FOR IMMEDIATE RELEASE
STATE INSURANCE
REGULATORS FINE
CONSECO
Multi-State Examination Finds Serious Long-Term Care Violations
KANSAS CITY, Mo. (May 7, 2008) - State insurance
regulators, working together through the National Association of Insurance
Commissioners (NAIC), today announced the details of a regulatory settlement
agreement between 40 jurisdictions and Conseco, Inc., due to a pattern
of consumer harm in the company's long-term care insurance business. This
multi-state investigation has resulted in a $2.3 million fine and $30
million in claims-handling improvements and restitution.
"Consumers need to have confidence in the insurance products they're
buying and in the companies they're doing business with," said Montana
State Auditor John Morrison, who chairs the NAIC Market Regulation and
Consumer Affairs Committee, which oversees multi-state examinations. "As
state insurance regulators, our No. 1 job is to protect consumers by making
sure companies pay claims in a prompt and appropriate manner - and to take
regulatory action when they fail to do so."
The states of Florida, Illinois,
Indiana, Pennsylvania
and Texas
led the settlement negotiations. According to the terms of the settlement,
Conseco will pay a $2.3 million penalty to be shared by all participating
states; pay at least $4 million in restitution and administrative costs to
harmed policyholders; and invest $26 million in system upgrades and improved
claims administration. Conseco is also obligated to pay an additional $10
million in fines if problems are not corrected.
"Conseco is among the nation's largest long-term care insurers,"
said Pennsylvania Acting Insurance Commissioner Joel Ario, whose department
served as the lead state on the investigation. "It is vital that
long-term care insurers make prompt and appropriate payment of claims to
consumers who are older and whose life and well-being are dependent upon it.
Conseco failed this test."
Specifically,
the on-site examination showed that:
- Investigation of pending
claims were not handled in a timely manner; - Claim files were not
properly documented or maintained; and - Time frames for company
responses to claimants did not adhere to applicable regulations.
The settlement involves two Conseco subsidiaries - Conseco Senior Health
Insurance Company and Bankers Life and Casualty Insurance Company - and
covers claims filed from Jan. 1, 2005, through April 30, 2007.
Conseco self-reported serious issues in complaint and claims handling, and
blamed the problems on the challenge of integrating various computer systems.
The settlement requires the company to contract with an experienced long-term
care claims administrator to process claims in a timely and appropriate
manner.
According to the terms of the settlement, Conseco Senior Health Insurance
Company, which is not actively writing new policies, will automatically
review 1,112 claims that were initially denied; will provide notices to
another 18,000 policyholders covering 49,000 claims that may have been
partially denied or subsequently denied after initial payment; and will set
up a toll-free call center for all claimants who believe their claim
settlement was not handled properly. The investigation found that the primary
problems in most cases were delays in claim payments, rather than outright
claim denials.
In the case of Bankers Life and Casualty Insurance Company, which is
writing new policies, the investigation uncovered inadequate marketing and
sales compliance issues. The settlement requires Bankers to:
- Enhance its producer
(agent) training program; - Eliminate producer
complaint thresholds, so that a single complaint can result in
disciplinary action; - Regularly review
experience-period results for all producers; and - Supervise all producers
and terminate them due to non-compliance with marketing standards.
Going forward, both companies are required to:
- Revise claims-handling
procedures to guarantee timely and accurate processing; - Handle all complaints
completely and in a timely fashion; - Create a centralized
complaint database; and - Establish a countrywide
contact for complaints.
State insurance regulators will conduct ongoing monitoring for appropriate
compliance benchmarks for complaint and claims processing; implement
quarterly reporting requirements; and, ultimately, conduct a re-examination
of the companies to ensure that all problems have been corrected.
Conseco has 30 days to mail notices to policyholders on how to seek review
of their claims. These notices will also include a toll-free number for all long-term
care claimants.
To date, jurisdictions that have adopted the settlement agreement include:
Alabama, Alaska, Arizona, Arkansas, Colorado, Delaware, District of Columbia,
Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana,
Maryland, Massachusetts, Michigan, Missouri, Montana, Nebraska, Nevada, New
Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio,
Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah,
Vermont, Washington, West Virginia and Wyoming.
Click HERE for a copy of the regulatory settlement agreement.
Click HERE for a copy of the market conduct examination report.

About the NAIC
Formed in 1871, the National Association of Insurance Commissioners (NAIC)
is a voluntary organization of the chief insurance regulatory officials of
the 50 states, the District of Columbia and
five U.S.
territories. The NAIC has three offices: Executive Office, Washington,
D.C.; Central Office, Kansas
City, Mo.; and Securities
Valuation Office, New York City.
The NAIC serves the needs of consumers and the industry, with an overriding
objective of supporting state insurance regulators as they protect consumers
and maintain the financial stability of the insurance marketplace. For more
information, visit www.naic.org.

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