Around the PIA Western Alliance States

California — Department of Insurance & Auto Claims: The California Department of Insurance is taking legal action against Go Maps, Inc., and its insurance underwriter, Topa Insurance Company, after an investigation found the app-based insurance seller mishandled consumer claims for more than two dozen drivers. Under the orders to show cause, both Go Maps, Inc. (Go Maps) and Topa Insurance Company (Topa) could be ordered to cease and desist selling insurance and pay financial penalties.

Go Maps is an “insurtech” company that uses an app-based marketing platform to sell and transact its insurance business for Topa, an insurance company licensed by the Department. Insurtech companies and insurance companies that use them to market and manage their products must both follow California consumer protection laws and have the insurance expertise and licensed individuals in place to properly transact insurance in this state.

The Department is taking this action in order to protect the public from further harm caused by Go Maps and Topa repeatedly violating various consumer protection laws relating to insurance claims. The Department’s investigation is ongoing, and consumers who have experienced problems with Go Maps are urged to contact the Department’s Consumer Services Hotline at 800-927-4357 or through insurance.ca.gov for assistance.

In 2019, Go Maps entered into an agreement with Topa to perform all the functions necessary for the sale, service, management, and claims handling of Topa’s private passenger automobile policies that were sold to the public through the Go Maps app. The Go Maps/Topa program has more than 10,000 California customers representing the vast majority of its approximately 12,000 policies nationwide.

Go Maps’ and Topa’s alleged failures to follow California’s existing consumer protection rules forced drivers to pay for rental car expenses and other costs while their insurance claims were delayed, among other alleged violations such as:

Failing to pay claims within 30 days after the coverage was determined or a settlement was reached. For one consumer, the companies missed the deadline by 52 days. The average delay was more than 24 days beyond the legal 30-day claims payment deadline.

Failing to acknowledge claims, provide necessary forms or instructions, or begin investigations within the statutory 15-day requirement. For one consumer, the companies missed the deadline by 30 days. The average delay was more than 8 days beyond the legal 15-day requirement.

Failing to respond to consumers’ inquiries about their claims within 15 days. For one consumer, the companies missed the deadline by 25 days. The average delay was more than 11 days beyond the legal 15-day requirement.

Failing to deny or accept claims within 40 days. For one consumer, the companies missed the deadline by 66 days. The average delay was more than 32 days beyond the legal 40-days deadline.

Hiring an unlicensed insurance adjusting firm to adjust claims.

The Department alleges that Go Maps’ and Topa’s actions constitute a “general business practice” of unfair claims settlement practices that may have affected additional policyholders and claimants who were involved in accidents with Go Maps/Topa policyholders.

If the Department’s allegations are sustained, Go Maps could face revocation or suspension of its license to transact insurance and Topa could face suspension of its Certificate of Authority with the Department. The companies could face a fine of of up to $5,000 for each deceptive or unfair act, or up to $10,000 for each act if committed willfully.

Current Go Maps/Topa customers who have complaints about the handling of their claims, underwriting, or other policy servicing should also contact the Department at 800-927-4357 or through our website for assistance.

California — Lara & Long Term Care Task Force: Insurance Commissioner Ricardo Lara announced the appointment of Becky Duffey, Executive Director of the California Association for Adult Day Services, to the California Long Term Care (LTC) Insurance Task Force. Duffey joins the Task Force as the representative of adult day services providers pursuant to AB 567 (Calderon, Chapter 746, Statutes of 2019).

”Protecting the health and safety of Californians as they age is a top priority,” said Commissioner Lara. “Becky’s experience as an advocate for expanding services for vulnerable communities is critical as we make recommendations for a statewide program that can close coverage gaps for older Californians.” 

Created by the Governor’s signing of AB 567, the LTC Insurance Task Force, under Commissioner Lara’s leadership, is exploring how a statewide long-term care insurance program could be designed and implemented to expand the options for people who are interested in insuring themselves should they encounter functional or cognitive disability that requires long-term care, services, and supports.

Over the next several months, the Task Force will solidify its recommended options for a statewide long-term care insurance program design and prepare a feasibility report for the Commissioner, the Governor, and the Legislature by January 1, 2023. The recommendations made by the Task Force in the feasibility report will then be analyzed in an actuarial report to ensure an adequate benefit within a solvent program which, if approved by the Task Force, will be submitted to the Legislature by January 1, 2024.

The next LTC Insurance Task Force meeting will be held on Thursday, June 30, 2022.

More details are available at: www.insurance.ca.gov/boards. This position is uncompensated.

Idaho — Reserve Financing: This Bulletin clarifies for authorized insurers the reporting of reserve financing transactions, specific to reinsurance involving XXX term life insurance business or AXXX universal life with secondary guarantees business, and the applicability of certain actuarial guidelines as set forth in the NAIC’s Accounting Practices and Procedures Manual and Valuation Manual, pursuant to the filing requirements of Idaho Code §§ 41-210(4), 41-335, and 41-336.

Annually, the Idaho Department of Insurance adopts guidance regarding which version of the Accounting Practices and Procedures Manual to use when reporting, in addition to which version of the Valuation Manual to use when calculating reserve amounts per Idaho Code § 41-612, the Standard Valuation Law. IDAPA 18.07.03, The Valuation of Life Insurance Policies Including the Use of Select Mortality Factors, provides rules that aid the Standard Valuation Law.

Effective January 1, 2015, and amended January 1, 2017, the Accounting Practices and Procedures Manual has included in Appendix C, Actuarial Guideline XLVIII – Actuarial Opinion and Memorandum Requirements for the Reinsurance of Policies Required to be Valued under Sections 6 and 7 of the NAIC Valuation of Life Insurance Policies Model Regulation (Model #830), hereinafter referred to as AG48.

IDAPA 18.07.03, sections 012 and 013 are equivalent to sections 6 and 7, respectively, of the NAIC Valuation of Life Insurance Policies Model Regulation (Model #830) and are the policies subject to AG48. Reporting in compliance with AG48 is included in the statutory requirement.

This Bulletin is not new law but is an agency interpretation of existing law, except as authorized by law or as incorporated into a contract. Requests for additional information or other inquiries regarding this Bulletin can be directed to the Company Activities Bureau Chief/Chief Examiner, Eric Fletcher at 208-334-4230 or Eric.Fletcher@doi.idaho.gov.

Oregon — The Oregon Division of Financial Regulation recently announced the following permanent rulemaking:

ID 2-2022: Pharmaceutical Representative Licensing Rules

Rules affected:  836-200-0600, 836-200-0605, 836-200-0610, 836-200-0615, 836-200-0620, 836-200-0625, 836-200-0630, 836-200-0635, 836-200-0640, 836-200-0645, 836-200-0650, 836-200-0655, 836-200-0660, 836-200-0670

Rules summary: The purpose of OAR 836-200-0600 to 836-200-0670 is to administer the licensure of pharmaceutical representatives doing business in the state of Oregon pursuant to Oregon Laws 2021, chapter 593.

Filed: June 16, 2022 

Effective: June 17, 2022

Washington — OIC/HCA/DOH behavioral health crisis services slide decks posted: The OID has posted the slide decks from the recent presentation hosted by the Office of the Insurance Commissioner, Department of Health, and Health Care Authority. The slides can be found on the OIC website using the following links:

HCA behavioral health crisis system presentation — https://bit.ly/3OrgVZi

DOH 988 implementation presentation — https://bit.ly/3OrgVZi

Behavioral health crisis services provider directory — https://bit.ly/39WgIyf

For more information on surprise billing, please visit the surprise billing and Balance Billing Protection Act webpage.

Washington — General filing instructions for carrier submission of provider agreements and HCBM contracts (R 2022-06) prepublication draft posted: The OIC released a pre-publication draft for the General Filing Instructions for Carrier Submission of Provider Agreements and HCBM Contracts rule (R 2022-06). This rule will amend existing rules to establish unique general filing instructions for the submission of provider agreements and HCBM contracts by carriers.

Comments on the First draft are due by close of business (5:00 PM) on Tuesday, July 21, 2022; please send comments to RulesCoordinator@oic.wa.gov.

A prepublication draft meeting will be held, via Zoom, on July 19, 2022 at 10:00 a.m. If you are interested in joining the meeting, please register for the meeting via Zoom.

For more information, including the text of the stakeholder draft, please visit the rule’s webpage.

Washington — Statement requirement for consumer adverse benefit determination notices (R 2022-04) prepublication draft posted: The OID released a prepublication draft for the Statement Requirement for Consumer Adverse Benefit Determination Notices rule (R 2022-04). This rule amends existing rules so required statements for consumer adverse benefit determination notices will be at a lower, more accessible reading level.

Comments on the First draft are due by close of business (5:00 PM) on Tuesday, July 14, 2022; please send comments to RulesCoordinator@oic.wa.gov.

A prepublication draft meeting will be held, via Zoom, on July 12, 2022 at 3:00 p.m. If you are interested in joining the meeting, please register for the meeting via Zoom.

For more information, including the text of the stakeholder draft, please visit the rule’s webpage.

Washington — Notice of rulemaking on General filing instructions for the submission of provider contracts (R 2022-06): The OID is starting rulemaking (R 2022-06) to amend the existing rules to establish unique general filing instructions for the submission of provider agreements and health care benefit manager (HCBM) contracts by carriers.

Comments are due July 15, 2022; please send them to rulescoordinator@oic.wa.gov.

Washington — Kreidler extends orders on coronavirus and surprise billing to July 27: Insurance Commissioner Mike Kreidler has extended two emergency orders. His order requiring health insurers to waive copays and deductibles for any consumer requiring testing for the coronavirus (COVID-19) and his order protecting consumers from receiving surprise bills for lab fees related to medically necessary diagnostic testing for COVID-19 are both extended until July 27.

Kreidler’s order waiving cost-sharing applies to all state-regulated health insurance plans and short-term, limited-duration medical plans. The order on surprise billing applies to both in-state and out-of-state laboratories when a provider orders diagnostic testing for COVID-19.

Also, insurers must continue:

Allowing a one-time early refill for prescription drugs.

Suspending any prior authorization requirement for treatment or testing of COVID-19.

In addition, if an insurer does not have enough medical providers in its network to provide testing or treatment for COVID-19, it must allow enrollees to be treated by another provider within a reasonable distance at no additional cost.