Insurers pay $66.8M in restitution in Q1 2015 to Pa. consumers

Acting Pennsylvania Insurance Commissioner Teresa Miller announced today that nearly 5,000 consumers in the state received $66.8 million in restitution payments or credits through the restoration of stolen funds, the payment of denied or underpaid claims, and the refunding of overcharged premiums during the first quarter of 2015.

“My Administration is committed to protecting consumers across the commonwealth,” said Governor Tom Wolf. “These types of predatory practices will not be tolerated on my watch. Families should always get the coverage they deserve at the prices they have agreed to pay.”

“Pennsylvanians spend hard earned money to protect their families by purchasing many types of coverage, including life, home, auto, and health insurance. The state has a competitive insurance market, which is good for consumers, because competition increases options and holds down prices,” added Acting Secretary Miller. “But, if a customer is victimized by an unscrupulous insurance producer or an unfair business practice, the PA Insurance Department will do everything possible to make that consumer whole.”

Four main areas of investigation

Miller said 4,830 Pennsylvania consumers received restitution payments or credits in the first three months of 2015, primarily in the following four main areas.

• Restoration of stolen funds. The Insurance Department investigated cases in which an insurance agent collected a personal check or cash as payment for a policy or annuity, but never sent that money to the insurance company, often stealing the customer’s money. In these instances, the department required the agent to repay the customer. If the agent couldn’t make this repayment, the insurance company for which the agent sold the policy is required to do so.
• Processing and payment of previously denied or underpaid claims. When an Insurance Department investigation found that a customer’s claim was inappropriately denied or only partially paid, the department required the company to pay the claim as it should under the policy.
• Refunding of overcharged premiums. Private auto and homeowners insurers must, under Pennsylvania law, receive prior approval from the Insurance Department for the rates they charge. When an investigation found an insurance company was using rates that were not approved, any premium payments above the rate that would have been approved were returned to the customers either in refunds or credits to the policy premiums.
• Making payments under a multi-state settlement with life insurance companies. Pennsylvania participated in a multi-state examination of life insurance companies, resulting in companies entering into settlement agreements requiring them to reform the way they do business for the benefit of policyholders and beneficiaries across the country. Insurance regulators nationwide focused on the life insurance industry’s selective use of the Social Security Administration’s Death Master File (DMF), and found that although some companies properly used this file, others used it to terminate the payment of annuity benefits, while at the same time failing to trigger the payment of life insurance policy benefits. Moving forward, life insurance companies that have entered these settlement agreements will use the DMF to identify potentially unpaid insurance benefits and search for beneficiaries to whom benefits might be due.

Miller urged anyone with concerns about insurance issues in Pennsylvania to visit www.insurance.pa.gov, and click on “Services for Consumers,” or call 1-877-881-6388.