FAQ - Disclosure Statement

Q. What is the D-1 Statement?

A. The D-1 statement is a freestanding document in 16-point, bold type containing wording specified by statute. The disclosure statement must be signed by the applicant at the time the producer accepts an application for any insurance policy issued by a nonadmitted insurer, other than a renewal of that policy. Refer to CIC Section 1764.1 for specific wording.

Q. Who is responsible for maintaining a copy of the D-1 statement?

A. The agent, broker, or surplus line broker who received the originally signed D-1 statement from the insured must maintain the original in his or her records for a period of at least five years and send copies of the D-1 to all agents, brokers, or surplus line brokers involved in the transaction. [NOTE: From recent discussions with the CDI, we understand that the requirement to send copies of the D-1 to all other agents, brokers or surplus line brokers will be considered satisfied if the surplus line broker obtains and maintains a copy of the signed D-1.] Refer to Exhibit VI for a sample of the D-1 statement.

Q. Is it necessary for a surplus line broker to file a copy of the D-1 statement with the policy submitted to the SLA?

A. It is not necessary for a surplus line broker to file a copy of the D-1 statement with the SLA.

Q. Does an Industrial Insured have to sign the D-1 Statement?

A. The D-1 statement is not required to be signed by the applicant for a renewal of a policy.

Q. Who qualifies as an Industrial Insured?

A. The insured who employs at least 25 employees on average during the prior 12 months and has aggregate annual premiums for insurance for all risks other than workers’ compensation and health coverage totaling no less than $25,000.00.
OR
The insured who obtains its insurance through a full-time employee acting as insurance manager or a continuously retained insurance consultant (but such consultant may not be an insurance producer or sub-producer involved in the placement)

Q. What is the D-2 statement?

A. The D-2 disclosure statement contains substantially the same wording as the D-1 disclosure statement but does not require a signature by the insured. Every policy issued by a nonadmitted insurer and every certificate evidencing the placement of insurance must contain, or have affixed on the front by the insurer or surplus line broker, this disclosure statement in 16-point bold type

Q. Is the D-2 statement required for the renewal of a policy?

A. The D-2 statement is required for the renewal of a policy.

Q. Is it necessary for a surplus line broker to file a copy of the D-2 statement with a policy submitted to the SLA?

A. It is not necessary for a surplus line broker to file a copy of the D-2 statement with a policy submitted to the SLA.