CONTROL GUIDELINES. A. GENERAL COMPANY RESPONSIBILITIES In general, the Company is responsible for: (1) Conducting all quality control reviews required under this section through objective and unbiased persons, who were not involved in establishing the guarantee or adjusting the loss, or in the sales or supervision of sales for the eligible livestock price insurance contract reviewed. (2) Verifying the information provided by the policyholder, agent, and loss adjuster is true and accurate through means, including, but not limited to, interviews, field inspections, file reviews, and obtaining production or other records from third parties. (3) Verifying that the information was provided timely. (4) Verifying that the livestock price insurance contract constitutes an eligible livestock price insurance contract. (5) Implementing procedures for detecting and reporting any instance of fraud, waste, and abuse by policyholders, employees or affiliates. (6) Correcting applicable monetary or livestock production data discrepancies as required by FCIC and timely processing such corrections to reconcile monthly accounting and statistical reports to reflect corrections, consistent with section III.B.6. of the Agreement. (7) Implementing administrative procedures to resolve and correct errors and assure accurate premium and loss determinations. (8) Maintaining loss files containing adequate supporting documentation, loss adjuster reports or any other necessary evidence to support the payment or denial of claims, including the actions taken to verify the applicable information. (9) Notifying FCIC of suspected fraud, waste or abuse in accordance with section IV of this Appendix and assisting FCIC in subsequent investigations. (10) Establishing a process to respond to policyholder complaints received directly from the public, state insurance departments, or complaints referred to the Company by FCIC or by the Company to FCIC, documenting the complaint and actions taken by the Company in response, and providing such documentation to FCIC upon request. (11) Retaining all documents obtained in the course of the reviews conducted and all completed forms as required by the Agreement. (12) Providing an outline of the plan the Company will use in carrying out its quality control program with the Plan of Operation. The quality control plan must include: (a) The names and titles of the persons who will have oversight responsibilities for the reviews required under this section. (b) The types of reviews conducted (random sampling, FCIC designated, discretionary, etc.) and the time period when such eligible livestock price insurance contracts will be selected for each review. (c) A complete description of the process to be followed by the reviewers for conducting each of the reviews required under this section. (13) Conducting such other reviews (including monitoring programs) as may be determined necessary by FCIC to protect program integrity. (14) Taking such actions as directed by FCIC to correct systemic, procedural, or other problems revealed by the quality control reviews. (15) Preparing and providing to FCIC, in a form determined by FCIC, not later than April 30 following each livestock reinsurance year (first report will be due April 30, 2006), an annual summary report detailing the results of the quality control program that will, at a minimum: (a) For eligible livestock price insurance contracts which did not have discrepancies or incorrect information detected: Identify by contract number and livestock, the name and title of the person who conducted the review for the respective eligible livestock price insurance contract, the date the review was completed, and the type of review conducted. (b) For eligible livestock price insurance contracts which had discrepancies or incorrect information: Identify by contract number and livestock, the name and title of the person who conducted the review for the respective eligible livestock price insurance contract, the date the review was completed and the type of review conducted, the type of discrepancy or incorrect information detected, the monetary effect, and the corrective action taken. (c) Include other relevant quality control information that may be required by FCIC (e.g., error rates). (d) Such other information as may be required by FCIC. (16) At the request of FCIC, provide copies of documentation completed by the reviewers for any of the reviews required under this section. (17) Reviewing claims in excess of $100,000 and reporting the results to FCIC in the annual report. (a) The review will consist of an examination of the information pertaining to the guarantee and loss, including the results of field inspections, to determine whether the claim can be substantiated. The Company must document the verification of the reported information pertaining to the claim and the sources used for verification. (b) If the review reveals errors in the claim, the Company must correct the claim or deny the claim. B. FCIC RESPONSIBILITIES (1) FCIC will evaluate the Company's annual report to assess its compliance with this Appendix. (2) FCIC will conduct periodic compliance evaluations of the Company's quality control programs to determine compliance with the requirements of this Appendix, assess the effectiveness of the systems, and the accuracy of the Company's conclusions with regard to the quality control reviews conducted under this section. (3) FCIC will conduct periodic evaluations or reviews of the operations of the Company or its affiliates relating to the Federal crop insurance program.
Appears in 5 contracts
Samples: Appendix, Appendix, Appendix to an Insurance Agreement
CONTROL GUIDELINES. A. GENERAL COMPANY RESPONSIBILITIES In general, the Company is responsible for:
(1) Conducting all quality control reviews required under this section through objective and unbiased persons, who were not involved in establishing the guarantee or adjusting the loss, or in the sales or supervision of sales for the eligible livestock price crop insurance contract reviewed.
(2) Verifying the information provided by the policyholder, agent, and loss adjuster is true and accurate through means, including, but not limited to, interviews, field inspections, file reviews, and obtaining production or other records from third parties.
(3) Verifying that the information was provided timely.
(4) Verifying that the livestock price crop insurance contract constitutes an eligible livestock price crop insurance contract.
(5) Implementing procedures for detecting and reporting any instance of fraud, waste, and abuse by policyholders, employees or affiliates.
(6) Correcting applicable monetary or livestock actual production data history discrepancies as required by FCIC and timely processing process such corrections to reconcile monthly accounting and statistical reports to reflect corrections, consistent with section III.B.6II.C.3. of the Agreement.
(7) Implementing administrative procedures to resolve and correct errors and assure accurate premium and loss determinations.
(8) Maintaining loss files containing adequate supporting documentation, loss adjuster reports or any other necessary evidence to support the payment or denial of claims, including the actions taken to verify the applicable information.
(9) Notifying FCIC of suspected fraud, waste or abuse in accordance with section IV of this Appendix and assisting FCIC in subsequent investigations.
(10) Establishing a process to respond to policyholder complaints received directly from the public, state insurance departments, or complaints referred to the Company by FCIC or by the Company to FCIC, documenting the complaint and actions taken by the Company in response, and providing such documentation to FCIC upon request.
(11) Following procedures related to companion eligible crop insurance contracts in force for other persons sharing in the crop.
(12) Retaining all documents obtained in the course of the reviews conducted and all completed forms as required by the Agreement.
(1213) Providing an outline of the plan the Company will use in carrying out its quality control program with the Plan of Operation. The quality control plan must include:
(a) The names and titles of the persons who will have oversight responsibilities for the reviews required under this section.
(b) The types of reviews conducted (random sampling, FCIC designated, discretionary, etc.) and the time period when such eligible livestock price crop insurance contracts will be selected for each review.
(c) A complete description of the process to be followed by the reviewers for conducting each of the reviews required under this section.
(1314) Conducting such other reviews (including monitoring programs) as may be determined necessary by FCIC to protect program integrity.
(1415) Taking such actions as directed by FCIC to correct systemic, procedural, or other problems revealed by the quality control reviews.
(1516) Preparing and providing to FCIC, in a form determined by FCIC, not later than April 30 following each livestock reinsurance crop year (first report will be due April 30, 2006), an annual summary report detailing the results of the quality control program that will, at a minimum:
(a) For eligible livestock price crop insurance contracts which did not have discrepancies or incorrect information detected: Identify by contract number and livestockcrop, the name and title of the person who conducted the review for the respective eligible livestock price crop insurance contract, the date the review was completed, and the type of review conducted.
(b) For eligible livestock price crop insurance contracts which had discrepancies or incorrect information: Identify by contract number and livestockcrop, the name and title of the person who conducted the review for the respective eligible livestock price crop insurance contract, the date the review was completed and the type of review conducted, the type of discrepancy or incorrect information detected, the monetary effecteffect or the effect on the APH, and the corrective action taken.
(c) Include other relevant quality control information that may be required by FCIC (e.g., error rates).
(d) Such other information as may be required by FCIC.
(1617) At the request of FCIC, provide copies of documentation completed by the reviewers for any of the reviews required under this section.
(1718) Reviewing claims in excess of $100,000 and reporting the results to FCIC in the annual report.
(a) The review will consist of an examination of the information pertaining to the guarantee and loss, including the results of field inspections, to determine whether the claim can be substantiated. The Company must document the verification of the reported information pertaining to the claim and the sources used for verification.
(b) If the review reveals errors in the claim, the Company must correct the claim or deny the claim.
B. FCIC RESPONSIBILITIES
(1) FCIC will evaluate the Company's annual report to assess its compliance with this Appendix.
(2) FCIC will conduct periodic compliance evaluations of the Company's quality control programs to determine compliance with the requirements of this Appendix, assess the effectiveness of the systems, and the accuracy of the Company's conclusions with regard to the quality control reviews conducted under this section.
(3) FCIC will conduct periodic evaluations or reviews of the operations of the Company or its affiliates relating to the Federal crop insurance program.
C. SPECIFIC REVIEW REQUIREMENTS The Company is required to conduct the following reviews on a crop year basis unless otherwise specified herein.
Appears in 2 contracts
CONTROL GUIDELINES. A. GENERAL COMPANY RESPONSIBILITIES In general, the Company is responsible for:
(1) Conducting all quality control reviews required under this section through objective and unbiased persons, who were not involved in establishing the guarantee or adjusting the loss, or in the sales or supervision of sales for the eligible livestock price crop insurance contract reviewed.
(2) Verifying the information provided by the policyholder, agent, and loss adjuster is true and accurate through means, including, but not limited to, interviews, field inspections, file reviews, and obtaining production or other records from third parties.
(3) Verifying that the information was provided timely.
(4) Verifying that the livestock price crop insurance contract constitutes an eligible livestock price crop insurance contract.
(5) Implementing procedures for detecting and reporting any instance of fraud, waste, and abuse by policyholders, employees or affiliates.
(6) Correcting applicable monetary or livestock actual production data history discrepancies as required by FCIC and timely processing process such corrections to reconcile monthly accounting and statistical reports to reflect corrections, consistent with section III.B.6. of the Agreement.
(7) Implementing administrative procedures to resolve and correct errors and assure accurate premium and loss determinations.
(8) Maintaining loss files containing adequate supporting documentation, loss adjuster reports or any other necessary evidence to support the payment or denial of claims, including the actions taken to verify the applicable information.
(9) Notifying FCIC of suspected fraud, waste or abuse in accordance with section IV of this Appendix and assisting FCIC in subsequent investigations.
(10) Establishing a process to respond to policyholder complaints received directly from the public, state insurance departments, or complaints referred to the Company by FCIC or by the Company to FCIC, documenting the complaint and actions taken by the Company in response, and providing such documentation to FCIC upon request.
(11) Following procedures related to companion eligible crop insurance contracts in force for other persons sharing in the crop.
(12) Retaining all documents obtained in the course of the reviews conducted and all completed forms as required by the Agreement.
(1213) Providing an outline of the plan the Company will use in carrying out its quality control program with the Plan of Operation. The quality control plan must include:
(a) The names and titles of the persons who will have oversight responsibilities for the reviews required under this section.
(b) The types of reviews conducted (random sampling, FCIC designated, discretionary, etc.) and the time period when such eligible livestock price crop insurance contracts will be selected for each review.
(c) A complete description of the process to be followed by the reviewers for conducting each of the reviews required under this section.
(1314) Conducting such other reviews (including monitoring programs) as may be determined necessary by FCIC to protect program integrity.
(1415) Taking such actions as directed by FCIC to correct systemic, procedural, or other problems revealed by the quality control reviews.
(1516) Preparing and providing to FCIC, in a form determined by FCIC, not later than April 30 following each livestock reinsurance crop year (first report will be due April 30, 2006), an annual summary report detailing the results of the quality control program that will, at a minimum:
(a) For eligible livestock price crop insurance contracts which did not have discrepancies or incorrect information detected: Identify by contract number and livestockcrop, the name and title of the person who conducted the review for the respective eligible livestock price crop insurance contract, the date the review was completed, and the type of review conducted.
(b) For eligible livestock price crop insurance contracts which had discrepancies or incorrect information: Identify by contract number and livestockcrop, the name and title of the person who conducted the review for the respective eligible livestock price crop insurance contract, the date the review was completed and the type of review conducted, the type of discrepancy or incorrect information detected, the monetary effecteffect or the effect on the APH, and the corrective action taken.
(c) Include other relevant quality control information that may be required by FCIC (e.g., error rates).
(d) Such other information as may be required by FCIC.
(1617) At the request of FCIC, provide copies of documentation completed by the reviewers for any of the reviews required under this section.
(1718) Reviewing claims in excess of $100,000 and reporting the results to FCIC in the annual report.
(a) The review will consist of an examination of the information pertaining to the guarantee and loss, including the results of field inspections, to determine whether the claim can be substantiated. The Company must document the verification of the reported information pertaining to the claim and the sources used for verification.
(b) If the review reveals errors in the claim, the Company must correct the claim or deny the claim.
B. FCIC RESPONSIBILITIES
(1) FCIC will evaluate the Company's annual report to assess its compliance with this Appendix.
(2) FCIC will conduct periodic compliance evaluations of the Company's quality control programs to determine compliance with the requirements of this Appendix, assess the effectiveness of the systems, and the accuracy of the Company's conclusions with regard to the quality control reviews conducted under this section.
(3) FCIC will conduct periodic evaluations or reviews of the operations of the Company or its affiliates relating to the Federal crop insurance program.
C. SPECIFIC REVIEW REQUIREMENTS The Company is required to conduct the following reviews on a crop year basis unless otherwise specified herein.
Appears in 1 contract
Samples: Appendix to an Insurance Agreement
