Enforcement Review Reveals State Regulators Fined Most TPAs for Annual Report Violations
The TPA Guide is available on payhip.com/ccg. The TPA guide is a 51-state compilation of statutes and regulations addressing the relationship of third-party administrators (TPAs) with insurers, policyholders, and state regulators, such as the state insurance departments. Each state section of the guide addresses application requirements, surety bond requirements, record maintenance requirements, notification requirements to policyholders, and claims reporting time frames, among other topics. The guide also includes an accessible list of more than 240 forms that TPAs use. An electronic copy of the TPA Guide is available for immediate download on https://payhip.com/ In its review of recent administrative orders issued by insurance departments, such as the Oregon Division of Financial Regulation (DFR), CCG discovered that the DFR issued 53 orders in 2023 and five in 2024. Of those orders issued against TPAs, nearly all were for failing to comply with Section 744.738(1). This Oregon statute requires a TPA to file an annual report of all the insurers with whom it had contracts in the prior calendar year. The report must be filed with the DFR by March 1st or by extensions granted by the DFR. While Section 731.988(1) authorizes the DFR to fine TPAs up to $10,000 for insurance violations, the DFR only issued cease and desist orders and a maximum of $5,000 in fines. Also, in cases where the DFR levied a minimum civil penalty of up to $1,000, it provided for a suspension of $500 of the $1,000 civil penalty if the TPA paid $500 of the civil penalty; timely filed future annual reports; and did not otherwise violate the terms of its consent order. Most of the TPAs CCG reviewed held TPA licenses in Oregon but were based outside Oregon. You may review Oregon's enforcement orders against TPAs at https://dfr.oregon.gov/ About Croneal Consulting Group Croneal Consulting Group is an information and research services firm that provides database development services and Web portals for members of the legal, regulatory, and government communities. Besides UST Reports, an insurance legislative/ For CCG's products and services, visit these sites: http://www.payhip.com/ http://www.insurancebulletins.com http://www.cronealconsultinggroup.com Photo: https://www.prlog.org/ End
|
Account Phone Number