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	Ben's=20 Guide to U.S. Government

=20

Home=20 Page > Executive=20 Branch > Code of=20 Federal Regulations > Electronic Code of Federal = Regulations

e-CFR=20 Data is current as of June 21, 2012

Title 44:=20 Emergency Management and Assistance

Browse=20 Previous | Browse=20 Next

PART 62=97SALE OF INSURANCE AND ADJUSTMENT OF CLAIMS

Section Contents

Subpart=20 A=97Issuance of Policies
=A7 62.1 &nbs= p; Purpose=20 of part.
=A7 62.2 &nbs= p; Definitions.
=A7 62.3 &nbs= p; Servicing=20 agent.
=A7 62.4 &nbs= p; Limitations=20 on sale of policies.
=A7 62.5 &nbs= p; Premium=20 refund.
=A7 62.6 &nbs= p; Minimum=20 commissions.

Subpart=20 B=97Claims Adjustment, Claims Appeals, and Judicial=20 Review
=A7 62.20 &nb= sp; Claims=20 appeals.
=A7 62.21 &nb= sp; Claims=20 adjustment.
=A7 62.22 &nb= sp; Judicial=20 review.

Subpart=20 C=97Write-Your-Own (WYO) = Companies
=A7 62.23 &nb= sp; WYO=20 Companies authorized.
=A7 62.24 &nb= sp; WYO=20 participation criteria.
Appendix=20 A to Part 62=97Federal Emergency Management Agency, Federal = Insurance=20 Administration, Financial Assistance/Subsidy=20 Arrangement
Appendix=20 B to Part 62=97National Flood Insurance = Program

Authority: 42 U.S.C. 4001 = et seq,;=20 Reorganization Plan No. 3 of 1978, 43 FR 41943, 3 CFR, 1978 = Comp., p.=20 329; E.O. 12127 of Mar. 31, 1979, 44 FR 19367, 3 CFR, 1979 Comp., = p.=20 376.

Source: 43 FR 2573, Jan. 17, = 1978,=20 unless otherwise noted. Redesignated at 44 FR 31177, May 31,=20 1979.

Subpart A=97Issuance of Policies

=20 top

=A7 62.1 Purpose of part.

=20 top

The purpose of this part is to set forth the manner in which = flood=20 insurance under the Program is made available to the general = public in=20 those communities designated as eligible for the sale of insurance = under=20 part 64 of this subchapter, and to prescribe the general method by = which=20 the Federal Insurance Administrator exercises his/her = responsibility=20 regarding the manner in which claims for losses are paid.

=A7 62.2 Definitions.

=20 top

The definitions set forth in part 59 of this subchapter are = applicable=20 to this part.

=A7 62.3 Servicing agent.

=20 top

(a) Pursuant to sections 1345 and 1346 of the Act, the Federal=20 Insurance Administrator has entered into the Agreement with a = servicing=20 agent to authorize it to assist in issuing flood insurance = policies under=20 the Program in communities designated by the Federal Insurance=20 Administrator and to accept responsibility for delivery of = policies and=20 payment of claims for losses as prescribed by and at the = discretion of the=20 Federal Insurance Administrator.

(b) National Con-Serv, Inc., whose offices are located in = Rockville,=20 Maryland, is the servicing agent for the Federal Insurance=20 Administration.

(c) The servicing agent will arrange for the issuance of flood=20 insurance to any person qualifying for such coverage under parts = 61 and 64=20 of this subchapter who submits an application to the servicing = agent in=20 accordance with the terms and conditions of the contract between = the=20 Agency and the servicing agent.

[43 FR 2573, Jan. 17, 1978. Redesignated at 44 FR 31177, May = 31, 1979,=20 as amended at 48 FR 44544, Sept. 29, 1983; 49 FR 4751, Feb. 8, = 1984; 58 FR=20 62447, Nov. 26, 1993]

=A7 62.4 Limitations on sale of=20 policies.

=20 top

(a) The servicing agent shall be deemed to have agreed, as a = condition=20 of its contract that it shall not offer flood insurance under any=20 authority or auspices in any amount within the maximum limits of = coverage=20 specified in =A761.6 of this subchapter, in any area the Federal = Insurance=20 Administrator designates in part 64 of this subchapter as eligible = for the=20 sale of flood insurance under the Program, other than in = accordance with=20 this part, and the Standard Flood Insurance Policy.

(b) The agreement and all activities thereunder are subject to = title VI=20 of the Civil Rights Act of 1964, 42 U.S.C. 2000d, and to the = applicable=20 Federal regulations and requirements issued from time to time = pursuant=20 thereto. No person shall be excluded from participation in, denied = the=20 benefits of, or subjected to discrimination under the Program, on = the=20 ground of race, color, sex, creed or national origin. Any = complaint or=20 information concerning the existence of any such unlawful = discrimination=20 in any matter within the purview of this part should be referred = to the=20 Federal Insurance Administrator.

[43 FR 2573, Jan. 17, 1978. Redesignated at 44 FR 31177, May = 31, 1979,=20 as amended at 48 FR 44544, Sept. 29, 1983; 49 FR 4751, Feb. 8, = 1984]

=A7 62.5 Premium refund.

=20 top

A Standard Flood Insurance Policyholder whose property has been = determined not to be in a special hazard area after the map = revision or a=20 Letter of Map Amendment under part 70 of this subchapter may = cancel the=20 policy within the current policy year provided (a) he was required = to=20 purchase or to maintain flood insurance coverage, or both, as a = condition=20 for financial assistance, and (b) his property was located in an=20 identified special hazard area as represented on an effective FHBM = or FIRM=20 when the financial assistance was provided. If no claim under the = policy=20 has been paid or is pending, the full premium shall be refunded = for the=20 current policy year, and for an additional policy year where the = insured=20 had been required to renew the policy during the period when a = revised map=20 was being reprinted. A Standard Flood Insurance Policyholder may = cancel a=20 policy having a term of three (3) years, on an anniversary date, = where the=20 reason for the cancellation is that a policy of flood insurance = has been=20 obtained or is being obtained in substitution for the NFIP policy = and the=20 NFIP obtains a written concurrence in the cancellation from any = mortgage=20 of which the NFIP has actual notice; or the policyholder has = extinguishing=20 the insured mortgage debt and is no longer required by the = mortgagee to=20 maintain the coverage. In such event, the premium refund shall be = pro rata=20 but with retention of the expense constant.

[43 FR 2573, Jan. 17, 1978. Redesignated at 44 FR 31177, May = 31, 1979,=20 as amended at 49 FR 33658, Aug. 24, 1984; 53 FR 16279, May 6, = 1988]

=A7 62.6 Minimum commissions.

=20 top

(a) The earned commission which shall be paid to any property = or=20 casualty insurance agent or broker duly licensed by a state = insurance=20 regulatory authority, with respect to each policy or renewal the = agent=20 duly procures on behalf of the insured, in connection with = policies of=20 flood insurance placed with the NFIP at the offices of its = servicing=20 agent, but not with respect to policies of flood insurance issued = pursuant=20 to Subpart C of this part, shall not be less than $10 and is = computed as=20 follows:

(1) In the case of a new or renewal policy, the following = commissions=20 shall apply based on the total premiums paid for the policy = term:

Premium amount	Commissions = (percent)
First $2,000 = of=20 Premium	15
Excess of = $2,000	5

(2) In the case of mid-term increases in amounts of insurance = added by=20 endorsements, the following commissions shall apply based on the = total=20 premiums paid for the increased amounts of insurance:

Premium amount	Commissions = (percent)
First $2,000 = of=20 Premium	15
Excess of = $2,000	5

(b) Any refunds of premiums authorized under this subchapter = shall not=20 affect a previously earned commission; and no agent shall be = required to=20 return that earned commission, unless the refund is made to = establish a=20 common policy term anniversary date with other insurance providing = coverage against loss by other perils in which case a return of = commission=20 will be required by the agent on a pro rata basis. In such cases, = the=20 policy shall be immediately rewritten for a new term with the same = amount(s) of coverage and with premium calculated at the then = current rate=20 and, as to return premium, returned, pro rata, to the insured = based on the=20 former policy's premium rate.

[46 FR 13515, Feb. 23, 1981, as amended at 53 FR 15221, Apr. = 28, 1988;=20 57 FR 19541, May 7, 1992]

Subpart B=97Claims Adjustment, Claims Appeals, and Judicial=20 Review

=20 top

=A7 62.20 Claims appeals.

=20 top

(a) Definitions.

Appeal decision means the disposition of the appeal by = the=20 Federal Insurance Administrator.

Decision means the insurer's final claim determination, = which is=20 the insurer's written denial, in whole or in part, of the = insured's=20 claim.

(b) Appeal. A National Flood Insurance Program (NFIP)=20 policyholder, whether insured by a participating Write-Your-Own = (WYO)=20 Company or directly by the Federal Emergency Management Agency = (FEMA), may=20 appeal a decision , including a determination of any = insurance=20 agent, adjuster, insurance company, or any FEMA employee or = contractor=20 with respect to a claim, proof of loss, and loss estimate. In = order to=20 file an appeal, the insured must comply with all requirements set = out in=20 the Standard Flood Insurance Policy (SFIP). This appeals process = is=20 available after the issuance of the insurer's final claim = determination,=20 which is the insurer's written denial, in whole or in part, of the = insured's claim. Once the final claim determination is issued, an = insured=20 may appeal any action taken by the insurer, FEMA employee, FEMA=20 contractor, insurance adjuster, or insurance agent.

(c) Limitations on Appeals. The appeals process is = intended to=20 resolve claim issues and is not intended to grant coverage or = limits that=20 are not provided by the SFIP. Filing an appeal does not waive any = of the=20 requirements for perfecting a claim under the SFIP or extend any = of the=20 time limitations set forth in the SFIP.

(1) Disputes that are or have been subject to appraisal as = provided for=20 in the SFIP cannot be appealed under this section.

(2) When a policyholder files an appeal on any issue, that = issue is no=20 longer subject to resolution by appraisal or other pre-litigation=20 remedies.

(d) Litigation preclusion. An insured who files suit = against an=20 insurer on the flood insurance claim issue is prohibited from = filing an=20 appeal under this section. All appeals submitted for decision but = not yet=20 resolved shall be terminated upon notice of the commencement of = litigation=20 regarding the claim.

(e) Procedures. To pursue an appeal under this section a = policyholder must:

(1) Submit a written appeal to FEMA within 60 days from the = date of the=20 decision. The appeal should be sent to: DHS/FEMA, Mitigation = Directorate,=20 Federal Insurance Administrator, 1800 South Bell Street, = Arlington, VA=20 20598=96MS3010;

(2) Provide a copy of the insurer's written denial, in whole or = in=20 part, of the claim;

(3) Identify relevant policy and claim information and state = the basis=20 for the appeal; and

(4) Submit relevant documentation to support the appeal. The=20 policyholder should submit only the documentation that pertains to = his or=20 her claim. The following are examples of the kinds of = documentation which=20 FEMA will require to adjudicate the appeal: A copy of the proof of = loss=20 submitted to the insurer as required in the policy; room by room = itemized=20 estimates from the adjuster (includes contractors' estimates), = detailing=20 unit cost and quantities for the items needing repair or = replacement;=20 replacement cost proofs of loss; Preliminary Report; Final Report; = detailed damaged personal property inventories that include the=20 approximate age of the items; completed Mobile Home Worksheet; = Mobile Home=20 Title, including Salvage Titles; real estate appraisals that = exclude land=20 values; advance payment information; clear photographs (exterior = and=20 interior) confirming damage resulted from direct physical loss by = or from=20 flood; proof of prior repair; evidence of insurance and policy = information=20 , i.e. declarations page; Elevation Certificate, if the = risk is an=20 elevated building; the community's determination made concerning=20 substantial damage; information regarding substantial improvement; = zone=20 determinations; pre-loss and post-loss inventories; financial = statements;=20 tax records, lease agreements, sales contracts, settlement papers, = deed,=20 etc. ; emergency (911) address change information; salvage=20 information (proceeds and sales); condominium association by-laws; = proof=20 of other insurance, including homeowners or wind policies and any = claim=20 information submitted to the other companies; Waiver, Letter of = Map=20 Revision (LOMR) or Letter of Map Amendment (LOMA) information; = paid=20 receipts and invoices including cancelled checks that support an = insured's=20 out-of-pocket expenses pertaining to the claim; underwriting = decisions;=20 architectural plans and drawings; death certificates; a copy of = the will;=20 divorce decree, power of attorney; current lienholder information; = current=20 loss payee information; paid receipts and invoices documenting = damaged=20 stock; detailed engineering reports specifically addressing = flood-related=20 damage and pre-existing damage; engineering surveys; market = values;=20 documentation of Flood Insurance Rate Maps (FIRM) dates; = documentation=20 reflecting date(s) of construction and substantial improvement; = loan=20 documents including closings; evidence of insurability as a = Residential=20 Condominium Association; Franchise Agreements; letters of = representation,=20 i.e. attorneys and public adjusters; any assignment of = interest in=20 a claim; and, any other pertinent information which FEMA may = request in=20 processing a claim.

(f) Appeal resolution. (1) FEMA will acknowledge, in = writing,=20 receipt of a policyholder's appeal and include in the = acknowledgement=20 contact information for a FEMA point of contact who can advise the = policyholder as to the status of his or her claim.

(2) The Federal Insurance Administrator will review the = appeal=20 documents and may notify the policyholder in writing of the need = for=20 additional information. A request for the additional information = will=20 include the date by which the information must be provided, and = shall in=20 no case be less than 14 calendar days. Failure to provide the = requested=20 information in full, or to request an extension by the due date, = may=20 result in a dismissal of the appeal. A re-inspection of the = policyholder's=20 property may be conducted at the discretion of the Federal = Insurance=20 Administrator to gather more information. The Federal = Insurance=20 Administrator will ensure that all information necessary to = rule on=20 the appeal has been provided prior to making an appeal = decision.=20

(3) The Federal Insurance Administrator will review the = appeal=20 documents, including any reinspection report, if appropriate. The = Federal=20 Insurance Administrator will provide specific information on what = grounds=20 the claim was denied initially. The Federal Insurance = Administrator will=20 provide an appeal decision in writing to the policyholder = and=20 insurer within 90 days from the date that all information has been = submitted by the policyholder and include specific information for = the=20 resolution of the appeal. No further administrative review will be = provided to the insured.

(4) A policyholder who does not agree with FEMA's appeal = decision=20 should refer to the SFIP, for options for further action ( see = Part=20 61, App. A(1) VII.R., Part 61, App. A(2) VII.R., and Part 61, App. = A(3)=20 VIII.R.). The one-year period to file suit commences with the = written=20 denial from the insurer and is not extended by the appeals = process.

[71 FR 30298, May 26, 2006, as amended at 71 FR 60438, Oct. 13, = 2006;=20 74 FR 56123, Oct. 30, 2009]

=A7 62.21 Claims adjustment.

=20 top

(a) In accordance with the Agreement, the servicing agent shall = arrange=20 for the prompt adjustment and settlement and payment of all claims = arising=20 from policies of insurance issued under the program. Investigation = of such=20 claims may be made through the facilities of its subcontractors or = insurance adjustment organizations, to the extent required and = appropriate=20 for the expeditious processing of such claims.

(b) All adjustment of losses and settlements of claims shall be = made in=20 accordance with the terms and conditions of the policy and parts = 61 and 62=20 of this subchapter.

=A7 62.22 Judicial review.

=20 top

(a) Upon the disallowance by the Federal Insurance = Administration, a=20 participating Write-Your-Own Company, or the servicing agent of = any claim=20 on grounds other than failure to file a proof of loss, or upon the = refusal=20 of the claimant to accept the amount allowed upon any claim after=20 appraisal pursuant to policy provisions, the claimant within one = year=20 after the date of mailing by the Federal Insurance Administration, = the=20 participating Write-Your-Own Company, or the servicing agent of = the notice=20 of disallowance or partial disallowance of the claim may, pursuant = to 42=20 U.S.C. 4072, institute an action on such claim against the insurer = only in=20 the U.S. District Court for the district in which the insured = property or=20 the major portion thereof shall have been situated, without regard = to the=20 amount in controversy.

(b) Service of process for all judicial proceedings where a = claimant is=20 suing the Administrator of FEMA pursuant to 42 U.S.C. 4071 shall = be made=20 upon the appropriate United States Attorney, the Attorney General = of the=20 United States, and the Federal Insurance Administrator of the = Federal=20 Emergency Management Agency.

[43 FR 2573, Jan. 17, 1978. Redesignated at 44 FR 31177, May = 31, 1979,=20 as amended at 47 FR 43061 Sept. 30, 1982; 49 FR 33879, Aug. 27, = 1984; 69=20 FR 45610, July 30, 2004]

Subpart C=97Write-Your-Own (WYO) Companies

=20 top

=A7 62.23 WYO Companies = authorized.

=20 top

(a) Pursuant to section 1345 of the Act, the Federal Insurance=20 Administrator may enter into arrangements with individual private = sector=20 property insurance companies or other insurers, such as public = entity risk=20 sharing organizations. Under these arrangements, such companies or = other=20 insurers may offer flood insurance coverage under the program to = eligible=20 applicants. Such WYO companies may offer flood coverage to = policyholders=20 insured by them under their own property business lines of = insurance,=20 pursuant to their customary business practices, including their = usual=20 arrangements with agents and producers. WYO companies may sell = flood=20 insurance coverage in any State in which the WYO company is = authorized to=20 engage in the business of property insurance. Other WYO insurers = may offer=20 flood insurance coverage to their pool members insured by them = under their=20 own property business lines of coverage, pursuant to their = customary=20 business practices. These other WYO insurers may provide flood = coverage in=20 any State that has authorized the other insurer to provide = property=20 coverage to its members. Arrangements entered into by WYO = Companies or=20 other insurers under this subpart must be in the form and = substance of the=20 standard arrangement, titled =93Financial Assistance/Subsidy = Arrangement,=94 a=20 copy of which is included in appendix A of this part and made a = part of=20 these regulations.

(b) Any duly authorized insurer so engaged in the Program shall = be a=20 WYO Company. (The term =93WYO Company=94 shall include the = following kinds of=20 insurers: Public entity risk-sharing organizations, an association = of=20 local governments, a State association of political subdivisions, = a=20 State-sponsored municipal league, and other intergovernmental = risk-sharing=20 pool for covering public entity structures.)

(c) A WYO Company is authorized to arrange for the issuance of = flood=20 insurance in any amount within the maximum limits of coverage = specified in=20 =A761.6 of this subchapter, as Insurer, to any person qualifying = for such=20 coverage under parts 61 and 64 of this subchapter who submits an=20 application to the WYO Company; coverage shall be issued under the = Standard Flood Insurance Policy.

(d) A WYO Company issuing flood insurance coverage shall = arrange for=20 the adjustment, settlement, payment and defense of all claims = arising from=20 policies of flood insurance it issues under the Program, based = upon the=20 terms and conditions of the Standard Flood Insurance Policy.

(e) In carrying out its functions under this subpart, a WYO = Company=20 shall use its own customary standards, staff and independent = contractor=20 resources, as it would in the ordinary and necessary conduct of = its own=20 business affairs, subject to the Act and regulations prescribed by = the=20 Federal Insurance Administrator under the Act.

(f) To facilitate the marketing of flood insurance coverage = under the=20 Program to policyholders of WYO Companies, the Federal Insurance=20 Administrator will enter into arrangements with such companies = whereby the=20 Federal Government will be a guarantor in which the primary = relationship=20 between the WYO Company and the Federal Government will be one of = a=20 fiduciary nature, i.e., to assure that any taxpayer funds are = accounted=20 for and appropriately expended. In furtherance of this end, the = Federal=20 Insurance Administrator has established =93A Plan to Maintain = Financial=20 Control for Business Written Under the Write Your Own Program=94, = a copy of=20 which is included in appendix B of this part and made a part of = these=20 regulations.

(g) A WYO Company shall act as a fiscal agent of the Federal=20 Government, but not as its general agent. WYO Companies are solely = responsible for their obligations to their insured under any flood = insurance policies issued under agreements entered into with the = Federal=20 Insurance Administrator, such that the Federal Government is not a = proper=20 party defendant in any lawsuit arising out of such policies.

(h) To facilitate the underwriting of flood insurance coverage = by WYO=20 Companies, the following procedures will be used by WYO = Companies:

(1) To expedite business growth, the WYO Company will encourage = its=20 present property insurance policyholders to purchase flood = insurance=20 through the NFIP WYO Program.

(2) To conform its underwriting practices to the underwriting = rules and=20 rates in effect as to the NFIP, the WYO Company will establish = procedures=20 to carry out the NFIP rating system and provide its policyholders = with the=20 same coverage as is afforded under the NFIP.

(3) The WYO Company may follow its customary billing practices = to meet=20 the Federal rules on the presentment of premium and net premium = deposits=20 to a Letter of Credit bank account authorized by the Federal = Insurance=20 Administrator and reduction of coverage when an underpayment is=20 discovered.

(4) The WYO Company is expected to meet the recording and = reporting=20 requirements of the WYO Transaction Record Reporting and = Processing Plan.=20 Transactions reported by the WYO Company under the WYO Transaction = Record=20 Reporting and Processing Plan will be analyzed by the NFIP Bureau = &=20 Statistical Agent. A monthly report will be submitted to the WYO = Company=20 and the FIA. The analysis will cover the timeliness of WYO Company = submissions, the disposition of transactions that have not passed = systems=20 edits and the reconciliation of the totals generated from = transaction=20 reports with those submitted on the WYO Company's reconciliation=20 reports.

(5) If a WYO Company rejects an application from an agent or a=20 producer, the agent or producer shall be notified so that the = business can=20 be placed through the NFIP Servicing Agent, or another WYO = Company.

(6) Flood insurance coverage will be issued by the WYO Company = on a=20 separate policy form and will not be added, by endorsement, to the = Company's other property insurance forms.

(7) Premium payment plans can be offered by the WYO Company so = long as=20 the net premium depository requirements specified under the = NFIP/WYO=20 Program accounting procedures are met. A cancellation by the WYO = Company=20 for non-payment of premium will not produce a pro rata return of = the net=20 premium deposit to the WYO Company.

(8) NFIP business will not be assumed by the WYO Companies at = any time=20 other than at renewal time, at which time the insurance producer = may=20 submit the business to the WYO Company as new business. However, = it is=20 permissible to cancel and rewrite flood policies to obtain = concurrent=20 expiration dates with other policies covering the property.

(i) To facilitate the adjustment of flood insurance claims by = WYO=20 Companies, the following procedures will be used by WYO = Companies.

(1) Under the terms of the Arrangement set forth at appendix A = of this=20 part, WYO Companies will adjust claims in accordance with general = Company=20 standards, guided by NFIP Claims manuals. The Arrangement also = provides=20 that claim adjustments shall be binding upon the FIA. For example, = the=20 entire responsibility for providing a proper adjustment for both = combined=20 wind and water claims and flood-alone claims is the responsibility = of the=20 WYO Company. The responsibility for providing a proper adjustment = for=20 combined wind and water claims is to be conducted by listing in = concert=20 with the Single Adjuster provisions listed in appendix A.

(2) The WYO Company may use its staff adjusters, independent = adjusters,=20 or both. It is important that the Company's Claims Department = verifies the=20 correctness of the coverage interpretations and reasonableness of = the=20 payments recommended by the adjusters.

(3) An established loss adjustment Fee Schedule is part of the=20 Arrangement and cannot be changed during an Arrangement year. This = is the=20 expense allowance to cover costs of independent or WYO Company=20 adjusters.

(4) The normal catastrophe claims procedure currently operated = by a WYO=20 Company should be implemented in the event of a claim catastrophe=20 situation. Flood claims will be handled along with other = catastrophe=20 claims.

(5) It will be the WYO Company's responsibility to try to = detect fraud=20 (as it does in the case of property insurance) and coordinate its = findings=20 with FIA.

(6) Pursuant to the Arrangement, the responsibility for = defending=20 claims will be upon the Write Your Own Company and defense costs = will be=20 part of the unallocated or allocated claim expense allowance, = depending on=20 whether a staff counsel or an outside attorney handles the defense = of the=20 matter. Claims in litigation will be reported by WYO Companies to = FIA upon=20 joinder of issue and FIA may inquire and be advised of the = disposition of=20 such litigation.

(7) The claim reserving procedures of the individual WYO = Company can be=20 used.

(8) Regarding the handling of subrogation, if a WYO Company = prefers to=20 forego pursuit of subrogation recovery, it may do so by referring = the=20 matter, with a complete copy of the claim file, to FIA. = Subrogation=20 initiatives may be truncated at any time before suit is commenced = (after=20 commencing an action, special arrangement must bemade). FIA, after = consultation with FEMA's Office of the Chief Counsel (OCC), will = forward=20 the cause of action to OCC or to the NFIP Bureau and Statistical = Agent for=20 prosecution. Any funds received will be deposited, less expenses, = in the=20 National Flood Insurance Fund.

(9) Special allocated loss adjustment expenses will include = such items=20 as: nonstaff attorney fees, engineering fees and special = investigation=20 fees over and above normal adjustment practices.

(10) The customary content of claim files will include coverage = verification, normal adjuster investigations, including statements = where=20 necessary, police reports, building reports and investigations, = damage=20 verification and other documentation relevant to the adjustment of = claims=20 under the NFIP's and the WYO Company's traditional claim = adjustment=20 practices and procedures. The WYO Company's claim examiners and = managers=20 will supervise the adjustment of flood insurance claims by staff = and=20 independent claims adjusters.

(11) The WYO Company will extend reasonable cooperation to = FEMA's=20 Office of the Chief Counsel on matters pertaining to litigation = and=20 subrogation, under paragraph (i)(8) of this section.

(j) To facilitate establishment of financial controls under the = WYO=20 Program, the WYO Company will:

(1) Have a biennial audit of the flood insurance financial = statements=20 conducted by an independent Certified Public Accountant (CPA) firm = at the=20 Company's expense to ensure that the financial data reported to us = accurately represents the flood insurance activities of the = Company. The=20 CPA firm must conduct its audits in accordance with the generally = accepted=20 auditing standards (GAAS) and Government Auditing Standards issued = by the=20 Comptroller General of the United States (commonly known as = =93yellow book=94=20 requirements). The Company must file with us (the Federal = Insurance=20 Administration) a report of the CPA firm's detailed biennial = audit, and,=20 after our review of the audit report, we will convey our = determination to=20 the Standards Committee.

(2) Participate in a WYO Company/FIA Operation review. We will = conduct=20 a review of the WYO Company's flood insurance claims, = underwriting,=20 customer service, marketing, and litigation activities at least = once every=20 three (3) years. As part of these reviews, we will reconcile = specific=20 files with a listing of transactions submitted by the Company = under the=20 Transaction Record Reporting and Processing (TRPP) Plan (Part 5). = We will=20 file a report of the Operation Review with the Standards = Committee.

(3) Meet the recording and reporting requirements of the WYO=20 Transaction Record Reporting and Processing Plan and the WYO = Accounting=20 Procedures Manual. Transactions reported to the National Flood = Insurance=20 Program's (NFIP's) Bureau and Statistical Agent by the WYO Company = under=20 the WYO Transaction Record Reporting and Processing Plan and the = WYO=20 Accounting Procedures Manual will be analyzed by the Bureau and=20 Statistical Agent and a monthly report will be submitted to the = WYO=20 Company and the FIA. The analysis will cover the timeliness of the = WYO=20 Company submissions, the disposition of transactions which do not = pass=20 systems edits and the reconciliation of the totals generated from=20 transaction reports with those submitted on WYO Company = reconciliation=20 reports.

(4) Cooperate with FEMA's Chief Financial Officer on Letter of = Credit=20 matters.

(5) Cooperate with FIA in the implementation of a claims = reinspection=20 program.

(6) Cooperate with FIA in the verification of risk rating=20 information.

(7) Cooperate with DHS's Office of the Inspector General on = matters=20 pertaining to fraud.

(k) To facilitate the operation of the WYO Program and in order = that a=20 WYO Company can use its own customary standards, staff and = independent=20 contractor resources, as it would in the ordinary and necessary = conduct of=20 its own business affairs, subject to the Act, the Federal = Insurance=20 Administrator, for good cause shown, may grant exceptions to and = waivers=20 of the regulations contained in this title relative to the = administration=20 of the NFIP.

(l)(1) WYO Companies may, on a voluntary basis, elect to = participate in=20 the Mortgage Portfolio Protection Program (MPPP), under which they = can=20 offer, as a last resort, flood insurance at special high rates, = sufficient=20 to recover the full cost of this program in recognition of the = uncertainty=20 as to the degree of risk a given building presents due to the = limited=20 underwriting data required, to properties in a lending = institution's=20 mortgage portfolio to achieve compliance with the flood insurance = purchase=20 requirements of the Flood Disaster Protection Act of 1973. Flood = insurance=20 policies under the MPPP may only be issued for those properties = that:

(i) Are determined to be located within special flood hazard = areas of=20 communities that are participating in the NFIP, and

(ii) Are not covered by a flood insurance policy even after a = required=20 series of notices have been given to the property owner = (mortgagor) by the=20 lending institution of the requirement for obtaining and = maintaining such=20 coverage, but the mortgagor has failed to respond.

(2) WYO Companies participating in the MPPP must provide a = detailed=20 implementation package to any lending institution that, on a = voluntary=20 basis, chooses to participate in the MPPP to ensure the lending=20 institution has full knowledge of the criteria in that program and = must=20 obtain a signed receipt for that package from the lending = institution.=20 Participating WYO Companies must also maintain evidence of = compliance with=20 paragraph (l)(3) of this section for review during the audits and = reviews=20 required by the WYO Financial Control Plan contained in appendix B = of this=20 part.

(3) The mortgagor must be protected against the lending = institution's=20 arbitrary placing of flood insurance for which the mortgagor will = be=20 billed by being sent three notification letters as described in = paragraphs=20 (l)(4) through (6) of this section.

(4) The initial notification letter must:

(i) State the requirements of the Flood Disaster Protection Act = of=20 1973, as amended;

(ii) Announce the determination that the mortgagor's property = is in an=20 identified special flood hazard area as delineated on the = appropriate FEMA=20 map, necessitating flood insurance coverage for the duration of = the=20 loan;

(iii) Describe the procedure to follow should the mortgagor = wish to=20 challenge the determination;

(iv) Request evidence of a valid flood insurance policy or, if = there is=20 none, encourage the mortgagor to obtain a Standard Flood Insurance = Policy=20 (SFIP) promptly from a local insurance agent (or WYO Company);

(v) Advise that the premium for a MPPP policy is significantly = higher=20 than a conventional SFIP policy and advise as to the option for = obtaining=20 less costly flood insurance; and

(vi) Advise that a MPPP policy will be purchased by the lender = if=20 evidence of flood insurance coverage is not received by a date=20 certain.

(5) The second notification letter must remind the mortgagor of = the=20 previous notice and provide essentially the same information.

(6) The final notification letter must:

(i) Enclose a copy of the flood insurance policy purchased = under the=20 MPPP on the mortgagor's (insured's) behalf, together with the = Declarations=20 Page,

(ii) Advise that the policy was purchased because of the = failure to=20 respond to the previous notices, and

(iii) Remind the insured that similar coverage may be available = at=20 significantly lower cost and advise that the policy can be = cancelled at=20 any time during the policy year and a pro rata refund provided for = the=20 unearned portion of the premium in the event the insured purchases = another=20 policy that is acceptable to satisfy the requirements of the 1973 = Act.

[61 FR 51219, Oct. 1, 1996, as amended at 64 FR 56176, Oct. 18, = 1999;=20 67 FR 13549, Mar. 22, 2002; 69 FR 45610, July 30, 2004; 74 FR = 15341, Apr.=20 3, 2009]

=A7 62.24 WYO participation = criteria.

=20 top

New companies or organizations eligible for the pilot project = we=20 describe in paragraph (b) of this section that seek to participate = in the=20 WYO program, as well as former WYO companies seeking to return to = the WYO=20 program, must meet standards for financial capability and = stability for=20 statistical and financial reporting and for commitment to program=20 objectives.

(a) To demonstrate the ability to meet the financial = requirements, a=20 private insurance company wishing to enter or reenter the WYO = program=20 must:

(1) Be a licensed property insurance company;

(2) Have a five (5) year history of writing property = insurance;

(3) Disclose any legal proceedings, suspensions, judgments,=20 settlements, or agreements reached with any State insurance = department,=20 State attorney general, State corporation commission, or the = Federal=20 Government during the immediately prior five (5) years regarding = the=20 company's business practices;

(4) Submit its most recent National Association of Insurance=20 Commissioners (NAIC) annual statement;

(5) Submit information, as data become available, to indicate = that the=20 company meets or exceeds NAIC standards for risk-based capital and = surplus; and

(6) Submit its last State or regional audit, which should = contain no=20 material negative findings.

(b) To demonstrate the ability to meet the financial = requirements, a=20 public entity risk-sharing organization, an association of local=20 governments, a State association of political subdivisions, a=20 State-sponsored municipal league, and any other intergovernmental=20 risk-sharing pool for covering public entity structures, wishing = to enter=20 the WYO program, which will end September 30, 2004, must:

(1) Have authority by a State to provide property coverage to = its=20 members;

(2) Have a five (5) year history of writing property = coverage;

(4) Submit its most recent two annual audits from an = independent=20 accounting firm performed in compliance with generally accepted = accounting=20 principles that show no material negative findings; and submit, as = data=20 become available, information to indicate that the other insurer = meets or=20 exceeds standards comparable to those of the NAIC for risk-based = capital=20 and surplus.

(c) An applicant for entry or reentry in the WYO program must = also pass=20 a test to determine the applicant's ability to process flood = insurance and=20 meet the Transaction Record Reporting and Processing (TRRP) Plan=20 requirements of the WYO Financial Control Plan. Unless the test=20 requirement is waived, e.g., where an already qualified performer = will=20 fulfill the applicant's reporting requirements, the applicant must = prepare=20 and submit test output monthly tape(s) and monthly financial = statements=20 and reconciliations for processing by the NFIP Bureau and = Statistical=20 Agent contractor. For test purposes, no error tolerance will be = allowed.=20 If the applicant fails the initial test, a second test will be = run, which=20 the applicant must pass to participate in the Program.

(d) To satisfy the requirement for commitment to Program goals, = including marketing of flood insurance policies, the applicant = will submit=20 information concerning its plans for the WYO Program including = plans for=20 the training and support of producers and staff, marketing plans = and sales=20 targets, and claims handling and disaster response plans. = Applicants must=20 also identify those aspects of their planned flood insurance = operations to=20 be performed by another organization, managing agent, another WYO = Company,=20 a WYO vendor, a service bureau or related organization. Applicants = will=20 also name, in addition to a Principal Coordinator, a corporate = officer=20 point of contact=97an individual, e.g., at the level of Senior = Executive=20 Vice President, who reports directly to the Chief Executive = Officer or the=20 Chief Operating Officer. Each applicant shall furnish the latest = available=20 information regarding the number of its fire, allied lines, = farm-owners=20 multiple peril, homeowners multiple peril, and commercial multiple = peril=20 policies or coverage documents in force, by line. A private = insurance=20 company applying for participation in the WYO program shall also = furnish=20 its Best's Financial Size Category for the purpose of setting = marketing=20 goals.

[67 FR 13550, Mar. 22, 2002]

Appendix A to Part 62=97Federal Emergency Management Agency, = Federal=20 Insurance Administration, Financial Assistance/Subsidy=20 Arrangement

=20 top

Purpose: To assist the company in underwriting flood = insurance=20 using the Standard Flood Insurance Policy.

Accounting Data: Pursuant to Section 1310 of the Act, a = Letter=20 of Credit shall be issued for payment as provided for herein from = the=20 National Flood Insurance Fund.

Effective Date: October 1, 2004.

Issued By: Federal Emergency Management Agency, Federal=20 Insurance Administration, Washington, DC 20472.

Article I=97Findings, Purpose, and Authority

Whereas, the Congress in its =93Finding and Declaration of = Purpose=94 in=20 the National Flood Insurance Act of 1968, as amended, (=93the = Act=94 or =93Act=94)=20 recognized the benefit of having the National Flood Insurance = Program (the=20 =93Program=94 or =93NFIP=94) =93carried out to the maximum extent = practicable by the=20 private insurance industry=94; and

Whereas the Federal Insurance Administration (FIA) within the=20 Mitigation Division recognizes this Arrangement as coming under = the=20 provisions of Section 1345 of the Act (42 U.S.C. 4081); and

Whereas, the goal of the FIA is to develop a program with the = insurance=20 industry where, over time, some risk-bearing role for the industry = will=20 evolve as intended by the Congress (Section 1304 of the Act (42 = U.S.C.=20 4011)); and

Whereas, the insurer (hereinafter the =93Company=94) under this = Arrangement=20 shall charge rates established by the FIA; and

Whereas, FIA has promulgated regulations and guidance = implementing the=20 Act and the Write-Your-Own Program whereby participating private = insurance=20 companies act in a fiduciary capacity utilizing Federal funds to = sell and=20 administer the Standard Flood Insurance Policies, and has = extensively=20 regulated the participating companies' activities when selling or=20 administering the Standard Flood Insurance Policies; and

Whereas, any litigation resulting from, related to, or arising = from the=20 Company's compliance with the written standards, procedures, and = guidance=20 issued by FEMA or FIA arises under the Act, regulations, or FIA = guidance,=20 and legal issues thereunder raise a federal question; and

Whereas, through this Arrangement, the Federal Treasury will = back all=20 flood policy claim payments by the Company; and

Whereas, this Arrangement has been developed to enable any = interested=20 qualified insurer to write flood insurance under its own name; = and

Whereas, one of the primary objectives of the Program is to = provide=20 coverage to the maximum number of structures at risk and because = the=20 insurance industry has marketing access through its existing = facilities=20 not directly available to the FIA, it has been concluded that = coverage=20 will be extended to those who would not otherwise be insured under = the=20 Program; and

Whereas, flood insurance policies issued subject to this = Arrangement=20 shall be only that insurance written by the Company in its own = name under=20 prescribed policy conditions and pursuant to this Arrangement and = the Act;=20 and

Whereas, over time, the Program is designed to increase = industry=20 participation, and accordingly, reduce or eliminate Government as = the=20 principal vehicle for delivering flood insurance to the public; = and

Whereas, the sole parties under this Arrangement are the WYO = Companies=20 and the Federal Government.

Now, therefore, the parties hereto mutually undertake the=20 following:

Article II=97Undertaking of the Company

A. Eligibility Requirements for Participation in the NFIP:

1. Policy Administration. All fund receipt, recording, control, = timely=20 deposit requirements, and disbursement in connection with all = Policy=20 Administration and any other related activities or = correspondences, must=20 meet all requirements of the Financial Control Plan. The Company = shall be=20 responsible for:

a. Compliance with the Community Eligibility/Rating = Criteria

b. Making Policyholder Eligibility Determinations

c. Policy Issuance

d. Policy Endorsements

e. Policy Cancellations

f. Policy Correspondence

g. Payment of Agents' Commissions

2. Claims Processing. All claims processing must be processed = in=20 accordance with the processing of all the companies' insurance = policies=20 and with the Financial Control Plan. Companies will also be = required to=20 comply with FIA Policy Issuances and other guidance authorized by = FIA or=20 the Federal Emergency Management Agency (=93FEMA=94).

3. Reports.

a. Monthly Financial Reporting and Statistical Transaction = reporting=20 requirements. All monthly financial reporting and statistical = transaction=20 reporting shall be in accordance with the requirements of the NFIP = Transaction Record Reporting and Processing Plan for the Company = Program=20 and the Financial Control Plan for business written under the WYO = (Write=20 Your Own) Program. 44 CFR part 62, appendix B. These data shall be = validated/edited/audited in detail and shall be compared and = balanced=20 against Company reports.

b. Monthly financial reporting procedure shall be in accordance = with=20 the WYO Accounting Procedures.

B. Time Standards. Time will be measured from the date of = receipt=20 through the date mailed out. All dates referenced are working = days, not=20 calendar days. In addition to the standards set forth below, all = functions=20 performed by the company shall be in accordance with the highest=20 reasonably attainable quality standards generally utilized in the=20 insurance and data processing field. Continual failure to meet = these=20 requirements may result in limitations on the company's authority = to write=20 new business or the removal of the Company from the program. = Applicable=20 time standards are:

1. Application Processing=9715 days (note: if the policy cannot = be mailed=20 due to insufficient or erroneous information or insufficient = funds, a=20 request for correction or added moneys shall be mailed within 10=20 days);

2. Renewal Processing=977 days.

3. Endorsement Processing=9715 days.

4. Cancellation Processing=9715 days.

5. Claims Draft Processing=977 days from completion of file=20 examination.

6. Claims Adjustment=9745 days average from the receipt of = Notice of Loss=20 (or equivalent) through completion of examination.

C. Single Adjuster Program. To ensure the maximum = responsiveness to the=20 NFIP policy holders following a catastrophic event, e.g., a = hurricane,=20 involving insured wind and flood damage to policyholders, the = Company=20 shall agree to the adjustment of the combined flood and wind = losses=20 utilizing one adjuster under an NFIP-approved Single Adjuster = Program=20 using procedures issued by the Federal Insurance Administrator. = The Single=20 Adjuster procedure shall be followed in the following cases:

1. Where the flood and wind coverage is provided by the = Company;

2. Where the flood coverage is provided by the Company and the = wind=20 coverage is provided by a participating State Property Insurance = Plan,=20 Windpool Association, Beach Plan, Joint Underwriting Association, = FAIR=20 Plan, or similar property insurance mechanism; and

3. Where the flood coverage is provided by the Company and the = wind=20 coverage is provided by another property insurer and the State = Insurance=20 Regulator has determined that such property insurer shall, in the = interest=20 of consumers, facilitate the adjustment of its wind loss by the = adjuster=20 engaged to adjust the flood loss of the Company.

D. Policy Issuance.

1. The flood insurance subject to this Arrangement shall be = only that=20 insurance written by the Company in its own name pursuant to the = Act.

2. The Company shall issue policies under the regulations = prescribed by=20 the Federal Insurance Administrator in accordance with the = Act.

3. All such policies of insurance shall conform to the = regulations=20 prescribed by the Federal Insurance Administrator pursuant to the = Act, and=20 be issued on a form approved by the Federal Insurance = Administrator.

4. All policies shall be issued in consideration of such = premiums and=20 upon such terms and conditions and in such States or areas or = subdivisions=20 thereof as may be designated by the Federal Insurance = Administrator and=20 only where the Company is licensed by State law to engage in the = property=20 insurance business.

5. The Federal Insurance Administrator may require the Company = to=20 discontinue issuing policies subject to this Arrangement = immediately in=20 the event Congressional authorization or appropriation for the = National=20 Flood Insurance Program is withdrawn.

E. The Company shall separate Federal flood insurance funds = from all=20 other Company accounts, at a bank or banks of its choosing for the = collection, retention and disbursement of Federal funds relating = to its=20 obligation under this Arrangement, less the Company's expenses as = set=20 forth in Article III, and the operation of the Letter of Credit=20 established pursuant to Article IV. All funds not required to meet = current=20 expenditures shall be remitted to the United States Treasury, in=20 accordance with the provisions of the WYO Accounting Procedures=20 Manual.

F. The Company shall investigate, adjust, settle and defend all = claims=20 or losses arising from policies issued under this Arrangement. = Payment of=20 flood insurance claims by the Company shall be binding upon the = FIA.

G. Compliance with Agency Standard and Guidelines.

1. The Company shall comply with written standards, procedures, = and=20 guidance issued by FEMA or FIA relating to the NFIP and applicable = to the=20 Company.

2. The Company shall market flood insurance policies in a = manner=20 consistent with marketing guidelines established by FIA.

3. The Company shall notify its agents of the requirement to = comply=20 with State regulations regarding flood insurance agent education, = notify=20 agents of flood insurance training opportunities, and assist FEMA = in=20 periodic assessment of agent training needs.

Article III=97Loss Costs, Expenses, Expense Reimbursement, and = Premium=20 Refunds

A. The Company shall be liable for operating, administrative = and=20 production expenses, including any State premium taxes, dividends, = agents'=20 commissions or any other expense of whatever nature incurred by = the=20 Company in the performance of its obligations under this = Arrangement but=20 excluding other taxes or fees, such as surcharges on flood = insurance=20 premium and guaranty fund assessments.

B. The Company may withhold as operating and administrative = expenses,=20 other than agents' or brokers' commissions, an amount from the = Company's=20 written premium on the policies covered by this Arrangement in=20 reimbursement of all of the Company's marketing, operating, and=20 administrative expenses, except for allocated and unallocated loss = adjustment expenses described in C. of this article. This amount = will=20 equal the sum of the average of industry expense ratios for = =93Other Acq.=94,=20 =93Gen. Exp.=94, and =93Taxes=94 calculated by aggregating = premiums and expense=20 amounts for each of five property coverages using direct premium = and=20 expense information to derive weighted average expense ratios. For = this=20 purpose, we (the Federal Insurance Administration) will use data = for the=20 property/casualty industry published, as of March 15 of the prior=20 Arrangement year, in Part III of the Insurance Expense Exhibit in = A.M.=20 Best Company's Aggregates and Averages for the following = five=20 property coverages: Fire, Allied Lines, Farmowners Multiple Peril, = Homeowners Multiple Peril, and Commercial Multiple Peril = (non-liability=20 portion). In addition, this amount will be increased by one = percentage=20 point to reimburse expenses beyond regular property/casualty = expenses.

The Company may retain fifteen percent (15%) of the Company's = written=20 premium on the policies covered by this Arrangement as the = commission=20 allowance to meet commissions or salaries of insurance agents, = brokers, or=20 other entities producing qualified flood insurance applications = and other=20 related expenses.

The amount of expense allowance retained by the Company may = increase a=20 maximum of two percentage points, depending on the extent to which = the=20 Company meets the marketing goals for the Arrangement year = contained in=20 marketing guidelines established pursuant to Article II.G. We will = pay the=20 company the amount of any increase after the end of the = Arrangement=20 year.

The Company, with the consent of the Federal Insurance = Administrator as=20 to terms and costs, may use the services of a national rating=20 organization, licensed under state law, to help us undertake and = carry out=20 such studies and investigations on a community or individual risk = basis,=20 and to determine equitable and accurate estimates of flood = insurance risk=20 premium rates as authorized under the National Flood Insurance Act = of=20 1968, as amended. We will reimburse the Company for the charges or = fees=20 for such services under the provisions of the WYO Accounting = Procedures=20 Manual.

C. Loss Adjustment Expenses shall be reimbursed as follows:

1. Unallocated loss adjustment expense shall be reimbursed to = the=20 Company pursuant to a =93ULAE Schedule=94 coordinated with the = Company and=20 provided by the Federal Insurance Administrator.

2. Allocated loss adjustment expense shall be reimbursed to the = Company=20 pursuant to a =93Fee Schedule=94 coordinated with the Company and = provided by=20 the Federal Insurance Administrator.

3. Special allocated loss expenses shall be reimbursed to the = Company=20 in accordance with guidelines issued by the Federal Insurance=20 Administrator.

D. Loss Payments.

1. Loss payments under policies of flood insurance shall be = made by the=20 Company from Federal funds retained in the bank account(s) = established=20 under Article II, Section E and, if such funds are depleted, from = Federal=20 funds derived by drawing against the Letter of Credit established = pursuant=20 to Article IV.

2. Loss payments include payments as a result of litigation = that arises=20 under the scope of this Arrangement, and the Authorities set forth = herein.=20 All such loss payments and related expenses must meet the = documentation=20 requirements of the Financial Control Plan and of this = Arrangement, and=20 the Company must comply with the litigation documentation and = notification=20 requirements established by FEMA. Failure to meet these = requirements may=20 result in the Federal Insurance Administrator's decision not to = provide=20 reimbursement.

3. Limitation on Litigation Costs.

a. Following receipt of notice of such litigation, the FEMA = Office of=20 the Chief Counsel (=93OCC=94) shall review the information = submitted. If the=20 FEMA OGC finds that the litigation is grounded in actions by the = Company=20 that are significantly outside the scope of this Arrangement, = and/or=20 involves issues of agent negligence, then the FEMA OCC shall make = a=20 recommendation to the Federal Insurance Administrator regarding = whether=20 all or part of the litigation is significantly outside the scope = of the=20 Arrangement.

b. In the event the Federal Insurance Administrator agrees with = the=20 determination of the FEMA OCC under Article III, Section D.3.a = then the=20 Company will be notified in writing within thirty (30) days of the = Federal=20 Insurance Administrator's decision that any award or judgment for = damages=20 and any costs to defend such litigation will not be recognized = under=20 Article III as a reimbursable loss cost, expense or expense=20 reimbursement.

c. In the event a question arises whether only part of a = litigation is=20 reimbursable, the FEMA OCC shall make a recommendation to the = Federal=20 Insurance Administrator about the appropriate division of = responsibility,=20 if possible.

d. In the event that the Company wishes to petition for = reconsideration=20 of the determination that it will not be reimbursed for any part = of the=20 award or judgment or any part of the costs expended to defend such = litigation made under Article III, Section D.3.a-c, it may do so = by=20 mailing, within thirty (30) days of the notice that reimbursement = will not=20 be made, a written petition to the Federal Insurance = Administrator, who=20 may request advice on other than legal matters of the WYO = Standards=20 Committee established under the WYO Financial Control Plan. The = WYO=20 Standards Committee will consider the request at its next = regularly=20 scheduled meeting or at a special meeting called for that purpose = by the=20 Chairman and issue a written recommendation to the Federal = Insurance=20 Administrator. The Federal Insurance Administrator's final = determination=20 will be made in writing within a reasonable time to the = Company.

E. Premium refunds to applicants and policyholders required = pursuant to=20 rules contained in the National Flood Insurance Program (NFIP) = =93Flood=20 Insurance Manual=94 shall be made by the Company from Federal = flood=20 insurance funds referred to in Article II, Section E, and, if such = funds=20 are depleted, from funds derived by drawing against the Letter of = Credit=20 established pursuant to Article IV. As fiscal agent, the Company = shall not=20 refund any premium to applicants or policyholders in any manner = other than=20 as specified in the NFIP's =93Flood Insurance Manual=94 since = flood insurance=20 premiums are funds of the Federal Government.

Article IV=97Undertakings of the Government

A. Letter(s) of Credit shall be established by the Federal = Emergency=20 Management Agency (FEMA) against which the Company may withdraw = funds=20 daily, if needed, pursuant to prescribed procedures implemented by = FEMA.=20 The amounts of the authorizations will be increased as necessary = to meet=20 the obligations of the Company under Article III, Sections C, D, = and E.=20 Request for funds shall be made only when net premium income has = been=20 depleted. The timing and amount of cash advances shall be as close = as is=20 administratively feasible to the actual disbursements by the = recipient=20 organization for allowable Letter of Credit expenses.

Request for payment on Letters of Credit shall not ordinarily = be drawn=20 more frequently than daily nor in amounts less than $5,000, and in = no case=20 more than $5,000,000 unless so stated on the Letter of Credit. = This Letter=20 of Credit may be drawn by the Company for any of the following=20 reasons:

1. Payment of claim as described in Article III, Section D;

2. Refunds to applicants and policyholders for insurance = premium=20 overpayment, or if the application for insurance is rejected or = when=20 cancellation or endorsement of a policy results in a premium = refund as=20 described in Article III, Section E; and

3. Allocated and unallocated Loss Adjustment Expenses as = described in=20 Article III, Section C.

B. The FIA shall provide technical assistance to the Company as = follows:

1. The FIA's policy and history concerning underwriting and = claims=20 handling.

2. A mechanism to assist in clarification of coverage and = claims=20 questions.

3. Other assistance as needed.

Article V=97Commencement and Termination

A. The initial period of this Arrangement is from October 1, = 2004=20 through September 30, 2005. Thereafter the Arrangement will be = effective=20 on an annual basis for the period October 1 through September 30. = The FIA=20 shall provide financial assistance only for policy applications = and=20 endorsements accepted by the Company during this period pursuant = to the=20 Program's effective date, underwriting and eligibility rules.

B. Each year, the FIA shall publish in the Federal Register and make available to the = Company=20 the terms for subscription or re-subscription to this Financial=20 Assistance/Subsidy Arrangement. The Company shall notify the FIA = of its=20 intent to re-subscribe or not re-subscribe within thirty days of=20 publication.

C. In order to assure uninterrupted service to policyholders, = the=20 Company shall promptly notify the FIA in the event the Company = elects not=20 to participate in the Program during the Arrangement year. If so = notified,=20 or if the FIA chooses not to renew the Company's participation, = the FIA,=20 at its option, may require the continued performance of all or = selected=20 elements of this Arrangement for the period required for orderly = transfer=20 or cessation of business and settlement of accounts, not to exceed = 18=20 months, and may either require Article V.C.1 or allow Article = V.C.2:

1. The delivery to the FIA of:

a. A plan for the orderly transfer to the FIA of any continuing = responsibilities in administering the policies issued by the = Company under=20 the Program including provisions for coordination assistance; = and

b. All data received, produced, and maintained through the life = of the=20 Company's participation in the Program, including certain data, as = determined by FIA, in a standard format and medium; and

c. All claims and policy files, including those pertaining to = receipts=20 and disbursements that have occurred during the life of each = policy. In=20 the event of a transfer of the services provided, the Company = shall=20 provide the FIA with a report showing, on a policy basis, any = amounts due=20 from or payable to insureds, agents, brokers, and others as of the = transition date; and

d. All funds in its possession with respect to any policies = transferred=20 to FIA for administration and the unearned expenses retained by = the=20 Company.

2. Submission of plans for the renewal of the business by = another WYO=20 Company or Companies or the submission of detailed plans for = another WYO=20 Company to assume responsibility for the Company's NFIP policies. = Such=20 plans shall assure uninterrupted service to policyholders and = shall be=20 accompanied by a formal request for FIA approval of such = transfers.

D. Financial assistance under this Arrangement may be canceled = by the=20 FIA in its entirety upon thirty (30) days written notice to the = Company by=20 certified mail stating one of the following reasons for such = cancellation:=20 (i) Fraud or misrepresentation by the Company subsequent to the = inception=20 of the Arrangement; or (ii) Nonpayment to the FIA of any amount = due the=20 FIA; or (iii) Material failure to comply with the requirements of = this=20 Arrangement or with the written standards, procedures, or guidance = issued=20 by FEMA or FIA relating to the NFIP and applicable to the Company. = Under=20 these specific conditions, the FIA may require the transfer of=20 administrative responsibilities and the transfer of data and = records as=20 provided in Article V, Section C.1.a through d. If transfer is = required,=20 the unearned expenses retained by the Company shall be remitted to = the=20 FIA. In such event, the Government will assume all obligations and = liabilities owed to policyholders under such policies, arising = before and=20 after the date of transfer. As an alternative to transfer of the = policies=20 to the Government, the FIA will consider a proposal, if it is made = by the=20 Company, for the assumption of responsibilities by another WYO = Company as=20 provided in Article V, Section C.2.

E. In the event that the Company is unable or otherwise fails = to carry=20 out its obligations under this Arrangement by reason of any order = or=20 directive duly issued by the Department of Insurance of any = jurisdiction=20 to which the Company is subject, the Company agrees to transfer, = and the=20 Government will accept, any and all WYO policies issued by the = Company and=20 in force as of the date of such inability or failure to perform. = In such=20 event the Government will assume all obligations and liabilities = within=20 the scope of the Arrangement owed to policyholders arising before = and=20 after the date of transfer, and the Company will immediately = transfer to=20 the Government all needed records and data and all funds in its = possession=20 with respect to all such policies transferred and the unearned = expenses=20 retained by the Company. As an alternative to transfer of the = policies to=20 the Government, the FIA will consider a proposal, if it is made by = the=20 Company, for the assumption of responsibilities by another WYO = Company as=20 provided by Article V, Section C.2.

F. In the event the Act is amended, or repealed, or expires, or = if the=20 FIA is otherwise without authority to continue the Program, = financial=20 assistance under this Arrangement may be canceled for any new or = renewal=20 business, but the Arrangement shall continue for policies in force = that=20 shall be allowed to run their term under the Arrangement.

Article VI=97Information and Annual Statements

The Company shall furnish to FEMA such summaries and analyses = of=20 information including claim file information, and property = address,=20 location, and/or site information in its records as may be = necessary to=20 carry out the purposes of the National Flood Insurance Act of = 1968, as=20 amended, in such form as the FIA, in cooperation with the Company, = shall=20 prescribe. The Company shall be a property/casualty insurer = domiciled in a=20 State or territory of the United States. Upon request, the Company = shall=20 file with the FIA a true and correct copy of the Company's Fire = and=20 Casualty Annual Statement, and Insurance Expense Exhibit or = amendments=20 thereof as filed with the State Insurance Authority of the = Company's=20 domiciliary State.

Article VII=97Cash Management and Accounting

A. FEMA shall make available to the Company during the entire = term of=20 this Arrangement and any continuation period required by FIA = pursuant to=20 Article V, Section C., the Letter of Credit provided for in = Article IV=20 drawn on a repository bank within the Federal Reserve System upon = which=20 the Company may draw for reimbursement of its expenses as set = forth in=20 Article IV that exceed net written premiums collected by the = Company from=20 the effective date of this Arrangement or continuation period to = the date=20 of the draw. In the event that adequate Letter of Credit funding = is not=20 available to meet current Company obligations for flood policy = claim=20 payments issued, FIA shall direct the Company to immediately = suspend the=20 issuance of loss payments until such time as adequate funds are = available.=20 The Companies are not required to pay claims from their own funds = in the=20 event of such suspension.

B. The Company shall remit all funds, including interest, not = required=20 to meet current expenditures to the United States Treasury, in = accordance=20 with the provisions of the WYO Accounting Procedures Manual or = procedures=20 approved in writing by the FIA.

C. In the event the Company elects not to participate in the = Program in=20 this or any subsequent fiscal year, or is otherwise unable or not=20 permitted to participate, the Company and FIA shall make a = provisional=20 settlement of all amounts due or owing within three months of the=20 expiration or termination of this Arrangement. This settlement = shall=20 include net premiums collected, funds drawn on the Letter of = Credit, and=20 reserves for outstanding claims. The Company and FIA agree to make = a final=20 settlement, subject to audit, of accounts for all obligations = arising from=20 this Arrangement within 18 months of its expiration or = termination, except=20 for contingent liabilities that shall be listed by the Company. At = the=20 time of final settlement, the balance, if any, due the FIA or the = Company=20 shall be remitted by the other immediately and the operating year = under=20 this Arrangement shall be closed.

Article VIII=97Arbitration

If any misunderstanding or dispute arises between the Company = and the=20 FIA with reference to any factual issue under any provisions of = this=20 Arrangement or with respect to the FIA's non-renewal of the = Company's=20 participation, other than as to legal liability under or = interpretation of=20 the standard flood insurance policy, such misunderstanding or = dispute may=20 be submitted to arbitration for a determination that shall be = binding upon=20 approval by the FIA. The Company and the FIA may agree on and = appoint an=20 arbitrator who shall investigate the subject of the = misunderstanding or=20 dispute and make a determination. If the Company and the FIA = cannot agree=20 on the appointment of an arbitrator, then two arbitrators shall be = appointed, one to be chosen by the Company and one by the FIA.

The two arbitrators so chosen, if they are unable to reach an=20 agreement, shall select a third arbitrator who shall act as = umpire, and=20 such umpire's determination shall become final only upon approval = by the=20 FIA.

The Company and the FIA shall bear in equal shares all expenses = of the=20 arbitration. Findings, proposed awards, and determinations = resulting from=20 arbitration proceedings carried out under this section, upon = objection by=20 FIA or the Company, shall be inadmissible as evidence in any = subsequent=20 proceedings in any court of competent jurisdiction.

This Article shall indefinitely succeed the term of this=20 Arrangement.

Article IX=97Errors and Omissions

In the event of negligence by the Company that has not resulted = in=20 litigation but has resulted in a claim against the Company, FEMA = will not=20 consider reimbursement of the Company for costs incurred due to = that=20 negligence unless the Company takes all reasonable actions to = rectify the=20 negligence and to mitigate any such costs as soon as possible = after=20 discovery of the negligence. Further, (i) if the claim against the = Company=20 is grounded in actions significantly outside the scope of this = Arrangement=20 or (ii) if there is negligence by the agent, FEMA will not = reimburse any=20 costs incurred due to that negligence. The Company will be = notified in=20 writing within thirty (30) days of a decision not to reimburse. In = the=20 event the Company wishes to petition for reconsideration of the = decision=20 not to reimburse, the procedure in Article III, Section D.3.d = shall=20 apply.

However, in the event that the Company has made a claim payment = to an=20 insured without including a mortgagee (or trustee) of which the = Company=20 had actual notice prior to making payment, and subsequently = determines=20 that the mortgagee (or trustee) is also entitled to any part of = said claim=20 payment, any additional payment shall not be paid by the Company = from any=20 portion of the premium and any funds derived from any Federal = Letter of=20 Credit deposited in the bank account described in Article II, = section E.=20 In addition, the Company agrees to hold the Federal Government = harmless=20 against any claim asserted against the Federal Government by any = such=20 mortgagee (or Trustee), as described in the preceding sentence, by = reason=20 of any claim payment made to any insured under the circumstances = described=20 above.

Article X=97Officials Not to Benefit

No Member or Delegate to Congress, or Resident Commissioner, = shall be=20 admitted to any share or part of this Arrangement, or to any = benefit that=20 may arise therefrom; but this provision shall not be construed to = extend=20 to this Arrangement if made with a corporation for its general=20 benefit.

Article XI=97Offset

At the settlement of accounts the Company and the FIA shall = have, and=20 may exercise, the right to offset any balance or balances, whether = on=20 account of premiums, commissions, losses, loss adjustment = expenses,=20 salvage, or otherwise due one party to the other, its successors = or=20 assigns, hereunder or under any other Arrangements heretofore or = hereafter=20 entered into between the Company and the FIA. This right of offset = shall=20 not be affected or diminished because of insolvency of the = Company.

All debts or credits of the same class, whether liquidated or=20 unliquidated, in favor of or against either party to this = Arrangement on=20 the date of entry, or any order of conservation, receivership, or=20 liquidation, shall be deemed to be mutual debts and credits and = shall be=20 offset with the balance only to be allowed or paid. No offset = shall be=20 allowed where a conservator, receiver, or liquidator has been = appointed=20 and where an obligation was purchased by or transferred to a party = hereunder to be used as an offset.

Although a claim on the part of either party against the other = may be=20 unliquidated or undetermined in amount on the date of the entry of = the=20 order, such claim will be regarded as being in existence as of the = date of=20 such order and any credits or claims of the same class then in = existence=20 and held by the other party may be offset against it.

Article XII=97Equal Opportunity

The Company shall not discriminate against any applicant for = insurance=20 because of race, color, religion, sex, age, handicap, marital = status, or=20 national origin.

Article XIII=97Restriction on Other Flood Insurance

As a condition of entering into this Arrangement, the Company = agrees=20 that in any area in which the Federal Insurance Administrator = authorizes=20 the purchase of flood insurance pursuant to the Program, all flood = insurance offered and sold by the Company to persons eligible to = buy=20 pursuant to the Program for coverages available under the Program = shall be=20 written pursuant to this Arrangement.

However, this restriction applies solely to policies providing = only=20 flood insurance. It does not apply to policies provided by the = Company of=20 which flood is one of the several perils covered, or where the = flood=20 insurance coverage amount is over and above the limits of = liability=20 available to the insured under the Program.

Article XIV=97Access to Books and Records

The FIA and the Comptroller General of The United States, or = their duly=20 authorized representatives, for the purpose of investigation, = audit, and=20 examination shall have access to any books, documents, papers and = records=20 of the Company that are pertinent to this Arrangement. The Company = shall=20 keep records that fully disclose all matters pertinent to this=20 Arrangement, including premiums and claims paid or payable under = policies=20 issued pursuant to this Arrangement. Records of accounts and = records=20 relating to financial assistance shall be retained and available = for three=20 (3) years after final settlement of accounts, and to financial = assistance,=20 three (3) years after final adjustment of such claims. The FIA = shall have=20 access to policyholder and claim records at all times for purposes = of the=20 review, defense, examination, adjustment, or investigation of any = claim=20 under a flood insurance policy subject to this Arrangement.

Article XV=97Compliance With Act and Regulations

This Arrangement and all policies of insurance issued pursuant = thereto=20 shall be subject to the provisions of the National Flood Insurance = Act of=20 1968, as amended, the Flood Disaster Protection Act of 1973, as = amended,=20 the National Flood Insurance Reform Act of 1994, and Regulations = issued=20 pursuant thereto and all Regulations affecting the work that are = issued=20 pursuant thereto, during the term hereof.

Article XVI=97Relationship Between the Parties (Federal = Government and=20 Company) and the Insured

Inasmuch as the Federal Government is a guarantor hereunder, = the=20 primary relationship between the Company and the Federal = Government is one=20 of a fiduciary nature, i.e. , to assure that any taxpayer = funds are=20 accounted for and appropriately expended. The Company is a fiscal = agent of=20 the Federal Government, but is not a general agent of the Federal=20 Government. The Company is solely responsible for its obligations = to its=20 insured under any policy issued pursuant hereto, such that the = Federal=20 Government is not a proper party to any lawsuit arising out of = such=20 policies.

Addendum to Appendix A to Part 62=97Federal Emergency = Management Agency,=20 Federal Insurance and Mitigation Administration, Financial=20 Assistance/Subsidy Arrangement

Note: This Addendum to Appendix A to Part 62 = applies only=20 to a public entity risk-sharing organization, an association of = local=20 governments, a State association of political subdivisions, a=20 State-sponsored municipal league, and any other intergovernmental=20 risk-sharing pool for covering public entity structures = participating in=20 the pilot project established in =A762.24(b) that permits = intergovernmental=20 risk-sharing pools to provide flood insurance to public entities = to cover=20 public buildings.

(1) =93Company=94 in the preceding Arrangement includes =93a = public entity=20 risk-sharing organization, an association of local governments, a = State=20 association of political subdivisions, a State-sponsored municipal = league,=20 and any other intergovernmental risk-sharing pool for covering = public=20 entity structures.=94

(2) The references to =93marketing guidelines=94 in Article = II=97Undertaking=20 of the Company and to =93marketing goals=94 in Article III=97Loss = Costs,=20 Expenses, Expense Reimbursement, and Premium Refunds shall apply = only to=20 the private insurance companies participating in the WYO = program.

[62 FR 39910, July 24, 1997, as amended at 63 FR 32761, June = 16, 1998;=20 64 FR 27709, May 21, 1999; 65 FR 36634, June 9, 2000; 66 FR 40917, = Aug. 6,=20 2001; 67 FR 13550, Mar. 22, 2002; 67 FR 51769, Aug. 9, 2002; 68 FR = 52701,=20 Sept. 5, 2003; 68 FR 75454, Dec. 31, 2003; 69 FR 23659, Apr. 30, = 2004; 69=20 FR 45611, July 30, 2004; 73 FR 18187, 18188, Apr. 3, 2008]

Appendix B to Part 62=97National Flood Insurance = Program

=20 top

A Plan to Maintain Financial Control for Business Written Under = the=20 Write Your Own Program.

(a) In general. Under the Write Your Own (WYO) Program, = we (the=20 Federal Insurance Administration (FIA), Federal Emergency = Management=20 Agency (FEMA)) may enter into an arrangement with individual = private=20 sector insurance companies licensed to engage in the business of = property=20 insurance. The arrangement allows these companies=97using their = customary=20 business practices=97to offer flood insurance coverage to eligible = property=20 owners. To assist companies in marketing flood insurance coverage, = the=20 Federal Government will be a guarantor of flood insurance coverage = for WYO=20 policies issued under the WYO Arrangement. To account for and = ensure=20 appropriate spending of any taxpayer funds, the WYO companies and = we will=20 implement this Financial Control Plan (Plan). Only the Federal = Insurance=20 Administrator may approve any departures from the requirements of = this=20 Plan.

(b) Financial Control Plan. (1) The WYO Companies are = subject to=20 audit, examination, and regulatory controls of the various States. = Additionally, the operating department of an insurance company is=20 customarily subject to examinations and audits performed by the = company's=20 internal audit or quality control departments, or both, and = independent=20 Certified Public Accountant (CPA) firms. This Plan will use to the = extent=20 possible the findings of these examinations and audits as they = pertain to=20 business written under the WYO Program.

(2) This Plan contains several checks and balances that can, if = properly implemented by the WYO Company, significantly reduce the = need for=20 extensive on-site reviews of the Company's files by us or our = designee.=20 Furthermore, we believe that this process is consistent with = customary=20 reinsurance practices and avoids duplication of examinations = performed=20 under the auspices of individual State Insurance Departments, NAIC = Zone=20 examinations, and independent CPA firms.

(c) Standards Committee established. (1) We establish in = this=20 Plan a Standards Committee for the WYO Program to oversee the = performance=20 of WYO companies under this Plan and to recommend appropriate = remedial=20 actions to the Federal Insurance Administrator. The Standards = Committee=20 will review and recommend to the Federal Insurance Administrator = remedies=20 for any adverse action arising from the implementation of the = Financial=20 Control Plan. Adverse actions include, but are not limited to, not = renewing a particular company's WYO Arrangement.

(2) The Federal Insurance Administrator appoints the members of = the=20 Standards Committee, which consists of five (5) members from FIA, = one (1)=20 member from FEMA's Office of Chief Financial Officer, and one (1) = member=20 from each of the six (6) designated WYO Companies, pools, or other = entities.

(3) A WYO company must=97

(A) Have a biennial audit of the flood insurance financial = statements=20 conducted by a CPA firm at the Company's expense to ensure that = the=20 financial data reported to us accurately represents the flood = insurance=20 activities of the Company. The CPA firm must conduct its audits in = accordance with generally accepted auditing standards (GAAS) and = the=20 Government Auditing Standards issued by the Comptroller General of = the=20 United States (commonly known as =93yellow book=94 requirements). = The Company=20 must file with us a report of the CPA firm's detailed biennial = audit, and,=20 after our review of the audit report, we will convey our = determination to=20 the Standards Committee.

(B) Participate in a WYO Company/FIA Operation review. We will = conduct=20 a review of the WYO Company's flood insurance claims, = underwriting,=20 customer service, marketing, and litigation activities at least = once every=20 three (3) years. As part of these reviews, we will reconcile = specific=20 files with a listing of transactions submitted by the Company = under the=20 Transaction Record Reporting and Processing Plan (Part 5). We will = file a=20 report of the Operation Review with the Standards Committee (Part = 7).

(C) Meet the recording and reporting requirements of the WYO=20 Transaction Record Reporting and Processing (TRRP) Plan and the = WYO=20 Accounting Procedures Manual. The National Flood Insurance = Program's=20 (NFIP) Bureau and Statistical Agent will analyze the transactions = reported=20 under the TRRP Plan and submit a monthly report to the WYO company = and to=20 us. The analysis will cover the timeliness of the WYO submissions, = the=20 disposition of transactions that do not pass systems edits, and = the=20 reconciliation of the totals generated from transaction reports = with those=20 submitted on the WYO Company's reports. (Parts 2 and 6).

(D) Cooperate with FEMA's Office of Financial Management on = Letter of=20 Credit matters.

(E) Cooperate with us in the implementation of a claims = reinspection=20 program (Part 3).

(F) Cooperate with us in the verification of risk rating=20 information.

(G) Cooperate with DHS's Office of Inspector General on matters = pertaining to fraud.

(d) This Plan incorporates by reference a separate document, = =93The Write=20 Your Own Program Financial Control Plan Requirements and = Procedures,=94 that=20 contains the following parts, each of which is incorporated by = reference=20 into and is applicable to the Financial Control Plan:

(1) Part 1=97Financial Audits, Audits for Cause, and State = Insurance=20 Department Audits;

(2) Part 2=97Transaction Record Reporting and Processing Plan=20 Reconciliation Procedures;

(3) Part 3=97Claims Reinspection Program;

(4) Part 4=97Report Certifications and Signature = Authorization;

(5) Part 5=97Transaction Record Reporting and Processing = Plan;

(6) Part 6=97Write Your Own (WYO) Accounting Procedures Manual; = and

(7) Part 7=97Operation Review Procedures.

(e) Interested members of the public may obtain a copy of = =93The Write=20 Your Own Program Financial Control Plan Requirements and = Procedures=94 by=20 contacting the FEMA Distribution Center, P.O. Box 2012, Jessup, MD = 20794.=94

[64 FR 56176, Oct. 18, 1999]

Browse=20 Previous | Browse=20 Next

For questions or comments = regarding e-CFR=20 editorial content, features, or design, email ecfr@nara.gov.

For = questions=20 concerning e-CFR programming and delivery issues, email webteam@gpo.gov.

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