.bmp){kind=small}
The annual meeting of the Association of Insurance Compliance Professionals (AICP) kicks off on September 25th in Orlando at the Peabody Hotel, famous for the ducks that mark the hotel décor in various forms and keynote the hotel’s brand. Thomas Hampton, former commissioner of the DC Insurance Department and now a senior advisor at SNR Denton US, and I will be sharing a panel at the conference for a presentation on “Hot Topics in Disability Income.”
On the state compliance front, a number of state insurance departments issued bulletins in the wake of Hurricane Irene cautioning insurers with regard to premium collection time frames and other policy requirements. Some of this activity pertained to property and casualty insurance matters, but bulletins from CT, NJ, NC and RI pertained to similar matters that arise in the administration of disability policies as well.
Wednesday, September 14, 2011
Thursday, August 11, 2011
8th Circuit Court Decision - Polich v. Prudential Life
Saw an interesting decision from the 8th Circuit Court of Appeals last week. In Polich v. Prudential Life, the circuit court upheld the district court’s ruling that the insurer was justified in denying a group LTD claim because the claimant refused to attend an independent medical exam (IME) the insurer had scheduled as part of its 2nd appeal review and also declined the insurer’s subsequent request that he provide “raw data” from his treating neuropsychologist regarding the condition that was the basis for his claim.
In this instance, the policy language allowed the insurer to deny or terminate a claim if the claimant refuses to be examined as reasonably required by the insurer or does not submit appropriate information requested by the insurer in support of the claim.
The claimant contended the request for the IME and the raw data from his treating physician were unreasonable, since the insurer should have requested all that as part of its prior review of the claim and initial appeal, especially since a medical professional the insurer consulted with on the initial claim had recommended obtaining the raw data.
The circuit court took a different view, holding that the claimant “was not required to pursue a second administrative appeal but when he continued to dispute the insurer’s conclusion and asked again for reconsideration, it surely was reasonable for Prudential to gather additional relevant information as part of its reexamination of the earlier decisions.”
In this instance, the policy language allowed the insurer to deny or terminate a claim if the claimant refuses to be examined as reasonably required by the insurer or does not submit appropriate information requested by the insurer in support of the claim.
The claimant contended the request for the IME and the raw data from his treating physician were unreasonable, since the insurer should have requested all that as part of its prior review of the claim and initial appeal, especially since a medical professional the insurer consulted with on the initial claim had recommended obtaining the raw data.
The circuit court took a different view, holding that the claimant “was not required to pursue a second administrative appeal but when he continued to dispute the insurer’s conclusion and asked again for reconsideration, it surely was reasonable for Prudential to gather additional relevant information as part of its reexamination of the earlier decisions.”
Wednesday, June 15, 2011
Recent Compliance News and Notes
Here are some legislative snippets before heading off for a week at the shore.
CT SB 34, which initially called for a ban on offsets for dependent Social Security awards in LTD policies before morphing into a study bill, died upon adjournment of the CT legislature last week…..AL and NV legislatures have just approved the Interstate Compact, and the Compact has recently issued instructions for member companies to extend Compact approved filings for use in IL (at least for products IL has authorized)…..MA Division of Insurance is about to release the results of the survey they conducted last year with disability insurers….OK Department of Insurance published bulletin LH 2011-01 on June 1 advising of the enactment of new rate filing requirements for health products, but clarified that disability income products are not included….MO and ND insurance authorities have recently issued bulletins extending grace periods and other provisions in the wake of natural disasters there.
CT SB 34, which initially called for a ban on offsets for dependent Social Security awards in LTD policies before morphing into a study bill, died upon adjournment of the CT legislature last week…..AL and NV legislatures have just approved the Interstate Compact, and the Compact has recently issued instructions for member companies to extend Compact approved filings for use in IL (at least for products IL has authorized)…..MA Division of Insurance is about to release the results of the survey they conducted last year with disability insurers….OK Department of Insurance published bulletin LH 2011-01 on June 1 advising of the enactment of new rate filing requirements for health products, but clarified that disability income products are not included….MO and ND insurance authorities have recently issued bulletins extending grace periods and other provisions in the wake of natural disasters there.
Friday, June 3, 2011
Group Disability Still On Hold For Interstate Compact
The Interstate Insurance Product Regulation Commission (IIPRC) is in the process of developing product standards for individual disability income products. Once product standards are adopted by the Compact, insurers may file that product for approval by the Compact, which then reviews and approves the filing for marketing in all the states that make up the compact (38 at last count).
A compact official told me last week, however, that it will be well into 2012 before the compact begins working up product standards for group disability products. Next up on the Compact’s docket is doing product standards for group life.
See the Compact’s website for further information at http://www.insurancecompact.org/.
A compact official told me last week, however, that it will be well into 2012 before the compact begins working up product standards for group disability products. Next up on the Compact’s docket is doing product standards for group life.
See the Compact’s website for further information at http://www.insurancecompact.org/.
Friday, May 6, 2011
AICP New England Chapter Annual Education Day
The New England regional chapter of the Association of Insurance Compliance Professionals (AICP) is holding its annual Education Day next Friday, May 13th at the Marriott Hotel in Windsor, CT. I will be part of a panel discussion on "Life and Health Hot Topics."
Hope to see you there!
Hope to see you there!
4 Biggest Myths About Disability Insurance
I recently saw an interesting little piece on disability insurance on a website that runs some decent insurance industry news and feature pieces.
http://www.insurancenetworking.com/blogs/disability_income_insurance_agents_advisers_myths-27841-1.html?ET=insurancenetworking:e1841:55178a:&st=email
http://www.insurancenetworking.com/blogs/disability_income_insurance_agents_advisers_myths-27841-1.html?ET=insurancenetworking:e1841:55178a:&st=email
Thursday, April 28, 2011
Massachusetts Legislative Session Brings Barrage of Disability Proposals
Massachusetts has been somewhat of a sleeping giant when it comes to group disability regulation. There are few MA laws focused specifically on group disability and the state does not require group disability policy forms to be filed for prior approval.
All that may be changing. Last year, the MA Division of Insurance required disability insurers to respond to a comprehensive state survey regarding insurers’ disability products and their existing books of disability business. The stated intent of the survey was to enable the Division “to understand the market for disability income insurance, and also to evaluate the effectiveness of laws and regulations governing Massachusetts’ marketplace for disability income insurance.”
Now we see that this year’s MA legislative session has brought no fewer than 6 proposals that would impose new requirements or prohibitions on disability products: a ban on discretionary authority provisions (SB 427), a prohibition on LTD offsets for Social Security disability benefits (SB 445), a “mental health parity” type requirement (HB 1147), guidelines on what insurers can require of claimants with regard to the frequency and locale of required medical exams (HB 2038) and a couple gender-based bills (SB 414 and SB 413).
While these proposals must still pass through the legislative review and political process at the MA state house, the flurry of proposal activity nonetheless seems to signal that the giant is stirring.
All that may be changing. Last year, the MA Division of Insurance required disability insurers to respond to a comprehensive state survey regarding insurers’ disability products and their existing books of disability business. The stated intent of the survey was to enable the Division “to understand the market for disability income insurance, and also to evaluate the effectiveness of laws and regulations governing Massachusetts’ marketplace for disability income insurance.”
Now we see that this year’s MA legislative session has brought no fewer than 6 proposals that would impose new requirements or prohibitions on disability products: a ban on discretionary authority provisions (SB 427), a prohibition on LTD offsets for Social Security disability benefits (SB 445), a “mental health parity” type requirement (HB 1147), guidelines on what insurers can require of claimants with regard to the frequency and locale of required medical exams (HB 2038) and a couple gender-based bills (SB 414 and SB 413).
While these proposals must still pass through the legislative review and political process at the MA state house, the flurry of proposal activity nonetheless seems to signal that the giant is stirring.
Subscribe to:
Posts (Atom)
Posts
