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

The Receivership Division (Office of the Receiver) is responsible for the administration of
insurance companies which are in a liquidation status in West Virginia. As of 2009, there were
no companies in a liquidation status in West Virginia.
The Self-Insurance Unit (Workers’ Compensation) 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 new companies were approved for self
insured status in calendar year 2009.
The Office of the Inspector General-Fraud Unit is responsible for facilitating a cooperative
approach in the detection, investigation, and prosecution of insurance fraud. They received a
total of 872 referrals in 2009 leading to 65 arrests and resulting in 57 convictions.
The Legal Division provides legal counsel to the Insurance Commissioner and staff, drafts and
promulgates statutes, investigates code/rule violations, responds to litigation, hearings and
coordinates receivership activities. During 2009, the Division was involved with 36 new
statutes or regulations directly impacting insurance, 6 matters of litigation, 61 Administrative or
Circuit Court Hearings, and 812 investigations by the regulatory compliance unit.
The Market Conduct Unit undertakes examinations of insurance companies doing business in
West Virginia in order to determine statutory compliance. Eighty-two (82) companies were
subject to analysis in 2009 concerning compliance with market conduct criteria and procedures.
Four Agreed Orders were entered by the Insurance Commissioner in 2009 with penalties
totaling $41,500.00 were assessed as a result of violations discovered during these
examinations. Additionally, West Virginia policyholders received $15,894,848.48 in
restitution as a result of market conduct examinations.
The Revenue Recovery Unit (Workers’ Compensation) is responsible for the collection of all
monies due to the Uninsured Employers’ Fund and to the Old Fund, as well as the collection of
fines imposed upon employers where workers’ compensation coverage has been cancelled.
During 2009, the unit collected over $2M from businesses in default and placed 1,666 liens on
businesses who had failed to work to cure default obligations.
The Medical Rates and Plans Unit calculates workers’ compensation maximum medical
reimbursement rates and evaluates workers’ compensation managed health care plans. In 2009
the division continued to maintain the fee schedules (comprised of thousands of codes and
fees), as well as evaluating 50 requests for modifications to workers’ compensation managed
health care plans.
The Office of Judges examines cases and renders decisions for contested Workers’
Compensation claims, third party claims arising under the Unfair Trade Practices Act, and also
reviews final decisions of the West Virginia Health Care Authority. During 2009, this division
produced 10,987 written motions, held 578 hearings, and rendered 3,468 decisions.
The Rates and Forms Division reviews and approves or disapproves proposed insurance rates
and forms for all regulated lines of insurance in West Virginia. During 2009, the division
received a total of 8,540 filings, 8,357 of which (99%) were received electronically.
Section 3 of this report provides enhanced detail from each regulated line of insurance. This section
separates the state’s insurance market into Property and Casualty insurance companies and Life and
Health insurance companies and proceeds to specify the amount of earned premiums, the percent of the
market that each company serves, and further identifies their admitted assets, liabilities, stock holdings,
and capital and surplus calculations.