Australian Capital Territory Numbered Regulations Australian Capital Territory Numbered Regulationssubstitute
Division 9.2 Conditions on insurers
71 Insurer must have reinsurance—Act, s 145J (c)
It is a condition of an insurer licence that the insurer maintain reinsurance that is capable of meeting the insurer's existing and expected liabilities under the Act.
72 Information about ability to meet liabilities etc—Act, s 145J (c) and (g)
(1) It is a condition of an insurer licence that the insurer give the regulator the following information, if requested in writing by the regulator:
(a) information about claims that have been made against the insurer under the Act;
(b) information to allow the regulator to assess—
(i) the insurer's continuing ability to meet the insurer's existing and expected liabilities under the Act; and
(ii) whether the insurer continues to be financially and prudentially sound; and
(iii) the insurer's continuing ability to meet its obligations under the Act.
(2) Information requested from an insurer in writing by the regulator must be reasonably necessary for the performance of the regulator's functions.
73 Insurer to provide information and pay costs of audit—Act, s 145J (c) and (f)
It is a condition of an insurer licence that for an audit under part 10A, the insurer—
(a) complies with the reasonable requirements of the person conducting the audit; and
(b) allows the person conducting the audit access to the information reasonably required to conduct the audit; and
(c) pays reasonable fees and reasonable expenses for the audit.
Note The Minister may approve a protocol about how a person who is subject to an audit must participate in the audit (see s 101 (2) (b)).
74 Information on working out premiums—Act, s 145J (c) and (e)
(1) It is a condition of an insurer licence that—
(a) on written request by the regulator, the insurer gives the regulator, in writing, any relevant information about how the insurer works out premiums for compulsory insurance policies; and
(b) the insurer must give information under paragraph (a) within the period stated in the request that is not less than 21 days after the day the regulator asked for the information.
(2) In this section:
"relevant information" means information the regulator is satisfied on reasonable grounds will help the regulator to decide whether premiums are being worked out in accordance with the principles for working out premiums under section 75.
75 Principles for working out premiums—Act, s 145J (c)
(1) It is a condition of an insurer licence that, in working out premiums, an insurer must—
(a) provide for sufficient (but not excessive) income from premiums to fully fund liabilities arising from policies of insurance to which the premiums relate; and
(b) ensure that premiums are structured to minimise, as far as reasonably practicable, the cross subsidisation of premium rating groups.
(2) For this section, there is sufficient income from premiums to fully fund the liabilities to which the premiums relate if the premiums are sufficient to do all of the following:
(a) fully fund claims liabilities arising from the insurance policies to which the premiums relate;
(b) pay all acquisition, policy administration and claims settlement expenses of the insurer;
(c) provide a profit margin after the payment of claims, costs and expenses that represents an adequate return on capital invested and compensation for the risk taken;
(d) provide for anything else that a prudent insurer should, in the circumstances, provide for;
(e) provide for contributions or other charges payable by the insurer under the Act.
(3) For subsection (2) (a), the amount of claims liabilities of the insurer does not include the treatment, care and support costs of a participant in the LTCS scheme.
Note LTCS scheme —see the LTCS Act
, dictionary.
(4) An insurer is taken to have complied with subsection (1) (a) if the insurer provides for sufficient (but not excessive) income from premiums in accordance with actuarial advice about the liability arising from policies of insurance to which the premiums relate.
76 Time for information to be given—Act, s 145J (c) and (g)
(1) It is a condition of an insurer licence that any information required to be given to the regulator is given—
(a) within 14 days after the day the information is requested; or
(b) if a longer period is allowed by the regulator or provided for the giving of the information—within that period.
(2) This section does not apply to section 74 (Information on working out premiums—Act, s 145J (c) and (e)).
77 Record keeping by licensed insurers—Act, s 145J (d)
(1) It is a condition of an insurer licence that a licensed insurer must keep records about the licensed insurer's policies, processes and decisions for the provision of an insurer service, in accordance with any protocol relating to the keeping of records.
(2) A record mentioned in subsection (1) must be kept for not less than 5 years after the day the record is made.
78 Action if rehabilitation provider's approval suspended or revoked—Act, s 145J (c)
It is a condition of an insurer licence that the insurer must arrange for another rehabilitation provider to be responsible for a worker's vocational rehabilitation under a personal injury plan if—
(a) the approval of the rehabilitation provider responsible for the worker's rehabilitation under the plan has been suspended or revoked; and
(b) the insurer is responsible for the personal injury plan for the worker.
Division 9.3 Action against insurers
79 Notice of proposed action against licensed insurer
If the regulator proposes to take action (the proposed action ) mentioned in section 80 (2) in relation to an insurer, or to cancel the insurer licence, the regulator must give the insurer written notice—
(a) stating the proposed action; and
(b) stating the grounds for the proposed action; and
(c) inviting the insurer to make written representations, within a stated period of not less than 14 days after the day the insurer is given the notice, about why the proposed action should not be taken.
80 Action other than cancellation of insurer licence—Act, s 223 (2) (h)
(1) This section applies to a licensed insurer if—
(a) the insurer—
(i) contravenes the Act
, section 112 (Compliance by insurers, including DI fund) or another provision of the Act; or
(ii) is unable to meet the insurer's existing and expected liabilities under the Act; or
(iii) no longer has unlimited reinsurance for a single event to cover the insurer's expected liability under the Act; or
(iv) fails to comply with a condition on the insurer licence; and
(b) the regulator has given the insurer notice under section 79.
(2) After considering any written representations made by the insurer within the period for representations stated in the notice, the regulator may—
(a) do 1 or more of the following:
(i) order the insurer to pay to the Territory a financial penalty of not more than $1 000;
(ii) impose a condition on the insurer licence of the insurer (for example, by including a condition providing for increased supervision of the insurer by the regulator);
(iii) censure the insurer;
(iv) order the insurer to take remedial action; or
(b) suspend the licence for not longer than the period.
(3) The regulator must tell the insurer in writing about the decision—
(a) if the decision is to take action other than suspension—by giving the insurer a reviewable decision notice; or
Note The requirements for reviewable decision notices are prescribed under the ACT Civil and Administrative Tribunal Act 2008
.
(b) if the decision is to suspend the insurer licence—in accordance with section 82 (Effect of regulator suspension or cancellation of insurer licence—Act, s 145J (h)).
(4) In this section:
"proposed action"—see section 79.
81 Cancellation of insurer licence—Act, s 145J (h)
(1) This section applies to an insurer licence if—
(a) a matter mentioned in section 80 (1) (a) applies to the insurer; and
(b) either—
(i) the regulator has taken action under section 80 (2), but the matter continues or is repeated; or
(ii) the regulator considers immediate action is required because of a serious circumstance; and
(c) the regulator gives notice under section 79 that the regulator proposes to cancel the licence.
(2) After considering any written representation made by the insurer within the period for representations stated in the notice, the regulator may—
(a) take action under section 80 (2); or
(b) cancel the insurer licence.
(3) For subsection (1) (b) (ii), a "serious circumstance" includes a circumstance in which the insurer—
(a) fails to establish an injury management program under the Act
, section 88 (Insurer to establish etc injury management program); or
(b) fails to give effect to an injury management program under the Act
, section 89 (Insurer to give effect to injury management program); or
(c) fails to establish a personal injury plan for an injured worker under the Act
, section 97 (Personal injury plan for worker with significant injury); or
(d) contravenes a direction under the Act
, section 114 (Unreasonableness in stopping payment); or
(e) fails to comply with the regulator's notice, or gives details that are false or misleading in a material respect, under the Act, section 164 (Provision of information to Minister).
(4) The regulator must tell the insurer, in writing, about the decision—
(a) if the decision is to take action other than suspension or cancellation—by giving the insurer a reviewable decision notice; or
Note The requirements for reviewable decision notices are prescribed under the ACT Civil and Administrative Tribunal Act 2008
.
(b) if the decision is to suspend or cancel the insurer licence—in accordance with section 82.
82 Effect of regulator suspension or cancellation of insurer licence—Act, s 145J (h)
(1) If the regulator decides to suspend or cancel an insurer licence, the regulator must give written notice of the decision, including when the suspension or cancellation takes effect, to the insurer who holds the licence.
Note The regulator's notice must comply with the requirements of the Act
, s 199A.
(2) A suspension or cancellation must not take effect earlier than 7 days after the day the insurer is told about the decision.
(3) Subject to the Act
, section 146 (Effect of cancellation or suspension of insurer licence), if the regulator suspends an insurer licence, the insurer is, during the suspension—
(a) taken not to be a licensed insurer; and
(b) disqualified from applying for a licence as an insurer.
(4) The regulator may, at any time, by written notice to the insurer, end or reduce the period of suspension of the insurer licence.
83 When does cancellation make previous insurance policies not compulsory insurance policies?—Act, s 146 (3)
(1) If an insurer licence is cancelled, a compulsory insurance policy issued before the cancellation is taken not to be a compulsory insurance policy only if a reason for the cancellation is the winding-up of the insurer.
(2) The compulsory insurance policy stops being a compulsory insurance policy 7 days after the day the cancellation takes effect.