Insurer settles charges that it slow-paid on LTCI claims

On follow-up exam, regulators found Bankers Life had not fully implemented previous recommendations

Nov 21, 2012 @ 1:49 pm

By Darla Mercado

LTCI
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Bankers Life and Casualty Co. will pay $3.2 million in a settlement with insurance regulators after examiners found that the insurer failed to make suggested updates to its claims practices.

The Pennsylvania Insurance Department was among the regulators participating in a multistate settlement agreement following the re-examination of Bankers Life. Illinois, Indiana, Florida and Texas were also lead regulators conducting the regulatory review.

In addition to the $3.2 million fine, the carrier will pay $800,000 to the lead regulators on the case to cover costs related to the re-examination.

Examiners visited Bankers Life on Feb. 8, 2010, in accordance with a 2008 settlement with the company. Back in 2007, regulators conducted a market examination report on Bankers Life and its then-sister company, Conseco Senior Health Insurance Co. At that time, authorities found that pending claims were not investigated in a timely manner and that claim files were not properly documented or kept.

As part of the ensuing 2008 settlement, regulators came up with a list of suggested corrective actions for the companies to take. In that agreement, insurance officials also said they would conduct a re-examination of Bankers Life.

In this latest checkup in 2010, authorities found that Bankers Life still hadn't revised its procedures to ensure that claims were paid and that claim investigations were completed in a timely manner.

Bankers Life also failed to update its underwriting practices to ensure “complete and accurate” applications, and the insurer did not revise its maximum-benefit claim denial letters to include details of a restoration of benefits provision in the contract, according to regulators.

Authorities in Pennsylvania indicated that the noncompliance affected the carrier's annuities, long-term-care insurance and life insurance businesses.

The company neither admitted nor denied the regulators' findings.

“We are pleased the examination is now resolved, and we appreciate the cooperation of Pennsylvania and the other lead states throughout the process,” said Bankers Life spokeswoman Barbara Ciesemier. “The original examination dealt with a number of legacy issues, and the re-examination confirmed significant progress and improvement on those areas, which the company continues to work to address.”

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