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News - 2009 Press Release

For Release: September 29, 2009

Insurance Commissioner Poizner Announces $600,000 Settlement with Life Insurance Company of North America for Alleged Claims Handling Violations

Insurance Commissioner Poizner announced today that the Department of Insurance has reached a $600,000 settlement agreement with Life Insurance Company of North America ("LINA") to resolve allegations of disability insurance claims handling violations from February 2005 through June 20, 2006. In addition to the fine, LINA agreed to make changes in its claims handling policies and procedures, and to review previously closed claims to determine if additional benefits are due.

"Individuals purchase long term disability insurance to protect themselves and their families in the event they become disabled and are unable to work," said Commissioner Poizner. "When insurance companies fail to follow the law in fairly and expeditiously adjusting these claims, it has a devastating impact on policyholders and their families. I am pleased that LINA has taken responsibility for its actions and has implemented changes in its policies, procedures and practices. The Department will continue to monitor the actions of all insurers selling and marketing disability insurance in the state of California."

The Department performed an onsite examination of LINA's claims handling practices. During this examination, the Department found instances where LINA had made claims determinations prior to requesting medical records and examples of LINA adjusters ignoring substantial new information after a claim had initially been denied. As part of the settlement, LINA has agreed to make significant improvements to its claims handling practices in order to avoid future violations.

Based on the results of the examination, CDI filed an Order to Show Cause/Statement of Charges/Accusation and Notice of Monetary Penalty alleging that LINA's claims handling practices were in violation of state law. In addition to the penalty, the settlement calls for LINA to cease and desist from engaging in any acts or practices in violation of California law. LINA's revised claims handling practices are designed to avoid the type of violations alleged and the Department will provide oversight to assure that this goal is being met.

LINA will review all California resident closed denied claims for the period January 2005 through December 2007 using the agreed upon quality standards outlined in the settlement.

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    “Seemingly at the end of my rope with nowhere to turn, a friend suggested I call the National Multiple Sclerosis Society, who referred me to you. From our first contact I began to feel hope where there had been none. You took over all communication with the insurance company. You kept me posted as things progressed and advised me as to each necessary action. What a relief you were! With you in my corner, I felt enabled and no longer alone. Some big insurance companies feel emboldened to take arbitrary action against those who do not have the resources to defend what is rightfully theirs. Thank goodness for people like you who advocate for folks in need. In closing, please know how very much our association has meant. You have restored my faith in the goodness of people and renewed my confidence in the future. I am forever grateful.”

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    “Hi Glenn- This is a very belated thank you for your generous assistance and advice last summer, when I was appealing UBH's decision for my son. I won the appeal, at least for care at the partial hospitalization level (they wouldn't budge on residential, but the facility was accepting the partial care reimbursement for residential treatment). But the appeal was a great moral victory, and I think it's a great thing to have in the record, just in case he needs to go for treatment again. Thanks again for your generous help, I was very grateful for it. Wishing you a most happy Thanksgiving.”

    Terry S.

  • I am a life you have touched. May God bless you richly.

    “After suffering with constant pain for nearly seven months, losing the job I loved and then being denied my long term disability, I was extremely discouraged when I began looking for help. With a few phone calls from Mr. Kantor to my insurance company, my long term disability was reinstated . The financial burden was lifted and I have hope again. I am a life you have touched. May God bless you richly.”

    Susan H.

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    “My thanks to you for pursuing my case with vigor. I don't know much about how these legal things are handled, but I could tell by your communications with me, making sure I was always informed, that you were on top of it all. Also, you were ALWAYS available to me to answer questions, and your compassion for me and my situation is very much appreciated. I have had limited exposure to the legal system and attorneys, but I have never been able to just call and talk to them, as I could with you. I always had to speak with someone in the office that couldn't really answer my questions.”

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    J.