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

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Jennifer Jo & Matthew Nichols, ages 39 and 35 of Coal City, each plead guilty to a reduced misdemeanor count of forgery of a certificate of insurance and each were given twelve (12) month jail terms plus $500 fines plus court costs. The jail terms were suspended and each was given eighteen (18) months of probation and ordered to assist in defraying their probation costs. The Nichols conspired and assisted each other in producing and presenting the fraudulent certificate of insurance after Mr. Nichols was given a citation for “no proof of insurance” during a traffic stop. There were additional subjects and cases not listed here due to the fact that some cases have multiple subjects involved and there are times that some subjects will enter a plea while others are still litigating their defense. Therefore, in an effort to not to jeopardize any pending prosecution, those individuals and cases were not detailed in this report. 118
Legal Division The Legal Division of the Offices of the West Virginia Insurance Commissioner (OIC) performs many functions including providing legal counsel to the Insurance Commissioner and other agency staff members, drafting and implementing legislation, administrative rules and informational letters, investigating agents and companies pursuant to complaints of alleged fraud or other code/rule violations, responding to general legal questions and Freedom of Information Act requests, litigation, hearings and coordination of receivership activities. As of January 1, 2006, a host of new regulatory duties were transferred to the OIC from the former Workers’ Compensation Commission, and the Legal Division performs several functions relative to those duties including recovery of pre December 1, 2005 workers’ compensation premium taxes and fines, collection of fines assessed against uninsured employers and injunction cases filed against uninsured employers. In addition, the OIC is responsible for the administration of several funds associated with the workers' compensation system, including the Uninsured Employers' Fund ("UEF" - for claims filed after 1-1-06 against uninsured employers) and the Workers' Compensation Old Fund (all claims with dates of injury or dates of last exposure before 7-1-05). Legal Division staff advises and works directly with the third party administrators of the UEF and the Old Fund on the proper administration, litigation and settlement of these claims. Some of the major activities of the Legal Division are discussed in more depth below. LEGISLATION The following is a brief synopsis of the significant legislation enacted during the 2009 regular session of the West Virginia Legislature. This information is not to be construed as inclusive of all legislation which may affect the insurance industry or insurance consumer, nor should it be construed as a comprehensive explanation of the bills addressed. Rather, the information provided is intended to highlight the bills significantly affecting the insurance community at large. BILLS Senate Bill 278 - Creating felony offense for willful failure to provide certain drug benefits. (Effective July 10, 2009) This bill amends W. Va. Code §33-15E-15 to clarify the criminal provisions in the discount medical/prescription plan act enacted in 2008. In the original legislation, determination of whether the crime of failing to provide promised benefits to plan members was a misdemeanor or a felony was based on the “value of the benefits denied” to the member. The bill amends this language to tie the misdemeanor/felony distinction to the amount of fees paid by the member. Now, if a person collects a fee for purported membership in a discount medical plan or discount prescription drug plan and knowingly and willfully fails to provide the promised benefits, he or she is guilty of a felony if the fees collected total $1,000 or more and a misdemeanor if less than $1,000. 119
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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
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FINANCIAL CONDITIONS DIVISION West
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WEST VIRGINIA ESSENTIAL PROPERTY IN
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2009 Summary of West Virginia Opera
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American Retirement Life Insurance
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ADP Totalsource, Inc. d/b/a ADP Tot
Page 68 and 69: FINANCIAL CONDITIONS DIVISION Merit
Page 70 and 71: FINANCIAL CONDITIONS DIVISION Compa
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Page 100 and 101: FINANCIAL CONDITIONS DIVISION Name
Page 106 and 107: ADA Risk Purchasing Group, Inc. (Am
Page 108 and 109: FINANCIAL CONDITIONS DIVISION Liqui
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 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
Page 160 and 161: Total for Top 10 Insurers 76.87% $4
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2009 West Virginia Market Share Rep
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Total for Top 10 Insurers 53.32% $6
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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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