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

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Representing Consumers in First and Third Party Administrative Hearings In 2009, the Office of the Consumer Advocate assisted insurance consumers in forty-seven (47) complaints before the West Virginia Insurance Commission. Twenty-six (26) of these complaints were third party complaints and the remaining twenty-one (21) complaints were first party matters. First party complaints are complaints filed by a consumer against their own insurer, while third party complaints are complaints filed by a consumer against another person's insurer. A total of One hundred-thirty two thousand, fifty three dollars, eighty six cents ($132,053.86) was awarded directly to West Virginia Consumers in the form of settlements in sixteen (16) of the twentysix (26) third party complaints. A market conduct exam was ordered against State Farm as a result of one consumer complaint decision. One (1) case went to hearing and the Hearing Examiner made a finding that no violation of the unfair trade practices act occurred. One (1) case was settled between the insurance company and consumer after our involvement was made known. Two (2) consumers obtained private council. Three (3) consumers did not request representation from this office. Three (3) consumer complaint cases are either awaiting hearing or are awaiting final order. A total of Fifty Eight Thousand One Hundred Sixty-five Dollars and Five Cents ($58,165.05) was awarded directly to West Virginia consumers in the form of settlements in eleven (11) of the twentyone (21) first party matters that the Office of the Consumer Advocate worked on in 2009. One (1) consumer withdrew their consumer complaint and pursued a settlement in circuit court. One (1) consumer had their non-monetary demands met by the insurance company. One (1) consumer obtained private council and the outcome of the case is not known. One (1) consumer, in addition to a monetary settlement, received a $40.00/month settlement. One (1) consumer complaint hearing was cancelled by the legal division for administrative reasons. Five (5) consumer complaint cases are either awaiting hearing or a final order. Three (3) third party consumers declined to request representation when contacted by the Office of the Consumer Advocate. 36
THIRD PARTY COMPLAINTS HANDLED BY THE OFFICE OF THE CONSUMER ADVOCATE IN 2009 RESPONDENT THIRD PARTY COMPLAINTANT RESOLUTION State Farm Insurance Company Denise Arthur Settlement - $5250.00 Blue Cross Blue Shield Ins. Co. John Kyer Settlement – $18,000.00 Nationwide Insurance Company Helen Johnson Settlement – $11,600.00 Farmers & Mechanics Fire & Cas. Jennie Santos Shuman Settlement – $5448.75 Safeco Insurance Company Brenda Greathouse Settlement - $1630.32 Erie Insurance Company Laura Beth Meadows Settlement - $500.00 The Phoenix Insurance Company Courtlandt Smith Settlement - $4250.00 American National P & C Ins. Co. Pete Sheehan Did not request rep. Hartford Casualty Insurance Co. Sherry Cossin Settlement - $1908.00 Argonaut Insurance Company Michael Humphrey Settlement - $929.97 P & C Ins. Co. of Hartford Leslie Cruse Settlement - $2771.26 P & C Ins. Co. of Hartford James Shannon Settlement - $1000.00 West American Insurance Co. Terry Kisner Settlement – $45,000.00 Metropolitan P & C Ins. Co. Barry Neeb Settlement - $5934.58 AIG Insurance Company Jeremie Williams Settled by ins. company AIG Insurance Company Joan Piko Did not request rep. Erie Insurance Company Charles Goff Settlement - $25,000 Erie Insurance Company Elsie Goff Pending 21 st Century Insurance Co. Brent Shaw Obtained private council State Automobile Insurance Co. Vennoria Ferrell Hearing – no UTP found Liberty Mutual Insurance Co. Bonita Helmick Settlement - $1860.27 General Insurance Co. of America Ferrell Parsons Settlement – 970.71 GEICO Michael Amtower Pending State Automobile Insurance Co. Greg Harkins Pending USAA Insurance Company Amber Midkiff Rep. withdrawn – obtained private council Allstate Insurance Company Stephen Foster Did not request rep. 37
Page 1 and 2: West Virginia Offices of the Insura
Page 3 and 4: Executive Summary This report to th
Page 5 and 6: TABLE OF CONTENTS SECTION 1 GENERAL
Page 7 and 8: Admitted Assets, Liabilities, Commo
Page 9 and 10: Organizational Chart Virgil Helton,
Page 11 and 12: FEES AND TAXES COLLECTED DURING THE
Page 13 and 14: WEST VIRGINIA OFFICES OF THE INSURA
Page 15 and 16: APPROPRIATED APPROPRIATED EXPENDITU
Page 17 and 18: SECTION 2 DIVISIONAL REPORTS 17
Page 19 and 20: An applicant must be a resident of
Page 21 and 22: Major Activities in 2009 The Plan
Page 23 and 24: Agents Licensing and Education Divi
Page 25: Workers’ Compensation Board of Re
Page 28 and 29: The focused settlement initiative h
Page 30 and 31: October 2008 November 2008 December
Page 32 and 33: Offices of the Insurance Commission
Page 34 and 35: January 2009 February 2009 March 20
Page 38 and 39: FIRST PARTY COMPLAINTS HANDLED BY T
Page 40 and 41: CERTIFICATE OF NEED - March 2009 FA
Page 42 and 43: Hospital Rate Review The Office of
Page 44 and 45: Consumer Service Division The Consu
Page 46 and 47: CONSUMER SERVICE COMPLAINTS CALENDA
Page 48 and 49: CONSUMER SERVICE COMPLAINTS CALENDA
Page 50 and 51: Employer Coverage Unit The Employer
Page 52 and 53: Financial Accounting Unit The Finan
Page 54 and 55: Financial Conditions Division The p
Page 56 and 57: 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
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FINANCIAL CONDITIONS DIVISION Risk
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National Health Club Purchasing Gro
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FINANCIAL CONDITIONS DIVISION Name
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ADA Risk Purchasing Group, Inc. (Am
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FINANCIAL CONDITIONS DIVISION Liqui
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Office of Inspector General—Fraud
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The following chart depicts statist
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James R. Hiroskey Jr., age 25 of Lo
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Ramona Mack, age 40 of Winfield, pl
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Jennifer Jo & Matthew Nichols, ages
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Senate Bill 284 - Relating to Viati
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Senate Bill 537 - Relating to Worke
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Senate Bill 537 -continued §33-2-2
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House Bill 3047 - Clarifying that t
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114 CSR 42 - Continuing Education f
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09-EO-03 - Emergency Order entered
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DISCIPLINARY ACTIONS Individual Ins
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Market Conduct Unit Four (4) “Agr
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Employer Violator System (EVS) The
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MANAGED HEALTH CARE PLANS: The West
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A Client Reporting process was deve
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Non-Workers’ Compensation Matters
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Rates and Forms Division The Rates
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2009 Filings by Product Commercial
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Approved Rate Change History of Top
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Private Passenger Auto Market Share
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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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Admitted Assets, Liabilities, Commo
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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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