044-4 Wyo. Code R. §§ 4-14 - Grounds for Denial, Suspension or Revocation of Licensure

(a) The commissioner may, deny, suspend or revoke the license of a TPA if, after notice and opportunity for hearing pursuant to Chapter 32 of the Wyoming Insurance Regulations, the commissioner finds that the TPA:

(i) Has a negative net worth;

(ii) Is using such methods or practices in the conduct of its business so as to render its further transaction of business in this state hazardous or injurious to insured persons or the public;

(iii) Has failed to pay any judgment rendered against it in this state within sixty (60) days after the judgment has become final;

(iv) Has violated any lawful rule or order of the commissioner or any provision of the insurance laws of this state;

(v) Has refused to produce its accounts, records and files for examination or investigation by the commissioner;

(vi) Has, without just cause, refused to pay proper claims or perform services arising under its contracts or has, without just cause, caused covered individuals to accept less than the amount due them or caused covered individuals to employ attorneys or bring suit against the TPA or a payor which it represents to secure full payment or settlement of such claims;

(vii) Is required pursuant to this chapter to have a license and fails at any time to meet any qualification for which issuance of a license could have been refused had the failure then existed and been known to the commissioner, unless the commissioner issued a license with knowledge of the ground for disqualification and had the authority to waive it;

(viii) Has one or more of the individuals responsible for the conduct of its affairs has been convicted of, or has entered a plea of guilty or nolo contendere to, any felony, without regard to whether adjudication was withheld;

(ix) Is under suspension or revocation in another state; or

(x) Has failed to file a timely renewal application pursuant to section 13.

(b) If the commissioner finds that sufficient grounds exist for the suspension or revocation of a license issued under this section the commissioner may, in lieu of or in addition to the suspension or revocation, impose a fine upon the TPA pursuant to W.S. § 26-1-107.

(c) The provisions of this section are in addition to and not instead of any other enforcement provisions contained in the Wyoming Insurance Code [title 26].

Notes

044-4 Wyo. Code R. §§ 4-14

Amended, Eff. 11/2/2022.