Insurance Commissioner Mike Kreidler disciplined and issued fines in July totaling $724,000 against insurance companies, agents and brokers who violated state insurance regulations.
Insurance companies.
The office of the insurance commissioner issues fines every month for everything from improper paperwork to large and small-scale insurance fraud, from companies and individuals.
Molina Healthcare of Washington, Inc., Seattle; fined $600,000, order 19-0240
$600,000 fine with $200,000 suspended and a Compliance Plan for failing to maintain adequate arrangements to ensure reasonable proximity of network providers and facilities, failing to make good faith attempts to contract with provider groups offering services within hospital emergency departments, failing to timely respond to inquiries of the Insurance Commissioner, failing to provide responses in writing and submit them using the Insurance Commissioner’s electronic company complaint system, erroneously applying cost-sharing to mammograms, erroneously applying a deductible to emergency room visits, improperly denying Autism therapy claims, failing to follow grievance procedures, failing to maintain an accurate provider directory, failing to follow standard protocol for tracking appeal, failing to provide a written response within the timeline established by the plan’s grievance procedures, and retroactively terminating coverage due to a systems failure. The Company violated WAC 284-170-200(6), WAC 284-170-260, WAC 284-170-370, WAC 284-30-360(2), WAC 284-30-650, WAC 284-43-5642(9)(e)(ii), WAC 284-43-5800(4), WAC 284-170-431(1), RCW 48.18.190, RCW 48.18.520, RCW 48.46.291, RCW 48.43.530(5)(c), RCW 48.46.100, RCW 48.18.180(1), RCW 48.46.380, justifying the imposition of a fine under RCW 48.05.185, RCW 48.46.130(2), and RCW 48.46.135.<<<<<<<
The health insurance company committed a number of violations involving provider networks, claims handling, consumer appeals and responding to Kreidler’s office. Kreidler suspended $200,000 of the fine as long as the company completes a compliance plan to correct the violations.
Preferred Contractors Insurance Risk Retention Group LLC, Billings, Mont.; fined $35,000, order 19-0270
The company accepted policy applications from an unlicensed producer and an unlicensed entity.
State Farm Fire and Casualty Co., Bloomington, Ill.; fined $20,000, order 19-0239
The company failed to attach a required endorsement to its commercial farm and ranch policies.
National Casualty Co., Columbus, Ohio; fined $20,000, order 19-0212
The company failed to use its correct legal name on more than half of its forms. Kreidler suspended $10,000 of the fine as long as the company reports that it has corrected all of its forms.
Employers Mutual Casualty Co., Des Moines, Iowa; fined $4,000, order 19-0243
The company failed to properly appoint producers and agencies and allowed unlicensed producers to process insurance transactions.