West Virginia Offices of the Insurance Commissioner 2009 Annual ...

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FINANCIAL CONDITIONS DIVISION Liquidations, Revocations, Suspension and Withdrawals January 1, 2009 to December 31, 2009 Phoenix Life Solutions, Inc. Withdrawn Effective: 3/5/2009 Pioneer Management Systems, Inc. Withdrawn Effective: 9/10/2008 Securities Dealers Risk Purchasing Group, Inc. Withdrawn Effective: 8/13/2009 Triangle Surety Agency Withdrawn Effective: 6/30/2009 U. S. Fidelis Insurance Company Risk Retention Group, Inc. Withdrawn Effective: 9/8/2009 US Transportation RPG, Inc. Withdrawn Effective: 9/16/2009 108
Self-Insurance (Workers’ Compensation) The Workers’ Compensation Self-Insurance Unit is responsible for regulating the 96 employers that currently self insure their workers’ compensation coverage in West Virginia and the approximately 100 employers who no longer self insure but continue to administer claims incurred during their period of self insurance. No companies were approved for self insured status in calendar year 2009. Self-insured employers in West Virginia self-administer their claims. Ordinarily, the employer hires a third party administrator (TPA) to mange and process claims although a small number of employers truly self-administer through an internal claim management department or a subsidiary company. Selfadministration provides the self-insured employer with a greater degree of control over the claim management process than participation in guaranty cost or deductible programs. Regulation of the self insured employers focuses primarily on two areas: maintenance of the risk pools and annual financial condition reviews. W. Va. Code St. R. § 85-19-1 et seq. establishes two risk pools in which the self-insured employers participate: the Security pool that covers claims with dates of injury, last exposure or death prior to July 1, 2004 (the date self-administration began) and the Guaranty pool that covers claims with dates of injury, last exposure or death on or after July 1, 2004. Active and inactive self-insured employers participate in the pools dependant upon each employer’s exposure base since self-insured employers are joint and severely liable for defaults of other self-insured employers. The purpose of the risk pools is to provide the means to pay claims for defaulted self-insured employers without placing the burden on the taxpayers of West Virginia. Annual financial condition reviews require the employer to submit three years of audited financial statements which are then analyzed to determine if the employer’s financial state has changed over the past year. W. Va. Code St. R. § 85-18-1 et seq. identifies the benchmarks against which the financial statements are measured and defines deteriorating financial condition. Employers who do not pass the annual review and are deemed to be in a deteriorating financial condition are required to provide additional security to cover the claims that would be paid out of the Guaranty pool in the case of a default. 109
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West Virginia Offices of the Insura
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Executive Summary This report to th
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TABLE OF CONTENTS SECTION 1 GENERAL
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Admitted Assets, Liabilities, Commo
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Organizational Chart Virgil Helton,
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FEES AND TAXES COLLECTED DURING THE
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WEST VIRGINIA OFFICES OF THE INSURA
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APPROPRIATED APPROPRIATED EXPENDITU
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SECTION 2 DIVISIONAL REPORTS 17
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An applicant must be a resident of
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Major Activities in 2009 The Plan
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Agents Licensing and Education Divi
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Workers’ Compensation Board of Re
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The focused settlement initiative h
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October 2008 November 2008 December
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Offices of the Insurance Commission
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January 2009 February 2009 March 20
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Representing Consumers in First and
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FIRST PARTY COMPLAINTS HANDLED BY T
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CERTIFICATE OF NEED - March 2009 FA
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Hospital Rate Review The Office of
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Consumer Service Division The Consu
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CONSUMER SERVICE COMPLAINTS CALENDA
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CONSUMER SERVICE COMPLAINTS CALENDA
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Employer Coverage Unit The Employer
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Financial Accounting Unit The Finan
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Financial Conditions Division The p
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FINANCIAL CONDITIONS DIVISION West
Page 58 and 59: FINANCIAL CONDITIONS DIVISION West
Page 60 and 61: WEST VIRGINIA ESSENTIAL PROPERTY IN
Page 62 and 63: 2009 Summary of West Virginia Opera
Page 64 and 65: American Retirement Life Insurance
Page 66 and 67: ADP Totalsource, Inc. d/b/a ADP Tot
Page 68 and 69: FINANCIAL CONDITIONS DIVISION Merit
Page 70 and 71: FINANCIAL CONDITIONS DIVISION Compa
Page 78 and 79: FINANCIAL CONDITIONS DIVISION Risk
Page 92 and 93: National Health Club Purchasing Gro
Page 100 and 101: FINANCIAL CONDITIONS DIVISION Name
Page 106 and 107: ADA Risk Purchasing Group, Inc. (Am
Page 110 and 111: Office of Inspector General—Fraud
Page 112 and 113: The following chart depicts statist
Page 114 and 115: James R. Hiroskey Jr., age 25 of Lo
Page 116 and 117: Ramona Mack, age 40 of Winfield, pl
Page 118 and 119: Jennifer Jo & Matthew Nichols, ages
Page 120 and 121: Senate Bill 284 - Relating to Viati
Page 122 and 123: Senate Bill 537 - Relating to Worke
Page 124 and 125: Senate Bill 537 -continued §33-2-2
Page 126 and 127: House Bill 3047 - Clarifying that t
Page 128 and 129: 114 CSR 42 - Continuing Education f
Page 130 and 131: 09-EO-03 - Emergency Order entered
Page 132 and 133: DISCIPLINARY ACTIONS Individual Ins
Page 134 and 135: Market Conduct Unit Four (4) “Agr
Page 136 and 137: Employer Violator System (EVS) The
Page 138 and 139: MANAGED HEALTH CARE PLANS: The West
Page 140 and 141: A Client Reporting process was deve
Page 142 and 143: Non-Workers’ Compensation Matters
Page 144 and 145: Rates and Forms Division The Rates
Page 146 and 147: 2009 Filings by Product Commercial
Page 148 and 149: Approved Rate Change History of Top
Page 150 and 151: Private Passenger Auto Market Share
Page 152 and 153: 2009 West Virginia Market Share Rep
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2009 West Virginia Market Share Rep
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Total for Top 10 Insurers 76.87% $4
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Admitted Assets, Liabilities, Net W
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Domestic Property Insurers Common P
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Admitted Assets, Liabilities, Capit
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Admitted Assets, Liabilities, Capit
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West Virginia Offices of the Insurance Commissioner 2009 Annual ...

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