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

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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.
TABLE OF CONTENTS SECTION 1 GENERAL: Organizational Chart.................................................................................................................................9 West Virginia Insurance Commissioners................................................................................................10 Fees and Taxes Collected during the last 5 Fiscal Years........................................................................11 2008 Appropriated Expenditure Schedule—Insurance Commission......................................................12 2008 Statement of Revenues, Expenses, and Changes in Fund Net Assets—Proprietary Funds……...13 2008 Appropriated Expenditure Schedule—Examination Fund ……....................................................15 2008 Appropriated Expenditure Schedule—Consumer Advocate .........................................................16 SECTION 2 DIVISIONAL REPORTS: AccessWV—WV Health Insurance Plan ................................................................................................18 Agents Licensing and Education Division..............................................................................................23 Board of Review (Workers’ Compensation)...........................................................................................25 Claims Services Division (Old Fund Workers’ Compensation)……………………………………….27 Consumer Advocacy Division ................................................................................................................35 Consumer Service Division ....................................................................................................................44 Employer Coverage (Workers’ Compensation)………….........……………………………………….50 Financial Accounting ………………………………………………………………………………..…52 Financial Conditions Division ................................................................................................................54 Self-Insurance (Workers’ Compensation)…………………………………………………….109 Fraud Unit (Office of the Inspector General)…….........…………………..……………………....….110 Legal Division.......................................................................................................................................119 Market Conduct……………………………………………………………………………….134 Revenue Recovery (Workers’ Compensation) ……………………………………………….135 Medical Rates and Plans (Workers’ Compensation)………………...…………………………...…...137 Office of Judges (Workers’ Compensation)..........................................................................................141 Rates and Forms Division.....................................................................................................................144 SECTION 3 INSURANCE BUSINESS IN WEST VIRGINIA: Market Share Reports by Line of Business: Property and Casualty Insurances: Aggregate Write-Ins (Not Otherwise Classified)………………………………….…….……152 Aircraft......................................................................................................................................153 Allied Lines..............................................................................................................................154 Boiler and Machinery ...............................................................................................................158 Burglary and Theft....................................................................................................................161 Commercial Multi-Peril (Liability)...........................................................................................163 Commercial Multi-Peril (Non-Liability) ..................................................................................167 Commercial Auto......................................................................................................................171 5
Page 1 and 2: West Virginia Offices of the Insura
Page 3: Executive Summary This report to th
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 36 and 37: Representing Consumers in First and
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
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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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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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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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