Interesting DOI fines

STIBROKER

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I like to look over the enforcement page every once in a while to see what people are getting busted for.....here are a few interesting ones.....

First American Title Insurance Company - Corpus Christi of Corpus Christi
Order Number: 080872
Date of Order: 10/3/2008
Order Final In: October
Action Taken: $2,300 fine
Violation: Illegal rebates for referrals of title insurance business; Provided door prizes for real estate open house events


Hamilton, Sarah Elizabeth of Austin
Order Number: 080812
Date of Order: 9/18/2008
Order Final In: September
Action Taken: General Life, Accident and Health License issued and placed on probation for 5 years
Violation: Criminal conduct, Driving While Intoxicated

Quintana, Josf Adam of Dallas
Order Number: 080816
Date of Order: 9/18/2008
Order Final In: September
Action Taken: General Life, Accident and Health License revoked
Violation: Submitted a fraudulent health insurance application; Forgery

Thayer, Lance Johnson of Dallas
Order Number: 080788
Date of Order: 9/12/2008
Order Final In: September
Action Taken: Cease and desist order
Violation: Offering illegal rebates and inducements

Aguirre, Isabel Fernandez of El Paso
Order Number: 080552
Date of Order: 6/26/2008
Order Final In: June
Action Taken: $2,000 fine; $1,000 restitution; Must complete 15 hours of continuing education; Must remove the state seal from all marketing materials
Violation: Materially misrepresented terms and conditions of an insurance policy; Distributed marketing materials that are inaccurate or misleading

Givens, Jerry Michael of Abernathy
Order Number: 080543
Date of Order: 6/20/2008
Order Final In: June
Action Taken: General Life, Accident and Health License and General Property and Casualty License revoked
Violation: Felony conviction involving moral turpitude

Great-West Life & Annuity Insurance Company of Greenwood Village, Colorado
Order Number: 080363
Date of Order: 4/23/2008
Order Final In: April
Action Taken: $8,000 fine
Violation: Applied discounts to out of network claims when not contractually entitled to do so
 
Re: Interesting DOI fines...

Interesting...
Okay, some seem unrelated to the day to day selling of insurance, but the rest seem somewhat random on what the enforcement is.

Door prizes gets a fine, but illegal rebates and inducement only gets a cease and desist???? I would have thought the door prizes wouldn't even be a problem (probably more to the story).

Hmmm, I guess no more prizes to little league from me!!!!
 
Re: Interesting DOI fines...

There is a guy here in Arkansas who found a nursing home in West Memphis, AR and set up a deal with the Admin of the home. I do not know if it is customary for the admin to have a power of attorney on their patients or residents, or whatever you call nursing home people, but this nursing home did.

The agent, which I will not say on here, talked the admin into signing POA on all of his MA application for its residents. The agent told the admin that it would result in more payments to his nursing home and that he would also be paid $25 per application. There was 98 people in this nursing home and over the course of two year they wrote a total of 390 MA application on the residents alone.

Long story short the agent was fined 5K and had his licensed revoked. Amazing what some people will do to make a quick buck.
 
Re: Interesting DOI fines...

What about referral fees...For example, my GA pays a 20% referral fee to home and auto insurance guys who refer him health cases he can get issued....The P and C guys are licensed in health, but don't like to write it...If he gets the referred case on the books and it stays there, the P and C guy gets 20% of his first year commission...He doesn't pay a flat referral fee for every referral, only those he can write. Distributes a 1099 to the P and C agent if his referral fees (the total 20% of his commissions) exceed $600 in a calendar year...Would most DOIs have an issue with this OR would most DOIs say you have to pay a flat referral fee for EVERY referral, whether it would turn into an issued case or not? I have heard that most DOI laws say that you have to pay a flat fee for every referral because that is more of a fixed lead acquistion cost, but really - I don't understand why the DOI would care.
 
Re: Interesting DOI fines...

As long as the P&C agents are licensed for health, that works. If not licensed, they would have to do a referral fee not contingent upon getting the sale.
 
Re: Interesting DOI fines...

This is interesting . . .

Great-West Life & Annuity Insurance Company of Greenwood Village, Colorado
Order Number: 080363
Date of Order: 4/23/2008
Order Final In: April
Action Taken: $8,000 fine
Violation: Applied discounts to out of network claims when not contractually entitled to do so


I have never heard of that resulting in a fine.
 
Re: Interesting DOI fines...

Yea right, they are paying out more in benefits, why fine em? Who is Great West anyway? World insurance?
 
Re: Interesting DOI fines...

World rents the GW network.

But (unless things have changed) GW is also in the large care group market. The offer primarily ASO plans but used to have stop loss as well.
 
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Re: Interesting DOI fines...

Last I heard in Texas all they do is TPA's.......

But (unless things have changed) GW is also in the large care group market. The offer primarily ASO plans but used to have stop loss as well.
 
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