It pays to Complain!

This newly issued press release from the CDI is evidence that complaints do matter. If you are having trouble with an insurance company's claims department, the magic words, as seen below, are "UNFAIR CLAIMS PRACTICES" and "DEPARTMENT OF INSURANCE COMPLAINT". Although "Market Conduct Examinations" happen on a routine basis (about once every 5 years), numerous similar complaints will often trigger early exams. And when it comes to matters involving seniors, California is all over them.

Enjoy the reading!

CALIFORNIA DEPARTMENT OF INSURANCE TAKES ACTION AGAINST INSURER
FOR UNFAIR CLAIMS HANDLING PRACTICES
Alleged mishandled claims include long term care, disability income and life insurance

The California Department of Insurance today announced the filing of an administrative enforcement action against RiverSource Life Insurance company for unfair claims handling practices affecting claims under long term care, disability income and life insurance policies.

The enforcement action focuses primarily on long term care policies and alleges that RiverSource mishandled numerous long term care claims and failed to adopt practices to assure that long term care and other policy benefits were paid. The action also alleges that RiverSource adopted business practices that were specifically designed to deny long term care benefits. The long term care claims typically involved persons in their 70's, 80's and 90's, including persons suffering from Alzheimer's disease and other impairments.

In addition to numerous examples of deficient claims handling, the enforcement action alleges that RiverSource systematically delayed investigating claims and intentionally created impediments to receiving policy benefits. Among other practices, RiverSource would not reasonably assist long term care policyholders in locating care facilities, requiring them to guess which facilities RiverSource might pay for, and putting them at risk of either receiving no benefits or moving multiple times until they found a facility that RiverSource would approve.

The enforcement action also alleges that RiverSource systematically denied coverage in facilities by requiring strict compliance with antiquated policy language drafted decades ago that no longer reasonably applies to the long term care industry.

The action is based on a Department of Insurance market conduct examination of RiverSource's own claims handling files. The action seeks penalties based on the violations found in the examination, plus penalties based on a proportional extrapolation of the violations found in the examination to all California claims handled by RiverSource.

The Insurance Code provides for penalties of up to $10,000 for each willful claims handling violation, $10,000 for each willful violation of long term care laws in particular, and $500,000 for each long term care general business practice in violation of long term care statutes.

9/22/2011 11:19 am