Posted: Mon May 26, 2008 1:19 pm Post subject: Hi all..
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i normally have more than one of those items each day that i can add to my insurance news blog.
Great job davet. !
It is this discovery of facts that would help others..& get your blog in demand. See, if you come across anything interesting, do share it with us within the community as well. May be you could save or help us from a possible loss or threat.
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Unfortunately, there are many bad apples in this industry, which doesn't help the public image of insurance agents.
Hi Salpro22, bad apples as per my notion don't find a place for good. I've heard of independent agents who've worked honestly & earned a name for themselves within the industry. Now, once they have operated over a broader arena, they have been able to create good databases upon the bond of cooperation & more importantly trust. Am I right!
Wow! I must have been asleep and just missed this one. I wonder if FK is still around? I'd really like to join this thread.
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Any organizations or associations, other than the FBI and the Justice Department's National Level Insurance Fraud Working Group that have Charged *any* Insurance Co. with Criminal fraud perpetrated against their policyholders?
I think the word "criminal" tends to be a bit confusing here. Insurance companies are not usually charged with criminal fraud. That would be like charging a car for the actions of its driver. Instead the States' Market Conduct Divisions complete their investigations and make recommendations. These often result in huge monetary penalties and types of injunctive relief.
It is the officers, employees, and agents who are charged, fined, and even incarcerated for cheating the policy holders.
Are these the types of links you're looking for?
United Healthcare Insurance Company of Hartford, Connecticut
Order Number: 080013
Date of Order: 1/10/2008
Order Final In: January
Action Taken: $166,667 fine
Violation: Failed to renew small employer group health benefit plans; Failed to market small employer health benefit plans as required
Mercy Health Plans of Missouri, Inc of Chesterfield, MO
Order Number: 080006
Date of Order: 1/4/2008
Order Final In: January
Action Taken: $100,000 fine
Violation: Failed to pay clean claims in a timely manner
Home Life Financial Assurance Corporation of Piscataway, New Jersey
Order Number: 080020
Date of Order: 1/10/2008
Order Final In: January
Action Taken: Utilization Review Agent certificate of authority revoked
Violation: Failed to comply with Commissioner’s Order
Allstate Texas
Order Number: 080011
Date of Order: 1/10/2008
Order Final In: January
Action Taken: $10,000 fine; Must file reports on status of all complaints
Violation: Allegedly failed to timely acknowledge and respond to claims following Hurricane Rita
Combined Insurance Company of America of Glenview, Illinois
Order Number: 071092
Date of Order: 12/10/2007
Order Final In: December
Action Taken: $30,000 fine
Violation: Failed to pay clean claims in a timely manner
Mega Life and Health Insurance of North Richland Hills
Order Number: 080124
Date of Order: 2/15/2008
Order Final In: February
Action Taken: $225,000 fine
Violation: Failed to pay clean claims in a timely manner
Great-Western Life & Annuity Insurance Company of Greenwood Village, Colorado
Order Number: 080363
Date of Order: 4/23/2008
Order Final In: April
Action Taken: $8,000 fine
Violation: Applied discounts to out of network claims when not contractually entitled to do so
And to bring things a little closer to home:
CA State Department of Insurance examiners reviewed files drawn from the category of Closed Claims for the period July 1, 2003 through June 30, 2004, commonly referred to as the "review period". The examiners reviewed 353 MLIC claim files, 15 GALIC claim files, one GLIC claim file, one MLI claim file, 22 MLI-CA claim files, 12 MLI-USA claim files, two MIAC claim files, and four NELIC claim files. The examiners cited 46 claims handling violations of the Fair Claims Settlement Practices Regulations and/or California Insurance Code Section 790.03 within the scope of this report. Further details with respect to the files reviewed and alleged violations are provided in the following tables and summaries.
MLIC (A)
LINE OF BUSINESS / CATEGORY
CLAIMS FOR REVIEW PERIOD REVIEWED
CITATIONS
Life Individual
4,214
40
5
Life Group
1,828
40
4
Disability Individual Income
109
33
9
Disability Group Long Term Income
1,964
66
4
Disability Group Short Term Income
2,292
66
5
Disability Group Dental
579,234
68
6
Disability Individual Medical
2,215
20
6
Disability Group Medical
955
20
0
TOTALS
592,811
353
39
Are there any other questions I can help you with? _________________ Please feel free to go to my website at www.markcolbert.com or, if you have a specific question, you can email me directly. I hope I can answer any questions you might have. If not, I can certainly find an answer right away.
