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

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Non-Workers’ Compensation Matters: Third Party Claims Arising under the Unfair Trade Practices Act: Pursuant to W.Va. Code §§33-11-4a(h) and §33-2-10, the OIC receives complaints arising from alleged unfair methods of competition or unfair or deceptive acts or practices of insurance policies and insurance contracts, except workers’ compensation insurance. The Office of Judges has been designated as at least one responsible entity to conduct hearings, receive evidence, briefs, memoranda or motions and issue a recommendation to the Insurance Commissioner. The Commissioner will enter a final order following the hearing. The hearing will be conducted in accordance with the West Virginia Administrative Procedures Act. WV Health Care Authority: Pursuant to Executive Order No. 3-99, the Office of Judges is designated as the entity to review final decisions of the West Virginia Health Care Authority with regard to their final written decisions on matters related to certificates of need for new institutional health services and to rate setting of hospitals pursuant to West Virginia Code §16-2D-1, et seq. and §16-29B-1, et. seq. The review is conducted in accordance with the West Virginia Administrative Procedures Act. In the wake of the statutory reforms enacted in 2003, and the onset of privatization in 2005, the volume of litigation before the Office of Judges substantially decreased. While litigation continues to decline, it is declining at a less rapid pace than in prior years. I. Recent Initiatives Recent initiatives at the Office of Judges have been aimed at adapting the operation to better serve West Virginia’s newly-privatized workers’ compensation market. In Fiscal Year 2010, the Office of Judges continued to make improvements to our work product with regard to quality and efficiency, including continued improvements in our goal of creating a Judge-centered system that recognizes the unique elements of each case and addresses the growing complexity of the issues placed in litigation. We believe these changes will improve the overall degree of satisfaction of the litigants participating in the appeals system. The OOJ continues to work in the area of public outreach and provides a statistical report to the Workers’ Compensation Industrial Council on a monthly basis, as well as provides a monthly update on litigation trends to the Workers’ Compensation Committee of the West Virginia State Bar. Also in FY 2010, the Office of Judges held legal workshops in Charleston and Morgantown. These workshops are designed to provide the workers’ compensation practitioner with pertinent information related to practicing before the Office of Judges, including litigation statistics, updates on the law and procedural practice pointers. In FY 2010, the Office of Judges successfully consolidated operations in our Charleston office by incorporating the hearing venue, previously separate from our main office, into our primary office space. The old hearing space was relinquished back to the building owner, resulting in additional financial savings. The new hearing rooms were upgraded with traditional courtroom style furniture, as well as modern recording equipment. We believe these improvements will lead to greater satisfaction in the litigation process. The increased decorum assists our office in expressing to our litigants that judicial review is a serious matter and that they always receive substantial due process when appealing their workers’ compensation matter to the Office of Judges. 142
II. Time Standard Compliance Pursuant to regulation, the Office of Judges is required to process protests in a timely manner in order that the parties to litigation may receive decisions without unreasonable delay. Additionally, on an annual basis, the Office of Judges is required to report on “the degree of compliance” with the time limitations set forth in the Rule. The following statistical analysis reflects the performance of the Office of Judge for Fiscal Year 2010. A. 93 CSR 2 § 4 Motions The Rule requires the Office of Judges to act upon a motion “within 45 days of the date of submission” of the motion or on the date of the final decision, whichever is earlier. Of the 10,987 written motions ruled upon in the past fiscal year, 94.2% were issued in compliance with the time standard. B. 93 CSR 2 § 5 Hearings The Rule requires the Office of Judges to schedule a hearing “within 60 days from the receipt of the request for hearing.” Of the 578 hearings scheduled in the past fiscal year, 90.31% were scheduled in compliance with the time standard. C. 93 CSR 2 § 6 Time Standards The Rule requires the Office of Judges to issue a final decision within various time limits depending upon the issue involved (measuring time from the date of receipt of the protest to issuance of the decision). Pursuant to 93 CSR 2 § 3.1 the percentage of final decisions that must be at or under the applicable time standards as provided in 93 CSR 2 § 6 is 80%. The Office of Judges issued 89% of its decisions within the time standard. D. 93 CSR 2 § 7 Issuance of Decisions The Rule requires the Office of Judges to issue 60% of its decisions within 30 days of the Order to Submit; 80% of its decisions within 60 days of the Order to Submit; and 100% of its decisions with 90 days of the Order to Submit. Of the 3,468 decisions issued in the past fiscal year, 45.8% were issued within 30 days, 73.5% were issued within 60 days and 97.8% were issued within 90 days of the Order to Submit. 143
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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
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FINANCIAL CONDITIONS DIVISION Merit
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FINANCIAL CONDITIONS DIVISION Compa
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FINANCIAL CONDITIONS DIVISION Risk
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Page 92 and 93: National Health Club Purchasing Gro
Page 94 and 95: FINANCIAL CONDITIONS DIVISION Risk
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 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 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 75.75% $2
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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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