96-2089. National Flood Insurance Program; Audit Program Revision  

  • [Federal Register Volume 61, Number 22 (Thursday, February 1, 1996)]
    [Proposed Rules]
    [Pages 3635-3644]
    From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
    [FR Doc No: 96-2089]
    
    
    
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    FEDERAL EMERGENCY MANAGEMENT AGENCY
    
    44 CFR Part 62
    
    RIN 3067-AC40
    
    
    National Flood Insurance Program; Audit Program Revision
    
    AGENCY: Federal Insurance Administration (FEMA).
    
    ACTION: Proposed rule.
    
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    SUMMARY: The Federal Insurance Administration (FIA) proposes to amend 
    its regulations regarding the manner in which its audits are conducted 
    under the National Flood Insurance Program's (NFIP) Write Your Own 
    (WYO) Program. The intent of the proposed regulations is to develop a 
    comprehensive, less burdensome, more efficient audit program. FIA 
    anticipates that these revisions will result in greater economy of 
    resources and new savings to the NFIP public.
    
    DATES: We invite your comments and ask that you submit them no later 
    than March 18, 1996.
    
    ADDRESSES: Please submit written comments to the Rules Docket Clerk, 
    Office of the General Counsel, Federal Emergency Management Agency, 500 
    C Street, SW., room 840, Washington, DC 20472, (fax) (202) 646-4536.
    
    FOR FURTHER INFORMATION CONTACT: Roland E. Holland, Federal Insurance 
    Administration, Federal Emergency Management Agency, 500 C Street, SW., 
    Washington, DC 20472, (202) 646-3439.
    
    SUPPLEMENTARY INFORMATION: Recently, after reviewing the programs and 
    services provided to the NFIP public, the Federal Insurance 
    Administrator concluded that the services currently being provided 
    could be enhanced and improved by revising the audit procedures. As a 
    result, FIA intends to discontinue the self-audit program, along with 
    the triennial claims and underwriting operations reviews. The 
    ``triennial'' audit will be revised to be conducted on a biennial 
    basis, and expanded to encompass greater claims and underwriting audits 
    that are to be conducted by Certified Public Accountant (CPA) firms, 
    selected by the WYO companies, at the companies' expense. These changes 
    are being made to facilitate improved management control over the audit 
    process. FIA believes these efforts will result in appreciable program 
    savings to both the WYO companies and the FIA.
    
    National Environmental Policy Act
    
        This proposed rule is categorically excluded from the requirements 
    of 44 
    
    [[Page 3636]]
    CFR Part 10, Environmental Consideration. No environmental impact 
    assessment has been prepared.
    
    Executive Order 12898, Environmental Justice
    
        The socioeconomic conditions relating to this proposed rule were 
    reviewed and a finding was made that no disproportionately high and 
    adverse effect on minority or low income populations result from this 
    proposed rule.
    
    Executive Order 12866, Regulatory Planning and Review
    
        This proposed rule is not a significant regulatory action within 
    the meaning of section 2(f) of E.O. 12866 of September 30, 1983, 58 FR 
    51735, and has not been reviewed by the Office of Management and Budget 
    (OMB). Nonetheless, this proposed rule adheres to the regulatory 
    principles set forth in E.O. 12866.
    
    Paperwork Reduction Act
    
        In accordance with the provisions of the Paperwork Reduction Act of 
    1995, 44 U.S.C. 3501 et seq., the collections of information contained 
    in this proposed rule have been submitted to and approved by the Office 
    of Management and Budget. To request additional information or copies 
    of the OMB submissions, contact the FEMA Informations Collections 
    Officer, Muriel B. Anderson, by calling (202) 646-2625 or by writing to 
    FEMA, 500 C Street, SW., Washington, DC 20472. The approved collections 
    of information are:
        OMB Number 3067-0169, Write Your Own (WYO) Program--To maintain 
    adequate financial control over Federal funds, the National Flood 
    Insurance Program requires each WYO company to meet the requirements of 
    the WYO Transaction Record Reporting and Processing Plan and to submit 
    monthly financial and statistical reports as required in FEMA 
    regulation 44 CFR Part 62, Appendix B. The number of respondents is 
    estimated at 105. The burden estimates per respondent are as follows: 
    Reconciliation Report, 30 minutes; Biennial Audit Administrative Review 
    Checklist, 1 hour; Monthly Financial and Statistical Reconciliation 
    Reports Certification Statement, 3 minutes; and Monthly Statistical 
    Transaction Reports Certification Statement, 3 minutes.
        OMB Number 3067-0229, Mortgage Portfolio Protection Program 
    (MPPP)--Lending institutions, mortgage servicing companies and others 
    servicing mortgage loan portfolios can bring their mortgage loan 
    portfolios into compliance with the flood insurance purchase 
    requirements of the Flood Disaster Protection Act of 1973. The number 
    of respondents is estimated at 6,526. The burden estimates per 
    respondent are as follows: 150 hours for WYO companies to set up 
    initial operations under the MPPP; 30 minutes per lender to sign an 
    agreement with a WYO company to notify each mortgagor (3 notices at 10 
    minutes per notice); and 30 minutes for each mortgagor to ask questions 
    and respond to the notices.
        Although the collections of information have been approved by OMB, 
    FEMA continues to solicit comments on (1) whether the collections of 
    information are necessary for the proper performance of the functions 
    of the agency, including whether the information will have practical 
    utility; (2) the accuracy of the agency's estimates of the burden of 
    the collections of information; (3) ways to enhance the quality, 
    utility, and clarity of the information to be collected; and (4) ways 
    to minimize the burden of the collections of information on those who 
    are to respond, including through the use of appropriate automated, 
    electronic, mechanical, or other technological collection techniques or 
    other forms of information technology.
        Submit comments within 60 days of this notice to the Federal 
    Emergency Management Agency, Attention: Information Collections 
    Management, 500 C Street S.W., room 311, Washington, D.C. 20472.
    
    Executive Order 12612
    
        This proposed rule involves no policies that have federalism 
    implications under Executive Order 12612, Federalism dated October 26, 
    1987.
    
    Executive Order 12778, Civil Justice Reform
    
        This proposed rule meets the applicable standards of 2(b)(2) of 
    Executive Order 12778.
    
    List of Subjects in 44 CFR Part 62
    
        Flood insurance.
    
        Accordingly, 44 CFR part 62 is proposed to be amended as follows:
    
    PART 62--SALE OF INSURANCE AND ADJUSTMENT OF CLAIMS
    
        1. The authority citation for Part 62 continues to read as follows:
    
        Authority: 42 U.S.C. 4001 et seq.; Reorganization Plan No. 3 of 
    1978, 43 FR 41943, 3 CFR, 1978 Comp., p. 329; E.O. 12127 of Mar. 31, 
    1979, 44 FR 19367, 3 CFR, 1979 Comp., 376.
    
    
    Sec. 62.23  [Revised]
    
        2. Section 62.23 is revised to read as follows:
    
    
    Sec. 62.23  WYO Companies authorized.
    
        (a) Pursuant to section 1345 of the Act, the Administrator may 
    enter into arrangements with individual private sector property 
    insurance companies whereby such companies may offer flood insurance 
    coverage under the Program to eligible applicants for such insurance, 
    including policyholders insured by them under their own property 
    insurance business lines of insurance pursuant to their customary 
    business practices including their usual arrangements with agents and 
    producers, in any State in which such WYO Companies are licensed to 
    engage in the business of property insurance. Arrangements entered into 
    by WYO Companies under this subpart shall be in the form and substance 
    of the standard arrangement, entitled ``Financial Assistance/Subsidy 
    Arrangement'', a copy of which is included in Appendix A of this part 
    and made a part of these regulations.
        (b) Any duly licensed insurer so engaged in the Program shall be a 
    WYO Company.
        (c) A WYO Company is authorized to arrange for the issuance of 
    flood insurance in any amount within the maximum limits of coverage 
    specified in Sec. 61.6 of this subchapter, as Insurer, to any person 
    qualifying for such coverage under parts 61 and 64 of this subchapter 
    who submits an 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 the adjustment, settlement, payment and defense of all claims 
    arising from policies of flood insurance it issues under the Program, 
    based upon the terms and conditions of the Standard Flood Insurance 
    Policy.
        (e) In carrying out its functions under this subpart, a WYO Company 
    shall use its own customary standards, staff and independent contractor 
    resources, as it would in the ordinary and necessary conduct of its own 
    business affairs, subject to the Act and regulations prescribed by the 
    Administrator under the Act.
        (f) To facilitate the marketing of flood insurance coverage under 
    the Program to policyholders of WYO Companies, the Administrator will 
    enter into arrangements with such companies whereby the Federal 
    Government will be a guarantor in which the primary relationship 
    between the WYO Company and the Federal Government will be one of a 
    fiduciary nature, i.e., to assure that any taxpayer funds are accounted 
    for and appropriately expended. In furtherance of this end, 
    
    [[Page 3637]]
    the Administrator has established ``A Plan to Maintain Financial 
    Control for Business Written Under the Write Your Own Program'', a copy 
    of which is included in Appendix B of this part and made a part of 
    these regulations.
        (g) WYO Companies shall not be agents of the Federal Government and 
    are solely responsible for their obligations to their insureds under 
    any flood insurance policies issued under arrangements entered into 
    with the Administrator.
        (h) To facilitate the underwriting of flood insurance coverage by 
    WYO Companies, the following procedures will be used by WYO Companies:
        (1) To expedite business growth, the WYO Company will encourage its 
    present property insurance policyholders to purchase flood insurance 
    and to transfer to the WYO Company, at the time of policy renewal, 
    business placed by its producers with the NFIP Bureau and Statistical 
    Agent.
        (2) To confirm its underwriting practices to the underwriting rules 
    and rates in effect as to the NFIP, the WYO Company will establish 
    procedures to carry out the NFIP rating system and to provide its 
    policyholders with the same coverage as is afforded under the NFIP.
        (3) The WYO Company may follow its customary billing practices to 
    meet the Federal rules on the presentment of premium and net premium 
    deposits to a Letter of Credit bank account authorized by the 
    Administrator and reduction of coverage when an underpayment is 
    discovered.
        (4) The WYO Company is expected to meet the recording and reporting 
    requirements of the WYO Transaction Record Reporting and Processing 
    Plan. Transactions reported by the WYO Company under the WYO 
    Transaction Record Reporting and Processing Plan will be analyzed by 
    the NIP Servicing Agent. A monthly report will be submitted to the WYO 
    Company and the FIA. The analysis will cover the timeliness of WYO 
    Company submissions, the disposition of transactions that have not 
    passed systems edits and the reconciliation of the totals generated 
    from transaction reports with those submitted on the WYO Company's 
    reconciliation reports.
        (5) If a WYO Company rejects an application from an agent or a 
    producer, the agent or producer should be notified so that the business 
    can be placed through the NFIP Servicing Agent, or another WYO Company.
        (6) Flood insurance coverage will be issued by the WYO Company on a 
    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 the net premium depository requirements specified under the NFIP/WYO 
    Program accounting procedures are met. A cancellation by the WYO 
    Company for non-payment of premium will not produce a pro rata return 
    of the net premium deposit to the WYO Company.
        (8) NFIP business will not be assumed by the WYO Companies at any 
    time other than at renewal time, at which time the insurance producer 
    may submit the business to the WYO Company as new business. However, it 
    is permissible to cancel and rewrite flood policies to obtain 
    concurrent expiration dates with other policies covering the property. 
    Where the insurance agent or producer of record of a flood insurance 
    policy issued by the Administrator has authorized the NFIP, in writing, 
    to release policy information for the conversion of the NFIP coverage 
    to a designated WYO Company represented by the agent or producer of 
    record, in order to facilitate policy issuance and reduce 
    administrative burdens upon the NFIP and WYO Companies and their agents 
    and producers, countersignature requirements in the several States 
    shall not apply.
        (i) To facilitate the adjustment of flood insurance claims by WYO 
    Companies, the following procedures will be used by WYO Companies.
        (1) Under the terms of the Arrangement set forth at appendix A of 
    this part, WYO Companies will adjust claims in accordance with general 
    Company standards, guided by NFIP Claims manuals. The Arrangement also 
    provides that claim adjustments shall be binding upon the FIA. For 
    example, the entire responsibility for providing a proper adjustment 
    for both combined wind and water claims and flood-alone claims is the 
    responsibility of the WYO Company.
        (2) The WYO Company may use its staff adjusters and/or independent 
    adjusters. It is important that the Company's Claims Department 
    verifies the correctness of the coverage interpretations and 
    reasonableness of the payments recommended by the adjusters.
        (3) An established loss adjustment Fee Schedule is part of the 
    Arrangement and cannot be changed during an Arrangement year. This is 
    the expense allowance to cover costs of independent or WYO Company 
    adjusters.
        (4) the normal catastrophe claims procedure currently operated by a 
    WYO Company should be implemented in the event of a claim catastrophe 
    situation. Flood claims will be handled along with other catastrophe 
    claims.
        (5) It will be the WYO Company's responsibility to try to detect 
    fraud (as it does in the case of property insurance) and coordinate its 
    findings with FIA.
        (6) Pursuant to the Arrangement, the responsibility of defending 
    claims will be upon the Write Your Own Company and defense costs will 
    be part of the unallocated or allocated claim expense allowance, 
    depending on whether a staff counsel or an outside attorney handles the 
    defense of the matter. Claims in litigation will be reported by WYO 
    Companies to FIA upon joinder of issue and FIA may inquire and be 
    advised of the disposition of such litigation.
        (7) The claim reserving procedures of the individual WYO Company 
    can be used.
        (8) Regarding the handling of subrogation, if a WYO Company prefers 
    to forego pursuit of subrogation recovery, it may do so by referring 
    the matter, with a complete copy of the claim file, to FIA. Subrogation 
    initiatives may be truncated at any time before suit is commenced 
    (after commencing an action, special arrangement must be made). FIA, 
    after consultation with FEMA's Office of the General Counsel (OGC), 
    will forward the cause of action to OGC or to the NFIP Bureau and 
    Statistical Agent for prosecution. Any funds received will be 
    deposited, less expenses, in the National Flood Insurance Fund.
        (9) Special allocated loss adjustment expenses will include such 
    items as: nonstaff attorney fees, engineering fees and special 
    investigation fees over and above normal adjustment practices.
        (10) The customary content of claim files will include coverage 
    verification, normal adjuster investigations, including statements 
    where necessary, police reports, building reports and investigations, 
    damage verification and other documentation relevant to the adjustment 
    of claims under the NFIP's and the WYO Company's traditional claim 
    adjustment practices and procedures. The WYO Company's claim examiners 
    and managers will supervise the adjustment of flood insurance claims by 
    staff and independent claims adjusters.
        (11) The WYO Company will extend reasonable cooperation to FEMA's 
    Office of the General Counsel on matters pertaining to litigation and 
    subrogation, under paragraph (i)(8) of this section.
        (j) To facilitate establishment of financial controls under the WYO 
    Program, the WYO Company will:
    
    [[Page 3638]]
    
        (1) Select a Certified Public Accountant (CPA) firm to conduct 
    biennial audits of the financial, claims and underwriting records of 
    the company. These audits shall be performed in accordance with the 
    Government Auditing Standards issued by the Comptroller General of the 
    United States (commonly known as yellow book). FIA further requires 
    that pre-selected policy and claims files the CPA firm is asked to 
    review are in addition to any files that the auditors may select for 
    their sample. A report of the detailed biennial audit conducted will be 
    filed with the FIA which, after a review of the audit report, will 
    convey its determination to the Standards Committee. The CPA firm 
    chosen to conduct the audit is expected to use qualified, skilled 
    persons with the requisite background in property insurance and a 
    knowledge of the NFIP. Persons performing claims audits are expected to 
    possess claims expertise which would allow them to ascertain whether 
    the scope of damage was proper, and if all applicable NFIP policy 
    provisions were properly followed. Persons performing underwriting 
    audits should be able to ascertain if the risk has been properly rated, 
    which would necessitate being aware of special NFIP rating situations, 
    such as elevated buildings.
        (2) Meet the recording and reporting requirements of the WYO 
    Transaction Record Reporting and Processing Plan and the WYO Accounting 
    Procedures Manual. Transactions reported to the National Flood 
    Insurance Program's (NFIP's) Bureau and Statistical Agent by the WYO 
    Company under the WYO Transaction Record Reporting and Processing Plan 
    and the WYO Accounting Procedures Manual will be analyzed by the Bureau 
    and Statistical Agent and a monthly report will be submitted to the WYO 
    Company and the FIA. The analysis will cover the timeliness of the WYO 
    Company submissions, the disposition of transactions which do not pass 
    systems edits and the reconciliation of the totals generated from 
    transaction reports with those submitted on WYO Company reconciliation 
    reports.
        (3) Cooperate with FEMA's Office of Financial Management on Letter 
    of Credit matters.
        (4) Cooperate with FIA in the implementation of a claims 
    reinspection program.
        (5) Cooperate with FIA in the verification of risk rating 
    information.
        (6) Cooperate with FEMA's Office of the Inspector General on 
    matters pertaining to fraud.
        (k) To facilitate the operation of the WYO Program and in order 
    that a WYO Company can use its own customary standards, staff and 
    independent contractor resources, as it would in the ordinary and 
    necessary conduct of its own business affairs, subject to the Act, the 
    Administrator, for good cause shown, may grant exceptions to and 
    waivers of the regulations contained in this title relative to the 
    administration of the NFIP.
        (l)(1) WYO Companies may, on a voluntary basis, elect to 
    participate in the Mortgage Portfolio Protection Program (MPPP), under 
    which they can offer, as a last resort, flood insurance at special high 
    rates, sufficient to recover the full cost of this program in 
    recognition of the uncertainty as to the degree of risk a given 
    building presents due to the limited underwriting data required, to 
    properties in a lending institution's mortgage portfolio to achieve 
    compliance with the flood insurance purchase requirements of the Flood 
    Disaster Protection Act of 1973. Flood insurance policies under the 
    MPPP may only be issued for those properties that:
        (i) Are determined to be located within special flood hazard areas 
    of communities that are participating in the NFIP, and
        (ii) Are not covered by a flood insurance policy even after a 
    required series of notices has been given to the property owner 
    (mortgagor) by the lending institution of the requirement for obtaining 
    and maintaining such coverage, but the mortgagor has failed to respond.
        (2) WYO Companies participating in the MPPP must provide a detailed 
    implementation package to any lending institution that, on a voluntary 
    basis, chooses to participate in the MPPP to ensure the lending 
    institution has full knowledge of the criteria in that program and must 
    obtain a signed receipt for that package from the lending institution. 
    Participating WYO Companies must also maintain evidence of compliance 
    with paragraph (l)(3) of this section for review during the audits and 
    reviews required by the WYO Financial Control Plan contained in 
    appendix B of this part.
        (3) The mortgagor must be protected against the lending 
    institution's arbitrary placing of flood insurance for which the 
    mortgagor will be billed by being sent three notification letters as 
    described in paragraphs (l)(4) through (6) of this section.
        (4) The initial notification letter must:
        (i) State the requirements of the Flood Disaster Protection Act of 
    1973, as amended;
        (ii) Announce the determination that the mortgagor's property is in 
    an identified special flood hazard area as delineated on the 
    appropriate FEMA map, necessitating flood insurance coverage for the 
    duration of the loan;
        (iii) Describe the procedure to follow should the mortgagor wish to 
    challenge the determination;
        (iv) Request evidence of a valid flood insurance policy or, if 
    there is none, encourage the mortgagor to promptly obtain a Standard 
    Flood Insurance Policy (SFIP) from a local insurance agent (or WYO 
    Company);
        (v) Advise that the premium for an MPPP policy is significantly 
    higher than a conventional SFIP policy and advise as to the option for 
    obtaining less costly flood insurance; and
        (vi) Advise that an MPPP policy will be purchased by the lender if 
    evidence of flood insurance coverage is not received by a date certain.
        (5) The second notification letter must remind the mortgagor of the 
    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 MPPP on the mortgage's (insured's) behalf, together with the 
    Declarations Page.
        (ii) Advise that the policy was purchased because of the failure to 
    respond to the previous notices, and
        (iii) Remind the insured that similar coverage may be available at 
    significantly lower cost and advise that the policy can be cancelled at 
    any time during the policy year and a pro rata refund provided for the 
    unearned portion of the premium in the event the insured purchases 
    another policy that is acceptable to satisfy the requirements of the 
    1973 Act. ``(Approved by the Office of Management and Budget under OMB 
    control number 3067-0229.)''
    
    Appendix B to Part 62 [Revised]
    
        3. Appendix B to Part 62--National Flood Insurance Program, is 
    proposed to be revised to read as follows:
    
    Appendix B to Part 62--National Flood Insurance Program
    
    A Plan To Maintain Financial Control for Business Written Under the 
    Write Your Own Program
    
        Under the Write Your Own (WYO) Program, the Federal Insurance 
    Administrator (Administrator) may enter into arrangements with 
    individual private sector insurance companies that are licensed to 
    engage in the business of property insurance, whereby these 
    companies may offer flood insurance coverage to eligible property 
    owners using their customary business practices. To facilitate the 
    marketing of flood 
    
    [[Page 3639]]
    insurance coverage, the Federal Government will be a guarantor of flood 
    insurance coverage for WYO Company policies issued under the WYO 
    Arrangement. To ensure that any taxpayer funds are accounted for and 
    appropriately expended, the Federal Insurance Administrator (FIA) 
    and WYO Companies will implement this Financial Control Plan. Any 
    departures from the requirements of this Plan must be approved by 
    the Administrator. The authority for the WYO Program is contained in 
    Sec. 1345 of the National Flood Insurance Act of 1968, 42 U.S.C. 
    4081, and 44 CFR parts 61 and 62, Secs. 61.13 and 62.23. The WYO 
    Financial Assistance/Subsidy Arrangement (Arrangement) which is 
    included in appendix A of this part is hereby made a part of this 
    Financial Control Plan.
        WYO Companies are subject to audit, examination, and regulatory 
    controls of the various states. Additionally, insurance company 
    operating departments are customarily subject to examinations and 
    audits performed by Company internal audit (and/or quality control) 
    departments and independent CPA firms. It is intended that this Plan 
    use to the extent possible, the findings of these examinations and 
    audits as they pertain to business written under the WYO Program 
    (Parts 3 and 4).
        The WYO Financial Control Plan contains several checks and 
    balances that can, if properly implemented by the WYO Company, 
    significantly reduce the need for extensive on-site reviews of 
    Company files by the FIA staff or their designee. Furthermore, we 
    believe that this process is consistent with customary reinsurance 
    practices and avoids duplication of examinations performed under the 
    auspices of individual State Insurance Departments, NAIC Zone 
    examinations, and independent CPA firms.
        The WYO Financial Control Plan requires the WYO Company to meet 
    the minimum requirements established by the Standards Committee. The 
    Standards Committee consists of four (4) members from FIA, one (1) 
    member from the Federal Emergency Management Agency's (FEMA's) 
    Office of Financial Management, one (1) member designated by the 
    Administrator who is not directly involved in the WYO Program, and 
    one (1) member from each of six (6) designated WYO Companies, pools 
    or other entities.
        The WYO Financial Control Plan must require the WYO Company to:
        1. Have a biennial audit of the flood insurance financial 
    statements and claims and underwriting activity conducted by an 
    independent accounting firm at the Company's expense to ensure that 
    the financial data reported to FIA accurately represents the flood 
    insurance activities of the Company. Require that the CPA firm's 
    audit be performed in accordance with GAO yellow book requirements. 
    Require that the auditors conduct their own review sample, even if 
    pre-selected policy and claims files are given to them for review.
        2. Meet the recording and reporting requirements of the WYO 
    Transaction Record Reporting and Processing Plan. Transactions 
    reported to the National Flood Insurance Program's (NFIP's) Bureau 
    and Statistical Agent by the WYO Company under the WYO Transaction 
    Record Reporting and Processing Plan will be analyzed by the Bureau 
    and Statistical Agent and a monthly report will be submitted to the 
    WYO Company and the FIA. The analysis will cover the timeliness of 
    the WYO Company's submissions, the disposition of transactions that 
    do not pass systems edits, and the reconciliation of the total 
    generated from transaction reports with those submitted on the WYO 
    Company's reports (part 1).
        3. Cooperate with FEMA's Office of Financial Management on 
    Letter of Credit matters.
        4. Cooperate with FIA in the implementation of a claims 
    reinspection program (part 2).
        5. Cooperate with FIA in the verification of risk rating 
    information.
        6. Cooperate with FEMA's Office of the Inspector General on 
    matters pertaining to fraud.
        The Standards Committee will review and make a recommendation to 
    the Administrator concerning any adverse action arising from the 
    implementation of the Financial Control Plan. Adverse actions 
    include, but are not limited to the FIA Operations Division's 
    recommendations not to renew a particular Company's WYO arrangement.
        This Plan includes the following guidelines:
    
    Part 1--Transaction Record Reporting and Processing Plan 
    Reconciliation Procedures
    Part 2--Claims Reinspection Program
    Part 3--Financial Audits, Underwriting Audits, Claims Audits, Audits 
    For Cause, and State Insurance Department Audits
    Part 4--Reports Certifications
    Part 5--WYO Financial Assistance/Subsidy Arrangement (Incorporated 
    by Reference)
    Part 6--Transaction Record Reporting and Processing Plan 
    (Incorporated by Reference)
    Part 7--Write Your Own (WYO) Accounting Procedures Manual 
    (Incorporated by Reference)
    
    Part 1--Transaction Record Reporting and Processing Plan 
    Reconciliation Procedures
    
    Transaction Record Reporting and Processing Plan Reconciliation 
    Objectives
    
        The objectives are: To reconcile transaction detail with monthly 
    financial statements submitted by the WYO Companies; to assess the 
    quality and timeliness of submitted data; and to provide for the 
    identification and resolution of discrepancies in the data. The 
    reliance on computer processing to perform the review of transaction 
    and financial data will help minimize the necessity for on-site 
    audits of WYO Companies. Reconciliation of the statistical reports 
    submitted will be performed by the WYO Companies and independently 
    by the NFIP Bureau and Statistical Agent.
        The Review of monthly financial statements and transaction level 
    detail will involve five areas:
        A. Financial control;
        B. Quality control (audit trails);
        C. Quality review of submitted data;
        D. Policy rating;
        E. Timeliness of reporting; and
        F. Monthly reports.
    
    A. Financial Control
    
        1. WYO Companies are required to submit a reconciliation report 
    (Exhibit ``A'') with the submission of transaction level detail. 
    This report will reconcile the transaction records data to the 
    financial report, explaining any discrepancies.
        2. WYO Companies are required to submit, on a form approved by 
    the Administrator, a tape transmittal document with the submission 
    of the statistical tape containing transaction detail. This will be 
    used to validate record counts and dollar amounts.
        3. The NFIP will review, at a minimum, the categories on the 
    attached format and produce a similar report reconciling the 
    transaction data to the monthly financial statement submitted by 
    each WYO Company.
        4. To facilitate financial reconciliation, transaction records 
    which do not pass various edits employed by the NEIP to review the 
    quality of submitted data will be so identified, but still maintain 
    whenever possible until the error is corrected by the company in 
    order to reconcile all financial data submitted to the NFIP.
    
    B. Quality Control
    
        Transaction level detail will be maintained in policy and claim 
    history files for record-keeping and audit purposes.
    
    C. Quality Review of Submitted Data
    
        1. Transaction records will be edited for correct format and 
    values.
        2. Relational edits will be performed on individual transactions 
    as well as between policy and claim transactions submitted against 
    those policies.
        3. Record validation will be performed to check that the 
    transaction type is allowable for the type of policy or claim 
    indicated.
        4. Errors will be categorized as critical or non-critical. The 
    rate of critical errors in the submission of statistical data will 
    be the basis by which company performance is reported to the 
    Standards Committee. Critical errors include those made in required 
    data elements. Required data elements:
        a. Identify the policyholder, the policy, the loss, and the 
    property location;
        b. Provide information necessary to rate the policy;
        c. Provide information used in financial control; and
        d. Provide information used for actuarial review of NFIP 
    experience.
        5. Non-critical errors are those made in data elements reported 
    by the WYO Companies at their option.
    
    D. Policy Rating
    
        1. The rating will be validated by the NFIP for all policies for 
    which the following transactions have been submitted:
        a. New Business;
        b. Renewals;
        c. Endorsements involving type A transaction records; and
        d. Corrections of type A transaction records previously 
    submitted for premium transactions.
        2. Incorrect rating will be considered a critical error.
    
    E. Timeliness of Reporting
    
        1. WYO Companies will be expected to submit monthly statistical 
    and financial 
    
    [[Page 3640]]
    reports within thirty days of the end of the month of record.
        2. The NFIP will provide reports based on review of submitted 
    data within thirty days after the due date or the first processing 
    cycle subsequent to the receipt of WYO Company submissions, 
    whichever is later.
    
    F. Monthly Reports
    
        1. Reports for each WYO Company's data submission will be sent 
    to the respective WYO Company and the FIA explaining any 
    discrepancies found by the NFIP review.
        2. Reports to WYO Companies. Transaction records that fail to 
    pass the quality review or policy rating edits will be reported to 
    the appropriate Company in transaction detail with error codes, 
    classification of errors as either critical or non-critical and any 
    codes used by the Company to identify the source of the transaction 
    data.
        3. Report to WYO Companies and the FIA:
        a. Summary statistics will be generated for each monthly 
    submission of transaction data. These will include:
        i. Absolute numbers of transactions read and transactions 
    rejected by transaction type; and
        ii. Dollar amounts associated with transactions read and 
    transactions rejected.
        b. Summary statistics for all policy and claim records submitted 
    to date (which may each be the result of multiple transactions) will 
    be generated, separately for critical and non-critical errors. These 
    will include:
        i. Absolute number of policy and claim records on file and those 
    containing errors; and
        ii. Relative values for the number of records containing 
    critical errors.
        c. Control totals will be generated for tapes submitted to and 
    processed by the NFIP. This front-end balancing procedure will 
    include:
        i. Numbers of records submitted according to the NFIP compared 
    with numbers of records submitted according to the WYO Company 
    transmittal document; and
        ii. Dollar amounts submitted according to the NFIP compared with 
    dollar amounts submitted according to the WYO Company transmittal 
    document.
        d. If there is any discrepancy between the NFIP reading of 
    dollar amounts from the tape and the WYO Company tape transmittal 
    document, then the monthly statistical tape submission will be 
    rejected and returned to the Company. The rejected tape must be 
    corrected and resubmitted by the next monthly submission due date.
        e. In cases where the NFIP reconciliation of transaction level 
    detail with the financial statements does not agree with the 
    reconciliation report submitted by the WYO Company, a separate 
    report will be generated and transmitted to the Company for 
    resolution and to the FIA.
    Reporting of Company Rating to the Standards Committee and the 
    Administrator
    A. Satisfactory Rating
        An annual end of the year report will be submitted to convey the 
    satisfactory rating of WYO Companies' submission of transaction data 
    and the reconciliation of this data with financial reports.
    B. Unsatisfactory Rating
        The report of an unsatisfactory rating will be submitted as soon 
    as errors and problems reach critical threshold levels. This rating 
    will be based on: Continuing problems in reconciling transaction 
    data with financial reports; statistics on the percentage of 
    transactions submitted with critical errors; the percentage of 
    policy and claim records on file that contain critical errors; and 
    late submission of statistical and financial reports.
    Exhibit ``A''--WYO Statistical Tape Transmittal Document
    
    Date Sent: ____________ 
    
    WYOPrefix Code ____________--------------------------------------------
    
    WYO Company Name:------------------------------------------------------
    
    Address:---------------------------------------------------------------
    
    ----------------------------------------------------------------------
    
    Reel Number (S) of Enclosed Tapes:-------------------------------------
    
    ----------------------------------------------------------------------
    
    Density ____________ LRECL ____________
    
    Blocksize ____________
    
    File Name (DSN)--------------------------------------------------------
    
    Contact Person---------------------------------------------------------
    
    Contact Number---------------------------------------------------------
    
    IBU Number ________________ (WYO Use Only
    
    Monthly Reconciliation--Net Written Premiums
    
    Company name-----------------------------------------------------------
    Month/year ending------------------------------------------------------
    Co. NAIC No------------------------------------------------------------
    Date submitted---------------------------------------------------------
    Preparer's name--------------------------------------------------------
    Telephone No-----------------------------------------------------------
    
    ----------------------------------------------------------------------------------------------------------------
                                                                Monthly statistical transactions report             
               Monthly financial report           ------------------------------------------------------------------
                                                              Trans. code              Record count   Premium amount
    ----------------------------------------------------------------------------------------------------------------
    Net Written premiums.........................  $                                                                
        (Income statement=Line 100)..............  11                                 ..............       $        
                                                   15                                 ..............  ..............
                                                   17                                 ..............  ..............
    Unprocessed statistical:                                                                                        
        (+) Prior month's........................  20                                 ..............  ..............
        (-) Current month's......................  23                                 ..............  ..............
    Other--Explain:                                                                                                 
        (+) Current month's......................  26                                 ..............             (-)
        (-) Prior month's........................  29                                 ..............             (-)
                                                   14 and 81                          ..............             (+)
          Total..................................  Total: Add 11 Through 23 less 26                                 
                                                    and 29                                                          
    Comments:                                                                                                       
    ----------------------------------------------------------------------------------------------------------------
    
    Monthly Reconciliation--Losses
    
    Company name-----------------------------------------------------------
    Month/year ending------------------------------------------------------
    Co. NAIC No------------------------------------------------------------
    Date submitted---------------------------------------------------------
    
    ----------------------------------------------------------------------------------------------------------------
                                                                                                         Loss/paid  
                                                              Trans. code              Record count     recoveries  
    ----------------------------------------------------------------------------------------------------------------
    100 Net paid losses..........................                                                                   
        (Income statement line 115)                                                                                 
    Unprocessed statistical:                                                                                        
                                                   31                                 ..............       $        
        140 (+) Prior month's....................  34                                 ..............  ..............
                                                   37                                 ..............  ..............
        150 (-) Current month....................  40                                 ..............  ..............
    
    [[Page 3641]]
                                                                                                                    
                                                   43                                 ..............  ..............
        160 Salvage not to be reported by                                                                           
         transaction (explain)                                                                                      
        170 Other--Explain.......................  46 and 61                          ..............  ..............
                                                   49                                 ..............  ..............
                                                   64                                 ..............  ..............
                                                   84 amd 87                          ..............  ..............
                                                   52 Recovery                        ..............  ..............
                                                   Salvage                            ..............  ..............
                                                   Subrogation                        ..............  ..............
                                                   67 Recovery                        ..............  ..............
                                                   Salvage                            ..............  ..............
                                                   Subrogation                        ..............  ..............
          Total: (Sum of Lines 100, 140, 160, and  Total: (Add 31, 34, 40 through 64  ..............  ..............
           170 less 150).                           less 52 and 67)                                                 
    Comments:                                                                                                       
    ----------------------------------------------------------------------------------------------------------------
    
    
    
    Monthly Reconciliation--Special Allocated LAE
    
    Company name-----------------------------------------------------------
    Month/year ending------------------------------------------------------
    Co. NAIC No------------------------------------------------------------
    Date submitted---------------------------------------------------------
    
    ----------------------------------------------------------------------------------------------------------------
                                                                 Monthly statistical transaction report             
               Monthly financial report           ------------------------------------------------------------------
                                                              Trans. code              Record count       Amounts   
    ----------------------------------------------------------------------------------------------------------------
    Special allocated loss adjustment expenses                                                                      
        (Other loss and LAE Calc.--Line 655)                                                                        
                                                   71                                 ..............       $        
                                                   74                                 ..............  ..............
    Unprocessed statistical:                                                                                        
        (+) Prior Month..........................  .................................  ..............  ..............
        (-) Current Month........................  .................................  ..............  ..............
    Other--Explain:                                                                                                 
        (1)......................................  .................................  ..............  ..............
        (2)......................................  .................................  ..............  ..............
          Total:.................................  Total:                             ..............  ..............
    Comments:                                                                                                       
    ----------------------------------------------------------------------------------------------------------------
    
    Monthly Reconciliation--Net Policy Service Fees
    
    Company name-----------------------------------------------------------
    Month/year ending------------------------------------------------------
    Co. NAIC No------------------------------------------------------------
    Date submitted---------------------------------------------------------
    
    ----------------------------------------------------------------------------------------------------------------
                                                                 Monthly statistical transaction report             
               Monthly financial report            -----------------------------------------------------------------
                                                                                       Record count     Fee amount  
    ----------------------------------------------------------------------------------------------------------------
    Net Policy Service                                                                                              
    Fees $____________ (Income Statement--Line                                                                      
     170)                                                                                                           
                                                                                                                    
    Unprocessed statistical:                                                                                        
                                                                                                                    
        (+) Prior Month's ____________............                                                                  
                                                                                                                    
        (-) Current Month's ____________..........                                                                  
                                                                                                                    
    Other--Explain:                                                                                                 
                                                                                                                    
        (1) ____________..........................                                                                  
                                                                                                                    
        (2) ____________..........................                                                                  
                                                                                                                    
          Total ____________                        Total ____________..............                                
    Comments:                                                                                                       
    ----------------------------------------------------------------------------------------------------------------
    
    (Approved by the Office of Management and Budget under OMB control 
    number 3067-0169.)
    
    Part 2--Claims Reinspection Program
    
    WYO--NFIP Claims Reinspection Program
    
        To keep WYO-NFIP Claims Management informed, to assist in the 
    overall claims operation, and to provide necessary assurances and 
    documentation for dealing with GAO, Congressional Oversight 
    Committees, and the public, the FIA and WYO Companies have 
    established a Claims Reinspection Program.
        The Program is comprised of the following major elements:
        A. All files are subject to reinspection.
        B. Files for reinspection may be randomly selected by flood 
    event, or size of loss, or class of business, as determined by WYO-
    NFIP Claims Management.
        C. WYO-NFIP Claims Management will utilize a binomial table to 
    define sample size for reinspections prior to payment. A larger 
    sample may be used depending upon error ratio.
        D. An agreed upon sample of closed files, by event, will be 
    subjected to reinspection as well.
    
    [[Page 3642]]
    
        E. A WYO representative will conduct the reinspection, 
    accompanied by an NFIP General Adjuster.
        F. A joint, single report will be issued by the WYO Company 
    representative and the NFIP General Adjuster.
        G. Copies of reinspection reports will be forwarded to the 
    Claims Management of both the WYO Company and the NFIP.
    
    Part 3--Financial Audits, Underwriting Audits, Claims Audits, 
    Audits for Cause, and State Insurance Department Audits
    
    A. Biennial Financial Audits
    
        1. Objectives of WYO Biennial Financial Audit. The biennial 
    financial audit is intended to provide the Federal Emergency 
    Management Agency with independent assessment of the quality of 
    financial controls over activities relating to the Company's 
    participation in the National Flood Insurance Program as well as the 
    integrity of the financial data reported to FEMA.
        a. Participating WYO companies are responsible for selecting and 
    funding independent Certified Public Accounting firms to conduct the 
    biennial audits. Such costs are considered part of the normal 
    administrative cost of operating the WYO program and as such are 
    included in the WYO expense allowance.
        b. The WYO Company's representative will be notified in writing 
    to arrange for a biennial audit. This notice should provide the WYO 
    Company at least 120 days to prepare for the biennial audit.
        c. It is also intended that the biennial audit will reduce if 
    not eliminate the need for FEMA auditors or their designees to 
    conduct on-site visits to WYO companies in their review of financial 
    activity. However, the requirement may still exist for such visits 
    to occur as determined by the auditors. The CPA firm's audit shall 
    be performed in accordance with GAO yellow book requirements. 
    Further, the CPA firm is required to select its own sample, even 
    though FIA may provide them with pre-selected policy and claim files 
    for review. In addition, nothing in this section should be construed 
    as limiting the ability of the General Accounting Office or FEMA's 
    Office of Inspector General to review the activities of the WYO 
    Program.
        d. The purpose of the biennial audit is to provide opinion on 
    the fairness of the financial statements, the adequacy of internal 
    controls, and the extent of compliance with laws and regulations.
    
    B. Audits for Cause
    
        In accordance with the terms of the Arrangement, the 
    Administrator, on his/her own initiative or upon recommendation of 
    the WYO Standards Committee or the FEMA Inspector General, may 
    conduct for-cause audits of participating companies. The following 
    criteria, in combination or independently may constitute the basis 
    for initiation of such an audit.
    
    1. Underwriting
    
        a. Excessively high frequency of errors in underwriting:
        i. Issuing policies for ineligible risks.
        ii. Issuing policies in ineligible communities.
        iii. Consistent premium rating errors.
        iv. Missing or insufficient documentation for submit for rate 
    policies.
        v. Other patterns of consistent errors.
        b. Abnormally high rate of policy cancellations or non-renewals.
        c. Policies not processed in a timely fashion.
        d. Duplication of policy coverage noted.
        e. Problems with Rollover from National Flood Insurance Program 
    (NFIP) to WYO (duplication of coverage, timeliness of changeover).
        f. Relational type edits indicate an unusually high or low 
    premium amount per policy for the geographical area.
        g. Biennial audit results indicate unusual volume of errors in 
    underwriting.
    
    2. Claims
    
        a. Reinspection indicates consistent patterns of:
        i. Losses being paid when not covered.
        ii. Statistical information being reported on original loss 
    adjustment found to be incorrect on reinspection.
        iii. Salvage/subrogation not being adequately addressed.
        iv. Consistent overpayment of claims.
        b. Unusually high count of erroneous assignments and/or claims 
    closed without payment (CWP). (WYO Company is paid a flat fee for 
    CWP cases where little or no work is done--risk is fraudulent CWP 
    cases).
        c. Unusually low count of CWP. (May indicate inadequate follow-
    up of claims submitted).
        d. Average claim payments which significantly exceed the average 
    for the Program as a whole.
        e. Lack of (adequate) documentation for paid claims.
        f. Claims not processed in a timely fashion.
        g. Consistent failure of WYO Company to receive authorization 
    for special allocated loss adjustment expenses prior to incurring 
    them.
        h. High submission of Special Allocated Loss Adjustment Expenses 
    (SALAE).
        i. Consistently high policyholder complaint level.
        j. Low/high count of salvage/subrogation.
        k. Biennial audit indicates significant problems.
    
    3. Financial Reporting/Accounting
    
        a. Consistently high reconciliation variations and/or errors in 
    statistical information.
        b. Financial and/or statistical information not received in a 
    timely fashion.
        c. Letter of Credit violations are found.
        d. WYO Company is not depositing funds to the Restricted Account 
    in a timely manner, or funds are not being transferred through the 
    automated clearinghouse on a timely basis.
        e. Premium suspense is consistently significant, older than 60 
    days, and/or cannot be detailed sufficiently.
        f. Large/unusual balance in Cash-Other (Receivable and/or 
    Payable).
        g. Large, unexplained differences in cash reconciliation.
        h. Large/unusual balances or variations between months noted for 
    key reported financial data.
        i. Financial statement to statistical data reconciliation sheets 
    improperly completed indicating proper review of information is not 
    being performed prior to signing certification statement.
        j. Repeated failure to respond fully in a timely manner to 
    questions raised by FIA or its servicing agent concerning monthly 
    financial reporting.
        k. Biennial audit indicates significant problems.
    
    C. Underwriting Audit
    
        1. Samples of new business policies, renewals, endorsements and 
    cancellations will be provided by the FIA with the biennial audit 
    instructions, including samples of the Mortgage Portfolio Protection 
    business, where applicable. The audit is to be conducted in 
    accordance with GAO yellow book requirements. The CPA firm may 
    supplement with its own sample of risks which were in-force during 
    all or part of the Arrangement Year under audit for detail testing.
        2. Underwriting Audit Outline.
        a. Review of the Underwriting Department's responsibilities, 
    authorities and composition.
        b. Personal interviews with management and key clerical 
    personnel to determine current processing activities, planned 
    changes and problems.
        c. Administrative review to verify compliance with company 
    procedures.
        d. Thorough examination of a random sample of underwriting files 
    to measure the quality of work. The CPA firm is expected to provide 
    a representative sample of its review to substantiate its opinion 
    and findings. At a minimum, the files should be reviewed to verify 
    the following:
        i. Policies are issued for eligible risks;
        ii. Rates are correct and consistent with the amount of 
    insurance requested on the application.
        iii. Waiting period for new business is consistent with 
    government regulations;
        iv. Elevation certification or difference is correctly shown on 
    application;
        v. The coverage does not include more than one building and/or 
    its contents per policy;
        vi. No binder is effective unless issued with the authorization 
    of FIA;
        vii. The FIRM zone shown on the application is applicable to the 
    community in which the property is located;
        viii. Community shown on application is eligible to purchase 
    insurance under the NFIP;
        ix. Information on type of building, etc., is fully complete;
        x. Applicable deductibles are recorded;
        xi. A new, fully completed application or a photocopy of the 
    most recent application, or similar documentation, with the 
    appropriate updates to reflect current information is on file for 
    each risk, including those formerly written by the NFIP Servicing 
    Facility;
        xii. If any files to be audited are unavailable, determine the 
    reason for the absence.
        e. Endorsement Processing.
        1. Complete tasks as applicable.
        2. Review requests for additional coverage to ensure that they 
    are subject to the waiting period rule.
    
    [[Page 3643]]
    
        3. Review controls established to ensure that no risk is insured 
    under endorsement provisions that are not acceptable as a new 
    business risk (i.e., a property located in a suspended community).
        f. Cancellation Processing. Verify controls to ensure that one 
    of the necessary reasons for cancellation exists and that the 
    transaction is accompanied by proper documentation.
        g. Renewal Processing. Determine controls to ensure that all 
    necessary information needed to complete the transaction is 
    provided.
        h. Expired Policies. Determine controls to ensure that each step 
    is carried out at the proper time.
        i. Observance of Waiting Period. Establish procedures to 
    document, as a matter of WYO Company business record and in each 
    transaction involving a new application, renewal, and endorsement, 
    that any applicable effective date and premium receipt rules have 
    been observed (44 CFR 61.11). Documentation reasonably suitable for 
    the purpose includes retention of postmarked envelopes (for three 
    (3) years) from date, date-stamping and retention (via hard copy or 
    microfilm process) of application, renewal and endorsement documents 
    and checks received in payment of premium; computer input of 
    document and premium receipt transactions and retention of such 
    records in the computer system; and other reasonable insurer methods 
    of verifying transactions involving requests for coverage and 
    receipts of premium.
    
    D. Claims Audit Outline
    
        1. Review of the Claims Department's responsibilities, 
    authorities, and composition.
        2. Personal interviews with management and key clerical 
    personnel to determine current processing activities, planned 
    changes and problems.
        3. Administrative review to verify compliance with company 
    procedures.
        4. Thorough examination of a random sample of claims files which 
    may be provided by FIA to measure the quality of work. At a minimum, 
    the files should be reviewed to verify the following:
        a. Verify controls to ensure that a file is set up for each 
    Notice of Loss received.
        b. Review adjuster reports to determine whether they contain 
    adequate evidence to substantiate the payment or denial of claims, 
    including amount of losses claimed, any salvage proceeds, 
    depreciation and potential subrogation.
        c. Ascertain that building and contents allocations are correct.
        d. Determine whether the file contains evidence identifying 
    subrogation possibilities.
        e. Verify that partial payments were properly considered in 
    processing the final draft or check.
        f. Verify that the loss payees are listed correctly (consider 
    insured and mortgagee).
        g. Verify that the total amount of the drafts or checks is 
    within the policy limits.
        h. Ascertain the relevance and validity of the criteria used by 
    the carrier to judge effectiveness of its claims servicing 
    operation.
        i. Confirm that when information is received from an independent 
    adjuster, the examiner either acts promptly to give proper feedback 
    with instructions or takes action to pay or deny the loss.
        j. Determine whether the Claims Department is using an 
    ``impression of risk'' program in reporting misrated policies, etc.
        k. Where attempts at fraud occur, verify that these instances 
    are being reported to FIA for referral to the FEMA Inspector 
    General's office.
        l. If any files to be audited are unavailable, determine the 
    reason for their absence. In undertaking this portion of the 
    biennial audit, the Administrative Review Checklist (Exhibit B) 
    below should be utilized.
    
    Exhibit ``B''--Administrative Review Checklist
    
    Policy #
    Insured's name:
    State:
    Date of loss:
    Date paid:
    Date reported:
    Amt. of loss: $
    Bldg. $
    Contents $
    Adjusting firm:
    Examiner's name:
    Comments
    
    
    1. Investigation and Adjustments                                        
        A. Application of Coverage                  Yes        No       N/A 
            (1) Insurable interest?...........     [  ]      [  ]      [  ] 
            (2) Is loss from the flood peril?.     [  ]      [  ]      [  ] 
            (3) Did loss occur within the                                   
             policy term?.....................     [  ]      [  ]      [  ] 
            (4) Does location and description                               
             of risk coincide with policy                                   
             information?.....................     [  ]      [  ]      [  ] 
            (5) Were proper deductibles                                     
             applied?.........................     [  ]      [  ]      [  ] 
            (6) Other insurance considered?...     [  ]      [  ]      [  ] 
            (7) Other losses?.................     [  ]      [  ]      [  ] 
        b. Application of Sound Adjusting                                   
         Practices                                                          
            (1) Was adjuster's report accurate/                             
             complete?........................     [  ]      [  ]      [  ] 
            (2) Was an attorney used in the                                 
             settlement?......................     [  ]      [  ]      [  ] 
            (3) Was a technical expert used in                              
             the settlement?..................     [  ]      [  ]      [  ] 
        c. Documentation                                                    
            (1) Are damages clearly                                         
             identified?......................     [  ]      [  ]      [  ] 
            (2) Are damages flood related?....     [  ]      [  ]      [  ] 
            (3) Are damages clearly and                                     
             completely itemized and                                        
             documented by the adjuster?......     [  ]      [  ]      [  ] 
            (4) Was depreciation considered?..     [  ]      [  ]      [  ] 
            (5) Has subrogation been                                        
             considered?......................     [  ]      [  ]      [  ] 
            (6) Has salvage been properly                                   
             handled?.........................     [  ]      [  ]      [  ] 
            (7) Was salvage timely?...........     [  ]      [  ]      [  ] 
    2. Supervision                                                          
        a. Assignments                                                      
            (1) Are assignments made promptly?     [  ]      [  ]      [  ] 
            (2) Is insured contacted promptly?     [  ]      [  ]      [  ] 
        b. Reserves                                                         
            (1) Are initial reserves indicated                              
             on the first report?.............     [  ]      [  ]      [  ] 
            (2) Are they adequate?............     [  ]      [  ]      [  ] 
            (3) Does final settlement compare                               
             favorably with last reserve                                    
             established?.....................     [  ]      [  ]      [  ] 
        c. Diary Control                                                    
            (1) Automatic?....................     [  ]      [  ]      [  ] 
            (2) Timely?.......................     [  ]      [  ]      [  ] 
            (3) Is file reviewed at diary date                              
             with examiner's comments?........     [  ]      [  ]      [  ] 
        d. Examiner Evaluation and Settlement                               
         Performances                                                       
            (1) Is examiner directing adjuster                              
             when needed?.....................     [  ]      [  ]      [  ] 
            (2) Are files documented?.........     [  ]      [  ]      [  ] 
            (3) Is adequate control maintained                              
             over in-house adjuster?..........     [  ]      [  ]      [  ] 
            (4) Is adequate control maintained                              
             over outside adjuster?...........     [  ]      [  ]      [  ] 
    
    [[Page 3644]]
                                                                            
        e. Salvage and Subrogation                  Yes        No       N/A 
            (1) Is salvage evaluated by                                     
             salvors?.........................     [  ]      [  ]      [  ] 
            (2) Is salvage disposed of                                      
             promptly?........................     [  ]      [  ]      [  ] 
            (3) Are salvage returns adequate?.     [  ]      [  ]      [  ] 
            (4) Is potential subrogation being                              
             promptly and properly                                          
             investigated?....................     [  ]      [  ]      [  ] 
            (5) Are proper subrogation forms                                
             used?............................     [  ]      [  ]      [  ] 
            (6) Are subrogation and salvage                                 
             files properly opened, diaried,                                
             and referred (if appropriate)?...     [  ]      [  ]      [  ] 
            (7) Are recovery funds for                                      
             subrogation and salvage being                                  
             properly handled?................     [  ]      [  ]      [  ] 
        f. Suits                                                            
            (1) Are suits properly identified?     [  ]      [  ]      [  ] 
            (2) Are suits being properly                                    
             evaluated?.......................     [  ]      [  ]      [  ] 
            (3) Are suits being referred to                                 
             attorneys promptly?..............     [  ]      [  ]      [  ] 
            (4) Are attorneys being advised as                              
             to handling settlement or                                      
             compromise?......................     [  ]      [  ]      [  ] 
            (5) Are suits being properly                                    
             controlled?......................     [  ]      [  ]      [  ] 
            (6) Are suits files properly                                    
             diaried?.........................     [  ]      [  ]      [  ] 
            (7)-(8) [Reserved]................     [  ]      [  ]      [  ] 
        g. Other                                                            
            (1) Was there other coverage by                                 
             the WYO Company?.................     [  ]      [  ]      [  ] 
            (2) Were damages correctly                                      
             apportioned?.....................     [  ]      [  ]      [  ] 
            (3) Was a solo adjuster used?.....     [  ]      [  ]      [  ] 
            (4) Were there prior flood claims?     [  ]      [  ]      [  ] 
            (5) Were prior damages repaired?..     [  ]      [  ]      [  ] 
            (6) Were prior claim files                                      
             reviewed?........................     [  ]      [  ]      [  ] 
            (7) Was a congressional complaint                               
             letter in file?..................     [  ]      [  ]      [  ] 
            (8) Was it responded to promptly?.     [  ]      [  ]      [  ] 
            (9) Is the statistical reporting                                
             correction file being properly                                 
             managed?.........................     [  ]      [  ]      [  ] 
                                                                            
    
    
    
    E. State Insurance--Department Examination
    
        1. It is expected that audits of WYO Companies by independent 
    accountants and/or state insurance departments, aside from those 
    conducted by the FIA or its designee, will include flood insurance 
    activity. When such audits occur, a financial officer for the WYO 
    Company will notify the FIA, identifying the auditing entity and 
    providing a brief statement of the overall conclusions that relate 
    to flood insurance and the insurer's financial condition, when 
    available. In the case of an audit in progress, a brief statement on 
    the scope of the audit should be provided to the FIA. A checklist 
    will be utilized for this reporting and will be provided to WYO 
    Companies by the FIA.
        2. The WYO Companies will maintain on file the reports resulting 
    from audits, subject to on-site inspection by the FIA or its 
    designee. At the FIA's request, the WYO Company will submit a copy 
    of the auditor's opinion, should one be available, summarizing the 
    audit conclusion. ``(Approved by the Office of Management and Budget 
    under OMB control number 3067-0169)''
    
    Part 4--Reports Certifications
    
    A. Certification Statement for Monthly Financial and Statistical 
    Reconciliation Reports
    
        I have reviewed the accompanying financial and statistical 
    reconciliation reports of XYZ Company as of ____________. All 
    information included in these statements is the representation of 
    the XYZ Company.
        Based on my review (with the exception of the matter(s) 
    described in the following paragraphs, if applicable), I certify 
    that I am not aware of any material modifications that should be 
    made to the accompanying reports.
    
    Signed-----------------------------------------------------------------
    (Responsible Financial Officer)
    
    Date-------------------------------------------------------------------
    
    B. Certification Statement for Monthly Statistical Transaction Report
    
        I have reviewed the accompanying statistical transaction report 
    control totals in conjunction with appropriate statistical 
    reconciliation reports. All information included in these reports is 
    the representation of the XYZ Company.
    
    ``(Approved by the Office of Management and Budget under OMB control 
    number 3067-0169.)''
    
    Signed-----------------------------------------------------------------
    (Responsible Reporting Officer)
    
    Date-------------------------------------------------------------------
    
    (Catalog of Federal Domestic Assistance No. 83.100, ``Flood 
    Insurance'')
    
        Dated: January 25, 1996.
    Elaine A. McReynolds,
    Administrator, Federal Insurance Administration.
    [FR Doc. 96-2089 Filed 1-31-96; 8:45 am]
    BILLING CODE 6718-05-M
    
    

Document Information

Published:
02/01/1996
Department:
Federal Emergency Management Agency
Entry Type:
Proposed Rule
Action:
Proposed rule.
Document Number:
96-2089
Dates:
We invite your comments and ask that you submit them no later than March 18, 1996.
Pages:
3635-3644 (10 pages)
RINs:
3067-AC40: National Flood Insurance Program; Audit Program Revision
RIN Links:
https://www.federalregister.gov/regulations/3067-AC40/national-flood-insurance-program-audit-program-revision
PDF File:
96-2089.pdf
CFR: (2)
44 CFR 1345
44 CFR 62.23