Insurance Regulatory practice provides insurers with expert advice on legal and operational challenges of doing business in a complex regulatory environment.
Our attorneys represent property/casualty insurers, health insurers and life insurers on a wide range of regulatory issues, including:

  • Compliance counseling
  • Insurer transactions
  • Reinsurance and captive arrangements
  • Rules adoption and judicial challenges to regulations
  • Regulatory enforcement actions and related class action litigation

Compliance Counseling

Our attorneys are skilled at identifying the particular problems that statutes and regulations pose for a client. Our approach is to craft practical solutions and work with in-house counsel to implement these solutions within their companies. We draft and review compliance guides, respond to business concerns, and provide analyses regarding the impact of law changes.

Sedgwick advises health insurers and managed care plans on regulations governing health care information, coverage requirements and managed care operations. Our attorneys advise health carriers on compliance and rate regulation issues under federal healthcare reform legislation.

We provide advice on state insurance statutes and regulations relevant to excess and surplus lines carriers and to reinsurers. The attorneys in our London office and associated Bermuda office offer their international insurance experience in providing multi-jurisdictional compliance advice.

Insurer Transactions

Sedgwick provides advice in connection with insurance company mergers and acquisitions.  We assist clients in structuring inter-company agreements, including mergers and acquisitions, reinsurance, management, services, and novel or unusually structured agreements.  

Our attorneys secure regulatory approvals for transactions and advised clients on insurance holding company act issues. We also obtain insurance regulatory approval for surplus note and other financing arrangements.

Reinsurance

Sedgwick advises insurers on reinsurance programs, including inter-company pooling arrangements. We also assist clients in London and Bermuda reinsurance transactions, including regulatory aspects of innovative products. Sedgwick attorneys have drafted loss portfolio transfer, novation and assumption reinsurance agreements for books of business in various lines of insurance.

Captive Insurers and Risk Retention Groups

Sedgwick provides advice on the formation of risk retention groups and U.S. and Bermuda captive insurers. We advise clients on business, regulatory and compliance issues relating to captive insurers and draft a variety of reinsurance and risk transfer mechanisms utilizing captive insurers.

Rules Adoption and Judicial Challenges to Regulations

Sedgwick attorneys have participated in state regulatory agency task forces and workshops in the development and adoption of rules governing the insurance industry. These interactions have included private discussions and presentations with agency staff and have covered topics such as rate setting, regulated premiums, and insurance application and coverage forms.

Our attorneys are very experienced with formal rulemaking hearings and have provided live testimony and written comments regarding a host of proposed regulatory changes. We have a strong track record in securing modifications to needless or counterproductive insurance regulations. Sedgwick’s attorneys have also been called on to provide comment to administrative entities that review insurance agency rule changes, including California’s Office of Administrative Law.

Sedgwick represents insurance industry interests in judicial challenges to adopted regulations.

Enforcement Action Defense and Litigation

We work with our clients to prepare for and respond to insurance regulator field examinations covering rates and underwriting, market conduct, and claims practices, and have advised insurers with respect to financial examinations associated with intercompany contracting. Sedgwick conducts file reviews, addresses confidentiality issues, responds to preliminary reports, negotiates resolutions and handles any “fallout” litigation.

We represent insurers in enforcement actions brought by state agencies charged with oversight of the industry. These actions have involved a broad spectrum of regulatory disputes. In some states, these disputes may begin with a civil investigative demand (CID) issued by the Attorney General’s Office. These investigations frequently arise out of consumer protection issues related to insurance sales, marketing practices or alleged misrepresentations as to coverages. CID investigations may escalate to the filing of a declaratory judgment action to challenge the statutory or constitutional authority of the regulatory body to conduct the investigation, or to determine an insurer’s compliance with applicable statutes and regulations. Sedgwick attorneys also represent insurance companies in private attorney general and unfair business practices lawsuits, including class actions. These cases have involved allegations of insurance code and regulation violations including premium, dividend, fee, underwriting, policy structure, disclosure and privacy disputes.

Our in-depth knowledge of insurance regulatory procedures combined with our firm’s extensive litigation resources enable us to structure multipronged defense strategies that include potential regulatory and legislative responses.

Additional Services

Insurer Insolvency

Working in conjunction with the members of Sedgwick’s Creditors’ Rights and Bankruptcy Group, our insurance attorneys represent financially troubled insurers in discussions with insurance regulators. We also represent reinsurers and creditors in insurance insolvency proceedings. In addition to involvement in U.S. insurer insolvency proceedings, Sedgwick’s attorneys also have participated in a number of Bermuda insolvencies and restructurings.

Public Records

Our attorneys are skilled in making and enforcing public records requests. We are also experienced in opposing state regulatory agency disclosure of confidential insurance company materials that are retained by agencies.

Legislation

Our attorneys work with insurance industry trade organizations and registered lobbyists to draft proposed legislation, initiative proposals and regulations. We also provide ongoing analysis of proposed changes in insurance laws and regulations.