Asked for their reaction to a March 26 New York Times article that said long term care insurers are denying thousands of claims of elderly policyholders, state regulators say they do protect LTC insurance policyholders, but are also promising to review assertions made in the article.
The National Association of Insurance Commissioners, Kansas City, Mo., will put the issue on the agenda of its senior issues task force, according to Eileen Mallow, assistant deputy commissioner with the Wisconsin insurance department. A discussion will be held, and, if needed, changes will be made to the NAIC’s Long Term Care Insurance model act, she says. Mallow declined to comment on whether the issue would be looked at by the Wisconsin department, saying “it is a regulatory issue.”
Pennsylvania regulators also addressed the issue. Pennsylvania was one of the states contacted by the Times for the article.
Randy Rohrbaugh, the new acting commissioner, says Pennsylvania always responds to LTC questions that surface and points to a department on-site investigation of an unnamed LTC insurer that is currently underway. “Where there is noise, we look.”
Among the potential red flags Pennsylvania watches for, he says, are companies with rapid growth in the business. However, he adds, this, in and of itself, would not necessarily indicate a problem.
Ron Gallagher, Pennsylvania deputy commissioner-office of consumer and product services, says LTC is an important issue to Pennsylvania regulators because the state has the third largest population of senior citizens in the nation.
One of the tools that has helped the department is the NAIC’s market analysis program, which, Rohrbaugh says, was partially responsible for helping to identify the LTC company it is currently investigating.
Rohrbaugh says the NAIC data referenced in the article was actually aggregate data across all business lines, not just data for LTC insurance, and the complaints cited included all types, not just LTCI claims complaints.
The NAIC’s complaint database system registered 190,572 consumer complaints to states in 2006–a 7.8% decline over 2005, according to the NAIC. The information is voluntarily submitted by state insurance departments. The NAIC does not collect all complaint data from all states.
Claims delays ranked number one among complaints tracked in 2006, with a total of 41,647 complaints, representing 21.9% of the total. Denial of claims complaints ranked second, with 35,601 registered–an 18.7% share.
In addition, a market analysis pilot program that has been developed by the NAIC is also considered by many regulators to be a concrete way to address market conduct problems.
In addition to data, Rohrbaugh says the Pennsylvania department is currently working on LTC consumer protections with the state’s legislature, but that those protections are not yet in bill form.