TDI Posts December Enforcements

The Texas Department of Insurance announced enforcement actions taken by Commissioner Mike Geeslin that became final during December 2005.

The actions include two license revocations, one license denial and fines and restitution totaling $5,228,742, including a $4 million penalty against United Healthcare Insurance Company for violating Texas’ prompt pay statutes, among other things, and a $1 million fine against Employers Resource Mangement Company of Boise, Idaho, for attempting to sell unauthorized insurance.

Copies of Geeslin’s orders may be obtained by contacting TDI’s Public Information Office.

Only final orders are listed. An order imposing disciplinary measures becomes final 20 days after the agent or insurance company has received notice of the order unless a motion for rehearing is filed within that period. A motion for rehearing stays the finality of an order until the Commissioner of Insurance acts upon the motion or upon the operation of law.

Commissioner’s orders are subject to appeal to state district court.

Advanced Adminstration, Inc. of Orlando, FL
Order Number: 051016
Date of Order: 12/1/2005
Order Final In: December
Action Taken: $113,000 fine subject to a dollar-for-dollar reduction by restitution to $1,000; Cease and Desist order
Violation: Acted as third party administrator without first obtaining a certificate of authority

Bankers Insurance Company of St. Petersburg, FL
Order Number: 051082
Date of Order: 12/21/2005
Order Final In: December
Action Taken: $8,000 fine
Violation: Allowed unlicensed individuals to act as insurance agents

Branton, Stephen Foster; Binggeli, Harold Dean of Midland
Order Number: 051092
Date of Order: 12/22/2005
Order Final In: December
Action Taken: $25,000 fine subject to a dollar-for-dollar reduction by restitution to $10,000
Violation: Acted as an agent for unauthorized entities

Browning, Danny of Dallas
Order Number: 051029
Date of Order: 12/5/2005
Order Final In: December
Action Taken: $5,000 fine subject to a dollar-for-dollar reduction by restitution to $1,500
Violation: Acted as an agent for unauthorized entities

Clarendon National Insurance Company of New York, NY
Order Number: 051083
Date of Order: 12/21/2005
Order Final In: December
Action Taken: $20,000 fine
Violation: Failed to provide experience rating data in a timely manner; Failed to timely respond to requests for information from TDI

Employers Resource Mangement Company of Boise, ID
Order Number: 050981
Date of Order: 11/10/2005
Order Final In: November
Action Taken: $1,000,000 fine; Cease and Desist order
Violation: Unauthorized insurance

Gregory, Rachael A., Gregory Insurance Services, LLC of Dallas
Order Number: 050964
Date of Order: 11/8/2005
Order Final In: December
Action Taken: Restitution; General Property and Casualty Licenses held by Rachael A. Gregory and Gregory Insurance Services, LLC revoked
Violation: Engaged in fraudulent or dishonest acts or practices; Misappropriated or converted money belonging to an insurer or insured; Unauthorized insurance

Matagorda County Title Company, LLC of Bay City
Order Number: 051055
Date of Order: 12/12/2005
Order Final In: December
Action Taken: $2,500 fine
Violation: Placed advertising for title agency before license issued

Medsolutions, Inc. of Franklin, TN
Order Number: 051051
Date of Order: 12/12/2005
Order Final In: December
Action Taken: $45,000 fine
Violation: Failed to issue adverse determinations in a timely manner

Progressive County Mutual Insurance Company of Mayfield Village, OH
Order Number: 051099
Date of Order: 12/23/2005
Order Final In: December
Action Taken: $10,000 fine
Violation: Failed to provide guidelines to its independent agents to ensure non-discriminatory application of its variable commission program

Shumate, Cynthia of Mt. Pleasant
Order Number: 051011
Date of Order: 11/29/2005
Order Final In: November
Action Taken: Insurance Service Representative License application denied
Violation: Engaged in fraudulent or dishonest acts or practices; Engaged in criminal conduct involving moral turpitude

Torres, Carlos G. of Brownsville
Order Number: 051084
Date of Order: 12/21/2005
Order Final In: December
Action Taken: Limited Lines License revoked
Violation: Engaged in fraudulent or dishonest acts or practices; Engaged in criminal conduct directly related to the business of insurance

Turner, Samuel Gerard of Houston
Order Number: 051052
Date of Order: 12/12/2005
Order Final In: December
Action Taken: $242 restitution
Violation: Engaged in fraudulent or dishonest acts or practices; Failed to comply with a previous order

United Healthcare Insurance Company; United Healthcare Of Texas, Inc. of Hartford, CT
Order Number: 051073
Date of Order: 12/19/2005
Order Final In: December
Action Taken: $4,000,000 penalty within 30 days; Additional contingent penalties for future similar violations; Restitution ordered for failure to properly pay statutory penalties on late clean claim payments
Violation: Violated Texas prompt pay statutes; Failed to file complete and accurate provider claim data reports; Failed to maintain adequate complaint logs and complaint records.