CT Insurance Bulletin PC-83
Public Act No. 16-136 - Automobile and Homeowners Insurance Third Party Designation (This Bulletin rescinds and replaces Bulletin PC-51)
STATE OF CONNECTICUT
INSURANCE DEPARTMENT
Bulletin PC-83
January 13, 2017
TO: ALL PROPERTY & CASUALTY INSURERS AUTHORIZED FOR PERSONAL
LINES INSURANCE PRODUCTS
RE: PUBLIC ACT NO. 16-136- AUTOMOBILE AND HOMEOWNERS INSURANCE
THIRD PARTY DESIGNATION
Effective October 1, 2017, Public Act No. 16-136, AN ACT CONCERNING HOMEOWNERS
AND MOTOR VEHICLE INSURANCE POLICIES (the "Act"), amends section 38a-323a of
the Connecticut General Statutes to require that personal lines automobile and homeowners
insurers include a conspicuous statement with the policy specifying that any named insured may
designate a third party to receive notice of cancellation or nonrenewal of the policy. Prior law
only permitted senior citizens to designate a third party to receive such notices. This Bulletin is
intended to update Bulletin PC-51 to reflect the changes made by Public Act No. 16-136.
Section 2 of the Act requires that the statement shall be in a form approved by the Insurance
Commissioner. Below, the Department has updated the Commissioner-approved form referred to
in Bulletin PC-51. Connecticut Designation Form 1-2016 meets the Act's requirements and is
approved for use by insurers. Insurers that provide the required statement using this form do not
need to file their form for approval. All such notices and copies shall be mailed to the policyholder
and third party designee in an envelope clearly marked on its face with the following:
"IMPORTANT INSURANCE POLICY INFORMATION: OPEN IMMEDIATELY"
A cancellation or nonrenewal notice is not effective ifthe company fails to give the required notice
to both the individual named insured and the third party designee.
Companies should review their procedures and bring them into compliance with Connecticut law.
Please call the Property & Casualty Division at 860-297-3867, if you have any questions
concerning this Bulletin.
L. Wwfc-
Katharine L. Wade
Insurance Commissioner
www.ct.gov/cid
P.O. Box 816 • Hartford, CT 06142-0816
An Equal Opportunity Employer
-----------------
----------------
----------------
[The company may modify font type and size, reformat information or add a company
name and logo]
IMPORTANT NOTICE
THIRD PARTY NOTIFICATION
If you are a named insured, Connecticut law permits you to designate a third party to whom we will send a
duplicate copy of any cancellation or nonrenewal notice issued to you for your automobile and/or
homeowner's policies.
If you are interested in designating someone to receive such duplicate notices, you should discuss this with
them and obtain their approval. Complete the lower portion of this form by:
I.
Entering the third party's name and address;
2.
Signing and dating this form;
3.
Having the third party sign and date it; and
4.
Returning it [certified mail, return receipt requested,] to:
(Show insurance company name and address here)
Keep a copy ofthe completed form for your records. The third party designation will become effective no
later than ten ( l 0) business days after we receive the completed form signed by both you and the third party
designee. You may terminate the third party designation by sending written notification [by certified mail,
return receipt requested,] to the designated third party and us.
Request To Designate a Third Party to Receive a Copy of Policy Termination Notices
Insured's Name
Policy Number _______
Address
Check Policy Type: Homeowners
Automobile
I designate the following person to receive a duplicate copy of any cancellation or nonrenewal notice that
you might send me for the policy number shown above.
Name:
Street:
City: ---------------State: _________ ZIP: ---------
Signature of Insured
Date
I accept the designation above. I understand my designation as a third party shall not constitute
acceptance of any liability on my part or the insurer for services provided to the insured. IfI decide
to terminate my designation, I must send written notification (by certified mail, return receipt
requested,] to both the insured and the insurer.
Signature of Third Party Designee
Date
[The company may omit information in brackets]
CT Designation Form 1-2016