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Administrative Orders - 2007
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Orders require Adobe Acrobat© Reader, available free. |
| ACE American Insurance Company |
| Philadelphia, Pennsylvania |
| Violation: Issued a group health insurance policy to unapproved associations. |
| Penalty: $15,000 fine |
| Date of Order: 04/30/2007; Amended: |
| Final |
| AIU Insurance Company American Home Assurance Company AIG Casualty Company Commerce and Industry Insurance Company Granite State Insurance Company Illinois National Insurance Company National Union Fire Insurance Company of Pittsburgh PA New Hampshire Insurance Company The Insurance Company of the State of Pennsylvania |
| Violation: Failed to comply with Oregon laws for processing claims of injured workers and reporting proof of insurance coverage. Used unapproved policy forms. Failed to accurately report workers' compensation premiums and claims data. |
| Penalty: $5 million fine, with $4 million suspended. The companies must comply with corrective actions contained in the order to avoid paying the suspended fine. |
| Date of Order: 07/05/2007; Amended: 01/28/2008 |
| Stipulation and Final Order |
| Amendment of Stipulation and Final Order |
| Amended Exhibit A |
| Exhibit B |
| Farmers Insurance Company of Oregon |
| Tigard, Oregon |
| Violation: A market conduct examination of Farmers as of December 31, 2004, found that the company did not comply with Oregon insurance credit scoring laws. Farmers also did not handle automobile total loss settlements in accordance with policy provisions and statues and rules. |
| Penalty: $20,000 fine |
| Date of Order: 04/03/2007; Amended: |
| Final |
| Market Conduct Examination |
| Fidelity National Title Insurance Company |
| Jacksonville, Florida |
| Violation: Issued a title insurance policy not in compliance with its approved rate filing. |
| Penalty: $10,000 fine |
| Date of Order: 03/19/2007; Amended: |
| Final |
| GEICO General Insurance Company |
| Washington, D.C. |
| Violation: Failed to promptly and equitably settle a claim. |
| Penalty: $5,000 fine |
| Date of Order: 03/14/2007; Amended: |
| Final |
| Guarantee Trust Life Insurance Company |
| Glenview, Illinois |
| Violation: Issued a group health insurance policy to an unapproved association. |
| Penalty: $5,000 fine |
| Date of Order: 05/21/2007; Amended: |
| Final |
| Healthy Alliance Life Insurance Company |
| St. Louis, Missouri |
| Violation: Issued a group life insurance policy to an unapproved association. |
| Penalty: $5,000 fine |
| Date of Order: 02/06/2007; Amended: |
| Final |
| John Alden Life Insurance Company |
| Milwaukee, Wisconsin |
| Violation: Failed to apply creditable coverage from prior health insurance policies. Used impermissible information to evaluate the health status of applicants. |
| Penalty: $10,000 fine |
| Date of Order: 02/13/2007; Amended: |
| Final |
| Kaiser Foundation Health Plan of the Northwest dba Kaiser Permanente |
| Portland, Oregon |
| Violation: Failed to timely pay or deny clean health insurance claims. |
| Penalty: $10,000 fine |
| Date of Order: 10/12/2007; Amended: |
| Final |
| Kaiser Foundation Health Plan of the Northwest dba Kaiser Permanente |
| Portland, Oregon |
| Violation: Evaluated the health status of applicants for group health insurance. |
| Penalty: $10,000 fine |
| Date of Order: 11/08/2007; Amended: |
| Final |
| Mid-Century Insurance Company |
| Los Angeles, California |
| Violation: A market conduct examination of Mid-Century as of December 31, 2004, found that the company did not comply with Oregon insurance credit scoring laws. Mid-Century also did not comply with claims handling laws and did not handle total loss settlements in accordance with policy provisions and statues and rules. |
| Penalty: $20,000 fine |
| Date of Order: 04/03/2007; Amended: |
| Final |
| Market Conduct Examination |
| Nationwide Mutual Insurance Company |
| Columbus, Ohio |
| Violation: Failed to acknowledge and act promptly on claim communications. |
| Penalty: $10,000 fine |
| Date of Order: 11/08/2007; Amended: |
| Final |
| Northland Insurance Company |
| St. Paul, Minnesota |
| Violation: Failed to promptly and equitably settle a claim. |
| Penalty: $5,000 fine |
| Date of Order: 05/30/2007; Amended: |
| Final |
| PacifiCare of Oregon, Inc. |
| Lake Oswego, Oregon |
| Violation: Denied claims without conducting a reasonable investigation. Failed to acknowledge and act promptly on claim communications. Failed to timely respond to an inquiry from the DCBS director. |
| Penalty: $34,000 fine |
| Date of Order: 09/20/2007; Amended: |
| Final |
| Presidential Life Insurance Company |
| Nyak, New York |
| Violation: Issued a group health insurance policy to an unapproved association. |
| Penalty: $5,000 fine |
| Date of Order: 12/26/2007; Amended: |
| Final |
| Presidential Life Insurance Company |
| Dallas, Texas |
| Violation: Issued a group health insurance policy to unapproved associations. |
| Penalty: $15,000 fine |
| Date of Order: 05/30/2007; Amended: |
| Final |
| Reliance Standard Life Insurance Company |
| Philadelphia, Pennsylvania |
| Violation: Issued a group life insurance policy and a group health insurance policy to an unapproved association. |
| Penalty: $10,000 fine |
| Date of Order: 04/16/2007; Amended: |
| Final |
| Reliance Standard Life Insurance Company |
| Philadelphia, Pennsylvania |
| Violation: Issued a group health insurance policy to an unapproved association. |
| Penalty: $5,000 fine |
| Date of Order: 11/13/2007; Amended: |
| Final |
| Stonebridge Life Insurance Company |
| Plano, Texas |
| Violation: Issued a group health insurance policy to an unapproved association. |
| Penalty: $5,000 fine |
| Date of Order: 04/30/2007; Amended: |
| Final |
| The MEGA Life and Health Insurance Company |
| North Richland Hills, Texas |
| Violation: Violations included failing to: 1) notify insureds about potential creditable coverage, 2) refer to policy provisions in notices of claim denial, 3) provide information to insureds about its grievance and appeal procedures, 4) provide information to insureds about how to access the DCBS complaint line, 5) acknowledge grievances, 6) timely acknowledge grievances, 7) timely decide a grievance, 8) timely file with DCBS summaries of grievances and appeals, and external reviews, 9) timely acknowledge or pay claims, 10) acknowledge and act promptly on claim communications, 11) provide an explanation of portability coverage to insureds, 12) give the required notice to insurance producers before termination. |
| Penalty: $50,000 fine |
| Date of Order: 10/11/2007; Amended: |
| Final |
| Ticor Title Insurance Company |
| Jacksonville, Florida |
| Violation: Gave a thing of value to an intermediary. |
| Penalty: $6,000 fine |
| Date of Order: 10/17/2007; Amended: |
| Final |
| Time Insurance Company (Formerly known as Fortis Insurance Company) |
| Milwaukee, Wisconsin |
| Violation: Failed to apply creditable coverage from prior health insurance policies. Refused to pay claims without conducting a reasonable investigation. Used impermissible information to evaluate the health status of applicants. Issued policies using an unapproved form. Failed to timely notify claimants that it needed more time to accept or deny claims. |
| Penalty: $60,000 fine |
| Date of Order: 02/13/2007; Amended: |
| Final |
| United Healthcare Insurance Company |
| Hartford, Connecticut |
| Violation: United Healthcare Insurance Company and 25 of its subsidiaries and affiliates entered into a regulatory settlement agreement (RSA) to resolve "areas of concern" identified in a multi-state analysis of the companies. Areas of concern included claims processing; coordination of benefits; complaints, grievances, and appeals; responses to regulatory and consumer inquiries; and oversight of contracted entities. |
| Penalty: Among provisions of the RSA, the companies agreed to pay up to a $20 million fine, make corrective actions, and pay any claims that should have been paid. Oregon's share of the fine is estimated to be $42,346.03. |
| Date of Order: 08/23/2007; Amended: |
| Final |
| Regulatory Settlement Agreement |
