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Life Insurance Company of North America Settles Charges it Mishandled Disability Claims

Sep 30, 2009 | Parker Waichman LLP

Life Insurance Company of North America has reached an agreement with the California Department of Insurance to settle charges of disability claims handling violations.  Under the terms of the settlement, Life Insurance Company of North America will pay a $600,000 fine, make changes in its claims handling policies and procedures, and review previously closed claims to determine if additional benefits are due.

The settlement stems from an onsite examination of Life Insurance Company of North America's claims handling practices conducted by the California Department of Insurance.  According to a press release issued by the Department, instances were found where Life Insurance Company of North America had made claims determinations prior to requesting medical records and examples of the company's adjusters ignoring substantial new information after a claim had initially been denied. As part of the settlement, Life Insurance Company of North America has agreed to make significant improvements to its claims handling practices in order to avoid future violations, the press release said.  

In addition to the $600,00 penalty, the settlement calls for Life Insurance Company of North America to cease and desist from engaging in any acts or practices in violation of California law. Life Insurance Company of North America's revised claims handling practices are designed to avoid the type of violations alleged.  The Department will provide oversight to assure that this goal is being met. Under the agreement, Life Insurance Company of North America will also 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.

"Individuals purchase long term disability insurance to protect themselves and their families in the event they become disabled and are unable to work," said California Insurance Commissioner Steve 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 (Life Insurance Company of North America) 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."

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