The Connecticut Insurance Department has negotiated a consent order with a group of 3 health carriers.
Connecticut officials say John Alden Life Insurance Company, Time Insurance Company and Union Security Insurance Company, units of Assurant Inc., New York, wrongly denied some claims based on the alleged existence of pre-existing conditions.
The companies also waited too long to investigate appeals involving denials based on pre-existing condition allegations, officials say.
Connecticut is requiring the Assurant units to pay restitution to the affected policyholders that the department has discovered through a 6-month investigation, and it is requiring the companies to pay restitution to affected policyholders who may be located through an external compliance audit.
The companies also must get medical personnel more involved in the claim review process, improve recordkeeping systems and do a better job of indicating which Assurant unit is actually writing each policy, officials say.
Earlier this month, the Oregon Insurance Division said it was fining 2 Assurant health insurance units in connection with concerns about how they had handled claims.
“We have signed this agreement with the Department of Insurance,” Rob Guilbert, a spokesman for Assurant’s Assurant Health unit, says in a statement. “We work very hard to make sure that our claims process is fair, equitable and consistent with state laws and industry standards.”
Like all insurers, Assurant regularly participates in market conduct reviews in close cooperation with state insurance departments to ensure that its practices are consistent with all applicable state laws and regulations, Guilbert says.