The Office of Market Regulation
The Office of Market Regulation is responsible for regulating the behavior of insurance companies, agencies, agents and other licensees' in Pennsylvania's Insurance Marketspace. The office ensures those entities adhere to Pennsylvania's insurance statutes and regulations by conducting investigations, following up on complaints and performing audits.
The Office of Market Regulation is comprised of three bureaus each with a specific focus to ensure the safety of Pennsylvania policyholders.
The Bureau of Consumer Services - Concentrates on health, life, and property & casualty complaints from policyholders who believe there was wrongdoing on the part of an insurance company or other licensee. They perform investigations to determine the validity of the complaint and, if a complaint is found to be valid, insurance companies may be ordered to reverse decisions and pay restitution to the consumer if applicable.
The Bureau of Market Actions - Performs audits of insurance companies, called Market Conduct Examinations, to ensure they are operating within the boundaries of PA statutes and regulations. These examinations may include a review of claims handling, received complaints, services to policyholders, advertising and marketing, and underwriting and rating to ensure fair and non-discriminatory practices.
This bureau also works to ensure offered products are suitable for policyholders, such as short-term limited duration plans and life annuities. If a violation is found the insurance company could be assessed penalties and ordered to pay restitution to policyholders.
The Bureau of Licensing and Enforcement - Responsibilities are two-fold. First, the licensing division issues licenses to agents, agencies, public adjusters, physical damage appraisers, title agents, surplus lines agents and health insurance navigators which are required in order to be able to conduct the business of insurance in Pennsylvania.
Secondly, the enforcement unit investigates misconduct by insurance licensees and, through the civil authority granted to them, will impose fines, suspend and revoke insurance licenses and order restitution be paid to consumers if a violation is found.