Specialist, LTCi, DI, Annuities, Life, Designs In Life, LLC, Utah
The State Departments of Insurance (DOI) regulate and oversee long-term care insurance sold and administered in each state. The General Accounting Office of the federal government (GAO) works in concert with the National Association of Insurance Commissioners (NAIC) to monitor the activities of the State DOI, and audit their work as it relates to payment of claims by individual insurance carriers, rate changes and approvals, and sales practices.
In 2008, the GAO released a report "State Oversight of Rate Setting and Claims Settlement Practices" involving 10 sample states on the topic and reported the following:
"Regulators in the 10 states GAO reviewed oversee claims settlement practices by monitoring consumer complaints and conducting examinations in an effort to ensure that companies are complying with standards. Claims settlement standards in these states largely focus on timely investigation and payment of claims and prompt communication with consumers, but the standards adopted and how states define timeliness vary notably across the states. Regulators told GAO that reviewing consumer complaints is one of the primary methods for monitoring companies’ compliance with state standards. In addition to monitoring complaints, these regulators also said that they use examinations of company practices to identify any violations in standards that may require further action. Finally, state regulators in 6 of the 10 states in GAO’s review reported that their states are considering additional protections related to claims settlement. For example, regulators in several states said that their states were considering an independent review process for consumers appealing claims denials. Such an addition may be useful as some regulators said that they lack authority to resolve complaints where, for example, the company and consumer disagree on a factual matter, such as a consumer’s eligibility for benefits."
Each state has a DOI website which includes a subsection on long-term care insurance sold in that state. Their Internet addresses are usually something like www.insurance.[abbreviation of state, like 'AZ'].gov. They can also be googled "[Name of state] State Department of Insurance".
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In 2008, the GAO released a report "State Oversight of Rate Setting and Claims Settlement Practices" involving 10 sample states on the topic and reported the following:
"Regulators in the 10 states GAO reviewed oversee claims settlement practices by monitoring consumer complaints and conducting examinations in an effort to ensure that companies are complying with standards. Claims settlement standards in these states largely focus on timely investigation and payment of claims and prompt communication with consumers, but the standards adopted and how states define timeliness vary notably across the states. Regulators told GAO that reviewing consumer complaints is one of the primary methods for monitoring companies’ compliance with state standards. In addition to monitoring complaints, these regulators also said that they use examinations of company practices to identify any violations in standards that may require further action. Finally, state regulators in 6 of the 10 states in GAO’s review reported that their states are considering additional protections related to claims settlement. For example, regulators in several states said that their states were considering an independent review process for consumers appealing claims denials. Such an addition may be useful as some regulators said that they lack authority to resolve complaints where, for example, the company and consumer disagree on a factual matter, such as a consumer’s eligibility for benefits."
Each state has a DOI website which includes a subsection on long-term care insurance sold in that state. Their Internet addresses are usually something like www.insurance.[abbreviation of state, like 'AZ'].gov. They can also be googled "[Name of state] State Department of Insurance".