C. Insurance Fraud Division

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C. Insurance Fraud Division TABLE OF CONTENTS Page I. Overview A. Introduction to the Maryland Insurance Administration ......................... 2 B. Fiscal Information ................................................................................... 3 C. Organizational Chart ............................................................................... 6 D. Agency Salary Listing ............................................................................. 7 II Staff Functions A. Commissioner Office............................................................................... 12 Fiscal and Support Services Unit Personnel Unit Training and Facilities Management Unit Office of Government Relations ............................................................. 15 Regulations Coordination ...................................................................... 20 Insurance Bulletins Office of Public Affairs .......................................................................... 34 B. Office of the Attorney General ............................................................. 35 C. Management Information Systems ...................................................... 40 III Consumer Protection A. Consumer Education and Advocacy Unit............................................ 42 B. Compliance and Enforcement Section ................................................. 44 Market Conduct Producer Enforcement Market Analysis Unit C. Insurance Fraud Division...................................................................... 47 Criminal Investigation Section AGIT Investigation Section D. Consumer Complaint Investigation .....................................................52 IV. Industry Regulation A. Examination and Auditing Section.......................................................54 Company Licensing Unit Financial Examination Unit Financial Analysis Unit B. Life and Health Section...........................................................................62 Rate and Form Review Unit Medical Director/PRA Oversight Unit Life and Health Complaint Unit Appeals and Grievance Unit C. Office of the Chief Actuary ...................................................................64 D. Producer Licensing ..............................................................................65 E. Property and Casualty Section..............................................................67 Rate and Form Review Unit Property and Casualty Complaint Section V. Company Statistical and Financial Data A. Financial Dental and Limited Health Service Organizations …………….… 73 Fraternal Organizations ……………………………………….…. 74 Health Maintenance Organizations ……………………………… 75 Non-Profit Companies ………………………………………….. 76 Life Insurance Companies ………………………………………. 77 Property and Casualty Companies ………………………………. 88 Title Companies …………………………………………………. 112 B. Complaint Data Homeowners …………….……………….……………….…….. 117 Private Passenger Auto …………….……………….………....... 120 Individual Life …………….……………….………………........ 125 Group Life …………….……………….……………….………. 134 Individual Accident and Health …………….………………....... 139 Group Accident and Health …………….……………….…….... 146 Credit …………….……………….……………….……………. 152 Medicare Supplement …………….……………….……………. 154 Long Term Care …………….……………….…………………. 156 Complaint Resolution Counts in 2008 .…….…………………... 158 ii I. OVERVIEW 1 A. INTRODUCTION TO THE MARYLAND INSURANCE ADMINISTRATION The Maryland Insurance Administration (MIA) is an independent State agency that regulates Maryland’s insurance industry and protects consumers by ensuring that insurance companies and health plans act in accordance with the State’s insurance law. In regulating the insurance industry, the MIA licenses insurance companies operating in Maryland, conducts financial examinations of companies to ensure solvency, and reviews and approves rates and contract forms. The agency’s budget comes from annual assessments on the insurance companies doing business in the State. In addition, the MIA is one of the largest sources of revenue for the Maryland General Fund through filing fees, administrative penalties and the collection of premium taxes. On behalf of consumers, the MIA investigates Life, Health, Automobile, Homeowners, or Property insurance complaints, as well as reports of insurance fraud. The MIA conducts market conduct examinations of companies to ensure compliance with Maryland law. The MIA also has a unit dedicated to consumer education and outreach in the community, which reaches hundreds of events and thousands of individual consumers annually. As designated by State law, the MIA is the Agency where consumers may file health insurance appeals or grievances concerning coverage decisions or claims denials. The MIA began in 1872 as the Insurance Department under the Comptroller of the Treasury. In 1878, it became an independent agency and was renamed the State Insurance Department, a title it held for 92 years. In 1970, the Insurance Department moved to the Department of Labor, Licensing and Regulation and was renamed the Insurance Division. The Agency was reorganized again in 1993 to become the independent agency it is today. 2 B. FISCAL INFORMATION MIA CONTRIBUTIONS TO THE GENERAL FUND - FISCAL YEAR 2009 Premium Taxes $274,578,304 Retaliatory Taxes $582,733 Fines $3,043,155 $278,204,192 MIA CONTRIBUTIONS TO THE GENERAL FUND - FISCAL YEAR 2009 Premium Taxes Retaliatory Taxes Fines 3 MIA FISCAL YEAR 2009 SPECIAL FUND REVENUE Agent / Broker Licensing Fees $4,831,154 Rate & Form Filing Fees $3,453,390 Insurance Company Examination Fees $2,279,338 Insurance Fraud Prevention Fee $1,451,785 Assessments $12,350,712 Miscellaneous Income $509,790 Company Licensing Fees $1,589,218 $26,465,387 MIA FISCAL YEAR 2009 REVENUE Agent / Broker Licensing Fees Rate & Form Filing Fees Insurance Company Examination Fees Insurance Fraud Prevention Fee Assessments Miscellaneous Income Company Licensing Fees 4 MIA FISCAL YEAR 2009 EXPENDITURES Salary and Wages $20,210,551 Communications $863,697 Travel $523,384 Contractual Services $2,258,778 Supplies and Materials $342,358 Equipment $1,413,930 Grants and Subsidies $455,246 Office Rent & Utilities $1,077,599 $27,145,543 MIA FISCAL YEAR 2009 EXPENDITURES Salary and Wages Communications Travel Contractual Services Supplies and Materials Equipment Grants and Subsidies Office Rent & Utilities 5 C. MARYLAND INSURANCE ADMINISTRATION OFFICE OF THE COMMISSIONER Commissioner Sr. Executive Assistant Executive Assistant Deputy Commissioner Deputy Commissioner Executive Assistant Director of Government Principal Counsel Relations Appeals Clerk Assoc. Comm., Assoc. Comm.. Assoc Comm., Exam & Assoc Comm., Assoc. Comm., P&C Assoc. Comm., L&H Assoc. Comm., Fraud Consumer Education & Producer Licensing Audit Compliance & Advocacy Enfforcement Director of Public Director, MIS Chief Actuary Affairs 6 D. AGENCY SALARY LISTING POSITION CLASSIFICATION SALARY ADMINISTRATIVE ASSISTANT MIA OFFICER I $46,408 DIRECTOR OF PUBLIC AFFAIRS MIA EXECUTIVE I $70,141 NETWORK SPECIALIST MIA ANALYST I $47,511 WEB DEVELOPER MIA ADMINISTRATOR I $59,421 CHIEF ACTUARY MIA CHIEF ACTUARY $136,365 DATABASE SPECIALIST MIA ANALYST II $49,313 DBA PROGRAMMER MIA ADMINISTRATOR I $58,299 PRINCIPAL COUNSEL DIV DIR OFC ATTY GENERAL $121,005 ASST. ATTORNEY GENERAL ASST ATTY GEN VI $81,609 ASST. ATTORNEY GENERAL ASST ATTY GEN VI $89,717 REGULATIONS COORDINATOR MIA ANALYST I $47,129 LEGAL SECRETARY MIA ASSOCIATE VI $42,013 DEPUTY COUNSEL ASST ATTY GEN VIII $98,356 EXECUTIVE ASSISTANT MIA ANALYST I $47,129 CTS ADMINSITRATOR MIA ANALYST II $57,386 LEGAL SECREATRY MIA ASSOCIATE V $44,052 DEPUTY COMMISSIONER MIA ASSOC DEP COMM $122,970 PROGRAMMER LEAD ANALYST MIA ADMINISTRATOR II $60,563 TECH SUPPORT SPECIALIST MIA ANALYST I $43,016 DIRECTOR OF MIS MIA EXECUTIVE I $92,164 ACTUARY MIA ADMINISTRATOR IV $71,699 APPEALS CLERK MIA OFFICER I $49,080 ASST. ATTORNEY GENERAL ASST ATTY GEN VI $89,717 ADMINSTRATIVE ASSISTANT MIA ASSOCIATE VI $44,389 ADMINISTRATIVE ASSISTANT MIA ASSOCIATE VI $40,506 STATE STAT ANALYST MIA ANALYST II $41,074 NETWORK SPECIALIST MIA ADMINISTRATOR I $66,627 ADMINISTRATIVE ASSISTANT MIA OFFICER I $43,118 TECH SUPPORT SPECIALIST MIA ANALYST I $59,135 OFFICE MANAGER MIA OFFICER II $52,356 ASST. ATTORNEY GENERAL ASST ATTY GENERAL VI $93,194 ASST. ATTORNEY GENERAL ASST ATTY GENERAL VI $83,165 SR. LEAD PROGRAMMER ANALYST MIA ADMINISTRATOR II $67,160 ACTUARY ASSISTANT MIA ADMINISTRATOR II $67,160 DIRECTOR OF GOVERNMENT RELATIONS MIA EXECUTIVE I $88,030 DEPUTY COMMISSIONER MIA DEPUTY COMM $123,708 LEGAL SECRETARY MIA ASSOCIATE V $34,788 ACTUARY MIA ADMINISTRATOR I $65,366 NETWORK SPECIALIST MIA ANALYST II $51,149 COMMISSIONER EXECUTIVE AIDE XI $156,060 DATABASE SPECIALIST MIA ANALYST II $47,511 SR. EXECTUIVE ASSISTANT MIA ADMINISTRATOR I $61,729 ACTUARY MIA EXECUTIVE II $102,180 SR. PROJECT MANAGER MIA EXECUTIVE I $81,609 PROGRAMMER ANALYST MIA ADMINISTRATOR II $68,457 DIRECTOR, COMPANY LICENSING AND PREMIUM TAX MIA ADMINISTRATOR IV $71,699 ASST. CHIEF FINAANCIAL EXAMINER MIA EXECUTIVE I $84,756 FINANCIAL ANALYST MIA ANALYST II $52,192 LICENSING TECHNICIAN MIA ASSOCIATE II $27,992 SENIOR EXAMINER MIA ADMINISTRATOR I $62,417 ASST. CHIEF EXAMINER MIA EXECUTIVE II $92,164 EXAMINER IN CHARGE MIA ADMINISTRATOR III $67,160 SENIOR INSURANCE EXAMINER MIA ANALYST II $51,214 INSURANCE EXAMINER MIA ADMINISTRATOR I $60,083 FINANCIAL ANALYST MIA ADMINISTRATOR I $54,635 INSURANCE EXAMINER MIA ANALYST I $48,928 ADMINSTRATIVE ASSISTANT MIA ASSOCIATE V $37,381 PREMIUM TAX SPECIALIST MIA ANALYST I $56,930 FINANCIAL ANALYST MIA ANALYST
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